WorldWideScience

Sample records for death initial experience

  1. Initial conditions and entanglement sudden death

    International Nuclear Information System (INIS)

    Qian, Xiao-Feng; Eberly, J.H.

    2012-01-01

    We report results bearing on the behavior of non-local decoherence and its potential for being managed or even controlled. The decoherence process known as entanglement sudden death (ESD) can drive prepared entanglement to zero at the same time that local coherences and fidelity remain non-zero. For a generic ESD-susceptible Bell superposition state, we provide rules restricting the occurrence and timing of ESD, amounting to management tools over a continuous variation of initial conditions. These depend on only three parameters: initial purity, entanglement and excitation. Knowledge or control of initial phases is not needed. -- Highlights: ► We study the possibility of managing disentanglement through initial conditions. ► The initial parameters are the amount of entanglement, excitation, and purity. ► Entanglement sudden death (ESD) free and ESD susceptible phases are identified. ► ESD onset time is also presented in the ESD susceptible phase. ► Our results may guide experiments to prepare ESD free or delayed ESD states.

  2. Nursing students' experience of patient's death

    OpenAIRE

    Rulíková, Klára

    2016-01-01

    Reflections on student nurse's experience with death of a patient during their studies were collected in form of questionnaires. Theory and practice were compared and research conducted into the needs of students, who experienced patient's death during their studies. Research concluded with recommendation for widening the nursing course programme and adding opportunities for students to share their feelings and experiences after their patients death. Key terms: death, dying patient, study, te...

  3. Attitudes and Experiences of Death Workshop Attendees

    Science.gov (United States)

    Kubler-Ross, Elisabeth; Worden, J. William

    1977-01-01

    Attendees at workshops and lectures were asked to complete a questionnaire which assessed the following: 1) First death experience, 2) Present conceptualization of death, 3) Anticipated reactions to a personal terminal illness, 4) Resources in managing one's own death, and 5) Difficulties experienced in working with dying persons. (Author)

  4. 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.

  5. anaesthetic registrars' experiences of perioperative death

    African Journals Online (AJOL)

    Death on the table: anaesthetic registrars' experiences of perioperative ... aDepartment of Anaesthesiology and Critical Care, University of KwaZulu-Natal, Durban, South Africa ... Results: Themes expressed by participants fell into three broad categories: ... number (up to 70%) of anaesthetists report experiencing adverse.

  6. Near-death experiences : A theological interpretation

    NARCIS (Netherlands)

    Goris, Harm

    2014-01-01

    Stories about near-death experiences (NDEs) draw much attention from the general public and are extensively discussed by medical doctors and neuroscientists. However, though eschatology belongs to their core business, only few theologians participate in the debate. This article proposes a

  7. Reading the near-death experience from an African perspective

    Directory of Open Access Journals (Sweden)

    Jock Agai

    2015-09-01

    Full Text Available The scientific study of near-death experience (NDE teaches that NDE does not entail evidence for life after death, but a study of NDE from an African perspective implies that NDE could serve as a yardstick which supports African traditional beliefs concerning death and resurrection. Using references from Ancient-Egyptian afterlife beliefs and those of the Yorubas of Nigeria, I argue that, for Africans, the percipients of NDE did not only come close to death but are regarded as having truly died. The purpose of this research is to initiate an African debate on the subject and to provide background-knowledge about NDE in Africa for counsellors who counsel NDE percipients that are Africans.

  8. 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....

  9. Life Experience with Death: Relation to Death Attitudes and to the Use of Death-Related Memories

    Science.gov (United States)

    Bluck, Susan; Dirk, Judith; Mackay, Michael M.; Hux, Ashley

    2008-01-01

    The study examines the relation of death experience to death attitudes and to autobiographical memory use. Participants (N = 52) completed standard death attitude measures and wrote narratives about a death-related autobiographical memory and (for comparison) a memory of a low point. Self-ratings of the memory narratives were used to assess their…

  10. Near death experiences: a multidisciplinary hypothesis.

    Science.gov (United States)

    Bókkon, István; Mallick, Birendra N; Tuszynski, Jack A

    2013-01-01

    Recently, we proposed a novel biophysical concept regarding on the appearance of brilliant lights during near death experiences (NDEs) (Bókkon and Salari, 2012). Specifically, perceiving brilliant light in NDEs has been proposed to arise due to the reperfusion that produces unregulated overproduction of free radicals and energetically excited molecules that can generate a transient enhancement of bioluminescent biophotons in different areas of the brain, including retinotopic visual areas. If this excess of bioluminescent photon emission exceeds a threshold in retinotopic visual areas, this can appear as (phosphene) lights because the brain interprets these intrinsic retinotopic bioluminescent photons as if they originated from the external physical world. Here, we review relevant literature that reported experimental studies (Imaizumi et al., 1984; Suzuki et al., 1985) that essentially support our previously published conception, i.e., that seeing lights in NDEs may be due to the transient enhancement of bioluminescent biophotons. Next, we briefly describe our biophysical visual representation model that may explain brilliant lights experienced during NDEs (by phosphenes as biophotons) and REM sleep associated dream-like intrinsic visual imageries through biophotons in NDEs. Finally, we link our biophysical visual representation notion to self-consciousness that may involve extremely low-energy quantum entanglements. This article is intended to introduce novel concepts for discussion and does not pretend to give the ultimate explanation for the currently unanswerable questions about matter, life and soul; their creation and their interrelationship.

  11. Death and consciousness--an overview of the mental and cognitive experience of death.

    Science.gov (United States)

    Parnia, Sam

    2014-11-01

    Advances in resuscitation science have indicated that, contrary to perception, death by cardiorespiratory criteria can no longer be considered a specific moment but rather a potentially reversible process that occurs after any severe illness or accident causes the heart, lungs, and brain to stop functioning. The resultant loss of vital signs of life (and life processes) is used to declare a specific time of death by physicians globally. When medical attempts are made to reverse this process, it is commonly referred to as cardiac arrest; however, when these attempts do not succeed or when attempts are not made, it is called death by cardiorespiratory criteria. Thus, biologically speaking, cardiac arrest and death by cardiorespiratory criteria are synonymous. While resuscitation science has provided novel opportunities to reverse death by cardiorespiratory criteria and treat the potentially devastating consequences of the resultant postresuscitation syndrome, it has also inadvertently provided intriguing insights into the likely mental and cognitive experience of death. Recollections reported by millions of people in relation to death, so-called out-of-body experiences (OBEs) or near-death experiences (NDEs), are often-discussed phenomena that are frequently considered hallucinatory or illusory in nature; however, objective studies on these experiences are limited. To date, many consistent themes corresponding to the likely experience of death have emerged, and studies have indicated that the scientifically imprecise terms of NDE and OBE may not be sufficient to describe the actual experience of death. While much remains to be discovered, the recalled experience surrounding death merits a genuine scientific investigation without prejudice. © 2014 New York Academy of Sciences.

  12. Near-death experiences and the physio-kundalini syndrome.

    Science.gov (United States)

    Greyson, B

    1993-12-01

    Near-death experiences (NDEs), transcendental experiences on the threshold of death with profound implications for both patient care and religious belief, have been hypothesized to be related to the awakening of a biological process known in Eastern traditions as kundalini. In a test of this proposed association between kundalini and NDEs, a sample of near-death experiencers acknowledged significantly more symptoms of a physio-kundalini syndrome than did control subjects.

  13. Near-death experiences and spiritual well-being.

    Science.gov (United States)

    Khanna, Surbhi; Greyson, Bruce

    2014-12-01

    People who have near-death experiences often report a subsequently increased sense of spirituality and a connection with their inner self and the world around them. In this study, we examined spiritual well-being, using Paloutzian and Ellison's Spiritual Well-Being Scale, among 224 persons who had come close to death. Participants who reported having near-death experiences reported greater spiritual well-being than those who did not, and depth of spiritual well-being was positively correlated with depth of near-death experience. We discussed the implications of these findings in light of other reported aftereffects of near-death experiences and of spiritual well-being among other populations.

  14. 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

  15. Western Scientific Approaches to Near-Death Experiences

    Directory of Open Access Journals (Sweden)

    Bruce Greyson

    2015-11-01

    Full Text Available Near-death experiences (NDEs are vivid experiences that often occur in life-threatening conditions, usually characterized by a transcendent tone and clear perceptions of leaving the body and being in a different spatiotemporal dimension. Such experiences have been reported throughout history in diverse cultures, and are reported today by 10% to 20% of people who have come close to death. Although cultural expectations and parameters of the brush with death influence the content of some NDEs, near-death phenomenology is invariant across cultures. That invariance may reflect universal psychological defenses, neurophysiological processes, or actual experience of a transcendent or mystical domain. Research into these alternative explanations has been hampered by the unpredictable occurrence of NDEs. Regardless of the causes or interpretations of NDEs, however, they are consistently associated with profound and long-lasting aftereffects on experiencers, and may have important implications for non-experiencers as well.

  16. Dealing with death: medical students' experiences with patient loss.

    Science.gov (United States)

    Pessagno, Regina; Foote, Carrie E; Aponte, Robert

    This article explores medical students' experiences and coping strategies when confronting patient loss in their 3rd and 4th years of their programs. Much of the literature on the impact of patient losses focuses on physicians. This article joins a handful of works aimed at how medical students experience and cope with patient loss. In-depth interviews with 20 medical students provided rich descriptions of their varying experiences coping with death. Consistent with previous work, students experience substantial emotional stress coping with patient deaths, though some were more difficult to bear than others, such as when the dying patient was a child or when treatment errors could have contributed to deaths. Common coping mechanisms included talking through their emotions, thrusting themselves into continuing their rounds, crying, participating in infant death rituals, and turning to religion. When deaths occurred, senior personnel who exhibited empathy toward the deceased and tolerance toward the students' emotional responses were lauded and made the process easier. Also emotionally daunting, in many instances, was dealing with the families of dying patients. Most of the students did not view death as a failure, contrary to much earlier literature, except in instances in which human error or decision making may have played a part in causing the death of a patient.

  17. A Pediatric Near-Death Experience: Tunnel Variants.

    Science.gov (United States)

    Serdahely, William J.

    1990-01-01

    Presents case study of boy who had near-death experience (NDE) due to nearly drowning when he was seven years old. Discusses case's variation of tunnel experience not before reported in either adult or pediatric NDE literature: while in the tunnel, the boy was comforted by two of his family's pets who had died prior to his accident. (Author/NB)

  18. 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...

  19. 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...

  20. 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

  1. An educational initiative to improve medical student awareness about brain death.

    Science.gov (United States)

    Lewis, Ariane; Howard, Jonathan; Watsula-Morley, Amanda; Gillespie, Colleen

    2018-04-01

    Medical student knowledge about brain death determination is limited. We describe an educational initiative to improve medical student awareness about brain death and assess the impact of this initiative. Beginning in July 2016, students at our medical school were required to attend a 90-min brain death didactic and simulation session during their neurology clerkship. Students completed a test immediately before and after participating in the initiative. Of the 145 students who participated in this educational initiative between July 2016 and June 2017, 124 (86%) consented to have their data used for research purposes as part of a medical education registry. Students correctly answered a median of 53% of questions (IQR 47-58%) on the pretest and 86% of questions (IQR 78-89%) on the posttest (p initiative (18% of students were comfortable performing a brain death evaluation before the initiative and 86% were comfortable doing so after the initiative, p initiative and 76% were comfortable doing so after the initiative, p initiative, but awareness and comfort dealing with brain death improved significantly after this initiative. Copyright © 2018 Elsevier B.V. All rights reserved.

  2. 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.

  3. Family Experience and PICU Death: A Meta-Synthesis.

    Science.gov (United States)

    Butler, Ashleigh E; Hall, Helen; Willetts, Georgina; Copnell, Beverley

    2015-10-01

    The PICU is the most common site for inpatient pediatric deaths worldwide. The impact of this clinical context on family experiences of their child's death is unclear. The objective of the study was to review and synthesize the best available evidence exploring the family experience of the death of their child in the PICU. Studies were retrieved from CINAHL Plus, OVID Medline, Scopus, PsycINFO, and Embase. Gray literature was retrieved from greylit.com, opengrey.edu, Trove, Worldcat, and Google scholar. Study selection was undertaken by 4 reviewers by using a multistep screening process, based on a previously developed protocol (International Prospective Register of Systematic Reviews 2015:CRD42015017463). Data was extracted as first-order constructs (direct quotes) or second-order constructs (author interpretations) onto a predeveloped extraction tool. Data were analyzed by thematic synthesis. One main theme and 3 subthemes emerged. "Reclaiming parenthood" encompasses the ways in which the parental role is threatened when a child is dying in the PICU, with the subthemes "Being a parent in the PICU," "Being supported," and "Parenting after death" elucidating the ways parents work to reclaim this role. The review is limited by a language bias, and by the limitations of the primary studies. When a child dies in a PICU, many aspects of the technology, environment, and staff actions present a threat to the parental role both during and after the child's death. Reclaiming this role requires support from health care providers and the wider community. Copyright © 2015 by the American Academy of Pediatrics.

  4. 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%

  5. Temporality of Features in Near-Death Experience Narratives

    Directory of Open Access Journals (Sweden)

    Charlotte Martial

    2017-06-01

    Full Text Available Background: After an occurrence of a Near-Death Experience (NDE, Near-Death Experiencers (NDErs usually report extremely rich and detailed narratives. Phenomenologically, a NDE can be described as a set of distinguishable features. Some authors have proposed regular patterns of NDEs, however, the actual temporality sequence of NDE core features remains a little explored area.Objectives: The aim of the present study was to investigate the frequency distribution of these features (globally and according to the position of features in narratives as well as the most frequently reported temporality sequences of features.Methods: We collected 154 French freely expressed written NDE narratives (i.e., Greyson NDE scale total score ≥ 7/32. A text analysis was conducted on all narratives in order to infer temporal ordering and frequency distribution of NDE features.Results: Our analyses highlighted the following most frequently reported sequence of consecutive NDE features: Out-of-Body Experience, Experiencing a tunnel, Seeing a bright light, Feeling of peace. Yet, this sequence was encountered in a very limited number of NDErs.Conclusion: These findings may suggest that NDEs temporality sequences can vary across NDErs. Exploring associations and relationships among features encountered during NDEs may complete the rigorous definition and scientific comprehension of the phenomenon.

  6. 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.

  7. Death Anxiety and Voluntary Passive Euthanasia: Influences of Proximity to Death and Experiences with Death in Important Other Persons.

    Science.gov (United States)

    Devins, Gerald M.

    1979-01-01

    Identified five sources of death anxiety. Significant relationships were observed between each source and experimental factors. The relationship between death anxiety and attitude toward voluntary passive euthanasia was explored, and a significant correlation was noted among elderly persons. Results were consistent with an idiographic orientation…

  8. 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

  9. Can deaths in police cells be prevented? Experience from Norway and death rates in other countries.

    Science.gov (United States)

    Aasebø, Willy; Orskaug, Gunnar; Erikssen, Jan

    2016-01-01

    To describe the changes in death rates and causes of deaths in Norwegian police cells during the last 2 decades. To review reports on death rates in police cells that have been published in medical journals and elsewhere, and discuss the difficulties of comparing death rates between countries. Data on deaths in Norwegian police cells were collected retrospectively in 2002 and 2012 for two time periods: 1993-2001 (period 1) and 2003-2012 (period 2). Several databases were searched to find reports on deaths in police cells from as many countries as possible. The death rates in Norwegian police cells reduced significantly from 0.83 deaths per year per million inhabitants (DYM) in period 1 to 0.22 DYM in period 2 (p police cells reduced by about 75% over a period of approximately 10 years. This is probably mainly due to individuals with severe alcohol intoxication no longer being placed in police cells. However, there remain large methodology difficulties in comparing deaths rates between countries. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  10. 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.

  11. 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

  12. Near-death experiences between science and prejudice

    Science.gov (United States)

    Facco, Enrico; Agrillo, Christian

    2012-01-01

    Science exists to refute dogmas; nevertheless, dogmas may be introduced when undemonstrated scientific axioms lead us to reject facts incompatible with them. Several studies have proposed psychobiological interpretations of near-death experiences (NDEs), claiming that NDEs are a mere byproduct of brain functions gone awry; however, relevant facts incompatible with the ruling physicalist and reductionist stance have been often neglected. The awkward transcendent look of NDEs has deep epistemological implications, which call for: (a) keeping a rigorously neutral position, neither accepting nor refusing anything a priori; and (b) distinguishing facts from speculations and fallacies. Most available psychobiological interpretations remain so far speculations to be demonstrated, while brain disorders and/or drug administration in critical patients yield a well-known delirium in intensive care and anesthesia, the phenomenology of which is different from NDEs. Facts can be only true or false, never paranormal. In this sense, they cannot be refused a priori even when they appear implausible with respect to our current knowledge: any other stance implies the risk of turning knowledge into dogma and the adopted paradigm into a sort of theology. PMID:22826697

  13. NEAR-DEATH EXPERIENCES BETWEEN SCIENCE AND PREJUDICE

    Directory of Open Access Journals (Sweden)

    Enrico eFacco

    2012-07-01

    Full Text Available Science exists to refute dogmas; nevertheless, dogmas may be introduced when undemonstrated scientific axioms lead us to reject facts incompatible with them.Several studies have proposed psychobiological interpretations of near-death experiences (NDEs, claiming that NDEs are a byproduct of brain functions gone awry; however, relevant facts incompatible with the ruling physicalist and reductionist stance have been often neglected. The awkward transcendent look of NDEs has deep epistemological implications, which call for: a keeping a rigorously neutral position, neither accepting nor refusing anything a priori; and b distinguishing facts from speculations and fallacies. Most available psychobiological interpretations remain so far speculations to be demonstrated, while brain disorders and/or drug administration in critical patients yield a well-known delirium in intensive care and anesthesia, the phenomenology of which is different from NDEs. Facts can be only true or false, never paranormal. In this sense, they cannot be refused a priori even when they appear implausible with respect to our current knowledge: any other stance implies the risk of turning knowledge into dogma and the adopted paradigm into a sort of theology.

  14. 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

  15. The Near-Death Experience: A Reality Check?

    Directory of Open Access Journals (Sweden)

    Michael N. Marsh

    2016-03-01

    Full Text Available This paper critically reviews assertions that near-death and out-of-body experiences (ND/OBE offer proof of extra-corporeal existence when the brain is supposedly “dead”. While this field has almost moved away from mere anecdotal recording, the current trend is focussed on demonstrating existence without functional brains. These endeavours have fallen far short of anticipated results—that cardiac patients would report on strategically-placed markers around acute resuscitation units. Two problems arise: a failure to produce corroborative empirical evidence for extra-corporeal cognition (a when the brain is “dead”, (or “clinically dead”, so-called and (b how the memory required for recall could paradoxically be set down at that critical time-point. The view advanced here is that ND/OBE occur as subjects’ states are returning to complete resumption of conscious-awareness and which, from several published accounts, is particularly abrupt but which nevertheless accounts perfectly for memory—and recall. Similar transcendental adventures accompanying returns to conscious-awareness occur with other preceding states of reduced consciousness. Most recollections are intensely geo-physical, anthropomorphic, banal and illogical: their dream-like fantasy provides nothing revelatory about life without a brain, or importantly, about other supposed cosmic contexts. Additionally, it is proposed that since prevalence rates are so extremely low (<1% globally, the few subjects undergoing ND/OBE may have predisposed brains, genetically, structurally or resulting from previous psychological stress. In a somewhat similar vein to post-traumatic stress disorder, subjects with predisposed brains exhibit markedly changed post-experiential phenotypes, so that the ND/OBE itself could be viewed as a transient, accompanying epiphenomenon.

  16. 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.

  17. The experience of death anxiety in Iranian war veterans: a phenomenology study.

    Science.gov (United States)

    Sharif Nia, Hamid; Ebadi, Abbas; Lehto, Rebecca H; Peyrovi, Hamid

    2015-01-01

    Recognition of death anxiety experienced by patients who have survived violence and threats to life during war is of strong importance in delivery of best care for veterans experiencing health stressors. The aim of the study was to explore the death anxiety experience of veterans from the Iran-Iraq war. Using a phenomenological approach, 11 war veterans were interviewed related to death anxiety experiences. Four major themes included afterlife fears; alienated farewell; ambiguous separation; and physical dissolution. Patients who have been exposed to death trauma in the battlefield may carry added burden from unique cognitions and fears related to personal death.

  18. Near-Death and Other Transpersonal Experiences Occurring During Catastrophic Events.

    Science.gov (United States)

    Lawrence, Madelaine

    2017-06-01

    The purpose of this article is to describe examples of near-death and other transpersonal experiences occurring during catastrophic events like floods, wars, bombings, and death camps. To date, researchers have limited their investigations of these transpersonal events to those occurring to seriously ill patients in hospitals, those dying from terminal illnesses, or to individuals experiencing a period of grief after the death of a loved one. Missing is awareness by first responders and emergency healthcare professionals about these transpersonal experiences and what to say to the individuals who have them. Some responders experience not only deaths of the victims they assist, but also deaths of their colleagues. Information about these transpersonal experiences can also be of comfort to them. The examples in this article include a near-death experience during the Vietnam War, an out-of-body experience after a bomb explosion during the Iraq War, a near-death visit to a woman imprisoned at Auschwitz, and two after-death communications, one from a person killed in Auschwitz and another from a soldier during World War I. Also included are interviews with two New York City policemen who were September 11, 2001 responders. It is hoped the information will provide knowledge of these experiences to those who care for those near death, or dying, or grieving because of catastrophic events, and encourage researchers to further investigate these experiences during disasters.

  19. 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.)

  20. Nursing home practices following resident death: the experience of Certified Nursing Assistants.

    Science.gov (United States)

    Barooah, Adrita; Boerner, Kathrin; van Riesenbeck, Isabelle; Burack, Orah R

    2015-01-01

    This study examined certified nursing assistants' (CNAs) experiences of nursing home practices following resident death. Participants were 140 CNAs who had experienced recent resident death. In semi-structured, in-person interviews, CNAs were asked about their experiences with the removal of the resident's body, filling the bed with a new resident, and how they were notified about the death. The facilities' practice of filling the bed quickly was most often experienced as negative. Responses to body removal and staff notification varied, but negative experiences were reported by a substantial minority. Being notified prior to returning to work was associated with a more positive experience. Learning about the death by walking into a room to find the bed empty or already filled was the most negative experience. Study findings suggest that more mindful approaches to the transitions related to resident deaths would be valued by CNAs and could improve their work experience. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Contribution of volcanic forcing to the initiation of the Black Death Epidemic

    Science.gov (United States)

    Fell, Henry; Baldini, James; Dodds, Ben

    2017-04-01

    The 14th Century plague epidemic, commonly termed the Black Death, coincided with the tumultuous climatic shift from the relative stability of the Medieval Climate Anomaly (MCA) to the initiation of the Little Ice Age (LIA). Plague is predominantly a vector borne disease that is spread through the transmission of the Yersinia pestis bacteria. This bacterium may have originated in the rodent populations of the Tibetan Plateau and later spread rapidly westward though Eurasia after vector transmission to humans. Several studies have determined that Asian rodent and vector populations are highly sensitive to climatic perturbations. The Samalas eruption of 1257 was the largest injection of aerosols in the Common Era and therefore probably had a significant climatic effect. Through a range of proxy records across Eurasia we reconstruct the climate for the period immediately preceding the outbreak of plague. This study investigates the interaction between the Samalas eruption of 1257, the climatic response to the event and the potential effect on the initiation of the Black Death epidemic which shaped population and culture across Eurasia for centuries.

  2. Near-Death Experiences and the "Fantasy-Prone" Personality: Preliminary Findings.

    Science.gov (United States)

    Council, James R.; Greyson, Bruce

    Near-death experiences (NDEs) are subjective experiences at the threshold of death which can include strong positive affect, dissociation from the physical body, and paranormal/transcendental phenomena. Empirical investigation of NDEs has typically relied upon retrospective reports and personality studies of individuals who have come close to…

  3. 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...

  4. Reading the near-death experience from an African perspective

    African Journals Online (AJOL)

    2015-09-14

    Sep 14, 2015 ... evidence for life after death, but a study of NDE from an African perspective implies that. NDE could serve .... brain through blood circulation will no longer be available as a result. .... eternal repose and happiness. It is rather a ...

  5. 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)

  6. Near-death experiences: the experience of the self as real and not as an illusion.

    Science.gov (United States)

    van Lommel, Pim

    2011-10-01

    Because the publication of several prospective studies on near-death experience (NDE) in survivors of cardiac arrest have shown strikingly similar results and conclusions, the phenomenon of the NDE can no longer be scientifically ignored. The NDE is an authentic experience that cannot be simply reduced to imagination, fear of death, hallucination, psychosis, the use of drugs, or oxygen deficiency. Patients appear to be permanently changed by an NDE during a cardiac arrest of only some minutes' duration. It is a scientific challenge to discuss new hypotheses that could explain the possibility of a clear and enhanced consciousness--with memories, self-identity, cognition, and emotions--during a period of apparent coma. The current materialistic view of the relationship between consciousness and the brain, as held by most physicians, philosophers, and psychologists, seems to be too restricted for a proper understanding of this phenomenon. There are good reasons to assume that our consciousness, with the continuous experience of self, does not always coincide with the functioning of our brain: enhanced or nonlocal consciousness, with unaltered self-identity, apparently can be experienced independently from the lifeless body. People are convinced that the self they experienced during their NDE is a reality and not an illusion. © 2011 New York Academy of Sciences.

  7. 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)

  8. 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…

  9. 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

  10. 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

  11. 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.)

  12. 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

  13. A Novel Initiation Mechanism of Death in Streptococcus pneumoniae Induced by the Human Milk Protein-Lipid Complex HAMLET and Activated during Physiological Death*

    Science.gov (United States)

    Clementi, Emily A.; Marks, Laura R.; Duffey, Michael E.; Hakansson, Anders P.

    2012-01-01

    To cause colonization or infection, most bacteria grow in biofilms where differentiation and death of subpopulations is critical for optimal survival of the whole population. However, little is known about initiation of bacterial death under physiological conditions. Membrane depolarization has been suggested, but never shown to be involved, due to the difficulty of performing such studies in bacteria and the paucity of information that exists regarding ion transport mechanisms in prokaryotes. In this study, we performed the first extensive investigation of ion transport and membrane depolarization in a bacterial system. We found that HAMLET, a human milk protein-lipid complex, kills Streptococcus pneumoniae (the pneumococcus) in a manner that shares features with activation of physiological death from starvation. Addition of HAMLET to pneumococci dissipated membrane polarity, but depolarization per se was not enough to trigger death. Rather, both HAMLET- and starvation-induced death of pneumococci specifically required a sodium-dependent calcium influx, as shown using calcium and sodium transport inhibitors. This mechanism was verified under low sodium conditions, and in the presence of ionomycin or monensin, which enhanced pneumococcal sensitivity to HAMLET- and starvation-induced death. Pneumococcal death was also inhibited by kinase inhibitors, and indicated the involvement of Ser/Thr kinases in these processes. The importance of this activation mechanism was made evident, as dysregulation and manipulation of physiological death was detrimental to biofilm formation, a hallmark of bacterial colonization. Overall, our findings provide novel information on the role of ion transport during bacterial death, with the potential to uncover future antimicrobial targets. PMID:22700972

  14. A novel initiation mechanism of death in Streptococcus pneumoniae induced by the human milk protein-lipid complex HAMLET and activated during physiological death.

    Science.gov (United States)

    Clementi, Emily A; Marks, Laura R; Duffey, Michael E; Hakansson, Anders P

    2012-08-03

    To cause colonization or infection, most bacteria grow in biofilms where differentiation and death of subpopulations is critical for optimal survival of the whole population. However, little is known about initiation of bacterial death under physiological conditions. Membrane depolarization has been suggested, but never shown to be involved, due to the difficulty of performing such studies in bacteria and the paucity of information that exists regarding ion transport mechanisms in prokaryotes. In this study, we performed the first extensive investigation of ion transport and membrane depolarization in a bacterial system. We found that HAMLET, a human milk protein-lipid complex, kills Streptococcus pneumoniae (the pneumococcus) in a manner that shares features with activation of physiological death from starvation. Addition of HAMLET to pneumococci dissipated membrane polarity, but depolarization per se was not enough to trigger death. Rather, both HAMLET- and starvation-induced death of pneumococci specifically required a sodium-dependent calcium influx, as shown using calcium and sodium transport inhibitors. This mechanism was verified under low sodium conditions, and in the presence of ionomycin or monensin, which enhanced pneumococcal sensitivity to HAMLET- and starvation-induced death. Pneumococcal death was also inhibited by kinase inhibitors, and indicated the involvement of Ser/Thr kinases in these processes. The importance of this activation mechanism was made evident, as dysregulation and manipulation of physiological death was detrimental to biofilm formation, a hallmark of bacterial colonization. Overall, our findings provide novel information on the role of ion transport during bacterial death, with the potential to uncover future antimicrobial targets.

  15. Brain death: close relatives' use of imagery as a descriptor of experience.

    Science.gov (United States)

    Frid, Ingvar; Haljamäe, Hengo; Ohlén, Joakim; Bergbom, Ingegerd

    2007-04-01

    This paper is a report of a study to explore the use of imagery to describe the experience of confronting brain death in a close relative. The brain death of a loved one has been described as an extremely difficult experience for close relatives, evoking feelings of anger, emotional pain, disbelief, guilt and suffering. It can also be difficult for relatives to distinguish brain death from the state of coma and thus difficult to apprehend information about the diagnosis. Narrative theory and a hermeneutic phenomenological method guided the interpretation of 17 narratives from close relatives of brain dead patients. All narratives were scrutinized for experiences of brain death. Data were primarily collected in 1999. The primary analysis related to close relatives' experience of brain death in a loved one. A secondary analysis of the imagery they used to describe their experience was carried out in 2003. Six categories of imagery used to describe the experience of confronting a diagnosis of brain death in a loved one emerged: chaotic unreality; inner collapse; sense of forlornness; clinging to the hope of survival; reconciliation with the reality of death; receiving care which gives comfort. Participants also identified two pairs of dimensions to describe their feelings about the relationship between their brain dead relative's body and personhood: presence-absence and divisibility-indivisibility. Being confronted with brain death meant entering into the anteroom of death, facing a loved one who is 'living-dead', and experiencing a chaotic drama of suffering. It is very important for members of the intensive care unit team to recognize, face and respond to these relatives' chaotic experiences, which cause them to need affirmation, comfort and caring. Relatives' use of imagery could be the starting point for a caring conversation about their experiences, either in conversations at the time of the death or when relatives are contacted in a later follow-up.

  16. Brain death determination: the imperative for policy and legal initiatives in Sub-Saharan Africa.

    Science.gov (United States)

    Waweru-Siika, Wangari; Clement, Meredith Edwards; Lukoko, Lilian; Nadel, Simon; Rosoff, Philip M; Naanyu, Violet; Kussin, Peter S

    2017-05-01

    The concept of brain death (BD), defined as irreversible loss of function of the brain including the brainstem, is accepted in the medical literature and in legislative policy worldwide. However, in most of Sub-Saharan Africa (SSA) there are no legal guidelines regarding BD. Hypothetical scenarios based on our collective experience are presented which underscore the consequences of the absence of BD policies in resource-limited countries (RLCs). Barriers to the development of BD laws exist in an RLC such as Kenya. Cultural, ethnic, and religious diversity creates a complex perspective about death challenging the development of uniform guidelines for BD. The history of the medical legal process in the USA provides a potential way forward. Uniform guidelines for legislation at the state level included special consideration for ethnic or religious preferences in specific states. In SSA, medical and social consensus on the definition of BD is a prerequisite for the development BD legislation. Legislative policy will (1) limit prolonged and futile interventions; (2) mitigate the suffering of families; (3) standardise clinical practice; and (4) facilitate better allocation of scarce critical care resources in RLCs. There is a clear-cut need for these policies, and previous successful policies can serve to guide these efforts.

  17. Retrospective Reports of the Lived School Experience of Adolescents after the Death of a Parent

    Science.gov (United States)

    Masterson, Ann

    2013-01-01

    This qualitative phenomenological study was done to better understand the school experience of adolescents after the death of a parent. The participants were adults over the age of 19 and between 3 and 43 years past the death of a parent during adolescence. The study involved personal, reflective interviews with each of the participants. The…

  18. How do parents experience support after the death of their child?

    NARCIS (Netherlands)

    Gijzen, S.; Hoir, M.P. L; Boere-Boonekamp, M.M.; Need, A.

    2016-01-01

    Background A child’s death is an enormous tragedy for both the parents and other family members. Support for the parents can be important in helping them to cope with the loss of their child. In the Netherlands little is known about parents’ experiences of the support they receive after the death of

  19. 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

  20. Trends in one-year cumulative incidence of death between 2005 and 2013 among patients initiating antiretroviral therapy in Uganda.

    Science.gov (United States)

    Bebell, Lisa M; Siedner, Mark J; Musinguzi, Nicholas; Boum, Yap; Bwana, Bosco M; Muyindike, Winnie; Hunt, Peter W; Martin, Jeffrey N; Bangsberg, David R

    2017-07-01

    Recent ecological data demonstrate improving outcomes for HIV-infected people in sub-Saharan Africa. Recently, Uganda has experienced a resurgence in HIV incidence and prevalence, but trends in HIV-related deaths have not been well described. Data were collected through the Uganda AIDS Rural Treatment Outcomes (UARTO) Study, an observational longitudinal cohort of Ugandan adults initiating antiretroviral therapy (ART) between 2005 and 2013. We calculated cumulative incidence of death within one year of ART initiation, and fit Poisson models with robust variance estimators to estimate the effect enrollment period on one-year risk of death and loss to follow-up. Of 760 persons in UARTO who started ART, 30 deaths occurred within one year of ART initiation (cumulative incidence 3.9%, 95% confidence interval [CI] 2.7-5.6%). Risk of death was highest for those starting ART in 2005 (13.0%, 95% CI 6.0-24.0%), decreased in 2006-2007 to 4% (95% CI 2.0-6.0%), and did not change thereafter ( P = 0.61). These results were robust to adjustment for age, sex, CD4 cell count, viral load, asset wealth, baseline depression, and body mass index. Here, we demonstrate that one-year cumulative incidence of death was high just after free ART rollout, decreased the following year, and remained low thereafter. Once established, ART programs in President's Emergency Fund for AIDS Relief-supported countries can maintain high quality care.

  1. Near-death experience: arising from the borderlands of consciousness in crisis.

    Science.gov (United States)

    Nelson, Kevin R

    2014-11-01

    Brain activity explains the essential features of near-death experience, including the perceptions of envelopment by light, out-of-body, and meeting deceased loved ones or spiritual beings. To achieve their fullest expression, such near-death experiences require a confluence of events and draw upon more than a single physiological or biochemical system, or one anatomical structure. During impaired cerebral blood flow from syncope or cardiac arrest that commonly precedes near-death, the boundary between consciousness and unconsciousness is often indistinct and a person may enter a borderland and be far more aware than is appreciated by others. Consciousness can also come and go if blood flow rises and falls across a crucial threshold. During crisis the brain's prime biologic purpose to keep itself alive lies at the heart of many spiritual experiences and inextricably binds them to the primal brain. Brain ischemia can disrupt the physiological balance between conscious states by leading the brainstem to blend rapid eye movement (REM) and waking into another borderland of consciousness during near-death. Evidence converges from many points to support this notion, including the observation that the majority of people with a near-death experience possess brains predisposed to fusing REM and waking consciousness into an unfamiliar reality, and are as likely to have out-of-body experience while blending REM and waking consciousness as they are to have out-of-body experience during near-death. © 2014 New York Academy of Sciences.

  2. 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

  3. Drama as a pedagogical tool for practicing death notification-experiences from Swedish medical students

    Directory of Open Access Journals (Sweden)

    Fjellman-Wiklund Anncristine

    2011-09-01

    Full Text Available Abstract Background One of the toughest tasks in any profession is the deliverance of death notification. Marathon Death is an exercise conducted during the fourth year of medical school in northern Sweden to prepare students for this responsibility. The exercise is designed to enable students to gain insight into the emotional and formal procedure of delivering death notifications. The exercise is inspired by Augusto Boal's work around Forum Theatre and is analyzed using video playback. The aim of the study was to explore reflections, attitudes and ideas toward training in delivering death notifications among medical students who participate in the Marathon Death exercise based on forum play. Methods After participation in the Marathon Death exercise, students completed semi-structured interviews. The transcribed interviews were analyzed using the principles of qualitative content analysis including a deductive content analysis approach with a structured matrix based on Bloom's taxonomy domains. Results The Marathon Death exercise was perceived as emotionally loaded, realistic and valuable for the future professional role as a physician. The deliverance of a death notification to the next of kin that a loved one has died was perceived as difficult. The exercise conjured emotions such as positive expectations and sheer anxiety. Students perceived participation in the exercise as an important learning experience, discovering that they had the capacity to manage such a difficult situation. The feedback from the video playback of the exercise and the feedback from fellow students and teachers enhanced the learning experience. Conclusions The exercise, Marathon Death, based on forum play with video playback is a useful pedagogical tool that enables students to practice delivering death notification. The ability to practice under realistic conditions contributes to reinforce students in preparation for their future professional role.

  4. Drama as a pedagogical tool for practicing death notification-experiences from Swedish medical students.

    Science.gov (United States)

    Nordström, Anna; Fjellman-Wiklund, Anncristine; Grysell, Tomas

    2011-09-28

    One of the toughest tasks in any profession is the deliverance of death notification. Marathon Death is an exercise conducted during the fourth year of medical school in northern Sweden to prepare students for this responsibility. The exercise is designed to enable students to gain insight into the emotional and formal procedure of delivering death notifications. The exercise is inspired by Augusto Boal's work around Forum Theatre and is analyzed using video playback. The aim of the study was to explore reflections, attitudes and ideas toward training in delivering death notifications among medical students who participate in the Marathon Death exercise based on forum play. After participation in the Marathon Death exercise, students completed semi-structured interviews. The transcribed interviews were analyzed using the principles of qualitative content analysis including a deductive content analysis approach with a structured matrix based on Bloom's taxonomy domains. The Marathon Death exercise was perceived as emotionally loaded, realistic and valuable for the future professional role as a physician. The deliverance of a death notification to the next of kin that a loved one has died was perceived as difficult. The exercise conjured emotions such as positive expectations and sheer anxiety. Students perceived participation in the exercise as an important learning experience, discovering that they had the capacity to manage such a difficult situation. The feedback from the video playback of the exercise and the feedback from fellow students and teachers enhanced the learning experience. The exercise, Marathon Death, based on forum play with video playback is a useful pedagogical tool that enables students to practice delivering death notification. The ability to practice under realistic conditions contributes to reinforce students in preparation for their future professional role.

  5. Diffusion is capable of translating anisotropic apoptosis initiation into a homogeneous execution of cell death.

    LENUS (Irish Health Repository)

    Huber, Heinrich J

    2010-01-01

    ABSTRACT: BACKGROUND: Apoptosis is an essential cell death process throughout the entire life span of all metazoans and its deregulation in humans has been implicated in many proliferative and degenerative diseases. Mitochondrial outer membrane permeabilisation (MOMP) and activation of effector caspases are key processes during apoptosis signalling. MOMP can be subject to spatial coordination in human cancer cells, resulting in intracellular waves of cytochrome-c release. To investigate the consequences of these spatial anisotropies in mitochondrial permeabilisation on subsequent effector caspase activation, we devised a mathematical reaction-diffusion model building on a set of partial differential equations. RESULTS: Reaction-diffusion modelling suggested that even if strong spatial anisotropies existed during mitochondrial cytochrome c release, these would be eliminated by free diffusion of the cytosolic proteins that instantiate the apoptosis execution network. Experimentally, rapid sampling of mitochondrial permeabilisation and effector caspase activity in individual HeLa cervical cancer cells confirmed predictions of the reaction-diffusion model and demonstrated that the signalling network of apoptosis execution could efficiently translate spatial anisotropies in mitochondrial permeabilisation into a homogeneous effector caspase response throughout the cytosol. Further systems modelling suggested that a more than 10,000-fold impaired diffusivity would be required to maintain spatial anisotropies as observed during mitochondrial permeabilisation until the time effector caspases become activated. CONCLUSIONS: Multi-protein diffusion efficiently contributes to eliminating spatial asynchronies which are present during the initiation of apoptosis execution and thereby ensures homogeneous apoptosis execution throughout the entire cell body. For previously reported biological scenarios in which effector caspase activity was shown to be targeted selectively to

  6. Oregon's Death With Dignity Act: 20 Years of Experience to Inform the Debate.

    Science.gov (United States)

    Hedberg, Katrina; New, Craig

    2017-10-17

    Twenty years ago, Oregon voters approved the Death With Dignity Act, making Oregon the first state in the United States to allow physicians to prescribe medications to be self-administered by terminally ill patients to hasten their death. This report summarizes the experience in Oregon, including the numbers and types of participating patients and providers. These data should inform the ongoing policy debate as additional jurisdictions consider such legislation.

  7. 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.

  8. 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…

  9. Death and caring for dying patients: exploring first-year nursing students' descriptive experiences.

    Science.gov (United States)

    Ek, Kristina; Westin, Lars; Prahl, Charlotte; Osterlind, Jane; Strang, Susann; Bergh, Ingrid; Hammarlund, Kina

    2014-10-01

    To describe first-year nursing students' experiences of witnessing death and providing end-of-life care. This study is part of a larger longitudinal project. Interviews (n=17) were conducted with nursing students at the end of their first year of education. To analyse the interviews (lived-experience descriptions), a thematic analysis, 'a search for meaning' ( Van Manen, 1997 ) was applied. The results are presented within the framework of four separate themes: (1) The thought of death is more frightening than the actual experience, (2) Daring to approach the dying patient and offering something of oneself, (3) The experience of not sufficing in the face of death and (4) Being confronted with one's own feelings. Nursing students require continuous support and opportunity to reflect and discuss their experiences about caring for dying patients and confronting death throughout the entirety of their education. In addition, teachers and clinical supervisors need to give support using reflective practice to help students to develop confidence in their capacity for caring for dying patients.

  10. Granzyme A Cleaves a Mitochondrial Complex I Protein to Initiate Caspase-Independent Cell Death

    Science.gov (United States)

    Martinvalet, Denis; Dykxhoorn, Derek M.; Ferrini, Roger; Lieberman, Judy

    2010-01-01

    SUMMARY The killer lymphocyte protease granzyme A (GzmA) triggers caspase-independent target cell death with morphological features of apoptosis. We previously showed that GzmA acts directly on mitochondria to generate reactive oxygen species (ROS) and disrupt the transmembrane potential (ΔΨm) but does not permeabilize the mitochondrial outer membrane. Mitochondrial damage is critical to GzmA-induced cell death since cells treated with superoxide scavengers are resistant to GzmA. Here we find that GzmA accesses the mitochondrial matrix to cleave the complex I protein NDUFS3, an iron-sulfur subunit of the NADH:ubiquinone oxidoreductase complex I, after Lys56 to interfere with NADH oxidation and generate superoxide anions. Target cells expressing a cleavage site mutant of NDUFS3 are resistant to GzmA-mediated cell death but remain sensitive to GzmB. PMID:18485875

  11. Sudden death in paediatrics as a traumatic experience for critical care nurses.

    Science.gov (United States)

    Lima, Lígia; Gonçalves, Sandra; Pinto, Cândida

    2018-01-01

    Research shows that nurses working in critical care units and in particular, paediatric units, are at risk of developing symptoms of secondary traumatic stress (STS). However, little attention has been given to this phenomenon when associated with situations of sudden death in paediatrics. This study aimed to examine the impact of sudden death in paediatrics on nurses working in paediatrics critical care units and to explore nurses' experiences of this event. This study used a mixed-methods design. The Impact of Event Scale - Revised was used for investigating the presence of STS symptoms. In addition, an interview was conducted with six nurses. Fifty-seven percent of nurses responded to the surveys and six nurses were interviewed. The results showed that the sudden death of children and adolescents is an event that elicits symptoms of STS in nurses. The quantitative assessment, revealed that 19·4% presented total scores indicating high impact. The participants interviewed described experiences of subjective distress, such as intrusive thoughts, avoidance and hyperarousal. Other factors were also reported as influencing the experience of the sudden death of a child/adolescent, namely, the child's age, the cause of death and the family's reaction to the loss. According to the participants, the emotional impact was also determined by parenthood, previous training and professional experience. Sudden death in paediatric critical care units is one of the most difficult situations in nursing practice and elicits STS symptoms, which may severely impact the physical and psychological health of nurses and ultimately affect the quality of the provided care. This study emphasizes the need for promoting better conditions for professional practice, namely, with regard to emotional support, as well as training programmes for skills development in the area of management of traumatic situations and of communication with clients. © 2017 British Association of Critical Care

  12. Ethics and the Experience of Death: Some Lessons from Sophocles, Shakespeare, and Donne

    Science.gov (United States)

    Sansom, Dennis L.

    2010-01-01

    I argue in this paper that the ability of art to express a holistic experience of life challenges the abstractness and formulaic tendencies of some philosophical ethics. The paper examines the presentation of death in three poet-playwrights--Sophocles's "Oedipus Rex," Shakespeare's "Hamlet," and John Donne's "Meditation XVII." Sophocles's…

  13. The interaction of socioeconomic status with place of death: a qualitative analysis of physician experiences.

    Science.gov (United States)

    Wales, Joshua; Kurahashi, Allison M; Husain, Amna

    2018-06-20

    Home is a preferred place of death for many people; however, access to a home death may not be equitable. The impact of socioeconomic status on one's ability to die at home has been documented, yet there remains little literature exploring mechanisms that contribute to this disparity. By exploring the experiences and insights of physicians who provide end-of-life care in the home, this study aims to identify the factors perceived to influence patients' likelihood of home death and describe the mechanisms by which they interact with socioeconomic status. In this exploratory qualitative study, we conducted interviews with 9 physicians who provide home-based care at a specialized palliative care centre. Participants were asked about their experiences caring for patients at the end of life, focusing on factors believed to impact likelihood of home death with an emphasis on socioeconomic status, and opportunities for intervention. We relied on participants' perceptions of SES, rather than objective measures. We used an inductive content analysis to identify and describe factors that physicians perceive to influence a patient's likelihood of dying at home. Factors identified by physicians were organized into three categories: patient characteristics, physical environment and support network. Patient preference for home death was seen as a necessary factor. If this was established, participants suggested that having a strong support network to supplement professional care was critical to achieving home death. Finally, safe and sustainable housing were also felt to improve likelihood of home death. Higher SES was perceived to increase the likelihood of a desired home death by affording access to more resources within each of the categories. This included better health and health care understanding, a higher capacity for advocacy, a more stable home environment, and more caregiver support. SES was not perceived to be an isolated factor impacting likelihood of home death

  14. 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

  15. 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

  16. 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.)

  17. 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

  18. 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

  19. 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)

  20. 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)

  1. Bortezomib initiates endoplasmic reticulum stress, elicits autophagy and death in Echinococcus granulosus larval stage

    Science.gov (United States)

    Nicolao, María Celeste; Loos, Julia A.; Rodriguez Rodrigues, Christian; Beas, Viviana

    2017-01-01

    Cystic echinococcosis (CE) is a worldwide distributed helminthic zoonosis caused by Echinococcus granulosus. Benzimidazole derivatives are currently the only drugs for chemotherapeutic treatment of CE. However, their low efficacy and the adverse effects encourage the search for new therapeutic targets. We evaluated the in vitro efficacy of Bortezomib (Bz), a proteasome inhibitor, in the larval stage of the parasite. After 96 h, Bz showed potent deleterious effects at a concentration of 5 μM and 0.5 μM in protoscoleces and metacestodes, respectively (P Echinococcus cell viability, we evaluated the efficacy of Bz in combination with rapamycin and a synergistic cytotoxic effect on protoscolex viability was observed when both drugs were used together. In conclusion, our findings demonstrated that Bz induced endoplasmic reticulum stress, autophagy and subsequent death allowing to identify unstudied parasite-host pathways that could provide a new insight for control of parasitic diseases. PMID:28817601

  2. 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.

  3. The DNA Inflammasome in Human Myeloid Cells Is Initiated by a STING-Cell Death Program Upstream of NLRP3

    Science.gov (United States)

    Gaidt, Moritz M.; Ebert, Thomas S.; Chauhan, Dhruv; Ramshorn, Katharina; Pinci, Francesca; Zuber, Sarah; O’Duill, Fionan; Schmid-Burgk, Jonathan L.; Hoss, Florian; Buhmann, Raymund; Wittmann, Georg; Latz, Eicke; Subklewe, Marion; Hornung, Veit

    2018-01-01

    Summary Detection of cytosolic DNA constitutes a central event in the context of numerous infectious and sterile inflammatory conditions. Recent studies have uncovered a bipartite mode of cytosolic DNA recognition, in which the cGAS-STING axis triggers antiviral immunity, whereas AIM2 triggers inflammasome activation. Here, we show that AIM2 is dispensable for DNA-mediated inflammasome activation in human myeloid cells. Instead, detection of cytosolic DNA by the cGAS-STING axis induces a cell death program initiating potassium efflux upstream of NLRP3. Forward genetics identified regulators of lysosomal trafficking to modulate this cell death program, and subsequent studies revealed that activated STING traffics to the lysosome, where it triggers membrane permeabilization and thus lysosomal cell death (LCD). Importantly, the cGAS-STING-NLRP3 pathway constitutes the default inflammasome response during viral and bacterial infections in human myeloid cells. We conclude that targeting the cGAS-STING-LCD-NLRP3 pathway will ameliorate pathology in inflammatory conditions that are associated with cytosolic DNA sensing. PMID:29033128

  4. Biomarkers Associated with Death After Initiating Treatment for Tuberculosis and HIV in Patients with Very Low CD4 Cells

    Directory of Open Access Journals (Sweden)

    Fred Richard Sattler

    2018-04-01

    Full Text Available Background: The risk of short-term death for treatment naive patients dually infected with Mycobacterium tuberculosis and HIV may be reduced by early anti-retroviral therapy. Of those dying, mechanisms responsible for fatal outcomes are unclear. We hypothesized that greater malnutrition and/or inflammation when initiating treatment are associated with an increased risk for death. Methods: We utilized a retrospective case-cohort design among participants of the ACTG A5221 study who had baseline CD4 < 50 cells/mm3. The case-cohort sample consisted of 51 randomly selected participants, whose stored plasma was tested for C-reactive protein, cytokines, chemokines, and nutritional markers. Cox proportional hazards models were used to assess the association of nutritional, inflammatory, and immunomodulatory markers for survival. Results: The case-cohort sample was similar to the 282 participants within the parent cohort with CD4 < 50 cells/mm3. In the case cohort, 7 (14% had BMI < 16.5 (kg/m2 and 17 (33% had BMI 16.5-18.5(kg/m2. Risk of death was increased per 1 IQR width higher of log10 transformed level of C-reactive protein (adjusted hazard ratio (aHR = 3.42 [95% CI = 1.33-8.80],P = 0.011, interferon gamma (aHR = 2.46 [CI = 1.02-5.90], P = 0.044, MCP-3 (3.67 [CI = 1.08-12.42], P = 0.037, and with IL-15 (aHR = 2.75 [CI = 1.08-6.98], P = 0.033 and IL-17 (aHR = 3.99 [CI = -1.06-15.07], P = 0.041. BMI, albumin, hemoglobin, and leptin levels were not associated with risk of death. Conclusions: Unlike patients only infected with M. tuberculosis for whom malnutrition and low BMI increase the risk of death, this relationship was not evident in our dually infected patients. Risk of death was associated with significant increases in markers of global inflammation along with soluble biomarkers of innate and adaptive immunity.

  5. The Contribution of Death-Related Experiences to Health Care Providers' Attitudes toward Dying Patients: II. Medical and Nursing Students with No Professional Experience.

    Science.gov (United States)

    Brent, Sandor B.; And Others

    1993-01-01

    Compared attitudes toward care of dying patients of beginning medical and nursing students with no professional death-related experience. On five of six attitude measures, female nursing students expressed more positive attitude than either male or female medical students. Hours of death-and-dying coursework and general life experience exerted…

  6. Bortezomib initiates endoplasmic reticulum stress, elicits autophagy and death in Echinococcus granulosus larval stage.

    Directory of Open Access Journals (Sweden)

    María Celeste Nicolao

    Full Text Available Cystic echinococcosis (CE is a worldwide distributed helminthic zoonosis caused by Echinococcus granulosus. Benzimidazole derivatives are currently the only drugs for chemotherapeutic treatment of CE. However, their low efficacy and the adverse effects encourage the search for new therapeutic targets. We evaluated the in vitro efficacy of Bortezomib (Bz, a proteasome inhibitor, in the larval stage of the parasite. After 96 h, Bz showed potent deleterious effects at a concentration of 5 μM and 0.5 μM in protoscoleces and metacestodes, respectively (P < 0.05. After 48 h of exposure to this drug, it was triggered a mRNA overexpression of chaperones (Eg-grp78 and Eg-calnexin and of Eg-ire2/Eg-xbp1 (the conserved UPR pathway branch in protoscoleces. No changes were detected in the transcriptional expression of chaperones in Bz-treated metacestodes, thus allowing ER stress to be evident and viability to highly decrease in comparison with protoscoleces. We also found that Bz treatment activated the autophagic process in both larval forms. These facts were evidenced by the increase in the amount of transcripts of the autophagy related genes (Eg-atg6, Eg-atg8, Eg-atg12, Eg-atg16 together with the increase in Eg-Atg8-II detected by western blot and by in toto immunofluorescence labeling. It was further confirmed by direct observation of autophagic structures by electronic microscopy. Finally, in order to determine the impact of autophagy induction on Echinococcus cell viability, we evaluated the efficacy of Bz in combination with rapamycin and a synergistic cytotoxic effect on protoscolex viability was observed when both drugs were used together. In conclusion, our findings demonstrated that Bz induced endoplasmic reticulum stress, autophagy and subsequent death allowing to identify unstudied parasite-host pathways that could provide a new insight for control of parasitic diseases.

  7. 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

  8. The experiences of staff who support people with intellectual disability on issues about death, dying and bereavement: A metasynthesis.

    Science.gov (United States)

    Lord, Ailsa J; Field, Stephen; Smith, Ian C

    2017-11-01

    Historically, people with intellectual disabilities have tended to be excluded from knowing about death, dying and bereavement. Staff in intellectual disability services can play a valuable role in improving understanding of these issues in those they support. This qualitative metasynthesis aimed to understand the experiences of staff supporting adults with intellectual disabilities with issues of death, dying and bereavement. Thirteen papers were identified following a systematic review of six databases. Three themes were developed following a lines-of-argument synthesis: (i) talking about death is hard: negotiating the uncertainty in death, dying and bereavement; (ii) the commitment to promoting a "good death"; and (iii) the grief behind the professional mask. "A cautious silence: The taboo of death" was an overarching theme. A more open culture around issues of death, dying and bereavement in intellectual disability settings is essential and could be promoted through staff training and support. © 2017 John Wiley & Sons Ltd.

  9. 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)

  10. 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.

  11. Infrequent near death experiences in severe brain injury survivors - A quantitative and qualitative study.

    Science.gov (United States)

    Hou, Yongmei; Huang, Qin; Prakash, Ravi; Chaudhury, Suprakash

    2013-01-01

    Near death experiences (NDE) are receiving increasing attention by the scientific community because not only do they provide a glimpse of the complexity of the mind-brain interactions in 'near-death' circumstances but also because they have significant and long lasting effects on various psychological aspects of the survivors. The over-all incidence-reports of NDEs in literature have varied widely from a modest Figure of 10% to around 35%, even up to an incredible Figure of 72% in persons who have faced close brush with death. Somewhat similar to this range of difference in incidences are the differences prevalent in the opinions that theorists and researchers harbor around the world for explaining this phenomena. None the less, objective evidences have supported physiological theories the most. A wide range of physiological processes have been targeted for explaining NDEs. These include cerebral anoxia, chemical alterations like hypercapnia, presence of endorphins, ketamine, and serotonin, or abnormal activity of the temporal lobe or the limbic system. In spite of the fact that the physiological theories of NDEs have revolved around the derangements in brain, no study till date has taken up the task of evaluating the experiences of near-death in patients where specific injury has been to brain. Most of them have evaluated NDEs in cardiac-arrest patients. Post-traumatic coma is one such state regarding which the literature seriously lacks any information related to NDEs. Patients recollecting any memory of their post-traumatic coma are valuable assets for NDE researchers and needs special attention. Our present study was aimed at collecting this valuable information from survivors of severe head injury after a prolonged coma. The study was conducted in the head injury department of Guangdong 999 Brain hospital, Guangzhou, China. Patients included in the study were the ones Recovered from the posttraumatic coma following a severe head injury. A total of 86 patients

  12. [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.

  13. 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.

  14. 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

  15. 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.

  16. [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

  17. Infrequent near death experiences in severe brain injury survivors - A quantitative and qualitative study

    Directory of Open Access Journals (Sweden)

    Yongmei Hou

    2013-01-01

    Full Text Available Background: Near death experiences (NDE are receiving increasing attention by the scientific community because not only do they provide a glimpse of the complexity of the mind-brain interactions in ′near-death′ circumstances but also because they have significant and long lasting effects on various psychological aspects of the survivors. The over-all incidence-reports of NDEs in literature have varied widely from a modest Figure of 10% to around 35%, even up to an incredible Figure of 72% in persons who have faced close brush with death. Somewhat similar to this range of difference in incidences are the differences prevalent in the opinions that theorists and researchers harbor around the world for explaining this phenomena. None the less, objective evidences have supported physiological theories the most. A wide range of physiological processes have been targeted for explaining NDEs. These include cerebral anoxia, chemical alterations like hypercapnia, presence of endorphins, ketamine, and serotonin, or abnormal activity of the temporal lobe or the limbic system. In spite of the fact that the physiological theories of NDEs have revolved around the derangements in brain, no study till date has taken up the task of evaluating the experiences of near-death in patients where specific injury has been to brain. Most of them have evaluated NDEs in cardiac-arrest patients. Post-traumatic coma is one such state regarding which the literature seriously lacks any information related to NDEs. Patients recollecting any memory of their post-traumatic coma are valuable assets for NDE researchers and needs special attention. Materials and Methods: Our present study was aimed at collecting this valuable information from survivors of severe head injury after a prolonged coma. The study was conducted in the head injury department of Guangdong 999 Brain hospital, Guangzhou, China. Patients included in the study were the ones Recovered from the posttraumatic

  18. [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.

  19. 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.)

  20. 47. A cardiac center experience with Brugada syndrome who survived sudden cardiac death

    Directory of Open Access Journals (Sweden)

    I. Suliman

    2016-07-01

    Full Text Available Brugada syndrome is a heritable arrhythmia syndrome that is characterized by an electrocardiographic pattern consisting of coved-type ST-segment elevation (2 mm followed by a negative T wave in the right precordial leads, V1 through V3 (often referred to as type 1 Brugada electrocardiographic pattern, here we describe 3 cases of Brugada who survived sudden cardiac death (SCD cardiac center experience with survived Brugada syndrome patients – case series. First Case: The Father 45 years old male, presented in 2005 after involvement in unprovoked motor vehicle accident, the patient was the driver who lost consciousness and rushed to the hospital. On arrival to our ER and putting the patient on the bed, the ER doctor observed a brief episode of VF on the monitor. The patient was taken to the catheterization Lab , his coronaries were normal. The diagnosis of Brugada was established and the patient received a defibrillator. At That Time all family members were screened and were negative. Second Case: The Son of the first patient 5 years later his 23 years old male rushed to our ER after he lost consciousness, he was passenger in the car of his friend. Third Case: The pilot A military pilot aged a male 35 years old was in very good health when he lost consciousness and brought to the hospital after resuscitation in 2005. He had full invasive cardiac evaluation, subsequently he received a defibrillator in the same admission period, till 2015 he is doing fine. Brugada syndrome is associated with high tendency for sudden cardiac death. In our three cases the first clinical presentation was survived sudden cardiac death (SCD and all three male patients survived. We did not encounter a female patient who survived sudden cardiac death.

  1. 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

  2. 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.

  3. 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...

  4. [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.

  5. Near-Death Experiences in a Multi-religious Hospital Population in Sri Lanka.

    Science.gov (United States)

    Chandradasa, Miyuru; Wijesinghe, Chamara; Kuruppuarachchi, K A L A; Perera, Mahendra

    2017-07-01

    Near-death experiences (NDEs) are a wide range of experiences that occur in association with impending death. There are no published studies on NDEs in general hospital populations, and studies have been mainly conducted on critically ill patients. We assessed the prevalence of NDEs and its associations in a multi-religious population in a general hospital in Sri Lanka. A randomised sample of patients admitted to the Colombo North Teaching Hospital was assessed using the Greyson NDE scale and clinical assessment. Out of total 826 participants, NDEs were described by 3%. Compared to the NDE-negative participants, the NDE-positive group had a significantly higher mean for age and a ratio of men. Women reported deeper NDEs. Patients of theistic religions (Christianity, Islam and Hinduism) reported significantly more NDEs compared to patients from the non-theistic religious group (Buddhism). NDE-positive patient group had significantly higher reporting of a feeling 'that they are about to die', the presence of loss of consciousness and a higher percentage of internal medical patients. This is the first time that NDEs are assessed in a general hospital population and NDEs being reported from Sri Lanka. We also note for the first time that persons with theistic religious beliefs reported more NDEs than those with non-theistic religious beliefs. Medical professionals need to be aware of these phenomena to be able to give an empathic hearing to patients who have NDE.

  6. Oregon's experience with aid in dying: findings from the death with dignity laboratory.

    Science.gov (United States)

    Coombs Lee, Barbara

    2014-11-01

    With passage of the Death with Dignity Act in 1994, Oregon became the first jurisdiction to authorize and regulate aid in dying. Data from that experience are comprehensive and bountiful, and answer a multitude of questions and concerns about whether the benefits of recognizing the medical practice of aid in dying justify the risks. An exhaustive description of findings from Oregon's aid-in-dying experience is beyond the scope of this or any single article on the subject. This article provides a summary of data highlights, gleaned from scientific investigations and governmental reporting. It organizes highlighted reports along subjects so that readers may see what various sources have to teach on a number of questions important to policy makers. © 2014 New York Academy of Sciences.

  7. Fantasy Proneness Correlates With the Intensity of Near-Death Experience

    Directory of Open Access Journals (Sweden)

    Charlotte Martial

    2018-06-01

    Full Text Available Little is known about the personality characteristics of those who have experienced a “Near-Death Experience” (NDE. One interesting candidate is fantasy proneness. We studied this trait in individuals who developed NDEs in the presence (i.e., classical NDEs or absence (i.e., NDEs-like of a life-threatening situation. We surveyed a total of 228 individuals. From those, 108 qualified as NDE experiencers (i.e., Greyson NDE scale total score ≥7: 51 had their NDEs in the context of a life-threatening situation; 57 had their NDEs not related to a life-threatening situation. From those who did not meet the criteria to be considered “experiencers,” 20 had their NDE in the absence of a life-threatening situation; 50 had faced death but did not recall a NDE and finally, 50 were healthy people without a history of life threat and/or NDE. All participants completed a measure of NDE intensity (the Greyson NDE scale and a measure of fantasy proneness (the Creative Experiences Questionnaire. People reporting NDEs-like scored higher on fantasy proneness than those reporting classical NDEs, individuals whose experiences did not meet the NDE criteria and matched controls. By contrast, individuals reporting classical NDEs did not show different engagement in fantasy as matched controls. The reported intensity of the experiences was positively correlated with engagement in fantasy. Our findings support the view that strong engagement in fantasy by individuals recalling NDEs-like might make these persons more likely to report such subjective experiences when exposed to suitable physiological and/or psychological conditions (e.g., meditation, syncope.

  8. 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.)

  9. 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.)

  10. Experiences of the families concerning organ donation of a family member with brain death

    Science.gov (United States)

    Yousefi, Hojatollah; Roshani, Asieh; Nazari, Fatemeh

    2014-01-01

    Background: In recent years, the lack of organ for transplantation has resulted in health planners and authorities in all countries, including Iran, paying serious attention to the issue. Despite the above-mentioned fact, families with a member affected by brain death are not interested in organ donation. Objective: This study is aimed at making an investigation into the decision-making process of organ donation in families with brain death. Also, the research is aimed at investigating how the deterrent and facilitating factors in the process of organ donation can be made. Materials and Methods: The current research is a qualitative study with descriptive exploratory approach. Data were collected through unstructured interviews with 10 family members who gave consent to organ donation of their family members in 2012. Purposeful sampling processes began in March 2012 and lasted up to June 2012. Simultaneously, thematic approach was used in analyzing the data. Results: Data analysis led to finding 24 categories and 11 themes, which fell into two categories: facilitating and deterrent factors. The five main deterrent themes included the five themes of prohibiting factors that were shock, hope for recovery, unknown process, and conflict of opinions, and worrying association. The six main facilitating themes included humanistic desires, immortality, culture making, satisfaction of the deceased, assurance, and eternal honor. Conclusion: The findings indicated that there is ambiguity and different interpretations on brain death. The research also showed that using the experiences of donator families can provide practical and applied solutions to facilitate the process of organ donation and solve the problems faced by the health care system. PMID:24949074

  11. Experiences of the families concerning organ donation of a family member with brain death.

    Science.gov (United States)

    Yousefi, Hojatollah; Roshani, Asieh; Nazari, Fatemeh

    2014-05-01

    In recent years, the lack of organ for transplantation has resulted in health planners and authorities in all countries, including Iran, paying serious attention to the issue. Despite the above-mentioned fact, families with a member affected by brain death are not interested in organ donation. This study is aimed at making an investigation into the decision-making process of organ donation in families with brain death. Also, the research is aimed at investigating how the deterrent and facilitating factors in the process of organ donation can be made. The current research is a qualitative study with descriptive exploratory approach. Data were collected through unstructured interviews with 10 family members who gave consent to organ donation of their family members in 2012. Purposeful sampling processes began in March 2012 and lasted up to June 2012. Simultaneously, thematic approach was used in analyzing the data. Data analysis led to finding 24 categories and 11 themes, which fell into two categories: facilitating and deterrent factors. The five main deterrent themes included the five themes of prohibiting factors that were shock, hope for recovery, unknown process, and conflict of opinions, and worrying association. The six main facilitating themes included humanistic desires, immortality, culture making, satisfaction of the deceased, assurance, and eternal honor. The findings indicated that there is ambiguity and different interpretations on brain death. The research also showed that using the experiences of donator families can provide practical and applied solutions to facilitate the process of organ donation and solve the problems faced by the health care system.

  12. Qualitative thematic analysis of the phenomenology of near-death experiences.

    Science.gov (United States)

    Cassol, Helena; Pétré, Benoît; Degrange, Sophie; Martial, Charlotte; Charland-Verville, Vanessa; Lallier, François; Bragard, Isabelle; Guillaume, Michèle; Laureys, Steven

    2018-01-01

    Near-death experiences (NDEs) refer to profound psychological events that can have an important impact on the experiencers' (NDErs) lives. Previous studies have shown that NDEs memories are phenomenologically rich. In the present study, we therefore aimed to extract the common themes (referred to as "features" in the NDE literature) reported by NDErs by analyzing all the concepts stored in the narratives of their experiences. A qualitative thematic analysis has been carried out on 34 cardiac arrest survivors' NDE narratives. Our results shed the light on the structure of the narratives by identifying 10 "time-bounded" themes which refer to isolated events encountered during the NDE and 1 "transversal" theme which characterizes the whole narrative and generally appears as a retrospective comment of self-reflection on the experience. The division of narratives into themes provides us with detailed information about the vocabulary used by NDErs to describe their experience. This established thematic method enables a rigorous description of the phenomenon, ensuring the inclusion of all self-reported manifestations of themes in narratives.

  13. Qualitative thematic analysis of the phenomenology of near-death experiences.

    Directory of Open Access Journals (Sweden)

    Helena Cassol

    Full Text Available Near-death experiences (NDEs refer to profound psychological events that can have an important impact on the experiencers' (NDErs lives. Previous studies have shown that NDEs memories are phenomenologically rich. In the present study, we therefore aimed to extract the common themes (referred to as "features" in the NDE literature reported by NDErs by analyzing all the concepts stored in the narratives of their experiences. A qualitative thematic analysis has been carried out on 34 cardiac arrest survivors' NDE narratives. Our results shed the light on the structure of the narratives by identifying 10 "time-bounded" themes which refer to isolated events encountered during the NDE and 1 "transversal" theme which characterizes the whole narrative and generally appears as a retrospective comment of self-reflection on the experience. The division of narratives into themes provides us with detailed information about the vocabulary used by NDErs to describe their experience. This established thematic method enables a rigorous description of the phenomenon, ensuring the inclusion of all self-reported manifestations of themes in narratives.

  14. The Coding Causes of Death in HIV (CoDe) Project: initial results and evaluation of methodology

    DEFF Research Database (Denmark)

    Kowalska, Justyna D; Friis-Møller, Nina; Kirk, Ole

    2011-01-01

    The Coding Causes of Death in HIV (CoDe) Project aims to deliver a standardized method for coding the underlying cause of death in HIV-positive persons, suitable for clinical trials and epidemiologic studies.......The Coding Causes of Death in HIV (CoDe) Project aims to deliver a standardized method for coding the underlying cause of death in HIV-positive persons, suitable for clinical trials and epidemiologic studies....

  15. Nano-Pulse Stimulation induces immunogenic cell death in human papillomavirus-transformed tumors and initiates an adaptive immune response.

    Directory of Open Access Journals (Sweden)

    Joseph G Skeate

    Full Text Available Nano-Pulse Stimulation (NPS is a non-thermal pulsed electric field modality that has been shown to have cancer therapeutic effects. Here we applied NPS treatment to the human papillomavirus type 16 (HPV 16-transformed C3.43 mouse tumor cell model and showed that it is effective at eliminating primary tumors through the induction of immunogenic cell death while subsequently increasing the number of tumor-infiltrating lymphocytes within the tumor microenvironment. In vitro NPS treatment of C3.43 cells resulted in a doubling of activated caspase 3/7 along with the translocation of phosphatidylserine (PS to the outer leaflet of the plasma membrane, indicating programmed cell death activity. Tumor-bearing mice receiving standard NPS treatment showed an initial decrease in tumor volume followed by clearing of tumors in most mice, and a significant increase in overall survival. Intra-tumor analysis of mice that were unable to clear tumors showed an inverse correlation between the number of tumor infiltrating lymphocytes and the size of the tumor. Approximately half of the mice that cleared established tumors were protected against tumor re-challenge on the opposite flank. Selective depletion of CD8+ T cells eliminated this protection, suggesting that NPS treatment induces an adaptive immune response generating CD8+ T cells that recognize tumor antigen(s associated with the C3.43 tumor model. This method may be utilized in the future to not only ablate primary tumors, but also to induce an anti-tumor response driven by effector CD8+ T cells capable of protecting individuals from disease recurrence.

  16. Nano-Pulse Stimulation induces immunogenic cell death in human papillomavirus-transformed tumors and initiates an adaptive immune response.

    Science.gov (United States)

    Skeate, Joseph G; Da Silva, Diane M; Chavez-Juan, Elena; Anand, Snjezana; Nuccitelli, Richard; Kast, W Martin

    2018-01-01

    Nano-Pulse Stimulation (NPS) is a non-thermal pulsed electric field modality that has been shown to have cancer therapeutic effects. Here we applied NPS treatment to the human papillomavirus type 16 (HPV 16)-transformed C3.43 mouse tumor cell model and showed that it is effective at eliminating primary tumors through the induction of immunogenic cell death while subsequently increasing the number of tumor-infiltrating lymphocytes within the tumor microenvironment. In vitro NPS treatment of C3.43 cells resulted in a doubling of activated caspase 3/7 along with the translocation of phosphatidylserine (PS) to the outer leaflet of the plasma membrane, indicating programmed cell death activity. Tumor-bearing mice receiving standard NPS treatment showed an initial decrease in tumor volume followed by clearing of tumors in most mice, and a significant increase in overall survival. Intra-tumor analysis of mice that were unable to clear tumors showed an inverse correlation between the number of tumor infiltrating lymphocytes and the size of the tumor. Approximately half of the mice that cleared established tumors were protected against tumor re-challenge on the opposite flank. Selective depletion of CD8+ T cells eliminated this protection, suggesting that NPS treatment induces an adaptive immune response generating CD8+ T cells that recognize tumor antigen(s) associated with the C3.43 tumor model. This method may be utilized in the future to not only ablate primary tumors, but also to induce an anti-tumor response driven by effector CD8+ T cells capable of protecting individuals from disease recurrence.

  17. [A scale for early assessment of risk of death and myocardial infarction during initial hospitalization of patients with acute coronary syndromes (based on data from the RECORD registry)].

    Science.gov (United States)

    Érlikh, A D

    2010-01-01

    Independent predictors of death and death or myocardial infarction (MI) during initial hospitalization of patients with acute coronary syndromes (ACS) were determined using database of Russian independent ACS registry RECORD. These predictors (admission Killip class II, ST-segment elevation 1 mm, systolic blood pressure 100 mm Hg, hemoglobin <110 g/L, age 65 years, history of diabetes) were attributed equal weight (1 point) and combined in a prognostic scale for assessment of risk of inhospital death and death or MI. The scale did not include markers of necrosis, and the most time consuming component was measurement of hemoglobin. Sensitivity and specificity of risk scores for prediction of death were 78.5%. The use of GRACE score in this group of patients gave similar results. These preliminary data require confirmation on larger populations of patients with ACS.

  18. 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

  19. Near-death experiences, posttraumatic growth, and life satisfaction among burn survivors.

    Science.gov (United States)

    Royse, David; Badger, Karen

    2017-03-01

    Survivors of large burns may face positive and negative psychological after-effects from close-to-death injuries. This study is the first to examine their near-death experiences (NDEs) and posttraumatic growth (PTG) and life satisfaction afterwards. With an available sample of 92 burn survivors, half met the criteria for an NDE using an objective scale. Those who indicated religion was a source of strength and comfort had high scores on life satisfaction, PTG, and the NDE Scale. Individuals with larger burns reported greater PTG than those with smaller total body surface area burned (TBSA). There were no significant differences on life satisfaction, PTG, or NDEs when examined by gender or years since the burn injury. Elements of the NDE most frequently reported were: An altered sense of time, a sense of being out of the physical body, a feeling of peace, vivid sensations, and sense of being in an "other worldly" environment. Social workers and other health providers need to be comfortable helping burn survivors discuss any NDEs and process these through survivors' spirituality and religious belief systems as they recover.

  20. Development of the Italian Version of the Near-Death Experience Scale

    Directory of Open Access Journals (Sweden)

    Francesca Pistoia

    2018-02-01

    Full Text Available Near-death experiences (NDEs have been defined as any conscious perceptual experience occurring in individuals pronounced clinically dead or who came very close to physical death. They are frequently reported by patients surviving a critical injury and, intriguingly, they show common features across different populations. The tool traditionally used to assess NDEs is the NDE Scale, which is available in the original English version. The aim of this study was to develop the Italian version of the NDE Scale and to assess its reliability in a specific clinical setting. A process of translation of the original scale was performed in different stages in order to obtain a fully comprehensible and accurate Italian translation. Later, the scale was administered to a convenience sample of patients who had experienced a condition of coma and were, at the time of assessment, fully conscious and able to provide information as requested by the scale. Inter-rater and test–retest reliability, assessed by the weighted Cohen’s kappa (Kw, were estimated. A convenience sample of 20 subjects [mean age ± standard deviation (SD 51.6 ± 17.1, median time from injury 3.5 months, interquartile range (IQR 2–10] was included in the study. Inter-rater [Kw 0.77 (95% CI 0.67–0.87] and test–retest reliability [Kw 0.96 (95% CI 0.91–1.00] showed good to excellent values for the total scores of the Italian NDE Scale and for subanalyses of each single cluster of the scale. An Italian Version of the NDE Scale is now available to investigate the frequency of NDE, the causes for NDE heterogeneity across different life-threatening conditions, and the possible neural mechanisms underlying NDE phenomenology.

  1. 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

  2. Near-death experiences in non-life-threatening events and coma of different etiologies

    Directory of Open Access Journals (Sweden)

    Vanessa eCharland-Verville

    2014-05-01

    Full Text Available Background: Near death experiences (NDEs are increasingly being reported as a clearly identifiable physiological and psychological reality of clinical significance. However, the definition and causes of the phenomenon as well as the identification of NDE experiencers is still a matter of debate. To date, the most widely used standardized tool to identify and characterize NDEs in research is the Greyson NDE Scale. Using this scale, retrospective and prospective studies have been trying to estimate their incidence in various populations but few studies have tackled to associate the experiences’ intensity and content related to etiology. Methods: This retrospective investigation assessed the most frequently recounted features of self-reported NDEs after a non-life-threatening event (i.e., NDE-like experience or after a pathological coma (i.e., classical NDEs and according to the etiology of the acute brain insult. We also compared our retrospectively acquired data in anoxic coma with historical data from the published literature on prospective post-anoxic studies using the Greyson NDE Scale. Results: From our 190 reports who met the criteria for NDE (i.e., NDE scale total score Conclusions: It appears that real NDEs after coma of different etiologies are similar to NDE-like experiences occurring after non-life threatening events. Subjects reporting NDEs retrospectively tend to have experienced a different content compared to the prospective experiencers

  3. 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…

  4. 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.

  5. 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.

  6. 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.

  7. 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

  8. 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.

  9. 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

  10. Reality of near-death-experience memories: Evidence from a psychodynamic and electrophysiological integrated study

    Directory of Open Access Journals (Sweden)

    Arianna ePalmieri

    2014-06-01

    Full Text Available The nature of near-death experiences (NDEs is largely unknown but recent evidence suggests the intriguing possibility that NDEs may refer to actually perceived, and stored, experiences (although not necessarily in relation to the external physical world. We adopted an integrated approach involving a hypnosis-based clinical protocol to improve recall and decrease memory inaccuracy together with Electroencephalography (EEG recording in order to investigate the characteristics of NDE memories and their neural markers compared to memories of both real and imagined events. We included 10 participants with NDEs, defined by the Greyson NDE scale, and 10 control subjects without NDE. Memories were assessed using the Memory Characteristics Questionnaire.Our hypnosis-based protocol increased the amount of details in the recall of all kind of memories considered (NDE, real, and imagined events. Findings showed that NDE memories were similar to real memories in terms of detail richness, self-referential, and emotional information. Moreover, NDE memories were significantly different from memories of imagined events. The pattern of EEG results indicated that real memories recall was positively associated with two memory-related frequency bands, i.e., high alpha and gamma. NDE memories were linked with theta band, a well-known marker of episodic memory. The recall of NDE memories was also related to delta band, which indexes processes such as the recollection of the past, as well as trance states, hallucinations, and other related portals to transpersonal experience. It is notable that the EEG pattern of correlations for NDE memories recall differed from the pattern for memories of imagined events. In conclusion, our findings suggest that, at a phenomenological level, NDE memories cannot be considered equivalent to imagined memories, and at a neural level, NDE memories are stored as episodic memories of events experienced in a peculiar state of consciousness.

  11. 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.

  12. 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…

  13. Drama as a pedagogical tool for practicing death notification-experiences from Swedish medical students

    OpenAIRE

    Fjellman-Wiklund Anncristine; Nordström Anna; Grysell Tomas

    2011-01-01

    Abstract Background One of the toughest tasks in any profession is the deliverance of death notification. Marathon Death is an exercise conducted during the fourth year of medical school in northern Sweden to prepare students for this responsibility. The exercise is designed to enable students to gain insight into the emotional and formal procedure of delivering death notifications. The exercise is inspired by Augusto Boal's work around Forum Theatre and is analyzed using video playback. The ...

  14. Gaining Insight into the Prevention of Maternal Death Using Narrative Analysis: An Experience from Kerman, Iran

    Directory of Open Access Journals (Sweden)

    Rana Eftekhar-Vaghefi

    2013-11-01

    Full Text Available Reduction in maternal mortality requires an in-depth knowledge of the causes of death. This study was conducted to explore the circumstances and events leading to maternal mortality through a holistic approach. Using narrative text analysis, all documents related to maternal deaths occurred from 2007 to 2011 in Kerman province/Iran were reviewed thoroughly by an expert panel. A 93-item chart abstraction instrument was developed according to the expert panel and literature. The instrument consisted of demographic and pregnancy related variables, underlying and contributing causes of death, and type of delays regarding public health aspects, medical and system performance issues. A total of 64 maternal deaths were examined. One third of deaths occurred in women less than 18 or higher than 35 years. Nearly 95% of them lived in a low or mid socioeconomic status. In half of the cases, inappropriate or nonuse of contraceptives was seen. Delay in the provision of any adequate treatment after arrival at the health facility was seen in 59% of cases. The most common medical causes of death were preeclampsia/eclampsia (15.6%, postpartum hemorrhage (12.5% and deep phlebothrombosis (10.9%, respectively. Negligence was accounted for 95% of maternal deaths. To overcome the root causes of maternal death, more emphasis should be devoted to system failures and patient safety rather than the underlying causes of death and medical issues solely.

  15. Feeling lonely in an unfamiliar place: older people's experiences of life close to death in a nursing home.

    Science.gov (United States)

    Österlind, Jane; Ternestedt, Britt-Marie; Hansebo, Görel; Hellström, Ingrid

    2017-03-01

    The aim of the study was to deepen the understanding of how older persons living in a nursing home experience life close to death. A move to and a life in a nursing home while being close to death is a reality for many older people in Sweden. Being able to express thoughts and feelings about death has been described as both crucial for sustaining personhood as well as for establishing a meaningful existence at the end of life. Important are the experiences of older people living in nursing homes who are approaching death. Six older people were interviewed on one to four occasions. A total of 16 interviews were conducted with the participants. An interpretative approach was chosen. The main interpretation, Feeling lonely in an unfamiliar place, is based on three themes (i) Waiting for death, with the subthemes death as a release and thinking of oneself as dead; (ii) Subordinate oneself to values and norms of the staff, with the subthemes feeling offended and feeling trapped; and (iii) Keep the courage up. The older people's lives were characterised by feelings of aloneness in an unfamiliar place which contributed to a sense of existential loneliness. They experienced few opportunities to discuss their thoughts of life and death, including preparations for passing away. It is of importance for professionals to be able to meet older people as they are and respect them as human beings in their transitions, before, during and after the move to a nursing home. It is important to find ways to support older people's wellbeing and identity near death. © 2016 John Wiley & Sons Ltd.

  16. 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

  17. 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...

  18. Caring for dying and meeting death: Experiences of Iranian and Swedish nurses

    Directory of Open Access Journals (Sweden)

    Sedigheh Iranmanesh

    2010-01-01

    Full Text Available Objective: Our world is rapidly becoming a global community, which creates a need to further understand the universal phenomena of death and professional caring for dying persons. This study thus was conducted to describe the meaning of nurses′ experiences of caring for dying people in the cultural contexts of Iran and Sweden. Materials and Methods: Using a phenomenological approach, phenomenon of caring for dying people was studied. Eight registered nurses who were working in oncology units in Tehran, Iran and eight registered nurses working in hospital and home care in North part of Sweden were interviewed. The interviews were analyzed using the principles of phenomenological hermeneutics. Results: The findings were formulated based on two themes included: (1 "Sharing space and time to be lost", and (2 "Caring is a learning process. Conclusions: The results showed that being with dying people raise an ethical demand that calls for personal and professional response, regardless of sex, culture or context. The physical and organizational context must be supportive and enable nurses to stand up to the demands of close relationships. Specific units and teamwork across various personnel seem to be a solution that is missing in Iran.

  19. Addressing maternal deaths due to violence: the Illinois experience.

    Science.gov (United States)

    Koch, Abigail R; Geller, Stacie E

    2017-11-01

    Homicide, suicide, and substance abuse accounted for nearly one fourth of all pregnancy-associated deaths in Illinois from 2002 through 2013. Maternal mortality review in Illinois has been primarily focused on obstetric and medical causes and little is known about the circumstances surrounding deaths due to homicide, suicide, and substance abuse, if they are pregnancy related, and if the deaths are potentially preventable. To address this issue, we implemented a process to form a second statewide maternal mortality review committee for deaths due to violence in late 2014. We convened a stakeholder group to accomplish 3 tasks: (1) identify appropriate committee members; (2) identify potential types and sources of information that would be required for a meaningful review of violent maternal deaths; and (3) revise the Maternal Mortality Review Form. Because homicide, suicide, and substance abuse are closely linked to the social determinants of health, the review committee needed to have a broad membership with expertise in areas not required for obstetric maternal mortality review, including social service and community organizations. Identifying additional sources of information is critical; the state Violent Death Reporting System, case management data, and police and autopsy reports provide contextual information that cannot be found in medical records. The stakeholder group revised the Maternal Mortality Review Form to collect information relevant to violent maternal deaths, including screening history and psychosocial history. The form guides the maternal mortality review committee for deaths due to violence to identify potentially preventable factors relating to the woman, her family, systems of care, the community, the legal system, and the institutional environment. The committee has identified potential opportunities to decrease preventable death requiring cooperation with social service agencies and the criminal justice system in addition to the physical

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. Differential Dimensions of Death Anxiety in Nursing Students with and without Nursing Experience

    Science.gov (United States)

    Chen, Yi-Chuen; Ben, Kevin S. Del; Fortson, Beverly L.; Lewis, Jean

    2006-01-01

    Researchers have demonstrated death anxiety in nursing professionals; however, it is unclear as to when this anxiety develops. This study used a multidimensional measure to investigate death anxiety in a group of experienced (n = 53) and inexperienced (n = 49) nursing students and a control group of non-nursing students (n = 50). Experienced…

  5. 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

  6. 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

  7. 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.)

  8. 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.)

  9. Sudden unexpected death from natural diseases: Fifteen years' experience with 484 cases in Seychelles.

    Science.gov (United States)

    Zhao, Peng; Wang, Ji-Gang; Gao, Peng; Li, Xia; Brewer, Rubell

    2016-01-01

    The aim of this study is to identify and subclassify sudden natural death (sudden death from natural diseases) cases in Seychelles. A total of 484 sudden natural death cases with autopsy at the Clinical Pathology Laboratory, Victoria Hospital, Seychelles between 1997 through 2012 were retrospectively reviewed. Among them, 363 cases (75%) were male and 121 (25%) were female. The most frequent sudden deaths were attributed to cardiovascular diseases (78.5%), and then followed by infectious diseases (9.9%), and gastrointestinal diseases (9.1%). This is the largest population-based study on sudden natural deaths in Seychelles. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. Parents' experience of a follow-up meeting after a child's death in the Paediatric Intensive Care Unit

    DEFF Research Database (Denmark)

    Brink, Helle L; Thomsen, Anja K; Laerkner, Eva

    2017-01-01

    OBJECTIVE: 'To identify parents' experience of a follow up meeting and to explore whether the conversation was adequate to meet the needs of parents for a follow-up after their child's death in the Paediatric Intensive Care Unit (PICU). DESIGN AND SETTING: Qualitative method utilising semi...

  16. The Experiences of Staff Who Support People with Intellectual Disability on Issues about Death, Dying and Bereavement: A Metasynthesis

    Science.gov (United States)

    Lord, Ailsa J.; Field, Stephen; Smith, Ian C.

    2017-01-01

    Background: Historically, people with intellectual disabilities have tended to be excluded from knowing about death, dying and bereavement. Staff in intellectual disability services can play a valuable role in improving understanding of these issues in those they support. This qualitative metasynthesis aimed to understand the experiences of staff…

  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. Next of kin’s experiences of sudden and unexpected death from stroke - a study of narratives

    Science.gov (United States)

    2013-01-01

    Background Death always evokes feelings in those close to the afflicted person. When death comes suddenly the time for preparation is minimal and the next of kin have to cope with the situation despite their own sorrow. The suddenness is found to be stressful for the next of kin and communication both with healthcare professionals and information about what has happened has been found helpful. The aim of this study was to illuminate the experiences of next of kin from the sudden and unexpected death of a relative from acute stroke. Methods Data was collected over a 12-month period in 2009–2010. Twelve next of kin of patients cared for in stroke units who died suddenly and unexpectedly from stroke were interviewed using a narrative method. The narratives were analyzed using narrative thematic analysis. Results Three themes emerged showing facets of next of kin’s experiences of a relative’s sudden and unexpected death from stroke: Divided feelings about the sudden and unexpected death; Perception of time and directed attention when keeping vigil; Contradictions and arbitrary memories when searching for understanding. Conclusions To have to live in the aftermath of severe stroke is absolute horror in people’s imagination and death is seen as the lesser of two evils. The sudden and unexpected death totally pervades the next of kin’s life, directs their attention to the dying person and even causes them to forget themselves and their own needs, and leads to difficulties in information intake. It is a challenge for the healthcare professionals to be able to identify the individual needs of the next of kin in this situation. PMID:23590246

  1. Adolescents' Experiences 7 and 13 Months Following the Death of a Brother or Sister.

    Science.gov (United States)

    Brooten, Dorothy; Youngblut, JoAnne M; Roche, Rosa M

    2017-06-01

    This qualitative study used semi-structured interviews to describe adolescents' responses at 7 and 13 months to siblings' NICU/PICU/ED death. At 7 months, adolescents were asked about events around the sibling's death; at 7 and 13 months, about concerns/fears, feelings, and life changes. Seventeen adolescents participated (13-18 years; M=15); 65% Black, 24% Hispanic, 11% White. Themes included death circumstances, burial events, thinking about the deceased sibling, fears, and life changes. Adolescents reported shock and disbelief that the sibling died; 80% knew the reason for the death; many had difficulty getting through burials; all thought about the sibling. From 7 - 13 months fears increased including losing someone and thoughts of dying. Adolescents reported more changes in family life and greater life changes in them (more considerate, mature) by 13 months; some felt friends abandoned them after the sibling's death. Girls had more fears and changes in family life and themselves. Adolescent's responses to sibling death may not be visually apparent. One recommendation from this study is to ask adolescents how they are doing separately from parents since adolescents may hide feelings to protect their parents, especially their mothers. Older adolescents (14-18 years) and girls may have more difficulty after sibling death.

  2. 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

  3. 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.

  4. 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.)

  5. Death and bereavement in the First World War: the Australian experience.

    Science.gov (United States)

    Jalland, Pat

    2014-06-01

    The First World War was a turning point in the cultural history of death and bereavement in Australia. The mass deaths of some 60,000 soldiers overseas led to communal rituals of mourning for the war dead and minimal public expressions of private grief. The mass slaughter of so many young men and the interminable grief of so many families devalued the deaths of civilians at home and helped to create a new cultural model of suppressed and privatised grieving which deeply constrained the next two generations. Emotional and expressive grieving became less common, mourning ritual was minimised and sorrow became a private matter. Copyright © 2014. Published by Elsevier Ltd.

  6. 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

  7. 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

  8. 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.

  9. 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.

  10. 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

  11. The role of background music in the experience of watching YouTube videos about death and dying

    OpenAIRE

    Panagiotis Pentaris; Maria Yerosimou

    2015-01-01

    YouTube is the largest video-sharing site live at the moment. It has been used to communicate a vast array of information, while it allows for user-generated content. This paper will focus on YouTube videos that communicate death, and, in particular, will present findings from a preliminary study undertaken by the authors considering the role that background music plays in these videos. Specifically, this study explores the experiences of the viewers of death-related YouTube videos with and w...

  12. OUTCOMES OF LIVER TRANSPLANTATION USING DONATIONS AFTER CIRCULATORY DEATH : A SINGLE-CENTER EXPERIENCE

    OpenAIRE

    MEURISSE, Nicolas; VANDEN BUSSCHE, S; JOCHMANS, I; FRANCOIS, J; DESSCHANS, B; LALEMAN, W; VAN DER MERWE, S; VAN STEENBERGEN, W; CASSIMAN, D; VERSLYPE, C; AERTS, R; NEVENS, F; PIRENNE, J; MONBALIU, D

    2012-01-01

    Introduction Orthotopic liver transplantation (OLT) (LTx) using donation after circulatory death (DCD) donors is increasingly performed, but still considered to risk of poorer outcomes compared with standard donations after brain death (DBD)-OLT. Therefore we reviewed our results of DCD-OLT. Patients and Methods Between 2003 and 2010, we performed 30 DCD-OLT (6% of all OLT). We retrospectively reviewed medical records of donors and recipients after DCD versus DBD-OLT to analyze bil...

  13. 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

  14. Effect of Therapeutic Hypothermia Initiated After 6 Hours of Age on Death or Disability Among Newborns With Hypoxic-Ischemic Encephalopathy: A Randomized Clinical Trial.

    Science.gov (United States)

    Laptook, Abbot R; Shankaran, Seetha; Tyson, Jon E; Munoz, Breda; Bell, Edward F; Goldberg, Ronald N; Parikh, Nehal A; Ambalavanan, Namasivayam; Pedroza, Claudia; Pappas, Athina; Das, Abhik; Chaudhary, Aasma S; Ehrenkranz, Richard A; Hensman, Angelita M; Van Meurs, Krisa P; Chalak, Lina F; Khan, Amir M; Hamrick, Shannon E G; Sokol, Gregory M; Walsh, Michele C; Poindexter, Brenda B; Faix, Roger G; Watterberg, Kristi L; Frantz, Ivan D; Guillet, Ronnie; Devaskar, Uday; Truog, William E; Chock, Valerie Y; Wyckoff, Myra H; McGowan, Elisabeth C; Carlton, David P; Harmon, Heidi M; Brumbaugh, Jane E; Cotten, C Michael; Sánchez, Pablo J; Hibbs, Anna Maria; Higgins, Rosemary D

    2017-10-24

    Hypothermia initiated at less than 6 hours after birth reduces death or disability for infants with hypoxic-ischemic encephalopathy at 36 weeks' or later gestation. To our knowledge, hypothermia trials have not been performed in infants presenting after 6 hours. To estimate the probability that hypothermia initiated at 6 to 24 hours after birth reduces the risk of death or disability at 18 months among infants with hypoxic-ischemic encephalopathy. A randomized clinical trial was conducted between April 2008 and June 2016 among infants at 36 weeks' or later gestation with moderate or severe hypoxic-ischemic encephalopathy enrolled at 6 to 24 hours after birth. Twenty-one US Neonatal Research Network centers participated. Bayesian analyses were prespecified given the anticipated limited sample size. Targeted esophageal temperature was used in 168 infants. Eighty-three hypothermic infants were maintained at 33.5°C (acceptable range, 33°C-34°C) for 96 hours and then rewarmed. Eighty-five noncooled infants were maintained at 37.0°C (acceptable range, 36.5°C-37.3°C). The composite of death or disability (moderate or severe) at 18 to 22 months adjusted for level of encephalopathy and age at randomization. Hypothermic and noncooled infants were term (mean [SD], 39 [2] and 39 [1] weeks' gestation, respectively), and 47 of 83 (57%) and 55 of 85 (65%) were male, respectively. Both groups were acidemic at birth, predominantly transferred to the treating center with moderate encephalopathy, and were randomized at a mean (SD) of 16 (5) and 15 (5) hours for hypothermic and noncooled groups, respectively. The primary outcome occurred in 19 of 78 hypothermic infants (24.4%) and 22 of 79 noncooled infants (27.9%) (absolute difference, 3.5%; 95% CI, -1% to 17%). Bayesian analysis using a neutral prior indicated a 76% posterior probability of reduced death or disability with hypothermia relative to the noncooled group (adjusted posterior risk ratio, 0.86; 95% credible interval

  15. Death and Death Anxiety

    OpenAIRE

    Gonca Karakus; Zehra Ozturk; Lut Tamam

    2012-01-01

    Although death and life concepts seem so different from each other, some believe that death and life as a whole that death is accepted as the goal of life and death completes life. In different cultures, societies and disciplines, there have been very different definitions of death which changes according to personality, age, religion and cultural status of the individual. Attitudes towards death vary dramatically according to individuals. As for the death anxiety, it is a feeling which start...

  16. POSITIVE LIVING STRATEGIES THAT CAN BE LEARNED FROM STUDIES ON NEAR-DEATH EXPERIENCES AND LIFE-THREATENING ILLNESSES

    Directory of Open Access Journals (Sweden)

    Kasiram, Madhu

    2015-09-01

    Full Text Available This article addresses the two related issues of near-death experience and life-threatening illness with a view to helping survivors and helping professionals appreciate how to make sense of the experience whilst considering future living and future service provision. The article is based on two related research studies, citing literature from different disciplines of nursing, women’s health, spirituality and near death. This research was undertaken in the light of these experiences affecting so many aspects of life and living. The need to “dialogue with death” (Easwaran, 2008: Foreword and life-threatening illness is the key message as opposed to shunning what is not readily understood and appreciated

  17. 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

  18. Dynamics of floret initiation/death determining spike fertility in wheat as affected by Ppd genes under field conditions.

    Science.gov (United States)

    Prieto, Paula; Ochagavía, Helga; Savin, Roxana; Griffiths, Simon; Slafer, Gustavo A

    2018-04-27

    As wheat yield is linearly related to grain number, understanding the physiological determinants of the number of fertile florets based on floret development dynamics due to the role of the particular genes is relevant. The effects of photoperiod genes on dynamics of floret development are largely ignored. Field experiments were carried out to (i) characterize the dynamics of floret primordia initiation and degeneration and (ii) to determine which are the most critical traits of such dynamics in establishing genotypic differences in the number of fertile florets at anthesis in near isogenic lines (NILs) carrying photoperiod-insensitive alleles. Results varied in magnitude between the two growing seasons, but in general introgression of Ppd-1a alleles reduced the number of fertile florets. The actual effect was affected not only by the genome and the doses but also by the source of the alleles. Differences in the number of fertile florets were mainly explained by differences in the floret generation/degeneration dynamics, and in most cases associated with floret survival. Manipulating photoperiod insensitivity, unquestionably useful for changing flowering time, may reduce spike fertility but much less than proportionally to the change in duration of development, as the insensitivity alleles did increase the rate of floret development.

  19. Lower risk of heart failure and death in patients initiated on sodium-glucose cotransporter-2 inhibitors versus other glucose-lowering drugs

    DEFF Research Database (Denmark)

    Kosiborod, Mikhail; Cavender, Matthew A.; Fu, Alex Z.

    2017-01-01

    and death in patients newly initiated on any SGLT-2i versus other glucose-lowering drugs in 6 countries to determine if these benefits are seen in real-world practice and across SGLT-2i class. METHODS: Data were collected via medical claims, primary care/hospital records, and national registries from...... for Germany. RESULTS: After propensity matching, there were 309 056 patients newly initiated on either SGLT-2i or other glucose-lowering drugs (154 528 patients in each treatment group). Canagliflozin, dapagliflozin, and empagliflozin accounted for 53%, 42%, and 5% of the total exposure time in the SGLT-2i...... class, respectively. Baseline characteristics were balanced between the 2 groups. There were 961 HHF cases during 190 164 person-years follow-up (incidence rate, 0.51/100 person-years). Of 215 622 patients in the United States, Norway, Denmark, Sweden, and the United Kingdom, death occurred in 1334...

  20. Why suicide? Elderly people who committed suicide and their experience of life in the period before their death.

    Science.gov (United States)

    Kjølseth, Ildri; Ekeberg, Oivind; Steihaug, Sissel

    2010-03-01

    The objective of this study is to acquire an understanding of the suicides among a group of elderly people by studying how they experienced their existence towards the end of life. This is a psychological autopsy study based on qualitative interviews with 63 informants in relation to 23 suicides committed by persons aged over 65 in Norway. Informants who knew the deceased persons well describe what the elderly person communicated to them about their experience of life in the period before the suicide and how they as informants saw and understood this. The informants comprise relatives, family doctors and home-based care nurses. The analysis of the interviews follows the systematic text condensation method. The descriptions are divided into three main elements: the elderly persons' experiences of life, their perception of themselves, and their conceptions of death. "Experience of life" has two sub-topics: this life has been lived and life as a burden. Everything that had given value to their life had been lost and life was increasingly experienced as a burden. Their "perception of themselves" concerned losing oneself. Functional decline meant that they no longer had freedom of action and self-determination. "Conceptions of death" involve the following sub-topics: acknowledgement/acceptance and death is better than life. Life had entered into its final phase, and they seemed to accept death. For some time, many of them had expressed the wish to die. The results lead us to argue that their suicides should be considered as existential choices. The sum total of the different forms of strain had made life a burden they could no longer bear. Age meant that they were in a phase of life that entailed closeness to death, which they could also see as a relief.

  1. The death of a young son in violent circumstance: understanding the experience of the mother.

    Science.gov (United States)

    Alarcão, Ana Carolina Jacinto; Carvalho, Maria Dalva de Barros; Pelloso, Sandra Marisa

    2008-01-01

    This study was aimed at understanding the life of a mother who lost their child in violent circumstances. The methodological proceedings were supported on phenomenology. The study population was constituted by five mothers who had lost its young children for homicide. These homicides occurred different times ranging from 50 days to 10 years. I used as instrument of collection of data open interview the phenomenological method guided by a orienting question. The analysis phenomenology in their discourses showed the comprehension of essential meanings which were systematized in categories: the child's mummification in the memory; the two ways followed by the publicity concerning the death; fondness to spirituality to endure the pain from the child's death; maternal complicity and impunity. The results of this study can contribute to elaboration of intervention proposals close to the mothers in the sense of helping them in the reorganization of their lives after son's death.

  2. Experiences with maternal and perinatal death reviews in the UK--the MBRRACE-UK programme.

    Science.gov (United States)

    Kurinczuk, J J; Draper, E S; Field, D J; Bevan, C; Brocklehurst, P; Gray, R; Kenyon, S; Manktelow, B N; Neilson, J P; Redshaw, M; Scott, J; Shakespeare, J; Smith, L K; Knight, M

    2014-09-01

    Established in 1952, the programme of surveillance and Confidential Enquiries into Maternal Deaths in the UK is the longest running such programme worldwide. Although more recently instituted, surveillance and confidential enquiries into perinatal deaths are also now well established nationally. Recent changes to funding and commissioning of the Enquiries have enabled both a reinvigoration of the processes and improvements to the methodology with an increased frequency of future reporting. Close engagement with stakeholders and a regulator requirement for doctors to participate have both supported the impetus for involvement of all professionals leading to greater potential for improved quality of care for women and babies. © 2014 Royal College of Obstetricians and Gynaecologists.

  3. 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.

  4. 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.

  5. Assessment of risk for asthma initiation and cancer and heart disease deaths among patrons and servers due to secondhand smoke exposure in restaurants and bars

    Science.gov (United States)

    Liu, Ruiling; Bohac, David L; Gundel, Lara A; Hewett, Martha J; Apte, Michael G; Hammond, S Katharine

    2014-01-01

    Background Despite efforts to reduce exposure to secondhand smoke (SHS), only 5% of the world's population enjoy smoke-free restaurants and bars. Methods Lifetime excess risk (LER) of cancer death, ischaemic heart disease (IHD) death and asthma initiation among non-smoking restaurant and bar servers and patrons in Minnesota and the US were estimated using weighted field measurements of SHS constituents in Minnesota, existing data on tobacco use and multiple dose-response models. Results A continuous approach estimated a LER of lung cancer death (LCD) of 18×10−6(95% CI 13 to 23×10−6) for patrons visiting only designated non-smoking sections, 80×10−6(95% CI 66 to 95×10−6) for patrons visiting only smoking venues/sections and 802×10−6(95% CI 658 to 936×10−6) for servers in smoking-permitted venues. An attributable-risk (exposed/non-exposed) approach estimated a similar LER of LCD, a LER of IHD death about 10−2 for non-smokers with average SHS exposure from all sources and a LER of asthma initiation about 5% for servers with SHS exposure at work only. These risks correspond to 214 LCDs and 3001 IHD deaths among the general non-smoking population and 1420 new asthma cases among non-smoking servers in the US each year due to SHS exposure in restaurants and bars alone. Conclusions Health risks for patrons and servers from SHS exposure in restaurants and bars alone are well above the acceptable level. Restaurants and bars should be a priority for governments’ effort to create smoke-free environments and should not be exempt from smoking bans. PMID:23407112

  6. The role of background music in the experience of watching YouTube videos about death and dying

    Directory of Open Access Journals (Sweden)

    Panagiotis Pentaris

    2015-12-01

    Full Text Available YouTube is the largest video sharing site live at the moment. It has been used to communicate a vast array of information, while it allows for user-generated content. This paper will focus on YouTube videos that communicate death, and in particular will present findings from a preliminary study undertaken by the authors considering the role that background music plays in these videos. Specifically, this study explores the experiences of the viewers of death-related YouTube videos with and without background music while it makes comparisons in relation to the impact that music has on the viewers’ emotional experiences. We conclude that background music elicits emotions and enhances feelings of sadness and sympathy in relation to the visual content of videos while recommendations for future research are made.

  7. Near-death-like experiences without life-threatening conditions or brain disorders: a hypothesis from a case report

    Directory of Open Access Journals (Sweden)

    Enrico eFacco

    2012-11-01

    Full Text Available Near-death experiences (NDEs are profound psychic experiences commonly occurring in life-threatening conditions. They include feeling a sense of peace, of seeing a bright light, encountering deceased relatives or religious figures, and of transcending space and time. To explain them, it has been suggested that they stem from brain disorders and/or psychological reactions to approaching death, a sort of wishful thinking in response to the perceived threat.This is a report on a case with most of the features typical of NDEs except that it occurred entirely without any life-threatening conditions. This evidence is theoretically incompatible with either of the above hypotheses, suggesting that a broader interpretation of the phenomenon is needed.

  8. A Dental School's Experience with the Death of an HIV Positive Faculty Member.

    Science.gov (United States)

    Butters, Janice M.; And Others

    1994-01-01

    This article reviews issues and circumstances surrounding the death of a University of Louisville (Kentucky) dental school faculty member found to be positive for the human immunodeficiency virus. it addresses administrative aspects including public relations, patient relations, epidemiological review, and staff counseling. (MSE)

  9. Visiting the Site of Death: Experiences of the Bereaved after the 2004 Southeast Asian Tsunami

    Science.gov (United States)

    Kristensen, Pal; Tonnessen, Arnfinn; Weisaeth, Lars; Heir, Trond

    2012-01-01

    The authors examined how many bereaved relatives of Norwegian tourists who perished in the 2004 Southeast Asian Tsunami had visited the site of death and the most important outcome from the visit. We conducted in-depth interviews (n = 110) and used self-report questionnaires (Impact of Event Scale--Revised, Inventory of Complicated Grief, and…

  10. Experiences, considerations and emotions relating to cardiogenetic evaluation in relatives of young sudden cardiac death victims

    NARCIS (Netherlands)

    van der Werf, Christian; Onderwater, Astrid T.; van Langen, Irene M.; Smets, Ellen M. A.

    2014-01-01

    Relatives of young sudden cardiac death (SCD) victims are at increased risk of carrying a potentially fatal inherited cardiac disease. Hence, it is recommended to perform an autopsy on the victim and to refer his or her relatives to a cardiogenetics clinic for a full evaluation to identify those at

  11. Experience with Euthanasia Is Associated with Fearlessness about Death in Veterinary Students

    Science.gov (United States)

    Witte, Tracy K.; Correia, Christopher J.; Angarano, Donna

    2013-01-01

    Veterinarians have an increased risk for suicide compared with the general population, yet there is little consensus regarding why this might be. We hypothesized that veterinarians become relatively fearless about death due to their repeated exposure to euthanasia. Accordingly, we predicted that there would be a positive relationship between…

  12. Hospice Comics: Representations of Patient and Family Experience of Illness and Death in Graphic Novels.

    Science.gov (United States)

    Czerwiec, M K; Huang, Michelle N

    2017-06-01

    Non-fiction graphic novels about illness and death created by patients and their loved ones have much to teach all readers. However, the bond of empathy made possible in the comic form may have special lessons for healthcare providers who read these texts and are open to the insights they provide.

  13. Pancreas transplantation with grafts from donors deceased after circulatory death (DCD) : 5 years single center experience

    NARCIS (Netherlands)

    Kopp, Wouter H; Lam, Hwai-Ding; Schaapherder, Alexander F M; Huurman, Volkert A L; van der Boog, Paul; de Koning, Eelco; de Fijter, Johan W; Baranski, Andrzej; Braat, Andries E

    2017-01-01

    INTRODUCTION: Donation after circulatory death (DCD) pancreas transplantation has been shown to be an additional way to deal with donor organ shortages. The results of 5-year DCD pancreas transplantation are presented. METHODS: A retrospective, single center analysis (2011 - 2015) was performed to

  14. 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 ...

  15. Assessing the quality of bereavement care after perinatal death: development and piloting of a questionnaire to assess parents' experiences.

    Science.gov (United States)

    Aiyelaagbe, Esther; Scott, Rebecca E; Holmes, Victoria; Lane, Emma; Heazell, Alexander E P

    2017-10-01

    Understanding parents' experience of care is essential to develop high-quality perinatal bereavement services. This study aimed at developing a questionnaire to identify parents' needs and record their experience of care. The patient experience questionnaire was developed by professionals and parents, and piloted in a tertiary maternity unit. Responses were received from 58 parents. Sensitivity and kindness of staff and time spent with their baby were ranked as 'very important' by 95% of parents. Care in these areas largely met their needs (90%), although 5% of respondents stated that partners could have been more involved. Between 8% and 15% of respondents did not feel that language used at the diagnosis of fetal death was sensitive, clear and unambiguous. Parents did not always receive written information about their care (5%) or post-mortem (13%). Analysis of bereaved parents' responses identified areas for improvement including greater involvement of partners and a need for timely information. Impact statement What is already known on this subject?: Good quality bereavement care after perinatal death reduces the negative emotional, psychological and social effects for parents. Description of parents' experiences is a potential means to improve the quality of perinatal bereavement care. What do the results of this study add?: Parents' needs and experiences of care after perinatal death were recorded using a patient-experience questionnaire designed by a multi-professional team and parents. Staff behaviour, particularly sensitivity and kindness was highly valued by parents. Giving both verbal and written information could be improved. Training is needed for professionals, particularly those who come into contact with bereaved parents less frequently. What are the implications of these findings for clinical practice and/or further research?: Description of parents' priorities and views can be used to identify areas for improvement in perinatal bereavement care

  16. 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

  17. Child death and maternal psychosis-like experiences in 44 low- and middle-income countries: The role of depression.

    Science.gov (United States)

    Koyanagi, Ai; Oh, Hans; Haro, Josep Maria; Hirayama, Fumi; DeVylder, Jordan

    2017-05-01

    Studies on the effect of child death on the mental wellbeing of women in low- and middle-income countries (LMICs) are scarce despite the high child mortality rates. Thus, the aim of the current study was to assess the association between child death and psychosis-like experiences (PLEs), as well as the role of depression in this association. Data from 44 LMICs which participated in the World Health Survey (WHS) were analyzed. A total of 59,444 women who ever gave birth, aged 18-49years, without a self-reported lifetime psychosis diagnosis, were included in the analysis. The World Mental Health Survey version of the Composite International Diagnostic Interview (CIDI) was used to establish the diagnosis of past 12-month DSM-IV depression, and assess four positive psychotic symptoms. Depression was defined as self-reported lifetime depression diagnosis and/or past 12-month depression. Multivariable logistic regression analyses were performed. After adjustment for potential confounders, women who experienced child death had higher odds for all types of PLEs (when unadjusted for depression) (OR 1.20-1.71; pchild death (OR=1.54; 95%CI=1.20-1.97). Child death may be an important determinant of mental wellbeing among women in LMICs. Given the known adverse health outcomes associated with PLEs and depression, as well as the co-occurrence of these symptoms, mental health care may be particularly important for mothers who have experienced child loss in LMICs. Copyright © 2016 Elsevier B.V. All rights reserved.

  18. Exploring the Experience of Life Stress Among Black Women with a History of Fetal or Infant Death: a Phenomenological Study.

    Science.gov (United States)

    Brown, Kyrah K; Lewis, Rhonda K; Baumgartner, Elizabeth; Schunn, Christy; Maryman, J'Vonnah; LoCurto, Jamie

    2017-06-01

    Disparate birth outcomes among Black women continue to be a major public health problem. Whereas prior research has investigated the influence of stress on Black women's birth outcomes, few studies have explored how stress is experienced among Black women across the life course. The objectives of this study were to describe the experience of stress across the life course among Black women who reported a history of fetal or infant death and to identify stressful life events (SLE) that may not be represented in the widely used SLE inventory. Using phenomenological, qualitative research design, in-depth interviews were conducted with six Black women in Kansas who experienced a fetal or infant death. Analyses revealed that participants experienced multiple, co-occurring stressors over the course of their lives and experienced a proliferation of stress emerging in early life and persisting into adulthood. Among the types of stressors cited by participants, history of sexual assault (trauma-related stressor) was a key stressful life event that is not currently reflected in the SLE inventory. Our findings highlight the importance of using a life-course perspective to gain a contextual understanding of the experiences of stress among Black women, particularly those with a history of adverse birth outcomes. Further research investigating Black women's experiences of stress and the mechanisms by which stress impacts their health could inform efforts to reduce disparities in birth outcomes. An additional focus on the experience and impact of trauma-related stress on Black women's birth outcomes may also be warranted.

  19. Effect of Therapeutic Hypothermia Initiated After 6 Hours of Age on Death or Disability Among Newborns With Hypoxic-Ischemic Encephalopathy

    Science.gov (United States)

    Laptook, Abbot R.; Shankaran, Seetha; Tyson, Jon E.; Munoz, Breda; Bell, Edward F.; Goldberg, Ronald N.; Parikh, Nehal A.; Ambalavanan, Namasivayam; Pedroza, Claudia; Pappas, Athina; Das, Abhik; Chaudhary, Aasma S.; Ehrenkranz, Richard A.; Hensman, Angelita M.; Van Meurs, Krisa P.; Chalak, Lina F.; Hamrick, Shannon E. G.; Sokol, Gregory M.; Walsh, Michele C.; Poindexter, Brenda B.; Faix, Roger G.; Watterberg, Kristi L.; Frantz, Ivan D.; Guillet, Ronnie; Devaskar, Uday; Truog, William E.; Chock, Valerie Y.; Wyckoff, Myra H.; McGowan, Elisabeth C.; Carlton, David P.; Harmon, Heidi M.; Brumbaugh, Jane E.; Cotten, C. Michael; Sánchez, Pablo J.; Hibbs, Anna Maria; Higgins, Rosemary D.

    2018-01-01

    IMPORTANCE Hypothermia initiated at less than 6 hours after birth reduces death or disability for infants with hypoxic-ischemic encephalopathy at 36 weeks’ or later gestation. To our knowledge, hypothermia trials have not been performed in infants presenting after 6 hours. OBJECTIVE To estimate the probability that hypothermia initiated at 6 to 24 hours after birth reduces the risk of death or disability at 18 months among infants with hypoxic-ischemic encephalopathy. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial was conducted between April 2008 and June 2016 among infants at 36 weeks’ or later gestation with moderate or severe hypoxic-ischemic encephalopathy enrolled at 6 to 24 hours after birth. Twenty-one US Neonatal Research Network centers participated. Bayesian analyses were prespecified given the anticipated limited sample size. INTERVENTIONS Targeted esophageal temperature was used in 168 infants. Eighty-three hypothermic infants were maintained at 33.5°C (acceptable range, 33°C–34°C) for 96 hours and then rewarmed. Eighty-five noncooled infants were maintained at 37.0°C (acceptable range, 36.5°C–37.3°C). MAIN OUTCOMES AND MEASURES The composite of death or disability (moderate or severe) at 18 to 22 months adjusted for level of encephalopathy and age at randomization. RESULTS Hypothermic and noncooled infants were term (mean [SD], 39 [2] and 39 [1] weeks’ gestation, respectively), and 47 of 83 (57%) and 55 of 85 (65%) were male, respectively. Both groups were acidemic at birth, predominantly transferred to the treating center with moderate encephalopathy, and were randomized at a mean (SD) of 16 (5) and 15 (5) hours for hypothermic and noncooled groups, respectively. The primary outcome occurred in 19 of 78 hypothermic infants (24.4%) and 22 of 79 noncooled infants (27.9%) (absolute difference, 3.5%; 95% CI, −1% to 17%). Bayesian analysis using a neutral prior indicated a 76% posterior probability of reduced death or

  20. 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

  1. Influence of model assumptions about HIV disease progression after initiating or stopping treatment on estimates of infections and deaths averted by scaling up antiretroviral therapy

    Science.gov (United States)

    Sucharitakul, Kanes; Boily, Marie-Claude; Dimitrov, Dobromir

    2018-01-01

    Background Many mathematical models have investigated the population-level impact of expanding antiretroviral therapy (ART), using different assumptions about HIV disease progression on ART and among ART dropouts. We evaluated the influence of these assumptions on model projections of the number of infections and deaths prevented by expanded ART. Methods A new dynamic model of HIV transmission among men who have sex with men (MSM) was developed, which incorporated each of four alternative assumptions about disease progression used in previous models: (A) ART slows disease progression; (B) ART halts disease progression; (C) ART reverses disease progression by increasing CD4 count; (D) ART reverses disease progression, but disease progresses rapidly once treatment is stopped. The model was independently calibrated to HIV prevalence and ART coverage data from the United States under each progression assumption in turn. New HIV infections and HIV-related deaths averted over 10 years were compared for fixed ART coverage increases. Results Little absolute difference (ART coverage (varied between 33% and 90%) if ART dropouts reinitiated ART at the same rate as ART-naïve MSM. Larger differences in the predicted fraction of HIV-related deaths averted were observed (up to 15pp). However, if ART dropouts could only reinitiate ART at CD4ART interruption did not affect the fraction of HIV infections averted with expanded ART, unless ART dropouts only re-initiated ART at low CD4 counts. Different disease progression assumptions had a larger influence on the fraction of HIV-related deaths averted with expanded ART. PMID:29554136

  2. 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.

  3. Transplante cardíaco humano: experiência inicial Human cardiac transplant: initial experience

    Directory of Open Access Journals (Sweden)

    Noedir A. G Stolf

    1986-12-01

    pulmonary artery pressure, capilary pulmonary wedge pressure, pulmonary vascular resistance and systemic vascular resistance. Three of the 11 patients had immediate renal dysfunction that returned to normal by the 15th day. Late postoperatively 2 patients had increase of creatinine levels. Only 3 patients had no rejection episodes; among the others these episodes were represented by hystological alterations with no clinical manifestations. Infections complications occurred in 9 patients and were easily clinically treated. Late postoperatively, hypertension was present in 8 patients; in 2 of them it was moderate. There was no death in these 11 patients; all are symptom free and the first 6 are working.

  4. 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.

  5. Patterns and Trends in Accidental Poisoning Deaths: Pennsylvania's Experience 1979-2014.

    Directory of Open Access Journals (Sweden)

    Lauren C Balmert

    Full Text Available The purpose of this study was to examine county and state-level accidental poisoning mortality trends in Pennsylvania from 1979 to 2014.Crude and age-adjusted death rates were formed for age group, race, sex, and county for accidental poisonings (ICD 10 codes X40-X49 from 1979 to 2014 for ages 15+ using the Mortality and Population Data System housed at the University of Pittsburgh. Rate ratios were calculated comparing rates from 1979 to 2014, overall and by sex, age group, and race. Joinpoint regression was used to detect statistically significant changes in trends of age-adjusted mortality rates.Rate ratios for accidental poisoning mortality in Pennsylvania increased more than 14-fold from 1979 to 2014. The largest rate ratios were among 35-44 year olds, females, and White adults. The highest accidental poisoning mortality rates were found in the counties of Southwestern Pennsylvania, those surrounding Philadelphia, and those in Northeast Pennsylvania near Scranton.The patterns and locations of accidental poisoning mortality by race, sex, and age group provide direction for interventions and policy makers. In particular, this study found the highest rate ratios in PA among females, whites, and the age group 35-44.

  6. Suicidal Death due to Organophosphorus Compound Poisoning ─ an Experience of 67 Cases

    Directory of Open Access Journals (Sweden)

    Nashid Tabassum Khan

    2016-05-01

    Full Text Available Background: Bangladesh is an agro-based country. Suicide by agrochemical compounds are increasing day by day in this country. Organophosphorus compounds (OPC are commonly used for suicide. Mostly these are used for suicidal purpose in rural areas in our country due to low cost, toxicity and availability. Objective: To find out the relationship of age and sex variation along with the causes that influenced different income group people to ingest OPC for committing suicide. Materials and Methods: This study was conducted in the Department of Forensic Medicine, Dhaka Medical College during January to December 2010. Data were collected at the time of autopsy and from postmortem examination report of viscera. Viscera were preserved and sent to the Chief Chemical Examiner’s Office, Dhaka for toxicological analysis. Results: In this study, middle aged subjects (20–30 years were found to commit suicide using OPC in comparison to other age groups. Among the cases male were 57% and female 43%. Poverty was found as the most common cause (20% of OPC poisoning. Conclusion: Poverty is the leading cause of death of OPC poisoning followed by failure in love and adultery. Business failure, unhappiness in conjugal life, demand for dowry and violence against women are other causes to commit suicide by OPC.

  7. An unanticipated cardiac arrest and unusual post-resuscitation psycho-behavioural phenomena/near death experience in a patient with pregnancy induced hypertension and twin pregnancy undergoing elective lower segment caesarean section

    Directory of Open Access Journals (Sweden)

    Mridul M Panditrao

    2010-01-01

    Full Text Available A case report of a primigravida, who was admitted with severe pregnancy induced hypertension (BP 160/122 mmHg and twin pregnancy, is presented here. Antihypertensive therapy was initiated. Elective LSCS under general anaesthesia was planned. After the birth of both the babies, intramyometrial injections of Carboprost and Pitocin were administered. Immediately, she suffered cardiac arrest. Cardio pulmonary resucitation (CPR was started and within 3 minutes, she was successfully resuscitated. The patient initially showed peculiar psychological changes and with passage of time, certain psycho-behavioural patterns emerged which could be attributed to near death experiences, as described in this case report.

  8. 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.)

  9. Death of a Child at Home or in Hospital: Experiences of Greek Mothers.

    Science.gov (United States)

    Papadatou, Danai; And Others

    1996-01-01

    Investigates experiences of Greek mothers who cared for a child dying of cancer. Highlighted some needs during the terminal period. Fifteen mothers were interviewed and both quantitative and qualitative procedures were used to analyze findings. Family networks played a significant role in supporting mother-child units, especially when death…

  10. "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,…

  11. 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

  12. 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,…

  13. 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

  14. 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.

  15. 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

  16. 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)

  17. 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.

  18. There is nothing paranormal about near-death experiences: how neuroscience can explain seeing bright lights, meeting the dead, or being convinced you are one of them.

    Science.gov (United States)

    Mobbs, Dean; Watt, Caroline

    2011-10-01

    Approximately 3% of Americans declare to have had a near-death experience. These experiences classically involve the feeling that one's soul has left the body, approaches a bright light and goes to another reality, where love and bliss are all encompassing. Contrary to popular belief, research suggests that there is nothing paranormal about these experiences. Instead, near-death experiences are the manifestation of normal brain function gone awry, during a traumatic, and sometimes harmless, event. Copyright © 2011 Elsevier Ltd. All rights reserved.

  19. Surviving death

    DEFF Research Database (Denmark)

    Gerstroem, Anna

    2013-01-01

    such phases. The aim of this paper is to explore how an organization’s identity is re-constructed after organizational death. Based on interviews with members of a bankrupted bank who narrate their bankruptcy experiences, the paper explores how legacy organizational identity is constructed after...... organizational death. The paper shows how members draw on their legacy organizational identity to justify their past interpretations and responses to the intensifying bankruptcy threats. Members refer to their firm belief in the bank’s solid and robust identity claim when they explain how they disregarded...

  20. Neonatal Death

    Science.gov (United States)

    ... Home > Complications & Loss > Loss & grief > Neonatal death Neonatal death E-mail to a friend Please fill in ... cope with your baby’s death. What is neonatal death? Neonatal death is when a baby dies in ...

  1. 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.

  2. Population age and initial density in a patchy environment affect the occurrence of abrupt transitions in a birth-and-death model of Taylor's law

    Science.gov (United States)

    Jiang, Jiang; DeAngelis, Donald L.; Zhang, B.; Cohen, J.E.

    2014-01-01

    Taylor's power law describes an empirical relationship between the mean and variance of population densities in field data, in which the variance varies as a power, b, of the mean. Most studies report values of b varying between 1 and 2. However, Cohen (2014a) showed recently that smooth changes in environmental conditions in a model can lead to an abrupt, infinite change in b. To understand what factors can influence the occurrence of an abrupt change in b, we used both mathematical analysis and Monte Carlo samples from a model in which populations of the same species settled on patches, and each population followed independently a stochastic linear birth-and-death process. We investigated how the power relationship responds to a smooth change of population growth rate, under different sampling strategies, initial population density, and population age. We showed analytically that, if the initial populations differ only in density, and samples are taken from all patches after the same time period following a major invasion event, Taylor's law holds with exponent b=1, regardless of the population growth rate. If samples are taken at different times from patches that have the same initial population densities, we calculate an abrupt shift of b, as predicted by Cohen (2014a). The loss of linearity between log variance and log mean is a leading indicator of the abrupt shift. If both initial population densities and population ages vary among patches, estimates of b lie between 1 and 2, as in most empirical studies. But the value of b declines to ~1 as the system approaches a critical point. Our results can inform empirical studies that might be designed to demonstrate an abrupt shift in Taylor's law.

  3. 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 ...

  4. 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.

  5. 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%

  6. 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.

  7. 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.

  8. 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

  9. 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

  10. Characteristics features and factors influencing early death in Acute promyelocytic leukemia; Experience from United Arab Emirates (UAE).

    Science.gov (United States)

    Hassan, Inaam Bashir; Zaabi, Mariam R Al; Alam, Arif; Hashim, Mohammed Jawad; Tallman, Martin S; Kristensen, Jorgen

    2017-07-01

    Although acute promyelocytic leukemia (APL) is a curable hematologic malignancy, early death (ED) remains a significant cause of treatment failure especially in developing countries. In a retrospective data analysis of 67 adult APL patients diagnosed in United Arab Emirates we report an ED rate of 11.9% which is comparable to that reported from more developed countries. We identified the following parameters at presentation as significant predictor of increased ED: Age >40 years (P = 0.015), fever (P = 0.030), WBC count >20 × 10 9 /L (P = 0.010), the breakpoints other than bcr1 (P = 0.043) and fibrinogen level 10 × 10 9 /L and expression of HLA-DR (P = 0.018) or CD2 (P = 0.017) were significant predictors for differentiation syndrome (DS) which was found to be a predictor of ED (P = 0.002). Reducing the APL related ED rate in centers with limited resources is feasible provided early initiation of ATRA administration and early correction of coagulopathy in high-risk patients in addition to prompt treatment of DS. To our knowledge this is the first report from the Arabian Gulf describing ED in APL.

  11. 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

  12. 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

  13. 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

  14. 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.

  15. 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

  16. 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

  17. 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

  18. 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. .

  19. 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)

  20. 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.

  1. 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.)

  2. 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.)

  3. 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

  4. 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.

  5. 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.

  6. 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.

  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. 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.

  10. 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.)

  11. Pretreatment CD4 cell slope and progression to AIDS or death in HIV-infected patients initiating antiretroviral therapy--the CASCADE collaboration: a collaboration of 23 cohort studies

    NARCIS (Netherlands)

    Wolbers, Marcel; Babiker, Abdel; Sabin, Caroline; Young, Jim; Dorrucci, Maria; Chêne, Geneviève; Mussini, Cristina; Porter, Kholoud; Bucher, Heiner C.; del Amo, Julia; Meyer, Laurence; Pillay, Deenan; Prins, Maria; Rosinska, Magda; Touloumi, Giota; Lodi, Sara; Coughlin, Kate; Walker, Sarah; Darbyshire, Janet; de Luca, Andrea; Fisher, Martin; Muga, Roberto; Kaldor, John; Kelleher, Tony; Ramacciotti, Tim; Gelgor, Linda; Cooper, David; Smith, Don; Gill, John; Jørgensen, Louise Bruun; Nielsen, Claus; Lutsar, Irja; Dabis, Francois; Thiebaut, Rodolphe; Masquelier, Bernard; Costagliola, Dominique; Guiguet, Marguerite; Vanhems, Philippe; Chaix, Marie-Laure; Ghosn, Jade; Boufassa, Faroudy; Hamouda, Osamah; Kucherer, Claudia; Pantazis, Nikos; Hatzakis, Angelos; Paraskevis, Dimitrios; Karafoulidoua, Anastasia; van der Helm, Jannie; Geskus, Ronald; Schuitemaker, Hanneke

    2010-01-01

    BACKGROUND: CD4 cell count is a strong predictor of the subsequent risk of AIDS or death in HIV-infected patients initiating combination antiretroviral therapy (cART). It is not known whether the rate of CD4 cell decline prior to therapy is related to prognosis and should, therefore, influence the

  12. 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

  13. Experiências de quase-morte: implicações clínicas Near-death experience: clinical implications

    Directory of Open Access Journals (Sweden)

    Bruce Greyson

    2007-01-01

    Full Text Available CONTEXTO: Quando algumas pessoas vivenciam um estado próximo da morte, elas referem uma experiência profunda de transcender o mundo físico, o que freqüentemente as conduz a uma transformação espiritual. Estas "experiências de quase-morte" (EQMs são relevantes para os clínicos pois produzem mudanças nas crenças, nas atitudes e nos valores; podem ser confundidas com os estados psicopatológicos, embora tenham conseqüências diferentes necessitando terapêuticas diferentes; e, por fim, porque podem ampliar a nossa compreensão em relação ao fenômeno da consciência. OBJETIVOS: Esta revisão de literatura examina as evidências relacionadas às explicações que têm sido propostas para o fenômeno das EQMs, incluindo expectativa, memórias do nascimento, alterações nos gases sangüíneos, alucinações tóxicas ou metabólicas e modelos neuroquímicos e neuroanatômicos. MÉTODOS: A literatura sobre EQM dos últimos 30 anos foi revisada de modo abrangente, incluindo bases de dados médicas, de enfermagem, psicológicas e sociológicas. RESULTADOS: As EQMs tipicamente produzem mudanças positivas em atitudes, crenças e valores, mas também podem levar a problemas interpessoais e intrapsíquicos. Esses problemas, embora tenham sido comparados a vários transtornos mentais, diferem desses quadros psicopatológicos. Várias estratégias terapêuticas têm sido propostas para ajudar indivíduos que apresentam conseqüências problemáticas de uma EQM, mas tais intervenções ainda não foram testadas. CONCLUSÕES: A consciência mística e o funcionamento mental intensificado durante uma EQM, quando o funcionamento cerebral está gravemente prejudicado, são um desafio para os modelos atuais sobre a interação cérebro/mente e podem, eventualmente, levar a modelos mais completos para o entendimento da consciência.BACKGROUND: When some people come close to death, they report a profound experience of transcending the physical world

  14. 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

  15. Death Cafe.

    Science.gov (United States)

    Miles, Lizzy; Corr, Charles A

    2017-06-01

    This article explains the meaning of the phrase Death Cafe and describes what typically occurs at a Death Cafe gathering. The article traces the history of the Death Cafe movement, explores some reasons why people take part in a Death Cafe gathering, and gives examples of what individuals think they might derive from their participation. In addition, this article notes similarities between the Death Cafe movement and three other developments in the field of death, dying, and bereavement. Finally, this article identifies two provisional lessons that can be drawn from Death Cafe gatherings and the Death Cafe movement itself.

  16. Self-Euthanasia, the Dutch Experience: In Search for the Meaning of a Good Death or Eu Thanatos.

    Science.gov (United States)

    Vink, Ton

    2016-11-01

    My main purpose in this article is to establish the meaning of a 'good death' when death is self-chosen. I will take as my point of departure the new notion of 'self-euthanasia' and the corresponding practice that has evolved in the Netherlands in recent years. Both physician-euthanasia and self-euthanasia refer to an ideal process of a good death, the first being ultimately the physician's responsibility, while the second is definitely the responsibility of the individual choosing to die. However, if we also accept the existence of a fundamental moral difference between ending another person's life and ending your own life, and if we accept this moral difference to be also relevant to the normatively laden good death, then this difference represents a strong reason for preferring self-euthanasia to physician-euthanasia. © 2016 John Wiley & Sons Ltd.

  17. Similarities and differences between continuous sedation until death and euthanasia - professional caregivers' attitudes and experiences: A focus group study

    NARCIS (Netherlands)

    Anquinet, L.; Raus, K.; Sterckx, S.; Smets, T.; Deliens, L.; Rietjens, J.A.C.

    2013-01-01

    Background: According to various guidelines about continuous sedation until death, this practice can and should be clearly distinguished from euthanasia, which is legalized in Belgium. Aim: To explore professional caregivers perceptions of the similarities and differences between continuous sedation

  18. 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

  19. 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.

  20. 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.)

  1. 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

  2. [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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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

  8. 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

  9. 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

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

    Directory of Open Access Journals (Sweden)

    Aryal Umesh

    2012-09-01

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

  11. [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.

  12. [Significances of the life experience for the long-lived elderly person in the process of death/dying and mourning].

    Science.gov (United States)

    Menezes, Tânia Maria de Oliva; Lopes, Regina Lúcia Mendonça

    2014-08-01

    This is a study using the Heideggerian theoretical-phenomenological approach, which sought to understand the significances of the life experience for the long-lived elderly person in the process of death/dying and mourning. It was conducted in 2009 with 16 long-lived senior citizens of both genders who were aged between 80 and 90, members of a community center for the elderly located in a suburban neighborhood of the city of Salvador in the state of Bahia, Brazil. The results showed that the long-lived elderly person experiences the mourning status process when relatives and friends become ill and die. Furthermore, they gave ambiguous reports with respect to the fear of death. With the attributed significances, it was possible to arrive at the unit of significance, namely the authenticity and lack of authenticity of the individual regarding imminent death. The conclusion reached is that long-lived elderly individuals faced with the process of death/dying and mourning is apparent or concealed in accordance with the moment they are experiencing and the opportunities that present themselves, in other words, it is greatly influenced by their past.

  13. 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.

  14. 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.

  15. 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)

  16. 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

  17. 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

  18. 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

  19. Deliberating death.

    Science.gov (United States)

    Landes, Scott D

    2010-01-01

    Utilizing a particular case study of a woman attempting to come to terms with her death, this article explores the difficult metaphors of death present within the Christian tradition. Tracing a Christian understanding of death back to the work of Augustine, the case study is utilized to highlight the difficulties presented by past and present theology embracing ideas of punishment within death. Following the trajectory of the case study, alternative understandings of death present in recent Christian theology and within Native American spirituality are presented in an attempt to find room for a fuller meaning of death post-reconciliation, but premortem.

  20. 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.)

  1. 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.)

  2. 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.

  3. 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

  4. 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)

  5. 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

  6. 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.

  7. 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.

  8. 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.

  9. 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.)

  10. 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.)

  11. 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.

  12. 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.

  13. 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.)

  14. 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.

  15. 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

  16. 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

  17. 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

  18. 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

  19. Redefining Death

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    The results of 20 years of research on brain death will be released to the public, the Chinese Ministry of Health reported in early April. A special ministry team has drafted the criteria for brain death in Criteria for the Diagnosis of Brain Death in Adults (Revised Edition) and Technical Specifications for the Diagnosis

  20. 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)

  1. A Death in the Family: Death as a Zen Concept

    Science.gov (United States)

    Black, Helen K.; Rubinstein, Robert L.

    2013-01-01

    This study is based on original research that explored family reaction to the death of an elderly husband and father. We interviewed 34 families (a family included a widow and two adult biological children) approximately 6 to 10 months after the death. In one-on-one interviews, we discussed family members' initial reaction to the death, how the…

  2. 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

  3. 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

  4. 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.

  5. 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.

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

    Directory of Open Access Journals (Sweden)

    Carlo Camargo Passerotti

    2012-02-01

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

  7. 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.

  8. 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.)

  9. 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

  10. 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

  11. 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.

  12. 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.

  13. 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

  14. 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,…

  15. Life not death

    DEFF Research Database (Denmark)

    Milner, George R.; Boldsen, Jesper L.

    2017-01-01

    Analytically sophisticated paleoepidemiology is a relatively new development in the characterization of past life experiences. It is based on sound paleopathological observations, accurate age-at-death estimates, an explicit engagement with the nature of mortality samples, and analytical procedures...

  16. On social death: ostracism and the accessibility of death thoughts.

    Science.gov (United States)

    Steele, Caroline; Kidd, David C; Castano, Emanuele

    2015-01-01

    Being rejected, excluded, or simply ignored is a painful experience. Ostracism researchers have shown its powerful negative consequences (Williams, 2007), and sociologists have referred to such experiences as social death (Bauman, 1992). Is this is just a metaphor or does being ostracized make death more salient in people's minds? An experiment was conducted in which participants experienced ostracism or inclusion using the Cyberball manipulation, and the accessibility of death-related thoughts was measured via a word-stem completion puzzle. Results showed enhanced death-thought accessibility in the ostracism condition, as well as a negative effect of dispositional self-esteem on the accessibility of death-related thoughts.

  17. Early differential cell death and survival mechanisms initiate and contribute to the development of OPIDN: A study of molecular, cellular, and anatomical parameters

    International Nuclear Information System (INIS)

    Damodaran, T.V.; Attia, M.K.; Abou-Donia, M.B.

    2011-01-01

    Organophosphorus-ester induced delayed neurotoxicity (OPIDN) is a neurodegenerative disorder characterized by ataxia progressing to paralysis with a concomitant central and peripheral, distal axonapathy. Diisopropylphosphorofluoridate (DFP) produces OPIDN in the chicken that results in mild ataxia in 7–14 days and severe paralysis as the disease progresses with a single dose. White leghorn layer hens were treated with DFP (1.7 mg/kg, sc) after prophylactic treatment with atropine (1 mg/kg, sc) in normal saline and eserine (1 mg/kg, sc) in dimethyl sulfoxide. Control groups were treated with vehicle propylene glycol (0.1 ml/kg, sc), atropine in normal saline and eserine in dimethyl sulfoxide. The hens were euthanized at different time points such as 1, 2, 5, 10 and 20 days, and the tissues from cerebrum, midbrain, cerebellum, brainstem and spinal cord were quickly dissected and frozen for mRNA (northern) studies. Northern blots were probed with BCL2, GADD45, beta actin, and 28S RNA to investigate their expression pattern. Another set of hens was treated for a series of time points and perfused with phosphate buffered saline and fixative for histological studies. Various staining protocols such as Hematoxylin and Eosin (H and E); Sevier-Munger; Cresyl echt Violet for Nissl substance; and Gallocynin stain for Nissl granules were used to assess various patterns of cell death and degenerative changes. Complex cell death mechanisms may be involved in the neuronal and axonal degeneration. These data indicate altered and differential mRNA expressions of BCL2 (anti apoptotic gene) and GADD45 (DNA damage inducible gene) in various tissues. Increased cell death and other degenerative changes noted in the susceptible regions (spinal cord and cerebellum) than the resistant region (cerebrum), may indicate complex molecular pathways via altered BCL2 and GADD45 gene expression, causing the homeostatic imbalance between cell survival and cell death mechanisms. Semi quantitative

  18. 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

  19. 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

  20. 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

  1. 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.

  2. 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

  3. 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...

  4. 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

  5. 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…

  6. 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…

  7. Impressions That Last: Particularly Negative and Positive Experiences Reported by Parents Five Years after the End of a Child's Successful Cancer Treatment or Death.

    Directory of Open Access Journals (Sweden)

    Lisa Ljungman

    Full Text Available To describe the experience of parenting a child diagnosed with cancer by examining particularly negative and positive experiences reported by parents of childhood cancer survivors and parents of children lost to cancer.168 parents (88 mothers, 80 fathers participated. Data were collected five years after the end of successful treatment or the child's death. The parents' experiences were identified by open-ended semi-structured questions about particularly negative and positive experiences of the child's cancer. An inductive approach was used in which the manifest verbal content of the answers was analysed using content analysis.The analysis revealed eight categories of negative experience (child late effects; distressing events; healthcare; impaired relationships; long-term psychological consequences; own reactions; surrounding institutions; the fact that the child got cancer and seven categories of positive experience (healthcare; improved relationships; long-term consequences for the child; personal development; support systems; treatment outcome; unexpected joy. The categories were related to past events or to the present situation. The findings indicate variations in experiences between parents of survivors and bereaved parents, and between fathers and mothers, as some experiences were only reported by parents of survivors and some experiences were only reported by mothers.The results highlight the importance of past and present events to parents, and accordingly the long-lasting impact of paediatric cancer on parents. The results also point to the wide range of negative as well as positive experiences involved in parenting a child diagnosed with cancer, and provide a comprehensive understanding of the overall experience for parents of children with cancer. Specifically, the findings give guidance to healthcare providers by illustrating the need to provide healthcare personnel with continuous training in communication skills, offering

  8. The bereavement experience of adolescents and early young adults with cancer: Peer and parental loss due to death is associated with increased risk of adverse psychological outcomes.

    Directory of Open Access Journals (Sweden)

    Liza-Marie Johnson

    Full Text Available Adolescents commonly experience loss due to death, and perceived closeness to the deceased can often increase the intensity of bereavement. Adolescents and early young adult (AeYA oncology patients may recall previous losses or experience new losses, possibly of other children with cancer, while coping with their own increased risk of mortality. The bereavement experiences of AeYA patients are not well described in the literature.This analysis of bereavement sought to describe the prevalence and types of losses, the support following a death, and the impact of loss on AeYAs aged 13-21 years with malignant disease (or a hematologic disorder requiring allogeneic transplant. Participants were receiving active oncologic therapy or had completed therapy within the past 3 years. Participants completed a bereavement questionnaire and inventories on depression, anxiety, and somatization. The cross-sectional study enrolled 153 AeYAs (95% participation, most (88% of whom had experienced a loss due to death. The most commonly reported losses were of a grandparent (58% or friend (37%. Peer deaths were predominantly cancer related (66%. Many participants (39% self-identified a loss as "very significant." As loss significance increased, AeYAs were more likely to report that it had changed their life "a lot/enormously" (P<0.0001, that they were grieving "slowly or never got over it" (P<0.0001, and that they felt a need for more professional help (P = 0.026. Peer loss was associated with increased risk of adverse psychological outcomes (P = 0.029, as was parental loss (P = 0.018.Most AeYAs with serious illness experience the grief process as slow or ongoing. Peer or parental loss was associated with increased risk of negative mental health outcomes. Given the high prevalence of peer loss, screening for bereavement problems is warranted in AeYAs with cancer, and further research on grief and bereavement is needed in AeYAs with serious illness.

  9. 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.

  10. Risks of serious complications and death from smallpox vaccination: A systematic review of the United States experience, 1963–1968

    Directory of Open Access Journals (Sweden)

    Aragón Tomás J

    2003-08-01

    Full Text Available Abstract Background The United States (US has re-instituted smallpox vaccinations to prepare for an intentional release of the smallpox virus into the civilian population. In an outbreak, people of all ages will be vaccinated. To prepare for the impact of large-scale ring and mass vaccinations, we conducted a systematic review of the complication and mortality risks of smallpox vaccination. We summarized these risks for post-vaccinial encephalitis, vaccinia necrosum (progressive vaccinia, eczema vaccinatum, generalized vaccinia, and accidental infection (inadvertant autoinoculation. Methods Using a MEDLINE search strategy, we identified 348 articles, of which seven studies met our inclusion criteria (the number of primary vaccinations and re-vaccinations were reported, sufficient data were provided to calculate complication or case-fatality risks, and comparable case definitions were used. For each complication, we estimated of the complication, death, and case-fatality risks. Results The life-threatening complications of post-vaccinial encephalitis and vaccinia necrosum were at least 3 and 1 per million primary vaccinations, respectively. Twenty-nine percent of vaccinees with post-vaccinial encephalitis died and 15% with vaccinia necrosum died. There were no deaths among vaccinees that developed eczema vaccinatum; however, 2.3% of non-vaccinated contacts with eczema vaccinatum died. Among re-vaccinees, the risk of post-vaccinial encephalitis was reduced 26-fold, the risk of generalized vaccinia was reduced 29-fold, and the risk of eczema vaccinatum was reduced 12-fold. However, the risk reductions of accidental infection and vaccinia necrosum were modest (3.8 and 1.5 fold respectively.

  11. 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...

  12. "These are not good things for other people to know": how rural Tanzanian women's experiences of pregnancy loss and early neonatal death may impact survey data quality.

    Science.gov (United States)

    Haws, Rachel A; Mashasi, Irene; Mrisho, Mwifadhi; Schellenberg, Joanna Armstrong; Darmstadt, Gary L; Winch, Peter J

    2010-11-01

    Little research in low-income countries has compared the social and cultural ramifications of loss in childbearing, yet the social experience of pregnancy loss and early neonatal death may affect demographers' ability to measure their incidence. Ninety-five qualitative reproductive narratives were collected from 50 women in rural southern Tanzania who had recently suffered infertility, miscarriage, stillbirth or early neonatal death. An additional 31 interviews with new mothers and female elders were used to assess childbearing norms and social consequences of loss in childbearing. We found that like pregnancy, stillbirth and early neonatal death are hidden because they heighten women's vulnerability to social and physical harm, and women's discourse and behaviors are under strong social control. To protect themselves from sorcery, spiritual interference, and gossip--as well as stigma should a spontaneous loss be viewed as an induced abortion--women conceal pregnancies and are advised not to mourn or grieve for "immature" (late-term) losses. Twelve of 30 respondents with pregnancy losses had been accused of inducing an abortion; 3 of these had been subsequently divorced. Incommensurability between Western biomedical and local categories of reproductive loss also complicates measurement of losses. Similar gender inequalities and understandings of pregnancy and reproductive loss in other low-resource settings likely result in underreporting of these losses elsewhere. Cultural, terminological, and methodological factors that contribute to inaccurate measurement of stillbirth and early neonatal death must be considered in designing surveys and other research methods to measure pregnancy, stillbirth, and other sensitive reproductive events. Copyright © 2010 Elsevier Ltd. All rights reserved.

  13. 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.

  14. 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

  15. 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...

  16. 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.

  17. 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

  18. A qualitative study about experiences and emotions of emergency medical technicians and out-of-hospital emergency nurses after performing cardiopulmonary resuscitation resulting in death.

    Science.gov (United States)

    Fernández-Aedo, I; Pérez-Urdiales, I; Unanue-Arza, S; García-Azpiazu, Z; Ballesteros-Peña, S

    To explore the experiences, emotions and coping skills among emergency medical technicians and emergency nurses after performing out-of-hospital cardiopulmonary resuscitation manoeuvres resulting in death. An exploratory qualitative research was performed. Seven emergency medical technicians and six emergency nurses were selected by non-probability sampling among emergency medical system workers. The meetings took place up to information saturation, achieved after six individual interviews and a focal group. The meetings were then transcribed and a manual and inductive analysis of the contents performed. After a failed resuscitation several short and long-term reactions appear. They can be negatives, such as sadness or uncertainty, or positives, such as the feeling of having done everything possible to save the patient's life. Emotional stress increases when ambulance staff have to talk with the deceased's family or when the patient is a child. The workers don't know of a coping strategy other than talking about their emotions with their colleagues. Death after a failed resuscitation can be viewed as a traumatic experience for rescuers. Being in contact with the suffering of others is an emotional, stress-generating factor with direct repercussions on the working and personal lives of emergency staff. Nevertheless, structured coping techniques are not common among those professionals. Copyright © 2016 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

  19. 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…

  20. 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.

  1. 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.

  2. 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.

  3. The major clinical determinants of maternal death among obstetric near-miss patients: a tertiary centre experience

    International Nuclear Information System (INIS)

    Simsek, Y.; Yilmaz, E.; Celik, E.

    2013-01-01

    Objective: To evaluate the characteristics of obstetric near-miss patients to clarify the major risk factors of maternal mortality. Methods: From among the patients referred to the Department of Obstetrics and Gynaecology, Inonu University of Medical Sciences, Turkey, between August 1, 2010 and March 1, 2012, electronic records of obstetric near-miss cases were retrospectively analysed. The obstetric and demographic characteristics of cases that were successfully treated (Group 1) as well as cases with maternal death (Group 2) were analysed and compared. SPSS 11.5 was used for statistical analysis. Results: Of the total 2687 cases handled during the study period, 95 (3.53%) were of the near-miss nature. The most frequently encountered underlying aetiology was severe preeclampsia (n=55; 57.89%) and haemolysis, elevated liver enzymes, low platelet count syndrome (n=20; 21.1%). These were followed by cases of postpartum bleeding (n=18; 18.9%). Maternal mortality occurred in 10 (10.5%) patients, representing Group 2. The amount of haemorrhage and blood transfused were significantly higher in the group. Maternal mortality cases had also significantly longer duration of intensive care unit admission. Conclusion: Early diagnosis and immediate management of the complications noted by the study can be the most important measures to prevent the occurrence of mortality. (author)

  4. 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....

  5. Giving Birth to Life--Again!: Bereaved Parents' Experiences with Children Born Following the Death of an Adult Son

    Science.gov (United States)

    Hamama-Raz, Yaira; Rosenfeld, Sarah; Buchbinder, Eli

    2010-01-01

    This article is based on a qualitative study examining the experiences of parents that lost a son during military service in Israel and consequently choose to give birth to another child. Seven couples and 3 mothers were interviewed for the study, and their interviews were analyzed using a phenomenological-hermeneutic approach. Three main themes…

  6. 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.

  7. People's initiative to counteract misinformation and marketing practices: the Pembo, Philippines, breastfeeding experience, 2006.

    Science.gov (United States)

    Salud, M A Lourdes B; Gallardo, Josephine I; Dineros, Juliana A; Gammad, Alma F; Basilio, Juanita; Borja, Vicenta; Iellamo, Alessandro; Worobec, Lana; Sobel, Howard; Olivé, Jean-Marc

    2009-08-01

    The Philippines is among 42 countries accounting for 90% of under 5-year-old deaths. Only 16% of 4 to 5 month old Filipinos exclusively breastfeed. In 2006, almost $100 million was spent advertising formula in the Philippines. To counter widespread misinformation and improve breastfeeding a peer counseling intervention was developed to target mothers with infants less than 2 months of age who were not exclusively breastfeeding or had difficulty breastfeeding. Participants received 3 peer counseling visits. At baseline and 3 weeks later, 24-hour food recalls for infants were collected. The number of exclusively formula-fed infants decreased seven-fold (P < .001). Mixed-fed infants decreased 37% (P < .001). Overall, of the 148 nonexclusively breastfeeding infants, 69.5% had changed feeding methods after 3 home visits, 76% of whom to exclusive breastfeeding. Community-based peer counseling was associated with a drastic improvement of exclusive breastfeeding practices. This intervention evolved and became sustainable by engaging political figures, cities, and communities throughout the process. In 2 years, the Department of Health, World Health Organization (WHO) program has scaled up to improve health service delivery for 161,612 persons in depressed urban communities in the Philippines.

  8. Transcatheter Potts shunt creation in patients with severe pulmonary arterial hypertension: initial clinical experience.

    Science.gov (United States)

    Esch, Jesse J; Shah, Pinak B; Cockrill, Barbara A; Farber, Harrison W; Landzberg, Michael J; Mehra, Mandeep R; Mullen, Mary P; Opotowsky, Alexander R; Waxman, Aaron B; Lock, James E; Marshall, Audrey C

    2013-04-01

    Patients with severe pulmonary arterial hypertension (PAH) face significant morbidity and death as a consequence of progressive right heart failure. Surgical shunt placement between the left PA and descending aorta (Potts shunt) appears promising for PAH palliation in children; however, surgical mortality is likely to be unacceptably high in adults with PAH. We describe a technique for transcatheter Potts shunt (TPS) creation by fluoroscopically guided retrograde needle perforation of the descending aorta at the site of apposition to the left PA to create a tract for deployment of a covered stent between these vessels. This covered stent-anchored by the vessel walls and surrounding tissue-serves as the shunt. TPS creation was considered in 7 patients and performed in 4. The procedure was technically successful in 3 patients; 1 patient died during the procedure as a result of uncontrolled hemothorax. One acute survivor, critically ill at the time of TPS creation, later died of comorbidities. The 2 mid-term survivors (follow-up of 10 and 4 months) are well at home, with symptomatic improvement and no late complications. The 3 candidate patients in whom the procedure was not performed died within 1 month of consideration, underscoring the tenuous nature of this population. TPS creation is feasible and may offer symptomatic relief to select patients with refractory PAH. Further study of this innovative approach is warranted. Copyright © 2013 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

  9. 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.

  10. [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.

  11. 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.

  12. Do out-of-body and near-death experiences point towards the reality of nonlocal consciousness? A critical evaluation

    Directory of Open Access Journals (Sweden)

    Pieter Craffert

    2015-07-01

    Full Text Available In recent years there was a steady flow of academic studies claiming that the mind or consciousness can function independently from a working brain. Such research is presented with great confidence as a scientific breakthrough and one that will alter received views on both humanity and the meaning of life as well as medical science in general and neuroscience in particular. In this article the three major streams of evidence for the existence of nonlocal consciousness are critically evaluated. Neither the testimonies of thousands of experients nor research on cardiac arrest patients or experimental research on veridical perception during out-of-body experiences at this stage provide sufficient evidence for such claims about nonlocal consciousness. Extraordinary claims about paradigm chances in the scientific world should be supported by uncontroversial and high quality evidence, which is currently not available.

  13. Fatherhood and suffering: a qualitative exploration of Swedish men's experiences of care after the death of a baby.

    Science.gov (United States)

    Cacciatore, J; Erlandsson, Kerstin; Rådestad, Ingela

    2013-05-01

    This study was designed to evaluate fathers' experiences of stillbirth and psychosocial care. Data were collected between 27 March 2008 and 1 April 2010 via a questionnaire posted on the homepage of the Swedish National Infant Foundation. The responses to the following open-ended questions were analyzed using content analysis: "Are you grateful today for anything that health care professionals did in connection with the birth of your child?" and "Are you sad, hurt or angry today about something personnel did in connection with the birth of your baby?". 113/131 (86%) fathers reported feelings of being grateful. Only 22/131 (16%) fathers reported feeling sad, hurt, or angry. Fathers expressed gratitude when health care professionals treated their newborn "with respect and without fear", "with extraordinary reverence", and when their fatherhood was validated by providers. They were also grateful when providers helped them to create memories of their baby. Fathers also reported feeling sad, hurt, or angry when providers were nonchalant and indifferent and when they perceived providers to be uncaring and disrespectful toward their baby. Bereaved fathers experience overall gratitude for person-centered psychosocial care in the aftermath of stillbirth, particularly when they feel validated as a grieving father and their child is acknowledged with reverence. Health care professionals should support fathers by treating the baby who died with respect and dignity and by validating and acknowledging both his grief experiences and his fatherhood just as they would for a grieving mother. Copyright © 2012 Elsevier Ltd. All rights reserved.

  14. Equivalência semântica da versão em português da Escala de Experiência de Quase-Morte Semantic equivalence of the Portuguese version of the Near-Death Experience Scale

    Directory of Open Access Journals (Sweden)

    Fernanda Barcellos Serralta

    2010-04-01

    Full Text Available Na literatura internacional, a experiência de quase-morte (EQM é avaliada principalmente por meio do instrumento The Near-Death Experience Scale (NDE, elaborado por Bruce Greyson, em 1983. O objetivo do presente estudo é verificar a existência de equivalência semântica entre a versão original da escala (em inglês e a versão traduzida ao português do Brasil, avaliando os significados geral e referencial. Após as diversas etapas de avaliação da equivalência semântica, a escala foi pré-testada em seis pacientes internados após alta de um Centro de Tratamento Intensivo (CTI de um Hospital Universitário. Na avaliação realizada por dois psicólogos e dois psiquiatras, constatou-se existir equivalência semântica entre a versão final em português e o original. Na aplicação da escala na população-alvo, verificou-se boa compreensão dos itens. Portanto, a escala está adequada à cultura brasileira, podendo ser utilizada para pesquisas sobre Experiências de Quase-Morte neste contexto.In the international literature, near-death experiences are often measured by The Near-Death Experience Scale (NDE, developed by Bruce Greyson in 1983. The aim of this study is to verify the existence of the semantic equivalence between the original version (in English and the translated version to Brazilian Portuguese, evaluating both the general and the referential meaning. The semantic evaluation was conducted according to the several steps. Thereafter, a pre-testing was performed in six post Intensive Care Unit patients of a University Hospital. The evaluations of two psychologists and two psychiatrists have found existence of semantic equivalence between the Brazilian and the original version of the scale. The pre-test applied on the target population proved the items were intelligible. Our findings suggest that the Brazilian version of the NDE might be used in the investigation of near-death experience in Brazilian culture.

  15. 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...

  16. 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.

  17. 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.

  18. 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…

  19. 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…

  20. 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.

  1. 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.

  2. 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.

  3. Remote pre-procedural ischemic stroke as the greatest risk in carotid‑stenting‑associated stroke and death: a single center's experience.

    Science.gov (United States)

    Rašiová, Mária; Špak, Ľubomír; Farkašová, Ľudmila; Pataky, Štefan; Koščo, Martin; Hudák, Marek; Moščovič, Matej; Leško, Norbert

    2017-08-01

    .4% (N.=10) of symptomatic patients and 2.8% (N.=9) of asymptomatic patients. The risk of periprocedural stroke/death was 3.4 times higher in patients with (N.=198) compared to patients without remote ischemic stroke (N.=304) (6.6% versus 2.0% of patients without remote ischemic stroke; P=0.008). Periprocedural stroke/death in symptomatic patients (N.=186) was non-significantly higher in patients with remote ischemic stroke (N.=76) compared with patients without remote ischemic stroke (N.=110) (7.9% versus 3.6%; P=0.206). Asymptomatic patients with remote ischemic stroke (N.=122) had a 5.6-time-higher periprocedural risk of stroke/death compared with asymptomatic patients without remote ischemic stroke (N.=194) (5.7% versus 1.0%; P=0.014). Patients ≥75 years (N.=83) had a 3.0-time-higher periprocedural risk of stroke/death compared with younger patients (N.=419) (8.4% versus 2.9%; P=0.015); a non-significant increase of periprocedural stroke/death was found in both symptomatic (N.=35) and asymptomatic (N.=48) elderly patients (11.4% versus 4.0%, P=0.078; and 6.3% versus 2.4%, P=0.124, respectively). Increased periprocedural risk of stroke/death was not documented in other analyzed patient subgroups. During long-term follow-up, a 1.5-time-higher mortality risk was found in patients with remote ischemic stroke compared with patients without remote ischemic stroke in multivariable analysis; other patient subgroups (except older versus younger patients) did not differ in long-term mortality following carotid stenting. In our experience, all patients with remote pre-procedural any-territory ischemic stroke belong to risky subgroup for periprocedural stroke death after CAS. All asymptomatic patients with remote ischemic stroke should not be treated with CAS. Remote ischemic stroke increases all-cause mortality in long-term follow-up after carotid stenting. Patients aged ≥75 years also have increased risk of periprocedural stroke and death after CAS. These factors should

  4. "A life of living death": the experiences of people living with chronic low back pain in rural Nigeria.

    Science.gov (United States)

    Igwesi-Chidobe, Chinonso N; Kitchen, Sheila; Sorinola, Isaac O; Godfrey, Emma L

    2017-04-01

    This study explored the experiences of people living with non-specific chronic low back pain (CLBP) in a rural Nigerian community. Qualitative in-depth semi-structured face-to-face interviews were conducted with purposively sampled participants until data saturation. Questions explored back pain beliefs, coping/management strategies and daily activities. Thematic analysis of transcripts was performed using the Framework approach. Themes showed that back pain beliefs were related to manual labour/deprivation, infection/degeneration, spiritual/cultural beliefs and rural-urban divide. These beliefs impacted on gender roles resulting in adaptive or maladaptive coping. Adaptive coping was facilitated by positive beliefs, such as not regarding CLBP as an illness, whereas viewing CLBP as illness stimulated maladaptive coping strategies. Spirituality was associated with both adaptive and maladaptive coping. Maladaptive coping strategies led to dissatisfaction with health care in this community. CLBP-related disability in rural Nigeria is strongly influenced by beliefs that facilitate coping strategies that either enhance or inhibit recovery. Interventions should therefore target maladaptive beliefs while emphasizing behavioural modification. Implications for Rehabilitation Non-specific chronic low back pain (CLBP) is highly prevalent and responsible for much pain and disability in rural Nigeria. No qualitative study has investigated the experiences of people living with CLBP in rural Nigeria or any other rural African context. Qualitative study of peoples' experiences of living with CLBP in rural Nigeria has the potential of exposing complex socio-cultural and psychological factors associated with CLBP which has potential implications for designing effective interventions. The results of this study may inform the development of complex interventions for reducing the disability associated with CLBP in rural Nigeria and other rural African contexts.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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...

  13. 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

  14. Parental divorce and parental death

    DEFF Research Database (Denmark)

    Marcussen, Jette; Thuen, Frode; Poul, Bruun

    2015-01-01

    The aim of this review was to identify research on children and adolescents who experience double bereavement, i.e. the experience of loss through parental divorce followed by either parental death or critical illness with imminent death. This knowledge may identify evidence to underpin knowledge......; challenges in both custodial and non-custodial parental death; risk of mental health problems, and the need of support and interventions....

  15. 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.

  16. 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

  17. 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

  18. 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.

  19. 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.

  20. 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.)

  1. 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.

  2. 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

  3. 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

  4. 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.

  5. 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

  6. 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

  7. 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)

  8. Incident AIDS or Death After Initiation of Human Immunodeficiency Virus Treatment Regimens Including Raltegravir or Efavirenz Among Adults in the United States.

    Science.gov (United States)

    Cole, Stephen R; Edwards, Jessie K; Hall, H Irene; Brookhart, M Alan; Mathews, W Christopher; Moore, Richard D; Crane, Heidi M; Kitahata, Mari M; Mugavero, Michael J; Saag, Michael S; Eron, Joseph J

    2017-06-01

    The long-term effectiveness of human immunodeficiency virus (HIV) treatments containing integrase inhibitors is unknown. We use observational data from the Centers for AIDS Research Network of Integrated Clinical Systems and the Centers for Disease Control and Prevention to estimate 4-year risk of AIDS and all-cause mortality among 415 patients starting a raltegravir regimen compared to 2646 starting an efavirenz regimen (both regimens include emtricitabine and tenofovir disoproxil fumarate). We account for confounding and selection bias as well as generalizability by standardization for measured variables, and present both observational intent-to-treat and per-protocol estimates. At treatment initiation, 12% of patients were female, 36% black, 13% Hispanic; median age was 37 years, CD4 count 321 cells/µL, and viral load 4.5 log10 copies/mL. Two hundred thirty-five patients incurred an AIDS-defining illness or died, and 741 patients left follow-up. After accounting for measured differences, the 4-year risk was similar among those starting both regimens (ie, intent-to treat hazard ratio [HR], 0.96 [95% confidence interval {CI}, .63-1.45]; risk difference, -0.9 [95% CI, -4.5 to 2.7]), as well as among those remaining on regimens (ie, per-protocol HR, 0.95 [95% CI, .59-1.54]; risk difference, -0.5 [95% CI, -3.8 to 2.9]). Raltegravir and efavirenz-based initial antiretroviral therapy have similar 4-year clinical effects. Vigilance regarding longer-term comparative effectiveness of HIV regimens using observational data is needed because large-scale experimental data are not forthcoming. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

  9. 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.

  10. 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.

  11. 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

  12. [Experience of parents after the loss of a newborn twin in the NICU: a qualitative study 3 years after the death].

    Science.gov (United States)

    Vasilescu, C; Garel, M; Caeymaex, L

    2013-04-01

    The mortality rate both before and after birth is higher in twins. Parents face a particularly difficult mourning experience when confronted with the loss of 1 of their newborn twins. The aim of this article is to describe how parents experience and cope with this situation over the long term, how they describe the loss at the time of the death in a neonatal intensive care unit (NICU), the way they are able to become attached to the surviving twin, and the role that NICU caregivers can play to help them. This study is part of a larger qualitative study on parental mourning after the loss of a newborn in 4 NICUs in France. Semi-structured research interviews were conducted 3years after the death. The interviews were recorded, transcribed, and anonymized. Discourse analysis was used to extract the data on different themes. Among the 166 participating parents, 26 had lost a newborn twin. The parents reported their difficulties when faced with simultaneous contradictory events at the time of the death of a twin child in the NICU. Mourning appeared to be more difficult in this particular case: to combine the loss of a deceased child with the care of the surviving newborn was very complicated. The existence of the "co-twin" was described as an essential support for the parents; however, over the long term, this child could not fulfill the feelings of emptiness. The relation with this surviving child was sometimes disturbed by parental anxiety that the accident could recur. Fathers and mothers showed repression of their sadness and despair. The representations of the 2 children in their parents' mind were sometimes very close or even overlapping and some parents were confused with regards to the place each of them could have. In the NICU, the caregivers should be able to listen to the parents expressing their contradictory feelings, to sustain the acknowledgement of the loss of 1 child, and in becoming attached to the surviving child. Parents need to be reassured about

  13. 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.

  14. 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)

  15. 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)

  16. 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.

  17. 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.)

  18. 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.)

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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.

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

    Science.gov (United States)

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

    2016-04-01

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

  5. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Butler, J.N.

    1991-03-01

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

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

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    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.

  8. Effectiveness of a Death-Education Program in Reducing Death Anxiety of Nursing Students.

    Science.gov (United States)

    Johansson, Noreen; Lally, Terry

    1991-01-01

    Evaluated effectiveness of death education program in reducing death anxiety experienced by 22 junior and senior nursing students. Subjects were pre- and posttested with State Form of State-Trait Anxiety Inventory and viewed film of death experience. Posttest analysis indicated that death education program was effective in decreasing death anxiety…

  9. 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.

  10. 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.

  11. 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.

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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.

  19. 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.

  20. 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.

  1. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  3. 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.

  4. 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)

  5. 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)

  6. Gallbladder Cancer Incidence and Death Rates

    Science.gov (United States)

    ... Campaigns Initiatives Stay Informed Gallbladder Cancer Incidence and Death Rates Recommend on Facebook Tweet Share Compartir Quick ... a late stage with a poor outcome, often death. The journal Cancer Epidemiology, Biomarkers and Prevention published ...

  7. 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

  8. 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

  9. "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

  10. "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

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

    Directory of Open Access Journals (Sweden)

    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

  12. 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

  13. 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.

  14. Death cap

    DEFF Research Database (Denmark)

    Rudbæk, Torsten R; Kofoed, Pernille Bouteloup; Bove, Jeppe

    2014-01-01

    Death cap (Amanita phalloides) is commonly found and is one of the five most toxic fungi in Denmark. Toxicity is due to amatoxin, and poisoning is a serious medical condition, causing organ failure with potential fatal outcome. Acknowledgement and clarification of exposure, symptomatic and focused...

  15. "Spectacular Death"

    DEFF Research Database (Denmark)

    Jacobsen, Michael Hviid

    2016-01-01

    be labelled ‘spectacular death’ in which death, dying and mourning have increasingly become spectacles. Moreover, the author proposes that what is currently happening in contemporary Western society can be interpreted as an expression of a ‘partial re-reversal’ of ‘forbidden death’ to some...

  16. 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.

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

    Science.gov (United States)

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

    2016-01-01

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

  18. Initial 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

  19. 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

  20. 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.

  1. 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

  2. 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

  3. 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

  4. 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

  5. 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

  6. Why people accept opioids: role of general attitudes toward drugs, experience as a bereaved family, information from medical professionals, and personal beliefs regarding a good death.

    Science.gov (United States)

    Shinjo, Takuya; Morita, Tatsuya; Hirai, Kei; Miyashita, Mitsunori; Shimizu, Megumi; Tsuneto, Satoru; Shima, Yasuo

    2015-01-01

    Many surveys have evaluated patient-related barriers to pain management. To explore associations between a preference for opioids and general attitudes toward drugs, the experience and information received as a bereaved family, and beliefs regarding a good death. A cross-sectional survey, performed in 2010, of bereaved families of patients with cancer in palliative care units across Japan. Questionnaires were sent to 997 families. A total of 66% of families responded. Of these, 224 responses were excluded because the family declined to participate in the study (n = 38), the patient was not receiving any opioid analgesics, and there were missing data (n = 164), or data were missing for the primary end points (n = 22). Thus, 432 responses were finally analyzed (43%). In total, 26%, 41%, and 31% of family members stated that they strongly want to receive, want to receive, or slightly want to receive opioids if needed in the future, respectively. Determinants associated with a preference for receiving opioid treatment were the following: a general appreciation of the drugs (P = 0.005), witnessing an improvement in the patient's quality of life as a result of pain relief (P = 0.003), information provided by medical professionals that the opioid could be discontinued if side effects developed (P = 0.042), and the belief that a good death was one that was free from pain and physical distress (P families whose relatives were treated with opioid analgesics reported a preference to receive opioid analgesics for the treatment of cancer pain, if necessary, in the future. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  7. That's not what you expect to do as a doctor, you know, you don't expect your patients to die." Death as a learning experience for undergraduate medical students.

    Science.gov (United States)

    Smith-Han, Kelby; Martyn, Helen; Barrett, Anthony; Nicholson, Helen

    2016-04-14

    Experiencing the death of a patient can be one of the most challenging aspects of clinical medicine for medical students. Exploring what students' learn from this difficult experience may contribute to our understanding of how medical students become doctors, and provide insights into the role a medical school may play in this development. This research examined medical students' responses of being involved personally in the death of a patient. Ten undergraduate medical students were followed through their three years of clinical medical education. A total of 53 individual semi-structured interviews were conducted. Grounded theory analysis was used to analyze the data. Students illustrated a variety of experiences from the death of a patient. Three main themes from the analysis were derived: (i) Students' reactions to death and their means of coping. Experiencing the death of a patient led to students feeling emotionally diminished, a decrease in empathy to cope with the emotional pain and seeking encouragement through the comfort of colleagues; (ii) Changing perceptions about the role of the doctor, the practice of medicine, and personal identity. This involved a change in students' perceptions from an heroic curing view of the doctor's role to a role of caring, shaped their view of death as a part of life rather than something traumatic, and resulted in them perceiving a change in identity including dampening their emotions; (iii) Professional environment, roles and responsibilities. Students began to experience the professional environment of the hospital by witnessing the ordinariness of death, understanding their role in formalizing the death of a patient, and beginning to feel responsible for patients. Along with an integrative approach to facilitate students learning about death, we propose staff development targeting a working knowledge of the hidden curriculum. Knowledge of the hidden curriculum, along with the role staff play in exercising this influence

  8. 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.

  9. Life and death.

    Science.gov (United States)

    Lloyd, J W

    1983-03-01

    In contrast with the other lectures given in the course on humanics and bioethics at the UOEH, which address the questions of life and death from the standpoint of the physician or the philosopher, this lecture considers these issues as seen by the cancer patient who has had a close encounter with death. The attitudes of Americans concerning abortion, the use of life-support systems, "mercy killings", suicide and the use of cancer chemotherapy are discussed with particular emphasis on restraints imposed by the courts, the churches and the family systems. An attempt is made to contrast the American and Japanese attitudes on these questions but this is difficult because of different cultural and religious backgrounds. The author describes his own experiences as a cancer patient who has approached death very closely and the changes in his own attitude toward life which results from the encounter with death. He also talks about the joy of being alive and describes his own experience with receiving cancer chemotherapy, the resulting discomfort and inconveniences and his feelings about a "tolerable" existence. Finally, the author considers the question of the "quality of life" for the cancer patient who has a violent reaction to certain forms of chemotherapy. This is a dilemma for the patient and the doctor who must consider the choice between death and a miserable existence.

  10. Experiments with Death and Snapchat

    DEFF Research Database (Denmark)

    Andersen, Mads Møller

    This article explores the strategic functions of an experimental approach used by the Danish public service television channel DR3 in its original programming. The article analyses two case examples Fuckr Med Døden (Eng.: “Fucking with Death”) and Valgaften på DR3 (Eng.: “Election night on DR3...

  11. 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

  12. 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.

  13. 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…

  14. Programmed cell death in the leaves of the Arabidopsis spontaneous necrotic spots (sns-D mutant correlates with increased expression of the eukaryotic translation initiation factor eIF4B2

    Directory of Open Access Journals (Sweden)

    Gwenael M.D.J.-M. Gaussand

    2011-04-01

    Full Text Available From a pool of transgenic Arabidopsis (Arabidopsis thaliana plants harboring an activator T-DNA construct, one mutant was identified that developed spontaneous necrotic spots (sns-D on the rosette leaves under aseptic conditions. The sns-D mutation is dominant and homozygous plants are embryo lethal. The mutant produced smaller rosettes with a different number of stomata than the wild-type. DNA fragmentation in the nuclei of cells in the necrotic spots and a significant increase of caspase-3 and caspase-6 like activities in sns-D leaf extracts indicated that the sns-D mutation caused programmed cell death (PCD. The integration of the activator T-DNA caused an increase of the expression level of At1g13020, which encodes the eukaryotic translation initiation factor eIF4B2. The expression level of eIF4B2 was positively correlated with the severity of sns-D mutant phenotype. Overexpression of the eIF4B2 cDNA mimicked phenotypic traits of the sns-D mutant indicating that the sns-D mutant phenotype is indeed caused by activation tagging of eIF4B2. Thus, incorrect regulation of translation initiation may result in PCD.

  15. 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)

  16. Exploring children's understanding of death: through drawings and the Death Concept Questionnaire.

    Science.gov (United States)

    Bonoti, Fotini; Leondari, Angeliki; Mastora, Adelais

    2013-01-01

    To investigate whether children's understanding of the concept of death varies as a function of death experience and age, 52 children aged 7, 9, and 11 years (26 had a personal death experience), drew a picture reflecting the meaning of the word death and completed the Death Concept Questionnaire for examination of Human and Animal Death. The results showed that the 2 methodological tools used offered complementary information and that children's understanding of death is related both to age and past experience. Children with death experience seem to have a more realistic understanding of death than their inexperienced age-mates. As regards to the effect of age, our findings support the assumption that the different components of death develop through different processes.

  17. What is a 'secure base' when death is approaching? A study applying attachment theory to adult patients' and family members' experiences of palliative home care.

    Science.gov (United States)

    Milberg, A; Wåhlberg, R; Jakobsson, M; Olsson, E-C; Olsson, M; Friedrichsen, M

    2012-08-01

    Attachment theory has received much interest lately in relation to how adults cope with stress and severe illness. The aim of this study was using the experiences of patients and family members to explore palliative home care as a 'secure base' (a central concept within the theory). Twelve patients and 14 family members were interviewed during ongoing palliative home care. The interviews were analysed with deductive qualitative content analysis. Informants expressed the relevance of sensing security during palliative home care because death and dying were threats that contributed to vulnerability. Palliative home care could foster a feeling of security and provide a secure base. This was facilitated when informants had trust in staff (e.g. due to availability and competence in providing symptom relief), felt recognised as individuals and welcomed to contact the team in times of needs. Being comfortable, informed and having an everyday life also contributed to a perception of palliative home care as a secure base. Family members stressed the importance of being relieved from responsibilities that were too heavy. The underlying meanings of experiencing palliative home care as a secure base involved gaining a sense of control and of inner peace, perceiving that despite a demanding and changed life situation, one could continue partially being oneself and having something to hope for, even if this no longer concerned cure for the ill person. Important aspects of palliative home care as providing a secure base were identified and these have implications for clinical practice. Copyright © 2011 John Wiley & Sons, Ltd.

  18. [Reflections on prehospitalisation deaths].

    Science.gov (United States)

    Hugenschmitt, Delphine; Allonneau, Alexandre; Cesareo, Éric; Gueugniaud, Pierre-Yves; Lefort, Hugues

    2017-12-01

    In the past, death was a family and community affair, but today it is institutional and entrusted to healthcare personnel. Thanks to a questionnaire on their feelings about prehospitalisation deaths, the experience and training needs for healthcare personnel at a mobile emergency and intensive care service were analysed. The majority of these professionals had been confronted with difficulties when faced with prehospitalisation deaths. There is little understanding of religious rites, even though this is an important point in dealing with the situation. There is a strong desire for training. The pedagogical support offered in response to the needs expressed was recognised as being useful and should be more widespread. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  19. 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

  20. 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

  1. 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.

  2. Death in the United States, 2011

    Science.gov (United States)

    ... Order from the National Technical Information Service NCHS Death in the United States, 2011 Recommend on Facebook ... 2011 SOURCE: National Vital Statistics System, Mortality. Do death rates vary by state? States experience different mortality ...

  3. 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

  4. 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.

  5. Births and deaths including fetal deaths

    Data.gov (United States)

    U.S. Department of Health & Human Services — Access to a variety of United States birth and death files including fetal deaths: Birth Files, 1968-2009; 1995-2005; Fetal death file, 1982-2005; Mortality files,...

  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. Death from Nitrous Oxide.

    Science.gov (United States)

    Bäckström, Björn; Johansson, Bengt; Eriksson, Anders

    2015-11-01

    Nitrous oxide is an inflammable gas that gives no smell or taste. It has a history of abuse as long as its clinical use, and deaths, although rare, have been reported. We describe two cases of accidental deaths related to voluntary inhalation of nitrous oxide, both found dead with a gas mask covering the face. In an attempt to find an explanation to why the victims did not react properly to oncoming hypoxia, we performed experiments where a test person was allowed to breath in a closed system, with or without nitrous oxide added. Vital signs and gas concentrations as well as subjective symptoms were recorded. The experiments indicated that the explanation to the fact that neither of the descendents had reacted to oncoming hypoxia and hypercapnia was due to the inhalation of nitrous oxide. This study raises the question whether nitrous oxide really should be easily, commercially available. © 2015 American Academy of Forensic Sciences.

  8. 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

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  11. 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

  12. Elements of healthy death: a thematic analysis.

    Science.gov (United States)

    Estebsari, Fatemeh; Taghdisi, Mohammad Hossein; Mostafaei, Davood; Rahimi, Zahra

    2017-01-01

    Background: Death is a natural and frightening phenomenon, which is inevitable. Previous studies on death, which presented a negative and tedious image of this process, are now being revised and directed towards acceptable death and good death. One of the proposed terms about death and dying is "healthy death", which encourages dealing with death positively and leading a lively and happy life until the last moment. This study aimed to explain the views of Iranians about the elements of healthy death. Methods: This qualitative study was conducted for 12 months in two general hospitals in Tehran (capital of Iran), using the thematic analysis method. After conducting 23 in-depth interviews with 21 participants, transcription of content, and data immersion and analysis, themes, as the smallest meaningful units were extracted, encoded and classified. Results: One main category of healthy death with 10 subthemes, including dying at the right time, dying without hassle, dying without cost, dying without dependency and control, peaceful death, not having difficulty at dying, not dying alone and dying at home, inspired death, preplanned death, and presence of a clergyman or a priest, were extracted as the elements of healthy death from the perspective of the participants in this study. Conclusion: The study findings well explained the elements of healthy death. Paying attention to the conditions and factors causing healthy death by professionals and providing and facilitating quality services for patients in the end stage of life make it possible for patients to experience a healthy death.

  13. 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.

  14. 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

  15. 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.

  16. 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.

  17. 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.)

  18. 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.

  19. 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.

  20. 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

  1. MRI of 'brain death'

    International Nuclear Information System (INIS)

    Nishino, Shigeki; Itoh, Takahiko; Tuchida, Shohei; Kinugasa, Kazushi; Asari, Shoji; Nishimoto, Akira; Sanou, Kazuo.

    1990-01-01

    Magnetic resonance imaging (MRI) was undertaken for two patients who suffered from severe cerebrovascular diseases and were clinically brain dead. The MRI system we used was Resona (Yokogawa Medical Systems, superconductive system 0.5 T) and the CT apparatus was Toshiba TCT-300. Initial CT and MRI were undertaken as soon as possible after admission, and repeated sequentially. After diagnosis of brain death, we performed angiography to determine cerebral circulatory arrest, and MRI obtained at the same time was compared with the angiogram and CT. Case 1 was a 77-year-old man who was admitted in an unconscious state. CT and MRI on the second day after hospitalization revealed cerebellar infarction. He was diagnosed as brain dead on day 4. Case 2 was a 35-year-old man. When he was transferred to our hospital, he was in cardiorespiratory arrested. Cardiac resuscitation was successful but no spontaneous respiration appeared. CT and MRI on admission revealed right intracerebral hemorrhage. Angiography revealed cessation of contrast medium in intracranial vessels in both of the patients. We found no 'flow signal void sign' in the bilateral internal carotid and basilar arteries on MRI images in both cases after brain death. MRI, showing us the anatomical changes of the brain, clearly revealed brain herniations, even though only nuclear findings of 'brain tamponade' were seen on CT. But in Case 1, we could not see the infarct lesions in the cerebellum on MR images obtained after brain death. This phenomenon was caused by the whole brain ischemia masking the initial ischemic lesions. We concluded that MRI was useful not only the anatomical display of lesions and brain herniation with high contrast resolution but for obtaining information on cerebral circulation of brain death. (author)

  2. 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

  3. 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