Male ductal carcinoma in situ presenting as bloody nipple discharge: a case report and literature review.

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Simmons, Rache M

2002-01-01

Male breast carcinoma accounts for 1% of all diagnosed breast carcinoma. Pure ductal carcinoma in situ in men is extremely rare. Unfortunately, male breast cancer is often diagnosed at a late stage because of the minimal awareness of presenting symptoms by the patient and sometimes by the health care provider. Because of this late presentation, the overall prognosis is less favorable. This case is presented to emphasize the importance of recognizing bloody nipple discharge as a clinical sign of male ductal carcinoma in situ and an opportunity for early diagnosis.

Does Ultrasound-Guided Directional Vacuum-Assisted Removal Help Eliminate Abnormal Nipple Discharge in Patients with Benign Intraductal Single Mass?

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Chang, Jung Min; Cho, Na Ri Ya; Moon, Woo Kyung [Seoul National University Hospital, Seoul (Korea, Republic of); Park, Jeong Seon [Hanyang University Hospital, Seoul (Korea, Republic of); Chung, Se Yeong [Seoul National University Boramae Hospital, Seoul (Korea, Republic of); Jang, Mi Jung [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

2009-12-15

To evaluate whether the removal of an intraductal mass using an ultrasound (US)-guided directional vacuum-assisted device can eliminate symptoms in patients presenting with abnormal nipple discharge. Between March 2004 and October 2006, 36 patients who presented with abnormal nipple discharge, underwent US-guided, 11-gauge vacuum-assisted biopsy for a benign intraductal single mass on US. The ability of the procedure to eliminate nipple discharge was evaluated by physical examination during follow-up US. Lesion characteristics, biopsy variables, and histologic features were analyzed to identify factors affecting symptom resolution. Of the 36 lesions, 25 (69%) were intraductal papillomas, 10 (28%) were fibrocystic changes, and one (3%) was a fibroadenoma. The nipple discharge disappeared in 69% (25 of 36) of the women at a mean follow-up time of 25 months (range 12-42 month). There was no difference in the lesion characteristics, biopsy variables, and the histologic features between groups that eliminated the symptom compared those with persistent nipple discharge. US-guided directional vacuum-assisted removal of an intraductal mass appears to eliminate nipple discharge in only 69% of patients and thus, it should not be considered as an alternative to surgical excision.

Galactography: the diagnostic procedure of choice for nipple discharge

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Tabar, L.; Dean, P.B.; Pentek, Z.

1983-01-01

Galactogrpahy was performed in 204 women with a nipple discharge and the secretion confirmed histopathologically. All 116 intraductal tumors (papilloma, papillomatosis, carcinoma), which were associated with a serous or bloody discharge, were detected preoperatively. A palpable mass had little diagnostic significance, and exfoliative cytology was positive in only 11% (2/18) of the patients with carcinoma. The authors recommend that all patients with a spontaneous bloody or serous discharge from a single lactiferous orifice undergo galactography in addition to physical, cytological, and mammographic examination. Intraductal injection of methylene blue dye will demonstrate the affected duct system to the surgeon and can often make surgery less radical or even unnecessary

Cytomorphology of nipple discharge and fine needle aspiration of duct papilloma

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H B Bannur

2012-01-01

Full Text Available The primary role of fine needle aspiration (FNA of the breast is the distinction between benign and malignant lesions; but in many cases, additional information may be obtained. The major breast lesions that yield papillary fragments on FNA are papillary carcinoma, papilloma, fibroadenoma, and invasive ductal carcinoma that have a papillary component. We present cytomorphological features of nipple discharge and FNA of breast lump in a 32-year female.

A nomogram based on mammary ductoscopic indicators for evaluating the risk of breast cancer in intraductal neoplasms with nipple discharge.

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Lian, Zhen-Qiang; Wang, Qi; Zhang, An-Qin; Zhang, Jiang-Yu; Han, Xiao-Rong; Yu, Hai-Yun; Xie, Si-Mei

2015-04-01

Mammary ductoscopy (MD) is commonly used to detect intraductal lesions associated with nipple discharge. This study investigated the relationships between ductoscopic image-based indicators and breast cancer risk, and developed a nomogram for evaluating breast cancer risk in intraductal neoplasms with nipple discharge. A total of 879 consecutive inpatients (916 breasts) with nipple discharge who underwent selective duct excision for intraductal neoplasms detected by MD from June 2008 to April 2014 were analyzed retrospectively. A nomogram was developed using a multivariate logistic regression model based on data from a training set (687 cases) and validated in an independent validation set (229 cases). A Youden-derived cut-off value was assigned to the nomogram for the diagnosis of breast cancer. Color of discharge, location, appearance, and surface of neoplasm, and morphology of ductal wall were independent predictors for breast cancer in multivariate logistic regression analysis. A nomogram based on these predictors performed well. The P value of the Hosmer-Lemeshow test for the prediction model was 0.36. Area under the curve values of 0.812 (95 % confidence interval (CI) 0.763-0.860) and 0.738 (95 % CI 0.635-0.841) was obtained in the training and validation sets, respectively. The accuracies of the nomogram for breast cancer diagnosis were 71.2 % in the training set and 75.5 % in the validation set. We developed a nomogram for evaluating breast cancer risk in intraductal neoplasms with nipple discharge based on MD image findings. This model may aid individual risk assessment and guide treatment in clinical practice.

Nipple Discharge: An Early Warning Sign of Breast Cancer

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Parthasarathy, Veda; Rathnam, Usharani

2012-01-01

Nipple discharge (ND) can be the earliest presenting symptom of breast cancer. We hereby present two cases of breast cancer with no palpable mass manifesting as isolated ND, which was whitish in color. In both cases, cytology of the discharge revealed highly pleomorphic cells indicating a high grade malignancy. Mammography showed diffuse, extensive microcalcifications. Simple mastectomy with axillary clearance was done. Histology in both cases revealed diffusely spreading intraductal carcinoma, with focus of microinvasion in one case. ND if scanty or not blood stained is often ignored by the patients and at times, the clinicians. This article highlights that ND can be an early warning sign of intraductal carcinomas that are non-invasive in early stage. Irrespective of the color or nature of the discharge, unilateral ND needs to be evaluated. Proper clinical assessment, cytological evaluation of the ND, and mammography ought to be performed in all such cases. Considering the low level of awareness in women regarding the warning signs of breast cancer, the current focus is to create “breast awareness.” Women should be sensitized to recognize any unusual changes in their breasts and report to their health care providers at the earliest. PMID:23189234

CT-guided thermoplastic assisted segmentectomy is an optimal breast conserving surgery for breast cancer with nipple discharge

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Makita, Masujiro; Gomi, Naoya; Tachikawa, Tomohiro

2004-01-01

Improvement of imaging by injecting contrast agents into the discharging duct and immobilizing the breast mound with a drape-type thermoplastic shell in breast conserving surgery was assessed by evaluating 96 cases of breast cancer patients with nipple discharge treated by partial mastectomy between April 1998 and August 2003. These patients were divided to three groups: Group A was treated by ordinary partial mastectomy or microdochectomy without new methods. Group B underwent contrast imaging without shell immobilization, and Group C received both shell immobilization and contrast imaging. The negative rates of surgical margins in Groups A, B and C were 19.0%, 17.2%, and 37.5%, respectively. The rates of negative ''lateral'' surgical margins in Groups A, B and C were 23.8%, 27.6%, and 50%, respectively. The rate of negative ''lateral'' surgical margins in Group C was significantly higher than that in Group A. Our findings suggest CT-guided thermoplastic assisted segmentectomy, adopting both ductography CT and immobilization by shell, is an optimal breast conserving surgery for breast cancer with nipple discharge. (author)

Nipple adenoma in a female patient presenting with persistent erythema of the right nipple skin: case report, review of the literature, clinical implications, and relevancy to health care providers who evaluate and treat patients with dermatologic conditions of the breast skin.

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Spohn, Gina P; Trotter, Shannon C; Tozbikian, Gary; Povoski, Stephen P

2016-05-20

Nipple adenoma is a very uncommon, benign proliferative process of lactiferous ducts of the nipple. Clinically, it often presents as a palpable nipple nodule, a visible nipple skin erosive lesion, and/or with discharge from the surface of the nipple skin, and is primarily seen in middle-aged women. Resultantly, nipple adenoma can clinically mimic the presentation of mammary Paget's disease of the nipple. The purpose of our current case report is to present a comprehensive review of the available data on nipple adenoma, as well as provide useful information to health care providers (including dermatologists, breast health specialists, and other health care providers) who evaluate patients with dermatologic conditions of the breast skin for appropriately clinically recognizing, diagnosing, and treating patients with nipple adenoma. Fifty-three year old Caucasian female presented with a one year history of erythema and induration of the skin of the inferior aspect of the right nipple/areolar region. Skin punch biopsies showed subareolar duct papillomatosis. The patient elected to undergo complete surgical excision with right central breast resection. Final histopathologic evaluation confirmed nipple adenoma. The patient is doing well 31 months after her definitive surgical therapy. Since nipple adenoma represents a benign proliferative process of the nipple, complete surgical excision is curative. However, the coexistence of nipple adenoma and ipsilateral or contralateral breast cancer is well reported in the literature. The potential for a direct causal link or association of nipple adenoma and breast cancer cannot be fully excluded.

Galactographic differentiation between malignant and benign disease in patients with pathologic nipple discharge

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Cho, Nariya; Cho, Hyun Yee [Gil Medical Center, Incheon (Korea, Republic of); Oh, Ki Keun [Yonsei University College of Medicine, Seoul (Korea, Republic of)

2003-06-01

To compare the galactographic findings of malignant and benign disease in patients with pathologic nipple discharge and to analyze the features suggesting malignancy. In 24 patients in whom pathologic nipple discharge had occurred, the findings of preoperative galactography were correlated with those of pathology. Nine of the 24 cases were malignant and the other 15 were benign. Intraductal calcification occurred in five malignant cases (56%) and two (13%) which were benign. Seven malignant cases (78%) involved the segmental ducts, and in eight (89%), the peripheral ducts below the subsegmental duct were involved. Five benign cases (33%) involved the lactiferous sinus, seven (47%) the segmental duct, and two (13%) the subsegmental duct. Distal duct dilatation occurred in four benign cases (27%), while ductal stenosis was noted in six cases (67%) and ductal distortion in seven (78%). A malignant tumor appeared as a multiple (n=5, 56%) or irregular (n=5, 56%) filling defect, and a benign tumor as a single (n=12, 80%), oval (n=6, 40%) or lobular (n=4, 27%) filling defect. At galactography, a malignant tumor frequently appeared as an irregular multiple intraductal filling defect in a peripheral duct. A benign tumor, on the other hand, appeared as an oval or lobular single lesion. The presence of ductal stenosis, distortion and intraductal microcalcifications not opacified by contrast material suggest possible malignancy.

The man with bilateral nipple pain

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Hong Hooi Chuen

2013-12-01

Full Text Available Figure 1 is a picture of a 48-year-old male patient who presents with progressive painful enlargement of the areolae of 10 months’ duration. There was no bleeding or nipple discharge. He was diagnosed with human immunodeficiency virus (HIV infection 16 months ago and was initiated on antiretroviral therapy (ARV, which consisted of zidovudine, lamivudine and efavirenz. As his CD4 cell count at diagnosis was less than 200 cells/mm3, he was prescribed trimethoprim-sulphamethoxazole (Bactrim for prophylaxis against pneumonia due to pneumocystis jirovecii. Physical examination was unremarkable except for bilateral breast enlargement and right-sided old shingles scar in the T4 dermatome distribution.

[Management of breast nipple discharge: Recommendations].

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Ouldamer, L; Kellal, I; Legendre, G; Ngô, C; Chopier, J; Body, G

2015-12-01

To investigate diagnostic value of imaging procedures and management strategies of the patients with nipple discharge (ND) to establish management recommendations. Bibliographical search in French and English languages by consultation of PubMed, Cochrane and Embase databases. Although, all ND require an systematic evaluation guided by clinical data, bloody ND could be a predictor of breast cancer risk among different colors of discharge particularly in patients of more than 50 years (LE2). The mammography and breast ultrasography are the imaging procedures to realize in first intention (grade C) but they turn out useful only when they detect radiological abnormalities (LE4). Galactography has only a localizing value of possible ductal abnormalities (when standard imaging procedures is not contributive) (LE4). Thus, in the diagnostic investigation of a suspicious ND, galactography it is not recommended in standard practice (grade C). The breast Magnetic Resonance Imaging (MRI) is recommended when breast standard imaging procedures are not contributive (grade C). The ND cytology is useful only if it is positive (i.e. reveal cancer cells). There is no proof on the diagnostic performance of the cytological analysis of the ND to allow a recommendation on its realization or not. In front of a suspicious ND, when breast-imaging procedures reveals an associated radiological lesion, an adapted percutaneous biopsy is recommended by percutaneous way (grade C). Vacuum-assisted breast biopsies is a diagnostic tool but can also be therapeutic allowing to avoid surgery in case of benign lesion but current literature data do not allow recommendations on the therapeutic aspect of vacuum-assisted breast biopsy (LE4). In the absence of associated radiological signal, and in case of reproducible bloody persistent ND, a pyramidectomy is recommended (grade C). Copyright © 2015 Elsevier Masson SAS. All rights reserved.

A novel duct-lobular segmentectomy for breast tumors with nipple discharge using near-infrared indocyanine green fluorescence imaging

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Tsuyoshi Ohno

2013-10-01

Full Text Available A 44-year-old woman was referred to our hospital with pathological nipple discharge from her left breast. Ultrasonography revealed a solid tumor beneath her left areola that measured 17 mm in diameter with a dilated mammary duct. Contrast-enhanced magnetic resonance imaging showed an early-enhanced cystic tumor and a dilated mammary duct. We performed a duct-lobular segmentectomy using near-infrared indocyanine green (ICG-fluorescence imaging. Under general anesthesia, a silicone tube was inserted into an orifice of a fluid-discharging mammary duct, and 1 mL dye-fluorescence liquid containing ICG and indigo carmine was injected into the mammary duct. A periareolar incision was made, and the fluorescence image of the demarcated mammary duct segment was obtained. The mammary duct segment was dissected, along with the demarcation line. The cystic lesion and dilated mammary duct were fully resected, and the pathological diagnosis was intraductal papilloma of the breast. We report that near-infrared ICG fluorescence could be applied for imaging of the mammary duct segment, and the fluorescence image allowed for easier duct-lobular segmentectomy for nipple discharge.

Nipple Reduction With the Chullo-Hat Technique.

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Sim, Hyung-Bo; Sun, Sang-Hoon

2015-08-01

Although various techniques of nipple reduction have been described in the literature, many are difficult to design or have unreliable outcomes. For men, as well as women who do not plan to breastfeed, it is not necessary to apply a complicated technique that protects the lactiferous ducts. The authors introduce a simple technique for nipple reduction that has achieved consistent, reproducible results. The desired nipple length is marked, and a chullo-hat excision pattern is drawn. After infiltration of a local anesthetic solution around the nipple, excision of the excess nipple tissue is performed, comprising 2 triangular flaps. The remaining 2 pillars are approximated with 5-0 Nylon simple interrupted sutures. However, the wound is not completely closed in the central area of the nipple, which promotes the drainage of discharge. Fifty-three women (106 nipples) underwent this surgery between December 2009 and December 2013. The follow-up period ranged from 6 months to 2 years (mean, 10 months). No major complications occurred, and the scars were very inconspicuous. The postoperative appearance of nipples was consistently similar in size and shape. This simple technique was safe and effective in nipples of different sizes. The results were reliable and consistent with expectations. Although this study included only women, the authors believe that outcomes would be successful in men as well. 4 Therapeutic. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

Bilateral extensive ductitis obliterans manifested by bloody nipple discharge in a patient with long-term diabetes mellitus.

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Wang, Zhiqin; Leonard, Morton H; Khamapirad, Tuenchit; Castro, Claudia Y

2007-01-01

Ductitis obliterans or mastitis obliterans is a rare late manifestation of mammary ductal ectasia. We describe a long-term diabetic patient who presented with bilateral bloody nipple discharge and poorly defined nodularities around the nipple of both breasts. The ductography showed multiple segments of irregular ductal narrowing and intraluminal filling defects in both breasts. The bilateral resection of the sub-areolar portion of the breast showed exuberant fibrous obliteration of the large- and medium-sized ducts by granulation tissue associated with few histiocytes. Ductal dilatation and intraductal accumulation of histiocytes was also present. This represents a late and florid form of mammary ductal ectasia. Differential diagnostic considerations including fibrocystic changes, diabetic sclerosing lymphocytic lobulitis, idiopathic granulomatous lobular mastitis, and periductal mastitis (Zuska disease) are discussed. Accurate diagnosis can help avoid or limit radical surgeries in this group of patients.

The Effects of Different Breastfeeding Training Techniques Given for Primiparous Mothers Before Discharge on the Incidence of Cracked Nipples.

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Eksioglu, Aysun; Yesil, Yesim; Demir Gungor, Dilek; Ceber Turfan, Esin

2017-06-01

This research investigated the effects of different breastfeeding training techniques for primiparous mothers before discharge on the incidence of cracked nipples. This was a controlled intervention study that was carried out between 2015 and 2016 on 90 mothers living in İzmir. The mothers were divided into three groups: the demonstration-based training group, brochure group, and routine care-receiving group. The mothers in the "brochure group" were provided with breastfeeding training brochures. Mothers in the demonstration-based training group received one-to-one training using designed doll and puppet tools. The rate of cracked nipples at age 2 weeks was 63.3% in the routine care-receiving group, 56.7% in the brochure group, and 20% in the demonstration-based training group. At the end of the fourth week, the rate was 30% in the routine care-receiving group and less than 10% in the other two groups (p raining group than in the other two groups (p roups in the percentage of exclusive breastfeeding. The results documented that breastfeeding training based on one-to-one demonstration utilizing specially designed audiovisual tools was more effective than the other two methods in the prevention of nipple cracks.

A Novel Nipple Reconstruction Technique for Maintaining Nipple Projection: The Boomerang Flap

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Young-Eun Kim

2016-09-01

Full Text Available Nipple-areolar complex (NAC reconstruction is the final step in the long journey of breast reconstruction for mastectomy patients. Successful NAC reconstruction depends on the use of appropriate surgical techniques that are simple and reliable. To date, numerous techniques have been used for nipple reconstruction, including contralateral nipple sharing and various local flaps. Recently, it has been common to utilize local flaps. However, the most common nipple reconstruction problem encountered with local flaps is the loss of nipple projection; there can be approximately 50% projection loss in reconstructed nipples over long-term follow-up. Several factors might contribute to nipple projection loss, and we tried to overcome these factors by performing nipple reconstructions using a boomerang flap technique, which is a modified C–V flap that utilizes the previous mastectomy scar to maintain long-term nipple projection.

A Novel Nipple Reconstruction Technique for Maintaining Nipple Projection: The Boomerang Flap.

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Kim, Young-Eun; Hong, Ki Yong; Minn, Kyung Won; Jin, Ung Sik

2016-09-01

Nipple-areolar complex (NAC) reconstruction is the final step in the long journey of breast reconstruction for mastectomy patients. Successful NAC reconstruction depends on the use of appropriate surgical techniques that are simple and reliable. To date, numerous techniques have been used for nipple reconstruction, including contralateral nipple sharing and various local flaps. Recently, it has been common to utilize local flaps. However, the most common nipple reconstruction problem encountered with local flaps is the loss of nipple projection; there can be approximately 50% projection loss in reconstructed nipples over long-term follow-up. Several factors might contribute to nipple projection loss, and we tried to overcome these factors by performing nipple reconstructions using a boomerang flap technique, which is a modified C-V flap that utilizes the previous mastectomy scar to maintain long-term nipple projection.

Nipple-Sparing Mastectomy Improves Long-Term Nipple But Not Skin Sensation After Breast Reconstruction: Quantification of Long-Term Sensation in Nipple Sparing Versus Non-nipple Sparing Mastectomy.

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Rodriguez-Unda, Nelson A; Bello, Ricardo J; Clarke-Pearson, Emily M; Sanyal, Abanti; Cooney, Carisa M; Manahan, Michele A; Rosson, Gedge D

2017-06-01

Changes in breast sensation after reconstruction are expected. Return of breast sensation after reconstruction and whether nipple-sparing mastectomy offers a substantial benefit in terms of sensation has been inconsistently documented in the literature. We conducted the current study using the pressure-specified sensory device to quantify postoperative breast sensation in patients undergoing nipple-sparing versus non-nipple-sparing mastectomy. Consecutive adult women who underwent nipple-sparing (NSM) and non-NSM (NNSM) and were at least 18 months postreconstruction were included. Breast measurements were taken in 4 quadrants (upper/lower lateral, upper/lower medial) and nipple. Averaged skin cutaneous thresholds [(UL+LL+UM+LM)/4] and nipple sensation between NSM and NNSM were compared as the primary outcome measure. A generalized estimating equations model was used; univariate and multivariate variable analyses were done when appropriate. Forty-four patients (74 breasts) were examined (53 NNSM vs 21 NSM). The groups were further subdivided into autologous versus implant-based reconstruction. Averaged cutaneous skin thresholds for quadrants were better for the NSM, 51.8(±24.5) g/mm versus NNSM, 56.5(±25.7) g/mm, although this difference was not statistically significant. However, NSM breasts measured higher nipple or nipple area sensitivity, 44.5(±30.8) g/mm versus NNSM, 83.8(±27.4) g/mm (P sensation was the number of revision surgeries, especially after third revision. Breast sensation is decreased after reconstruction in both NSM and NNSM, but nipple sensation or nipple area is better preserved in NSM breasts. Number of revision surgeries (>3) was a predictor of decreased sensation.

Nipple placement in simple mastectomy with free nipple grafting for severe gynecomastia.

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Murphy, T P; Ehrlichman, R J; Seckel, B R

1994-11-01

Severe gynecomastia with excessive skin is difficult to treat by only periareolar excision or suction-assisted lipectomy or both. In these patients, total mastectomy and free nipple grafting may be the best option. Placement of the nipple, however, has been arbitrary. With use of 20 "aesthetically perfect" men as models, standard nipple distances were identified. The average sternal notch-to-nipple measurement was 21 cm. In addition, two consistent ratios were identified. The nipple plane was located 0.33 times the distance from the sternal notch to the pubis, and the internipple distance was 0.23 times the chest circumference. With use of preoperatively obtained measurements of the sternal notch to pubis and chest circumference, accurate nipple placement can be accomplished.

Effects of menthol essence and breast milk on the improvement of nipple fissures in breastfeeding women

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Sedigheh Amir Ali Akbari

2014-01-01

Full Text Available Background: Nipple fissure is a common disorder during breastfeeding. With high prevalence of nipple fissures and its impacts on breastfeeding, as well as the existence of evidence in favor of the application of peppermint as an antiinflammatory and antiinfection herb, the purpose of this study is to determine the effect of Menthol essence on improving nipple fissures in the primiparous breastfeeding women. Materials and Methods: This study was conducted using a clinical trial method. Samples were divided randomly into two groups of 55 women. The women in the peppermint group applied four drops of Menthol essence on their nipple and areola after each feeding. The control group applied four drops of their own milk on the nipple and areola after each feeding. Then, the two groups were studied on days 10 and 14 postpartum. For intensity of pain, the visual analog scale (0-10 cm and to measure the severity of damage, Amir scale (1-10 cm were applied and the existence or lack of nipple discharge was also recorded. The data were analyzed using SPSS 17 software. Results: The mean intensity of pain and nipple fissure before treatment (8.55 ± 1.74 and day 10 after delivery (4.26 ± 1.57 and before treatment and day 14 after delivery in the case group (1.32 ± 1.02 had a significant difference (P < 0.001. Nipple discharge between the two groups, before treatment (%75.2 and day 10 after delivery (%31.6 and before treatment and day 14 after delivery (%15.7, the case group had a significant difference (P < 0.001. Conclusion: Menthol essence can improve nipple fissures in the primiparous breastfeeding women.

Paget disease of the male nipple.

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El Harroudi, T; Tijami, F; El Otmany, A; Jalil, A

2010-01-01

Breast cancer occurring in the mammary gland of men is infrequent. It accounts for 0.8% of all breast cancers, which is less than one per cent of all newly diagnosed male cancers and 0.2% of male cancer deaths. However, Paget disease of the male nipple is extremely rare. We report a single case of Paget disease with infiltrative ductal carcinoma of the breast in a 61-year-old man.

Hyperkeratosis of the nipple and areola.

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Kuhlman, D S; Hodge, S J; Owen, L G

1985-10-01

Hyperkeratosis of the nipple and areola is a rare condition. We report two cases of hyperkeratosis of the nipple and areola occurring in men with no underlying endocrinopathy or synthetic estrogenic drug therapy. Both patients demonstrated prompt resolution of the hyperkeratosis of the nipples with a keratolytic gel. Because our cases were not associated with ichthyosis or epidermal nevus, they best fit into the category of nevoid hyperkeratosis of the nipples.

Magnetic resonance imaging in patients with nipple discharge: should we recommend it?

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Lorenzon, Michele; Zuiani, Chiara; Linda, Anna; Londero, Viviana; Girometti, Rossano; Bazzocchi, Massimo

2011-01-01

Comparing the sensitivity of Contrast-Enhanced Magnetic Resonance Imaging (CEMRI), mammography and ultrasonography in patients with nipple discharge (ND). We retrospectively evaluated 38 women with ND who underwent mammography, ultrasound and 1.5 T CEMRI between March 2007 and July 2009. Imaging findings, pathological diagnosis and follow-up data (mean follow-up: 20 months) were compared. Sensitivity and specificity values were reckoned. Statistical differences in sensitivity were assessed. 5/38 malignancies (13.2%; 3 invasive, 2 intraductal; 4 ipsilateral, 1 contralateral to ND), and 14/38 High-Risk Lesion (HRL - 36.8%; 11 intraductal papillomas, 1 papilloma with LCIS, 1 sclerosing papilloma and 1 atypical intraductal hyperplasia, all ipsilateral) were found. CEMRI identified 5/5 cancers and 13/14 HRL (Overall Sensitivity - OSS = 94.7%; Overall Specificity - OSP = 78.9%). 3/5 cancers (1 invasive, 1 in-situ; 1 invasive contralateral) and 2/14 HRL were detected by CEMRI only. Mammography found 2/5 cancer and 3/14 HRL (OSS = 26.3%; OSP = 94.7%). Ultrasound identified 1/5 cancer and 11/14 HRL (OSS = 63.2%; OSP = 84.2). 1/14 HRL was detected by ultrasound only. Compared with mammography and ultrasound, CEMRI showed statistically significantly higher OSS values (p < 0.0001, p = 0.042 respectively). In women with ND, CEMRI should be recommended when conventional imaging is negative. Unexplained ND could be considered an indication for CEMRI. (orig.)

The use of nipple shields: A review

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Selina Chow

2016-11-01

Full Text Available A nipple shield is a breastfeeding aid with a nipple-shaped shield that is positioned over the nipple and areola prior to nursing. Nipple shields are usually recommended to mothers with flat nipples or in cases in which there is a failure of the baby to effectively latch onto the breast within the first two days postpartum. The use of nipple shields is a controversial topic in the field of lactation. Its use has been an issue in the clinical literature since some older studies discovered reduced breast milk transfer when using nipple shields, while more recent studies reported successful breastfeeding outcomes. The purpose of this review was to examine the evidence and outcomes with nipple shield use. Methods: A literature search was conducted in Ovid MEDLINE, OLDMEDLINE, EMBASE Classic, EMBASE, Cochrane Central Register of Controlled Trials and CINAHL. The primary endpoint was any breastfeeding outcome following nipple shield use. Secondary endpoints included the reasons for nipple shield use and the average/median length of use. For the analysis, we examined the effect of nipple shield use on physiological responses, premature infants, mothers’ experiences, and health professionals’ experiences. Results: The literature search yielded 261 articles, 14 of which were included in this review. Of these 14 articles, three reported on physiological responses, two reported on premature infants, eight reported on mothers’ experiences, and one reported on health professionals’ experiences. Conclusion: Through examining the use of nipple shields, further insight is provided on the advantages and disadvantages of this practice, thus allowing clinicians and researchers to address improvements on areas that will benefit mothers and infants the most.

Duodenal ileus caused by a calf feeding nipple in a cow

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Gerspach Christian

2011-01-01

Full Text Available Abstract Background The aim of this report was to describe duodenal obstruction caused by a rubber foreign body in a cow. Case Presentation The clinical, biochemical and ultrasonographic findings in a five-year-old Swiss Braunvieh cow with duodenal ileus caused by a calf feeding nipple are described. The main clinical signs were anorexia, ruminal tympany, decreased faecal output and abomasal reflux syndrome. Ultrasonographic examination revealed reticular hyperactivity and a dilated duodenum. A diagnosis of duodenal ileus was made and the cow underwent right-flank laparotomy, which revealed a dilation of the cranial part of the duodenum because of obstruction by a pliable foreign body. This was identified via enterotomy as a calf feeding nipple. The cow was healthy at the time of discharge four days after surgery and went on to complete a successful lactation. Conclusions To our knowledge, this is the first description of duodenal obstruction by a calf feeding nipple. This is an interesting case, which broadens the spectrum of the causes of duodenal ileus, which is usually caused by obstruction of the duodenum by a phytobezoar.

Molluscum contagiosum of nipple

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Nisha Marwah

2012-01-01

Full Text Available Molluscum contagiosum is a virus-induced dermatologic condition causing characteristic pearly lesions on the surface of skin. The lesion is common in children. In adults, it is usually a sexually transmitted disease. Molluscum contagiosum may be found anywhere on the body, although it rarely occurs on the palms and soles. Dermatosis of nipple due to molluscum contagiosum is rare. If it occurs, it is accompanied by lesions in other sites. Isolated involvement of nipple by the virus is unusual and has been reported only once in previous literature to the best of our knowledge. Here, we report this unusual case of isolated molluscum contagiosum of nipple in 30-year-old female.

Is chronic nipple piercing associated with hyperprolactinemia?

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Sun, Grace E Ching; Pantalone, Kevin M; Gupta, Manjula; Kennedy, Laurence; Nasr, Christian; Constantiner, Marigel; Hamrahian, Amir H; Hatipoglu, Betul

2013-09-01

Literature on hyperprolactinemia in the setting of a nipple piercing is limited to individuals with concomitant breast/chest wall infection. It is unclear if chronic nipple stimulation from a piercing alone can cause sustained elevations of serum prolactin. Nipple piercing is emerging as a more mainstream societal form of body art, and the answer to this clinical question would potentially alter patient management. Our aim was to assess serum prolactin levels in subjects with nipple piercing. Inclusion criteria were as follows: men and women ≥ 18 years old with nipple piercing(s) present > 6 months. Exclusion criteria included: women who are pregnant, lactating or men and eight women were enrolled. Median (range) ages for men and women were 33 (24-42) and 27 years (23-42), respectively. All except one subject had bilateral piercings. The median interval from nipple piercing to blood draw was 4.0 (2.0-12.0) years. None of the subjects had hyperprolactinemia. Median (range) prolactin levels for men and women were 5.6 ng/mL (3.8-7.4) and 8.0 ng/mL (2.8-10.9), respectively. Our results suggest that in the absence of any concomitant infection, chronic nipple piercing is not associated with hyperprolactinemia.

21 CFR 880.5640 - Lamb feeding nipple.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Lamb feeding nipple. 880.5640 Section 880.5640 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... Devices § 880.5640 Lamb feeding nipple. (a) Identification. A lamb feeding nipple is a device intended for...

Computerized nipple identification for multiple image analysis in computer-aided diagnosis

International Nuclear Information System (INIS)

Zhou Chuan; Chan Heangping; Paramagul, Chintana; Roubidoux, Marilyn A.; Sahiner, Berkman; Hadjiiski, Labomir M.; Petrick, Nicholas

2004-01-01

Correlation of information from multiple-view mammograms (e.g., MLO and CC views, bilateral views, or current and prior mammograms) can improve the performance of breast cancer diagnosis by radiologists or by computer. The nipple is a reliable and stable landmark on mammograms for the registration of multiple mammograms. However, accurate identification of nipple location on mammograms is challenging because of the variations in image quality and in the nipple projections, resulting in some nipples being nearly invisible on the mammograms. In this study, we developed a computerized method to automatically identify the nipple location on digitized mammograms. First, the breast boundary was obtained using a gradient-based boundary tracking algorithm, and then the gray level profiles along the inside and outside of the boundary were identified. A geometric convergence analysis was used to limit the nipple search to a region of the breast boundary. A two-stage nipple detection method was developed to identify the nipple location using the gray level information around the nipple, the geometric characteristics of nipple shapes, and the texture features of glandular tissue or ducts which converge toward the nipple. At the first stage, a rule-based method was designed to identify the nipple location by detecting significant changes of intensity along the gray level profiles inside and outside the breast boundary and the changes in the boundary direction. At the second stage, a texture orientation-field analysis was developed to estimate the nipple location based on the convergence of the texture pattern of glandular tissue or ducts towards the nipple. The nipple location was finally determined from the detected nipple candidates by a rule-based confidence analysis. In this study, 377 and 367 randomly selected digitized mammograms were used for training and testing the nipple detection algorithm, respectively. Two experienced radiologists identified the nipple locations

Cost and quality implications of discrepancies between admitting and discharge diagnoses.

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McNutt, Robert; Johnson, Tricia; Kane, Jason; Ackerman, Mariel; Odwazny, Richard; Bardhan, Jaydeep

2012-01-01

Presenting and discharge diagnoses of hospitalized patients may differ as a result of patient complexity, diagnostic dilemmas, or errors in clinical judgment at the time of primary assessment. When diagnoses at admission and discharge are not in agreement, this discrepancy may indicate more complex processes of care and resultant costs. It is unclear whether surrogate measures reflecting quality of care are impacted by discrepant diagnoses. To assess whether an association exists between admitting and discharge International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes and other quality markers including hospital length of stay, total cost of care, and 30-day readmission rate. This was a retrospective, cross-sectional analysis of general internal medicine patients aged 18 years and older. Diagnosis discrepancy was defined as a difference between the 3-digit ICD-9 diagnosis code at admission and the principal 3-digit ICD-9 diagnosis code at discharge. Sixty-eight percent of patients had a diagnosis discrepancy. Diagnosis discrepancy was associated with a 0.41-day increase in length of stay (P < .001), $663 increase in direct costs (P < .001), and a 1.55 times greater odds of readmission within 30 days (P < .001). Diagnosis discrepancy was associated with hospital quality outcome measures. This finding likely reflects variations in patients' diagnostic complexity.

Appropriate location of the nipple-areola complex in males.

Science.gov (United States)

Shulman, O; Badani, E; Wolf, Y; Hauben, D J

2001-08-01

Gynecomastia is a common deformity encountered by plastic surgeons. The appropriate location of the nipple-areola complex is a major determinant of the aesthetic success of the procedure. To study the natural location of the nipple-areola complex in the normally built male, 50 nonobese men with no evidence of gynecomastia and an average age of 27.9 years were examined. Three ratios were calculated and found to be relatively constant; they were the ratio between the height of the nipple and the height of the patient, the ratio between the distance between the nipples and chest circumference, and the ratio between the suprasternal notch-to-nipple distance and the height of the patient. Using these three parameters, a method of locating the nipple-areola complex on the male chest wall was devised. The method is advocated as a reliable, simple, and useful technique.

Galactography paper in the handling of patient with secretion for the nipple: Comparison with cytology

International Nuclear Information System (INIS)

Gonzalez C, Aurelio; Ortiz U, Jaime Eduardo; Patino P, Jairo Hernando; Diaz G, Constanza

1993-01-01

It was done galactography and cytology in 30 patients with spontaneous secretion through the nipple. The haematic secretion was the most frequent (43.3%). the fibrocystic changes were the most common case of diagnosed telorrea by the two methods (60% by galactography and 56.7% by cytology), which coincide in the papilloma diagnose in 50% of the cases and in the 70,6% in the non-tumoral benign pathology diagnose. The galactography continues being the elected method to evaluate the patients with haematic secretion, keeping the cytology as a complementary exam

Nipple adenoma in a 2-year-old boy.

Science.gov (United States)

Fujisawa, Kou; Kato, Motoi; Kono, Tatsuki; Utsunomiya, Hiroki; Watanabe, Azusa; Watanabe, Shoji

2018-05-01

Nipple adenoma is an uncommon proliferative process of the breast and predominantly occurs in women aged 40-50. Its incidence is extremely low in men, and it has not been reported in a boy. Although nipple adenoma is rare and benign, being familiar with it is important because it clinically resembles Paget disease and histologically adenocarcinoma. We report a case of nipple adenoma in a boy. © 2018 Wiley Periodicals, Inc.

Primary Buttonhole Mastopexy and Nipple-Sparing Mastectomy: A Preliminary Report.

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Salibian, Arthur H; Harness, Jay K; Mowlds, Donald S

2016-10-01

Patients undergoing nipple-sparing mastectomy and immediate-implant based reconstruction occasionally require a mastopexy based on their breast size and degree of ptosis. Previous reports have shown the feasibility of mastopexy-nipple-sparing mastectomy in selected patients to raise the nipple up to 5 cm. Major mastopexy with nipple transposition more than 6 cm in conjunction with nipple-sparing mastectomy for therapeutic indications has not been described. The authors review their experience with primary buttonhole mastopexy performed in conjunction with nipple-sparing mastectomy. Between 2008 and 2014, 16 patients (32 breasts) underwent bilateral primary mastopexy and nipple-sparing mastectomy with immediate staged implant-based reconstruction. The Passot buttonhole technique was used for the mastopexy in all patients, raising the nipple from 7 to 12 cm. Tumor-related data, risk factors, breast size, degree of ptosis, expander size, fill volume, selection criteria, and complications are discussed. The average follow-up period was 33 months (range, 14 to 80 months). There were no tumor recurrences, and all patients completed their reconstruction. Two patients required removal of the expander and delayed reconstruction because of infection and implant exposure due to nipple-areola loss. The reasons for nipple-areola loss and technical modifications to enhance skin viability by retaining a thin layer of subareolar breast tissue for removal during the second-stage implant exchange are discussed. Primary mastopexy using the buttonhole technique performed together with nipple-sparing mastectomy is a safe procedure with predictable results in patients with very large or ptotic breasts requiring lifts greater than 6 cm. The success of the combined procedure depends on preserving a thin layer of subareolar breast tissue and removing it at the time of implant exchange.

Acellular dermal matrix based nipple reconstruction: A modified technique

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Raghavan Vidya

2017-09-01

Full Text Available Nipple areolar reconstruction (NAR has evolved with the advancement in breast reconstruction and can improve self-esteem and, consequently, patient satisfaction. Although a variety of reconstruction techniques have been described in the literature varying from nipple sharing, local flaps to alloplastic and allograft augmentation, over time, loss of nipple projection remains a major problem. Acellular dermal matrices (ADM have revolutionised breast reconstruction more recently. We discuss the use of ADM to act as a base plate and strut to give support to the base and offer nipple bulk and projection in a primary procedure of NAR with a local clover shaped dermal flap in 5 breasts (4 patients. We used 5-point Likert scales (1 = highly unsatisfied, 5 = highly satisfied to assess patient satisfaction. Median age was 46 years (range: 38–55 years. Nipple projection of 8 mm, 7 mm, and 7 mms were achieved in the unilateral cases and 6 mm in the bilateral case over a median 18 month period. All patients reported at least a 4 on the Likert scale. We had no post-operative complications. It seems that nipple areolar reconstruction [NAR] using ADM can achieve nipple projection which is considered aesthetically pleasing for patients.

Metastatic syringoid eccrine carcinoma of the nipple

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Ballardini P

2012-07-01

Full Text Available Pierluigi Ballardini,1 Guido Margutti,1 Massimo Pedriali,2 Patrizia Querzoli21Department of Internal Medicine, Hospital of the Delta, Lagosanto, 2Institute of Pathology, S Anna Hospital, Ferrara, ItalyAbstract: Syringoid eccrine carcinoma is a very rare skin tumor. Herein we describe a 72-year-old male patient presenting with a syringoid eccrine carcinoma of the nipple with associated axillary lymph node metastases. Surgery associated with adjuvant radiotherapy was performed. To the best of our knowledge, this is the first case of syringoid eccrine carcinoma of the nipple ever reported.Keywords: syringoid carcinoma, nipple, axillary metastases, radiotherapy

Polyurethane Foam Wound Dressing Technique for Areola Skin Graft Stabilization and Nipple Protection After Nipple-Areola Reconstruction.

Science.gov (United States)

Satake, Toshihiko; Muto, Mayu; Nagashima, Yu; Haga, Shoko; Homma, Yuki; Nakasone, Reiko; Kadokura, Marina; Kou, Seiko; Fujimoto, Hiroshi; Maegawa, Jiro

2018-04-01

We describe a new wound management technique using a soft dressing material to stabilize the areola skin graft and protect the nipple after nipple-areola reconstruction at the final stage of breast reconstruction. We introduced a center-fenestrated multilayered hydrocellular polyurethane foam dressing material that provides adequate pressure and retains a moist environment for a smooth skin graft "take." Moreover, the reconstructed nipple can be monitored at any time through the fenestrated window for adequate blood circulation. Altogether, this simple and inexpensive wound dressing technique improves the clinical outcome. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Surgical outcomes and nipple projection using the modified skate flap for nipple-areolar reconstruction in a series of 422 implant reconstructions.

Science.gov (United States)

Zhong, Toni; Antony, Anu; Cordeiro, Peter

2009-05-01

Numerous techniques have been used in an attempt to achieve long-term nipple projection following nipple-areolar reconstruction (NAR). A common setback, however, is the diminution of projection over time; this phenomenon is particularly evident following implant based breast reconstruction. The purpose of this report was thus to evaluate surgical outcomes and long-term nipple projection with the use of "modified skate flap" technique in exclusively implant based postmastectomy reconstructions. A retrospective review was performed for the period between 1993 and 2007. All consecutive patients with 2-staged tissue expander/implant reconstructions followed by NAR using the modified skate flap technique performed by the senior author (P.C.) were identified in a prospectively maintained breast reconstruction database. Only patients with a minimum of 1-year follow-up were included in the study. Patients with a history of irradiation to the breast were excluded from nipple projection assessment. Clinical outcome measurements included long-term nipple projection as well as incidence of complications from the NAR procedure using the modified skate flap technique. Over the 15-year study period, 475 patients underwent 2-staged tissue expander/implant reconstruction followed by NAR using the modified skate flap technique. Of these, there was a total of 292 patients with the minimum requirement of 1-year follow-up post NAR (61% follow-up rate). The total number of reconstructed nipple areolar complexes evaluated in this series was 422 (130 bilateral and 162 unilateral NAR). Forty patients (28 unilateral and 12 bilateral NAR) who received radiation to their breasts were excluded from nipple projection assessment. At a median follow-up of 44 months (range: 12-84 months), mean nipple projection was 2.5 mm (range: 1-4 mm). Minor complications occurred in 7.2% of the patients (n = 292). Skin graft donor site dehiscence was the most common complication (3.1%) followed by partial skin

An anatomic study of nipple position and areola size in Asian men.

Science.gov (United States)

Kasai, Shogo; Shimizu, Yusuke; Nagasao, Tomohisa; Ohnishi, Fumio; Minabe, Toshiharu; Momosawa, Akira; Kishi, Kazuo

2015-02-01

In planning gender-reassignment surgery for biological women and treating men with gynecomastia, surgeons must have a thorough understanding of anatomically correct nipple positions and appropriate areola sizes in men. The authors sought to determine whether body height or body mass index (BMI) affects nipple position or areola size in men. Anatomic measurements of the nipples and areolae of 50 Japanese men were obtained. A relative coordinate system was defined, where the medial-lateral and superior-inferior positions of the nipple were quantitatively indicated by distance ratios between anatomic landmarks. Nipple positions were evaluated for each patient by referring to this coordinate system, and the positions were compared between groups categorized by body height or BMI. Nipple position was not significantly affected by body height. However, the nipple tended to be located more laterally in participants with higher BMI. The vertical nipple position differed between standing and supine positions. Tall men had larger areolae than short men; however, areola size did not differ with respect to BMI. Nipple position and areola size vary by body shape. Consideration of the differences is recommended when performing procedures such as female-to-male gender-reassignment surgery or correction of gynecomastia. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

Nipple piercing may be contraindicated in male patients with chest implants.

Science.gov (United States)

de Kleer, N; Cohen, M; Semple, J; Simor, A; Antonyshyn, O

2001-08-01

The authors present a man who underwent chest augmentation and nipple piercing. The patient developed chronic nipple infection, which led to unnecessary invasive diagnostic procedures, serious implant infection, and eventually urgent explantation. This unfavorable scenario illustrates the distinct features of the procedure in men, which includes close proximity of the nipple to the implant and reduced awareness by health care providers. Based on this case the authors recommend avoiding nipple piercing in men with chest implants.

Basal cell carcinoma of the nipple-areola complex.

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Ferguson, Mark S; Nouraei, S A Reza; Davies, Ben J H; McLean, N R

2009-11-01

Basal cell carcinoma (BCC) of the nipple-areola complex is uncommon. It has been suggested that BCCs in this region behave more aggressively, with a higher potential for distant spread, than in other anatomical sites. To address questions about etiology, behavior, optimal treatment, and prognosis of this entity. A literature search identifying all cases of BCC of the nipple and nipple-areola complex in the English literature from 1893 to 2008. Thirty-four cases of BCC of the nipple, areola, or both were identified, mostly affecting middle-aged men. The majority of patients were treated with tissue-sparing surgery. There was a metastatic rate of 9.1%, and one patient died from the disease (3.0%). The optimal treatment of this condition should be local excision, but patients with this condition should be followed up for primary site recurrence and axillary metastasis, because there is greater incidence than with BCC at other anatomical sites. Furthermore, proven axillary metastasis should be surgically treated.

Immunophenotype of nipple adenoma in a male patient.

Science.gov (United States)

Fernandez-Flores, Angel; Suarez-Peñaranda, Jose-Manuel

2011-03-01

Adenoma of the nipple is rare in men. It must be distinguished from a breast carcinoma and from Paget disease. In this sense, immunohistochemistry can be of some help. In women, for instance, immunoexpression of c-erbB-2 favors a diagnosis of Paget disease, according to some studies. Nevertheless, we have not found any studies on HER2/neu status, estrogen receptors, or progesterone receptors in nipple adenoma of male patients. We present a case of an adenoma of the nipple in a 21-year-old man in which we carried out a wide immunohistochemical study. The lesion did not express estrogen receptors, progesterone receptors, or androgen receptors. The HercepTest was negative. Smooth muscle Actin and p63 were remarked in the basal layer of the tumoral tubules, supporting the benignancy of the lesion. This case of adenoma of the nipple in a male shows an immunophenotype that is similar to the ones reported in female patients.

Validating diagnoses from hospital discharge registers change risk estimates for acute coronary syndrome

DEFF Research Database (Denmark)

Joensen, Albert Marni; Schmidt, E.B.; Dethlefsen, Claus

2007-01-01

of acute coronary syndrome (ACS) diagnoses identified in a hospital discharge register changed the relative risk estimates of well-established risk factors for ACS. Methods All first-time ACS diagnoses (n=1138) in the Danish National Patient Registry were identified among male participants in the Danish...

Nipple/Breast stimulation and sexual arousal in young men and women.

Science.gov (United States)

Levin, Roy; Meston, Cindy

2006-05-01

The role of nipple/breast stimulation in influencing sexual arousal in men and women during lovemaking has only been the subject of opinion-based comment rather than evidence-based study. No attempt to question people about such sexual behavior has ever been undertaken. The study was designed to ascertain the effects of nipple/breast manipulation in young men and women on their sexual arousal. A short questionnaire about nipple/breast stimulation during sexual activity was administered to 301 (148 men; 153 women) sexually experienced undergraduates (age range 17-29 years, 95% between 18 and 22). Replies to questions in questionnaire. The major findings in regard to the women were that 81.5% reported that stimulation of their nipples/breasts caused or enhanced their sexual arousal, 78.2% agreed that when sexually aroused such manipulation increased their arousal, 59.1% had asked to have their nipples stimulated during lovemaking, and only 7.2% found that the manipulation decreased their arousal. In regard to the men, 51.7% reported that nipple stimulation caused or enhanced their sexual arousal, 39% agreed that when sexually aroused such manipulation increased their arousal, only 17.1% had asked to have their nipples stimulated, and only 7.5% found that such stimulation decreased their arousal. Manipulation of the nipples/breasts causes or enhances sexual arousal in approximately 82% of young women and 52% of young men with only 7-8% reporting that it decreased their arousal.

The preference for water nipples vs. water bowls in dairy goats

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Andersen Inger L

2011-09-01

Full Text Available Abstract Background Previous studies have reported that the design of the water dispensers can influence the water intake in farm animals. Horses and dairy cows seem to prefer to drink from an open surface whereas sheep and pigs apparently prefer water nipples, probably because of the worse water quality in water bowls. The aim of the present study was to examine the preference of dairy goats for water nipples or water bowls. Methods In each of the two experiments (exp. 1, dry goats, exp. 2 lactating goats, 42 dairy goats were allotted into 6 groups of 7 goats. In period 1, the goats had access to a water nipple. In period 2, they had access to a water bowl and in period 3 (preference test they had access to both a water nipple and a water bowl. Water usage and wastage was recorded and water intake (water usage - water wastage was calculated for each group for the two last days of each period. In experiment 2, water samples from each dispenser were analyzed for heterotrophy germs at 22°C, Escherichia coli and turbidity. Results Water usage was higher from water nipples than from water bowls both in experiment 1 (dry goats and experiment 2 (lactating goats. There was however, no difference in water intake from water nipples and water bowls. In the preference test (period 3, the water intake tended to be higher from the water nipple than from the water bowl both for the dry goats (exp. 1 and lactating goats (exp. 2. Especially for the dry goats, the differences between groups were large. Turbidity and heterotrophy germs were much higher in the samples from the water bowls than from the water nipples. Water wastage from the water bowls was negligible compared to the water nipples. From the water nipples the water wastage was 30% and 23% of water usage for the dry and lactating goats respectively. Conclusions We conclude that type of water dispenser (nipple or bowl was probably of minor importance for water intake in goats, but water bowls had a

Configuration and localization of the nipple-areola complex in men.

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Beer, G M; Budi, S; Seifert, B; Morgenthaler, W; Infanger, M; Meyer, V E

2001-12-01

The causes of bilateral absence of the nipple-areola complex in men are seldom congenital, but attributable rather to destruction as a result of trauma, or after mastectomy in female-to-male transsexuals and in male breast cancer, or after the correction of extreme bilateral gynecomastia. Such a bilateral loss becomes a major reconstructive challenge with respect to the configuration and localization of a new nipple-areola complex. Because there is very little information available in the literature, we carried out a cross-sectional study on the configuration and localization of the nipple-areola complex in men.A total of 100 healthy men aged 20 to 36 years were examined under standardized conditions. The first part of the study dealt with the configuration of the nipple-areola complex (dimensions, round or oval shape). The second part concentrated on the localization of the complex on the thoracic wall with respect to anatomic landmarks and in correlation to various parameters such as weight and height of the body, circumference of the thorax, length of sternum, and position in the intercostal space. Of the 100 subjects examined, 91 had oval and seven had a round nipple-areola complex. An asymmetry between the right and the left side was found in two cases. The mean ratio of the horizontal/vertical diameter of an oval nipple-areola complex was 27:20 mm and the mean diameter for a round nipple-areola complex was 23 mm. The center of the nipple-areola complex was in the fourth intercostal space in 75 percent and in the fifth intercostal space in 23 percent of the subjects. To localize the nipple-areola complex on the thoracic wall de novo, at least two reproducible measurements proved to be necessary, composed of a horizontal line (distance from the midsternal line to the nipple = A) and a vertical line (distance from the sternal notch to the intersection of line A, = B). The closest correlation for the horizontal distance A was given by the circumference of the

Gynecomastia associated with herniated nipples: an optimal surgical approach.

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Jaiswal, Rohit; Pu, Lee L Q

2012-04-01

Gynecomastia is a common disorder observed in male plastic surgery patients. Treatment options may include observation, surgical excision, or liposuction techniques. Congenital herniated nipple is a more rare condition, especially in male patients. We present the case of a 12-year-old boy with bilateral gynecomastia and herniated nipple-areolar complexes. A staged repair was undertaken in this patient with grade 2 gynecomastia. The first operation was ultrasonic liposuction bilaterally, yielding 200 mL of aspirate from the left and 400 mL on the right, to correct the gynecomastia. The second procedure, performed 6 months later, was a bilateral periareolar mastopexy to repair the herniated nipple-areolar complexes. The result of the first procedure was flattened and symmetrical breast tissue bilaterally, essentially a correction of the gynecomastia. The herniated nipples were still present, however. Bilateral periareolar mastopexies were then performed with resulting reduction of the herniations. There were no complications with either procedure, and a good cosmetic result was achieved. A staged surgical approach was successful in correcting both conditions with an excellent aesthetic result and the advantage of decreased risk for nipple complications.

Biologic collagen cylinder with skate flap technique for nipple reconstruction.

Science.gov (United States)

Tierney, Brian P; Hodde, Jason P; Changkuon, Daniela I

2014-01-01

A surgical technique using local tissue skate flaps combined with cylinders made from a naturally derived biomaterial has been used effectively for nipple reconstruction. A retrospective review of patients who underwent nipple reconstruction using this technique was performed. Comorbidities and type of breast reconstruction were collected. Outcome evaluation included complications, surgical revisions, and nipple projection. There were 115 skate flap reconstructions performed in 83 patients between July 2009 and January 2013. Patients ranged from 32 to 73 years old. Average body mass index was 28.0. The most common comorbidities were hypertension (39.8%) and smoking (16.9%). After breast reconstruction, 68.7% of the patients underwent chemotherapy and 20.5% underwent radiation. Seventy-one patients had immediate breast reconstruction with expanders and 12 had delayed reconstruction. The only reported complications were extrusions (3.5%). Six nipples (5.2%) in 5 patients required surgical revision due to loss of projection; two patients had minor loss of projection but did not require surgical revision. Nipple projection at time of surgery ranged from 6 to 7 mm and average projection at 6 months was 3-5 mm. A surgical technique for nipple reconstruction using a skate flap with a graft material is described. Complications are infrequent and short-term projection measurements are encouraging.

Predictive value of acute coronary syndrome discharge diagnoses in the Danish national patioent registry

DEFF Research Database (Denmark)

Joensen, Albert Marni; Jensen, Majken K.; Overvad, Kim

Background: Updated data on the predictive value of acute coronary syndrome (ACS) diagnoses, including unstable angina pectoris, myocardial infarction and cardiac arrest, in hospital discharge registries are sparse. Design: Validation study. Methods: All first-time ACS diagnoses in the Danish...

Nipple-areolar complex (nac) composite grafts in the Management ...

African Journals Online (AJOL)

composite” graft. This is because the skin of the areola and especially the nipple are usually thicker than the case is in the usual full-thickness skin grafts (FTSG). In traditional breast reductions, the nipple-areolar complex is located to its new position ...

Biologic Collagen Cylinder with Skate Flap Technique for Nipple Reconstruction

Directory of Open Access Journals (Sweden)

Brian P. Tierney

2014-01-01

Full Text Available A surgical technique using local tissue skate flaps combined with cylinders made from a naturally derived biomaterial has been used effectively for nipple reconstruction. A retrospective review of patients who underwent nipple reconstruction using this technique was performed. Comorbidities and type of breast reconstruction were collected. Outcome evaluation included complications, surgical revisions, and nipple projection. There were 115 skate flap reconstructions performed in 83 patients between July 2009 and January 2013. Patients ranged from 32 to 73 years old. Average body mass index was 28.0. The most common comorbidities were hypertension (39.8% and smoking (16.9%. After breast reconstruction, 68.7% of the patients underwent chemotherapy and 20.5% underwent radiation. Seventy-one patients had immediate breast reconstruction with expanders and 12 had delayed reconstruction. The only reported complications were extrusions (3.5%. Six nipples (5.2% in 5 patients required surgical revision due to loss of projection; two patients had minor loss of projection but did not require surgical revision. Nipple projection at time of surgery ranged from 6 to 7 mm and average projection at 6 months was 3–5 mm. A surgical technique for nipple reconstruction using a skate flap with a graft material is described. Complications are infrequent and short-term projection measurements are encouraging.

Management of flat or inverted nipples with simple rubber bands.

Science.gov (United States)

Chakrabarti, Kamalendu; Basu, Subhra

2011-08-01

Occurrences of flat or inverted nipples are not uncommon problems, and although they should not preclude breastfeeding, they often seriously hamper initiation and continuation of breastfeeding. Various therapies including nipple exercise, breast shells, inverted syringes, or surgical corrections have been reported with varying success rates. A new method has been devised by the authors that consisted of tying a rubber band around the base of the nipple, with the help of a syringe applicator, to make it prominent. Latex rubber bands cut from condom rims were used in this study. The band had to be worn only during feeding. This method was tested on 19 mothers with flat, inverted, or otherwise deformed nipples. The babies were born in hospitals and were between 9 and 38 days old, mostly fed by bottle feeding, at the time of presentation. The mothers had been counseled about the importance of good attachment during breastfeeding and shown the new method. They were instructed to use the method at home and attend follow-up on day 3, day 7, and day 28. Sixty-three percent of mothers could achieve latching at the breast with good attachment within 3 days, and all did by the end of the month, as nipples no longer remained a problem. The insufficiency of milk was gradually taken care of by frequent suckling with time. No complications like pain or slipping of the band were reported. This simple method may be a good bedside solution for flat/retracted nipples. The authors strongly believe that if the new method is applied immediately after birth under supervision, no mother with nipple problem will be required to feed nonhuman milk to her baby.

[Benign cutaneous lymphadenosis (Bäfverstedt's disease) of the nipple (author's transl)].

Science.gov (United States)

Kindermann, G; Sebicke, E

1977-12-01

Benign circumscribed cutaneous lymphadenosis of the areola of the nipple (Bäfverstedt's disease) occurs in children and adults. We observed 11 cases: 3 men, 3 children and 6 women. The areola undergoes rapid swelling and becomes red. At times the nipple itself is included. Unilateral enlargment and distortion of the nipple area becomes apparent. Sometimes this is associated with a tumor-like infiltration of the retro-mammillary tissue. In Contradistinction to Pagets disease of the nipple and to a mammillary adenoma there is no eczema and no ulceration. The clinical features and the typical pruritic course establish the diagnosis. Healing is spontaneous, but protracted. The aetiology is probably of an inflammatory nature. Treatment with short courses of antibiotics and anti-inflammatory agents resulted in a faster reduction of the cutaneous signs and corroborated the clinical diagnosis. We consider surgical treatment as unnecessary because circumscript benign lymphadenosis of the nipple area has a harmless course.

Nipple adenoma arising from axillary accessory breast: a case report

Directory of Open Access Journals (Sweden)

Shioi Yoshihiro

2012-11-01

Full Text Available Abstract Nipple adenoma is a relatively rare benign breast neoplasm, and cases of the disease arising from the axillary accessory breast have very seldom been reported in the English literature. We report a case of nipple adenoma arising from axillary accessory breast including clinical and pathological findings. An 82-year-old woman presented with the complaint of a small painful mass in the right axilla. Physical examination confirmed a well-defined eczematous crusted mass that was 8 mm in size. The diagnosis of nipple adenoma was made from an excisional specimen on the basis of characteristic histological findings. Microscopic structural features included a compact proliferation of small tubules lined by epithelial and myoepithelial cells, and the merging of glandular epithelial cells of the adenoma into squamous epithelial cells in the superficial epidermal layer. Because clinically nipple adenoma may resemble Paget’s disease and pathologically can be misinterpreted as tubular carcinoma, the correct identification of nipple adenoma is an important factor in the differential diagnosis for axillary tumor neoplasms. Virtual slides The virtual slide(s for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1186821489769063

Gynecomastia Surgery Is Associated with Improved Nipple Location in Young Korean Patients

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Bo Hyung Lee

2014-11-01

Full Text Available BackgroundGynecomastia is benign enlargement of breast tissue in males and is fairly common. Mastectomy not only helps in improving the shape of anterior chest, but can also improve the location of nipple. Therefore, a principle element of mastectomy design is defining the normal location of nipple based on major anatomical reference points. Here, the nipple location was compared for before and after gynecomastia surgery. In addition, the same was also compared between male patients undergoing gynecomastia surgery and control group of subjects without gynecomastia.MethodsWe retrospectively analyzed gynecomastia patients who underwent conventional subcutaneous mastectomy. Preoperative and postoperative anatomical landmark distances and chest circumferences were measured and compared to the same anthropometric data from 20 healthy adult male controls.ResultsNipple locations were compared among 13 patients and 20 controls. The mean weight of resected breast tissue was 246 g, and overall patient satisfaction grade was 4.3 out of 5. In the patient group, the slopes for the height-distance from the sternal notch to the nipple and chest circumference-distance between the mid-line of the sternum and the nipple were 0.175 and 0.125 postoperatively, respectively. The slopes of the control group were 0.122 and 0.177, respectively; these differences were statistically significant (P<0.05.ConclusionsNipple positions were considerably lower in patients with gynecomastia than in control subjects. Subcutaneous mastectomy was associated with mild elevations, but postoperative locations were still lower compared to controls. Further efforts are needed to improve the location of postoperative nipple-areola complex in patients with gynecomastia.

With Nipple Piercing

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Mark D. Pearlman

1995-01-01

Full Text Available Background: Breast abscesses are typically seen in the setting of complicated mastitis in lactating women. Abscesses resulting from foreign bodies are not commonly seen in the breast. Over the past few decades, body piercing has become increasingly common, yet the infectious morbidity resulting from it is not well recognized. A breast abscess associated with nipple piercing is described in this report.

A New Local Flap Nipple Reconstruction Technique Using Dermal Bridge and Preoperatively Designed Tattoo

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Iwahira, Yoshiko

2017-01-01

Background: Nipple–areolar reconstruction is the final step in breast reconstruction. Reconstruction using local flaps and tattooing is useful in cases of bilateral reconstruction, a small nipple–areolar complex (NAC) as the donor site, and avoiding disturbance of the normal side and other body parts. However, this method can cause projection loss and color fading of the nipple. Moreover, the breast mound is reconstructed with an implant. Methods: We performed nipple–areolar reconstruction of 90 nipples using clover-designed flaps oriented at 120 degrees and tattooing after breast silicone implantation in 64 women. The tattoo was designed before flap operation and stained darker. Following donor site closure, a dermal flap was made as a bridge for nipple support. The nipple space was separated by the dermal flap from the breast mound and was filled with subcutaneous tissue. The size of the reconstructed nipple projection was measured postoperatively and 1 year later. The projection maintenance rate was calculated. Results: The heights of the nipple projection were 11.3 ± 1.8 mm (95% confidence interval [CI]: 10.9–11.7) just after the operation and 6.09 ± 2.4 mm (95% CI: 5.6–6.6) 1 year later. The actual range of nipple projection between these 2 heights was 5.2 ± 2.4 mm (95% CI: 4.7–5.7). The maintenance rate of the reconstructed nipple projection after 12 months was 54.1 ± 20.9 (95% CI: 49.7–58.5). The nipple color was maintained for over a year. Conclusions: Our nipple–areolar reconstruction technique could maintain the projection and color of the reconstructed nipple for a long period. Good outcomes were obtained in this implant-based breast reconstruction. PMID:28507843

One-stage nipple and breast reconstruction following areola-sparing mastectomy.

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Kim, Hye Ri; Lim, Jin Soo; Kim, Sue Min; Jung, Sung No; Yoo, Gyeol; Rha, Eun Young

2013-09-01

Skin-sparing mastectomy with immediate breast reconstruction is increasingly becoming a proven surgical option for early-stage breast cancer patients. Areola-sparing mastectomy (ASM) has also recently become a popular procedure. The purpose of this article is to investigate the reconstructive and aesthetic issues experienced with one-stage nipple and breast reconstruction using ASM. Among the patients who underwent mastectomy between March 2008 and March 2010, 5 women with a low probability of nipple-areolar complex malignant involvement underwent ASM and immediate breast reconstruction with simultaneous nipple reconstruction using the modified C-V flap. The cosmetic outcomes of this series were reviewed by plastic surgeons and patient self-assessment and satisfaction were assessed via telephone interview. During the average 11-month follow-up period, there were no cases of cancer recurrence, the aesthetic outcomes were graded as excellent to very good, and all of the patients were satisfied. Two patients developed a gutter-like depression around the reconstructed nipple, and one patient developed skin erosion in a small area of the areola, which healed with conservative dressing. The other complications, such as necrosis of the skin flap or areola, seroma, hematoma, or fat necrosis did not occur. Since one-stage nipple and breast reconstruction following ASM is an oncologically safe, cost-effective, and aesthetically satisfactory procedure, it is a good surgical option for early breast cancer patients.

Breast abscess after nipple piercing: sonographic findings with clinical correlation.

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Leibman, A Jill; Misra, Monika; Castaldi, Maria

2011-09-01

The purpose of this series was to review the spectrum of clinical and sonographic features associated with infection after nipple piercing. Between 2002 and 2010, 6 patients presented to our breast center with a breast abscess after nipple piercing. A retrospective analysis of the imaging findings was performed with clinical and pathologic correlation. Patients with breast infections after nipple piercing tend to be young, and the timing since piercing varies from 2 weeks to 17 months. Sonography showed a complex or hypoechoic mass in 5 of 6 patients. Treatment of breast abscesses included surgical incision and drainage, percutaneous drainage, and antibiotic therapy. Surgical evacuation is commonly performed; however, sonographically guided aspiration may be an appropriate management strategy.

Basal cell carcinoma of the nipple - an unusual location in a male patient.

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Avci, Oktay; Pabuççuoğlu, Uğur; Koçdor, M Ali; Unlü, Mehtat; Akin, Ciler; Soyal, Cüneyt; Canda, Tülay

2008-02-01

Although basal cell carcinoma is extremely common, it only rarely occurs on the nipple. Men are affected more often than women. Basal cell carcinoma of the nipple-areola complex may be more aggressive as metastases to regional lymph nodes have been reported. We report a basal cell carcinoma of the nipple with features of a fibroepithelioma of Pinkus in a man and review the literature.

Why do mothers use nipple shields and how does this influence duration of exclusive breastfeeding?

DEFF Research Database (Denmark)

Kronborg, Hanne; Foverskov, Else; Nilsson, Ingrid

2017-01-01

with introducing nipple shields were lower- gestational age and birthweight. The use of nipple shields was furthermore found to be associated with a threefold increased risk of earlier cessation of exclusive breastfeeding: among primiparae odds ratio = 3.80 (confidence interval 2.61–5.53); among multiparae odds......The present study addressed the contentious discussions about the benefits and risks of nipple shield use. The objective was to explore self-reported reasons for using a nipple shield and examine associations pertaining to the mother, the infant and duration of breastfeeding. Data were collected...... breastfeeding period. Primiparae used nipple shields more often than multiparae, and early breastfeeding problems as well as background factors like lower age, education and higher body mass index were associated with a higher likelihood of using nipple shields. Characteristics of infants associated...

One-Stage Nipple and Breast Reconstruction Following Areola-Sparing Mastectomy

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Hye Ri Kim

2013-09-01

Full Text Available BackgroundSkin-sparing mastectomy with immediate breast reconstruction is increasingly becoming a proven surgical option for early-stage breast cancer patients. Areola-sparing mastectomy (ASM has also recently become a popular procedure. The purpose of this article is to investigate the reconstructive and aesthetic issues experienced with one-stage nipple and breast reconstruction using ASM.MethodsAmong the patients who underwent mastectomy between March 2008 and March 2010, 5 women with a low probability of nipple-areolar complex malignant involvement underwent ASM and immediate breast reconstruction with simultaneous nipple reconstruction using the modified C-V flap. The cosmetic outcomes of this series were reviewed by plastic surgeons and patient self-assessment and satisfaction were assessed via telephone interview.ResultsDuring the average 11-month follow-up period, there were no cases of cancer recurrence, the aesthetic outcomes were graded as excellent to very good, and all of the patients were satisfied. Two patients developed a gutter-like depression around the reconstructed nipple, and one patient developed skin erosion in a small area of the areola, which healed with conservative dressing. The other complications, such as necrosis of the skin flap or areola, seroma, hematoma, or fat necrosis did not occur.ConclusionsSince one-stage nipple and breast reconstruction following ASM is an oncologically safe, cost-effective, and aesthetically satisfactory procedure, it is a good surgical option for early breast cancer patients.

How well do discharge diagnoses identify hospitalised patients with community-acquired infections? - a validation study

DEFF Research Database (Denmark)

Henriksen, Daniel Pilsgaard; Nielsen, Stig Lønberg; Laursen, Christian Borbjerg

2014-01-01

-10 diagnoses was 79.9% (95%CI: 78.1-81.3%), specificity 83.9% (95%CI: 82.6-85.1%), positive likelihood ratio 4.95 (95%CI: 4.58-5.36) and negative likelihood ratio 0.24 (95%CI: 0.22-0.26). The two most common sites of infection, the lower respiratory tract and urinary tract, had positive likelihood......BACKGROUND: Credible measures of disease incidence, trends and mortality can be obtained through surveillance using manual chart review, but this is both time-consuming and expensive. ICD-10 discharge diagnoses are used as surrogate markers of infection, but knowledge on the validity of infections...... in general is sparse. The aim of the study was to determine how well ICD-10 discharge diagnoses identify patients with community-acquired infections in a medical emergency department (ED), overall and related to sites of infection and patient characteristics. METHODS: We manually reviewed 5977 patients...

Predictive value of stroke discharge diagnoses in the Danish National Patient Register.

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Lühdorf, Pernille; Overvad, Kim; Schmidt, Erik B; Johnsen, Søren P; Bach, Flemming W

2017-08-01

To determine the positive predictive values for stroke discharge diagnoses, including subarachnoidal haemorrhage, intracerebral haemorrhage and cerebral infarction in the Danish National Patient Register. Participants in the Danish cohort study Diet, Cancer and Health with a stroke discharge diagnosis in the National Patient Register between 1993 and 2009 were identified and their medical records were retrieved for validation of the diagnoses. A total of 3326 records of possible cases of stroke were reviewed. The overall positive predictive value for stroke was 69.3% (95% confidence interval (CI) 67.8-70.9%). The predictive values differed according to hospital characteristics, with the highest predictive value of 87.8% (95% CI 85.5-90.1%) found in departments of neurology and the lowest predictive value of 43.0% (95% CI 37.6-48.5%) found in outpatient clinics. The overall stroke diagnosis in the Danish National Patient Register had a limited predictive value. We therefore recommend the critical use of non-validated register data for research on stroke. The possibility of optimising the predictive values based on more advanced algorithms should be considered.

Validation of cardiovascular diagnoses in the Greenlandic Hospital Discharge Register for epidemiological use

DEFF Research Database (Denmark)

Tvermosegaard, Maria; Ronn, Pernille Falberg; Pedersen, Michael Lynge

2018-01-01

not previously been validated specifically. The objective of the study was to validate diagnoses of CVD in GHDR. The study was conducted as a validation study with primary investigator comparing information in GHDR with information in medical records. Diagnoses in GHDR were considered correct and thus valid......Cardiovascular disease (CVD) is one of the leading causes of death worldwide. In Greenland, valid estimates of prevalence and incidence of CVD do not exist and can only be calculated if diagnoses of CVD in the Greenlandic Hospital Discharge Register (GHDR) are correct. Diagnoses of CVD in GHDR have...... if they matched the diagnoses or the medical information in the medical records. A total of 432 online accessible medical records with a cardiovascular diagnosis according to GHDR from Queen Ingrid's Hospital from 2001 to 2013 (n=291) and from local health care centres from 2007 to 2013 (n=141) were reviewed...

Basal cell carcinoma of the nipple-areola complex: a case report.

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Huang, Ching-Wen; Pan, Ching-Kuen; Shih, Teng-Fu; Tsai, Cheng-Chien; Juan, Chung-Chou; Ker, Chen-Guo

2005-10-01

Basal cell carcinoma (BCC) of the nipple-areola complex is very rare. Only 24 cases were reported in the literature and 17 (70.8%) of these cases arose in men. Most of the cases were treated with simple excision. We report on a case of BCC of the nipple-areola complex in a 46-year-old woman, treated with partial mastectomy. Metastasis to the axillary lymph nodes had been noted in 3 (12.5%) of the 24 reported cases of BCC of the nipple-areola complex. Thus, we applied the concept of the sentinel lymph node to detect possible metastases of axillary lymph nodes, letting us avoid the unnecessary axillary lymph node dissection and possible future morbidity.

Mesostructure of Ordered Corneal Nano-nipple Arrays: The Role of 5-7 Coordination Defects

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Lee, Ken C.; Yu, Qi; Erb, Uwe

2016-06-01

Corneal nano-nipple structures consisting of hexagonally arranged protrusions with diameters around 200 nm have long been known for their antireflection capability and have served as biological blueprint for solar cell, optical lens and other surface designs. However, little is known about the global arrangement of these nipples on the ommatidial surface and their growth during the eye development. This study provides new insights based on the analysis of nano-nipple arrangements on the mesoscale across entire ommatidia, which has never been done before. The most important feature in the nipple structures are topological 5- and 7-fold coordination defects, which align to form dislocations and interconnected networks of grain boundaries that divide the ommatidia into crystalline domains in different orientations. Furthermore, the domain size distribution might be log-normal, and the domains demonstrate no preference in crystal orientation. Both observations suggest that the nipple growth process may be similar to the nucleation and growth mechanisms during the formation of other crystal structures. Our results are also consistent with the most recently proposed Turing-type reaction-diffusion process. In fact, we were able to produce the key structural characteristics of the nipple arrangements using Turing analysis from the nucleation to the final structure development.

original Article double-nippled ureteroneocystostomy: A novel ...

African Journals Online (AJOL)

The lowest segment of the dilated obstructed ureter is transected and passed through the bladder dome for ... conclusion: Double-nippled ureteroneocystostomy is a safe and efficient surgical modality for ..... Strup SE, Bagley DH. Endoscopic ...

Nipple-sparing mastectomy with immediate implant reconstruction: cosmetic outcomes and technical refinements.

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Salgarello, Marzia; Visconti, Giuseppe; Barone-Adesi, Liliana

2010-11-01

Nipple-sparing mastectomy is gaining widespread popularity, as it could allow improved aesthetic outcome without increasing oncologic risk. To investigate the reconstructive issues experienced with immediate implant reconstruction, the authors reviewed the cosmetic outcomes of their series. The authors retrospectively analyzed the data on 33 cases of nipple-sparing mastectomy for both cancer and prophylaxis with immediate implant reconstruction using the submusculo-subfascial pocket. Cosmetic evaluation methods were clinical and photography-based assessments and a patient-satisfaction survey. The average follow-up period was 26.8 months. No nipple-areola complex cancer involvement was registered. The reconstructive outcomes ranged from good to excellent in 83 percent of the cases. Patients' satisfaction was high to very high, except in one patient who experienced total nipple-areola complex loss (one breast, 2.4 percent). Overall, early minor complications were registered in four breasts (9.5 percent) and late minor complications in five cases (12 percent). The authors' series suggest that nipple-sparing mastectomy is an option for carefully selected and screened patients. Larger studies with longer follow-up are needed, however. On the whole, the immediate one-stage implant reconstruction with hyperprojected anatomical gel implants represents a valid option. The skin incision algorithm proposed, which is based on the breast size, shape, and previous scars, might aid in the decision-making process to achieve satisfying results using this procedure. The radial approaches represent a good compromise between the oncologic and reconstructive procedures.

Effects of laser-assisted lipolysis on nipple-areola complex.

Science.gov (United States)

Sönmez Ergün, Selma; Kayan, Reşit Burak; Güleş, Mustafa Ekrem; Kuzu, İsmail Melih

2017-08-01

Gynecomastia, as a most common benign condition, represents itself as the enlargement of the male breast and also nipple-areola complex as the severity of the condition increases. With this study, we aimed to clarify the effects of 980-nm diode laser on nipple-areola complex (NAC). Although numerous open techniques have been described to correct gynecomastia, nowadays trends have shifted to minimally invasive techniques such as laser-assisted lipolysis (LAL). A total of 25 patients with bilateral gynecomastia treated with LAL by using a 980-nm diode laser. The resultant contour and reduced size of the complex were satisfactory. LAL leads to significant reduction of the size of NAC.

Inverted Nipple Correction with Selective Dissection of Lactiferous Ducts Using an Operative Microscope and a Traction Technique.

Science.gov (United States)

Sowa, Yoshihiro; Itsukage, Sizu; Morita, Daiki; Numajiri, Toshiaki

2017-10-01

An inverted nipple is a common congenital condition in young women that may cause breastfeeding difficulty, psychological distress, repeated inflammation, and loss of sensation. Various surgical techniques have been reported for correction of inverted nipples, and all have advantages and disadvantages. Here, we report a new technique for correction of an inverted nipple using an operative microscope and traction that results in low recurrence and preserves lactation function and sensation. Between January 2010 and January 2013, we treated eight inverted nipples in seven patients with selective lactiferous duct dissection using an operative microscope. An opposite Z-plasty was added at the junction of the nipple and areola. Postoperatively, traction was applied through an apparatus made from a rubber gasket attached to a sterile syringe. Patients were followed up for 15-48 months. Adequate projection was achieved in all patients, and there was no wound dehiscence or complications such as infection. Three patients had successful pregnancies and subsequent breastfeeding that was not adversely affected by the treatment. There was no loss of sensation in any patient during the postoperative period. Our technique for treating an inverted nipple is effective and preserves lactation function and nipple sensation. The method maintains traction for a longer period, which we believe increases the success rate of the surgery for correction of severely inverted nipples. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PREVENTION OF NIPPLE CRACKS OF THE MAMMARY GLAND IN THE EARLY POSTNATAL PERIOD

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Marina L. Travina

2017-01-01

Full Text Available Preservation and prolongation of the lactation period is not only a guarantee of the child's full physical and mental development but also one of the most important methods for reducing the risk of developing breast cancer. Problems with the mammary gland nipple in a woman in the early postnatal period lead to a refusal of lactation. We carried out a retrospective analysis (period from 2010 to 2016 of the causes of traumatizing mammary gland nipples in the early postnatal period in 172 women (mean age 29.1 ± 4.3 years. Methods of prevention and treatment of nipple injuries in the early postnatal period have been offered for the lactation period prolongation.

[Brownish coloration of the left nipple in a 60-year-old woman].

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Blum, A; Hartmann, K W; Rütten, A

2010-01-01

Pigmented Paget disease of the nipple is a rare disease. We report on a 60-year-old woman in whom this diagnosis was made based on clinical findings, dermoscopy, histology and immunohistology. Circumscribed pigmentation of the nipple includes a wide spectrum of benign and malignant differential diagnostic considerations. Dermoscopy can enhance the clinical diagnosis. Biopsies should always be performed on unclear pigmentation of the nipple in both women and men. On histology, rare melanocytic tumors must be differentiated from pigmented Paget disease and pigmented Bowen disease. Pagetoid intraepithelial cells of a melanocytic tumor are positive for S100, HMB45 or melan A, but not for cytokeratins. Intraepithelial tumor cells of Paget disease are positive for cytokeratin 7. The clear cells in Bowen diseases are usually not positive for cytokeratin 7 and are also negative for all melanocytic markers.

The preference for water nipples vs. water bowls in dairy goats

OpenAIRE

B?e, Knut E; Ehrlenbruch, Rebecca; Andersen, Inger L

2011-01-01

Abstract Background Previous studies have reported that the design of the water dispensers can influence the water intake in farm animals. Horses and dairy cows seem to prefer to drink from an open surface whereas sheep and pigs apparently prefer water nipples, probably because of the worse water quality in water bowls. The aim of the present study was to examine the preference of dairy goats for water nipples or water bowls. Methods In each of the two experiments (exp. 1, dry goats, exp. 2 l...

Calcitonin gene-related peptide (CGRP) in the nipple of the rat mammary gland

DEFF Research Database (Denmark)

Thulesen, J; Rasmussen, T N; Schmidt, P

1994-01-01

The distribution of nerve fibres immunoreactive to calcitonin gene-related peptide (CGRP) was investigated by immunohistochemistry in nipples and mammary glands from lactating and non-lactating rats and compared to the immunoreactivity of other neuropeptides including substance P (SP), neuropepti...... in the nipples of the pregnant (day 10) rats exceeded almost ninefold the maximum concentration of SP (7.7 +/- 2.0 pmol/g).(ABSTRACT TRUNCATED AT 250 WORDS)....... The location of SP-IR appeared to be comparable to CGRP-IR, but in fewer fibres. Dense NPY-IR networks of nerve fibres were closely associated with the fascicles of smooth musculature in the core of the nipple base. In contrast, VIP-IR fibres were only sparsely present, and SOM-IR was not detected...

MR imaging of the skin and nipple of the breast: differentiation between tumour recurrence and post-treatment change

International Nuclear Information System (INIS)

Ralleigh, G.; Walker, A.E.; Hall-Craggs, M.A.; Lakhani, S.R.; Saunders, C.

2001-01-01

Contrast-enhanced MR imaging of the breast has been found to be valuable in the assessment of local recurrence of previously treated breast cancer. We looked specifically at the appearances of the skin and nipple of the treated breast in order to describe the appearances of post-treatment change and recurrence in this region. Thirty-nine women treated for breast cancer had MR imaging of one or both breasts reviewed retrospectively with particular attention to the nipple and skin. The skin and chest wall were assessed for patients with mastectomies. All available histology of the skin and/or nipple, obtained following MR imaging, was reviewed. In patients who did not undergo surgery following MR imaging, clinical follow-up was obtained. Six of 39 cases had nodular enhancing areas seen on MR imaging, which correlated with histology demonstrating tumour recurrence within the skin and/or nipple. Of the remaining 33 patients, changes of linear or diffuse enhancement were seen in the skin and/or nipple of 15 patients. These changes were shown to be benign post-treatment changes at surgery/biopsy in 4 cases or by clinical follow-up in the remainder. In this article we demonstrate differing patterns of contrast enhancement within the skin and nipple in recurrent breast carcinoma vs post-treatment changes. This suggests that contrast-enhanced MR imaging of the breast may be a useful tool in differentiating tumour recurrence from post-treatment changes within the skin and nipple. (orig.)

Florid papillomatosis of the nipple. A study of 51 patients, including nine with mammary carcinoma.

Science.gov (United States)

Rosen, P P; Caicco, J A

1986-02-01

The present study was undertaken to review the pathology of florid papillomatosis (FP) of the nipple and to examine the relationship of FP to breast carcinoma. Clinical features of 49 women studied did not differ appreciably from those noted on prior reports, except that in one instance the lesion was probably congenital. Histologically, three distinct growth patterns were found: sclerosing papillomatosis (17 cases), papillomatosis (12 cases), and adenosis (3 cases). In 17 other cases, mixtures of these proliferative patterns were seen. FP with the sclerosing papillomatosis pattern more frequently had areas of focal necrosis in hyperplastic ducts and scattered mitoses, features that might be interpreted as evidence of carcinoma. No prognostic significance can be attributed to these patterns, since all types were cured by excision with follow-up that averaged 8.3 years. Seven of the 49 women had carcinoma in the same breast as FP: Two women had invasive carcinoma that appeared to arise from FP, and four women had concurrent invasive carcinomas that were separate from the FP; the seventh woman developed diffuse intraductal carcinoma 10 years after FP was excised from the same breast. Three of the seven women were also treated for contralateral breast carcinoma. Also reviewed were lesions from two men who had carcinoma arising in FP. One had intraductal carcinoma with Paget's disease and the other had invasive carcinoma. Appreciation of the diverse histological patterns of FP may be helpful in avoiding an erroneous diagnosis of carcinoma. Features indicative of carcinoma arising in FP are Paget's disease and areas of invasion. FP of the nipple is rarely the substrate for mammary carcinoma and is adequately treated by local excision. Coexistence with carcinoma elsewhere in the same or opposite breast occurs often enough to warrant thorough examination of the breasts when FP of the nipple is diagnosed. The risk of subsequent carcinoma following excision of FP appears to

Review of nipple reconstruction techniques and introduction of v to y technique in a bilateral wise pattern mastectomy or reduction mammaplasty.

Science.gov (United States)

Riccio, Charles A; Zeiderman, Matthew R; Chowdhry, Saeed; Wilhelmi, Bradon J

2015-01-01

Nipple-areola complex reconstruction (NAR) is the final procedure in breast reconstruction after the majority of mastectomies. Many methods of NAR have been described, each with inherent advantages and disadvantages depending on local healthy tissue availability, previous scarring and procedures, and the operative morbidity of the NAR technique. Nipple reconstructions may be complicated by scars or previous nipple reconstruction, making the procedure more challenging. We propose the use of the V-Y advancement flap as a new method that is suitable for both novice and experienced surgeons wishing to broaden their range of techniques for difficult nipple reconstructions. A traditional V-Y advancement flap is lifted at the site of the future nipple. Mastectomy scars from prior mastectomy, mammoplasty, or nipple reconstruction can be incorporated into the flap. The flap is folded caudally upon itself and the secondary defect at the apex of the flap is linearly closed. At 6-month postoperative evaluation, adequate nipple projection and patient satisfaction were achieved with this method. The V-Y advancement flap is a suitable method for achieving satisfactory results when faced with challenging NAR. The method is easy to perform, reproducible, has low operative morbidity, and incorporates previous wise pattern mastectomy or mammaplasty scars into the newly reconstructed nipple, thereby decreasing new scar formation on the breast and leading to favorable cosmetic results.

Validity of Principal Diagnoses in Discharge Summaries and ICD-10 Coding Assessments Based on National Health Data of Thailand.

Science.gov (United States)

Sukanya, Chongthawonsatid

2017-10-01

This study examined the validity of the principal diagnoses on discharge summaries and coding assessments. Data were collected from the National Health Security Office (NHSO) of Thailand in 2015. In total, 118,971 medical records were audited. The sample was drawn from government hospitals and private hospitals covered by the Universal Coverage Scheme in Thailand. Hospitals and cases were selected using NHSO criteria. The validity of the principal diagnoses listed in the "Summary and Coding Assessment" forms was established by comparing data from the discharge summaries with data obtained from medical record reviews, and additionally, by comparing data from the coding assessments with data in the computerized ICD (the data base used for reimbursement-purposes). The summary assessments had low sensitivities (7.3%-37.9%), high specificities (97.2%-99.8%), low positive predictive values (9.2%-60.7%), and high negative predictive values (95.9%-99.3%). The coding assessments had low sensitivities (31.1%-69.4%), high specificities (99.0%-99.9%), moderate positive predictive values (43.8%-89.0%), and high negative predictive values (97.3%-99.5%). The discharge summaries and codings often contained mistakes, particularly the categories "Endocrine, nutritional, and metabolic diseases", "Symptoms, signs, and abnormal clinical and laboratory findings not elsewhere classified", "Factors influencing health status and contact with health services", and "Injury, poisoning, and certain other consequences of external causes". The validity of the principal diagnoses on the summary and coding assessment forms was found to be low. The training of physicians and coders must be strengthened to improve the validity of discharge summaries and codings.

Breast abscess following nipple piercing: a case report and review of the literature.

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Kapsimalakou, Smaragda; Grande-Nagel, Isabell; Simon, Martin; Fischer, Dorothea; Thill, Marc; Stöckelhuber, Beate M

2010-12-01

Nipple piercing gains popularity and social acceptance within the last years, especially among young people. The medical literature reports an increase of complications in the post-piercing period. We report a case of a young woman, who presented with a light enlargement of the right breast and tenderness in the retroareolar region following nipple piercing 5 months ago. On ultrasound, a poorly marginated hypoechoic lesion was seen which was suspicious of an inflammation. After 1 week of antibiotic therapy, the mass had enlarged. As carcinoma could not be excluded, open biopsy was performed. Histology showed signs of chronic mastitis. To date, only a few reports of breast abscess after nipple piercing have been published. With the increasing prevalence of body piercing, it is important to document and report infections which may be discovered many months following piercing. Carcinoma can mimic breast abscess and should be included in the differential diagnosis.

The frequency of using different types of pacifier and bottle nipple among 1-24 months old children

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Hamidreza Poureslami

2016-03-01

Full Text Available BACKGROUND AND AIM: Sucking of some types of a pacifier may be a risk factor for mal-development of orofacial structures and malocclusion. This study assessed the prevalence of using of different types of pacifier and bottle nipple among 1-24 months old children in Kerman, Iran. METHODS: In this cross-sectional study, a total of 300 mothers interviewed at 20 specialized private pediatric offices in Kerman. The mothers had 1-24 months old children. A checklist includes items about pacifier sucking, bottle feeding habits, as well as mothers’ ability to recognize different kinds of available pacifier and bottle nipple was used. RESULTS: The rate of pacifier-sucking was 37.3%, and use of bottle feeding was 42.3%, and among of the users, 24.0 and 35.7% were used orthodontic (functional types of pacifier and bottle nipple respectively. However, only 28.7% of mothers had adequate ability to recognize orthodontic pacifier and bottle nipple. CONCLUSION: The rates of using orthodontic kind of pacifier and bottle nipple were low, and a few mothers had adequate ability to recognize their differences.

One-Stage Nipple and Breast Reconstruction Following Areola-Sparing Mastectomy

Directory of Open Access Journals (Sweden)

Hye Ri Kim

2013-09-01

Full Text Available Background Skin-sparing mastectomy with immediate breast reconstruction is increasinglybecoming a proven surgical option for early-stage breast cancer patients. Areola-sparingmastectomy (ASM has also recently become a popular procedure. The purpose of this articleis to investigate the reconstructive and aesthetic issues experienced with one-stage nippleand breast reconstruction using ASM.Methods Among the patients who underwent mastectomy between March 2008 and March2010, 5 women with a low probability of nipple-areolar complex malignant involvement underwentASM and immediate breast reconstruction with simultaneous nipple reconstructionusing the modified C-V flap. The cosmetic outcomes of this series were reviewed by plasticsurgeons and patient self-assessment and satisfaction were assessed via telephone interview.Results During the average 11-month follow-up period, there were no cases of cancer recurrence,the aesthetic outcomes were graded as excellent to very good, and all of the patientswere satisfied. Two patients developed a gutter-like depression around the reconstructednipple, and one patient developed skin erosion in a small area of the areola, which healedwith conservative dressing. The other complications, such as necrosis of the skin flap or areola,seroma, hematoma, or fat necrosis did not occur.Conclusions Since one-stage nipple and breast reconstruction following ASM is an oncologicallysafe, cost-effective, and aesthetically satisfactory procedure, it is a good surgical optionfor early breast cancer patients.

Mycobacterium fortuitum and anaerobic breast abscess following nipple piercing: case presentation and review of the literature.

Science.gov (United States)

Bengualid, Victoria; Singh, Veera; Singh, Herpreet; Berger, Judith

2008-05-01

Body piercing has become increasingly prevalent. We describe a case of breast infection with combined mycobacteria and anaerobe following nipple piercing, and review the literature. A 17-year-old female developed a breast abscess 4 months after nipple piercing. Cultures grew Prevotalla melangenica and Mycobacterium fortuitum. She required drainage and antibiotic treatment. Three months into her treatment she stopped her medications, relapsed, and required drainage. Two months later, on antimycobacteria therapy, her wound is healing. Review of the infectious complications of nipple piercing yielded 12 cases, 5 of which had a foreign body. The pathogens isolated (coagulase negative staphylococcus, mycobacteria, streptococcus, anaerobe, and gordonia) are not the usual organisms to be isolated from a breast abscess. This could result from reporting bias or the presence of a foreign body, the nipple ring. The three cases of mycobacteria, in addition to ours, are reviewed. The average age is 22 years. Three to 9 months elapsed between piercing and infection. All cases required drainage. Antimycobacteria therapy was used in three of the four cases for 10 days to 6 months. With the increasing prevalence of body piercing, it is important to document and report infections. We describe a breast abscess following nipple piercing with combined anaerobic and a mycobacterial pathogens. This underscores the need for obtaining cultures including anaerobes and mycobacteria.

Basal cell carcinomas of the areola-nipple complex: case reports and review of the literature.

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Betti, Roberto; Martino, Patrizia; Moneghini, Laura; Vergani, Raffaelle; Tolomio, Elena; Crosti, Carlo

2003-11-01

Two white men 57 and 39 years old, and a 47-year-old white woman were seen with slowly developing papulo-nodular lesions of the areola-nipple complex. None of the patients presented with regional lymphadenopathy, history of trauma, or relevant sun-exposure. After excison of the mass, the histologic diagnosis of basal cell carcinoma was made. At two years of follow-up, no recurrence was evident. The low incidence of basal cell carcinoma in this particular site allows us to consider the areola-nipple complex location as unusual. Moreover, literature reports do not suggest that these BCCs have an increased potential for malignancy. The treatment options depend on the extension of the tumor and on the possible involvement of the areola-nipple complex and mammary tissue.

Double-nippled ureteroneocystostomy: a novel surgical technique in ...

African Journals Online (AJOL)

The lowest segment of the dilated obstructed ureter is transected and passed through the bladder dome for ureterovesical implantation. The distal 3 cm is folded twice like a sleeve to fashion a double-nippled valve. Evaluation of the appearance and function of the ureter and ipsilateral renal function was done by laboratory, ...

Evolution in Monitoring of Free Flap Autologous Breast Reconstruction after Nipple-Sparing Mastectomy: Is There a Best Way?

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Frey, Jordan D; Stranix, John T; Chiodo, Michael V; Alperovich, Michael; Ahn, Christina Y; Allen, Robert J; Choi, Mihye; Karp, Nolan S; Levine, Jamie P

2018-05-01

Free flap monitoring in autologous reconstruction after nipple-sparing mastectomy remains controversial. The authors therefore examined outcomes in nipple-sparing mastectomy with buried free flap reconstruction versus free flap reconstruction incorporating a monitoring skin paddle. Autologous free flap reconstructions with nipple-sparing mastectomy performed from 2006 to 2015 were identified. Demographics and operative results were analyzed and compared between buried flaps and those with a skin paddle for monitoring. Two hundred twenty-one free flaps for nipple-sparing mastectomy reconstruction were identified: 50 buried flaps and 171 flaps incorporating a skin paddle. The most common flaps used were deep inferior epigastric perforator (64 percent), profunda artery perforator (12.1 percent), and muscle-sparing transverse rectus abdominis myocutaneous flaps (10.4 percent). Patients undergoing autologous reconstructions with a skin paddle had a significantly greater body mass index (p = 0.006). Mastectomy weight (p = 0.017) and flap weight (p < 0.0001) were significantly greater in flaps incorporating a skin paddle. Comparing outcomes, there were no significant differences in flap failure (2.0 percent versus 2.3 percent; p = 1.000) or percentage of flaps requiring return to the operating room (6.0 percent versus 4.7 percent; p = 0.715) between groups. Buried flaps had an absolute greater mean number of revision procedures per nipple-sparing mastectomy (0.82) compared with the skin paddle group (0.44); however, rates of revision procedures per nipple-sparing mastectomy were statistically equivalent between the groups (p = 0.296). Although buried free flap reconstruction in nipple-sparing mastectomy has been shown to be safe and effective, the authors' technique has evolved to favor incorporating a skin paddle, which allows for clinical monitoring and can be removed at the time of secondary revision. Therapeutic, III.

Trans-nipple removal of fibro-glandular tissue in gynaecomastia surgery without additional scars: An innovative approach

Directory of Open Access Journals (Sweden)

R K Mishra

2014-01-01

Full Text Available Context: The established techniques that have been used to treat gynaecomastia are said to have relatively less patient satisfaction rate as they leave some visible scars or mild elevation over the nipple areola complex, resulting in aesthetically unsatisfactory results. Even the slightest elevation or smallest scar over nipple areola complex leave patients extremely self conscious and in a dilemma of having a second intervention to get rid of that blemish. Aims: The aim of the study is to achieve - A flat chest without adding a scar and with no chances of re-occurrence of the condition. This article suggests an innovative approach to address the problem. Materials and Methods: The author presents trans-nipple incision approach for the delivery of fibro-glandular tissue component following liposuction for maximum patient satisfaction. This method consists of a unique small criss-cross incision right on the nipple itself for retrieving any volume of tough fibro-glandular tissues. Between the duration of January 2012 to October 2013, 28 male patients of different ages were operated with this technique. Results: The surgery resulted in well-shaped, symmetric chest contour without any visible elevation or additional scars on nipple areola complex. No complications were noticed in any of the patients. Conclusions: The presented technique is proved to have a high patient satisfaction rate and to be promising method to achieve good aesthetic results in gynaecomastia surgery.

Review of Nipple Reconstruction Techniques and Introduction of V to Y Technique in a Bilateral Wise Pattern Mastectomy or Reduction Mammaplasty

OpenAIRE

Riccio, Charles A.; Zeiderman, Matthew R.; Chowdhry, Saeed; Wilhelmi, Bradon J.

2015-01-01

Introduction: Nipple-areola complex reconstruction (NAR) is the final procedure in breast reconstruction after the majority of mastectomies. Many methods of NAR have been described, each with inherent advantages and disadvantages depending on local healthy tissue availability, previous scarring and procedures, and the operative morbidity of the NAR technique. Nipple reconstructions may be complicated by scars or previous nipple reconstruction, making the procedure more challenging. We propose...

Synchronous bilateral male breast cancer: a case report.

Science.gov (United States)

Sun, Woo-Young; Lee, Ki-Hyeong; Lee, Ho-Chang; Ryu, Dong-Hee; Park, Jin-Woo; Yun, Hyo-Young; Song, Young-Jin

2012-06-01

Synchronous bilateral breast cancer is extremely rare in men and has not, up to date, been reported in Korea. A 54-year-old man presented with a palpable mass in the right breast. The right nipple was retracted and bilateral axillary accessory breasts and nipples were present. On physical examination, a 2 cm-sized mass was palpated directly under the right nipple, and, with squeezing, bloody discharge developed in a single duct of the left nipple. There was no palpable mass in the left breast, and axillary lymph nodes were not palpable. Physical examination of external genitalia revealed a unilateral undescended testis on the left side. Synchronous bilateral breast cancer was diagnosed using mammography, ultrasonography, and core-needle biopsy. Histopathological examination revealed invasive ductal carcinoma in the right breast and ductal carcinoma in situ in the left breast. Bilateral total mastectomy, sentinel lymph node biopsy, and excision of accessory breasts in the axilla were performed.

Basal cell carcinoma of the nipple. Report of two cases.

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Cain, R J; Sau, P; Benson, P M

1990-02-01

Two cases of basal cell carcinoma of the nipple are presented, bringing the total number of reported cases to 15. The majority, including our two patients, are elderly men. This finding suggests a causal role of exposure to ultraviolet radiation. In our cases excision was curative.

Original Article The incidence of cancer in women presenting with ...

African Journals Online (AJOL)

user

Objectives: To determine the frequency of breast cancer in patients presenting with bloody nipple discharge at the ... cytology of discharges, breast ultrasonography, mammography ... the histologic diagnosis of the nipple discharge. Results.

Features of the Diagnosis of Intraductal Breast Diseases in Adolescent Girls Through the Example of Clinical Cases. The Algorithm of Examination And Treatment of Pathologies in Adolescence

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M. L. Travina

2016-01-01

Full Text Available Intraductal breast diseases are characterized by a high risk of transformation in breast cancer. Difficulties of diagnosing intraductal lesions are associated with the only symptom — the appearance of pathologic discharge from the breast nipple. In adolescent girls, taking into account the immaturity of the nipple and it flatness, there are difficulties with removing it correctly. On physical examination, as well as with the high density of the surrounding tissue and areola, the control over the presence of pathologic discharge from the mammary ducts is difficult. The intraductal pathology requires ultrasound examination, mammography, and only after a full examination — ductographic research. The article presents its own clinical observations of the intraductal pathology in adolescent girls aged 14 and 15 years. The algorithms of examination and patient surveillance with intraductal pathology are described.

Nipple- and areola-sparing mastectomy for the treatment of breast cancer.

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Mota, Bruna S; Riera, Rachel; Ricci, Marcos Desidério; Barrett, Jessica; de Castria, Tiago B; Atallah, Álvaro N; Bevilacqua, Jose Luiz B

2016-11-29

The efficacy and safety of nipple-sparing mastectomy and areola-sparing mastectomy for the treatment of breast cancer are still questionable. It is estimated that the local recurrence rates following nipple-sparing mastectomy are very similar to breast-conserving surgery followed by radiotherapy. To assess the efficacy and safety of nipple-sparing mastectomy and areola-sparing mastectomy for the treatment of ductal carcinoma in situ and invasive breast cancer in women. We searched the Cochrane Breast Cancer Group's Specialized Register, the Cochrane Center Register of Controlled Trials (CENTRAL), MEDLINE (via PubMed), Embase (via OVID) and LILACS (via Biblioteca Virtual em Saúde [BVS]) using the search terms "nipple sparing mastectomy" and "areola-sparing mastectomy". Also, we searched the World Health Organization's International Clinical Trials Registry Platform and ClinicalTrials.gov. All searches were conducted on 30th September 2014 and we did not apply any language restrictions. Randomised controlled trials (RCTs) however if there were no RCTs, we expanded our criteria to include non-randomised comparative studies (cohort and case-control studies). Studies evaluated nipple-sparing and areola-sparing mastectomy compared to modified radical mastectomy or skin-sparing mastectomy for the treatment of ductal carcinoma in situ or invasive breast cancer. Two review authors (BS and RR) performed data extraction and resolved disagreements. We performed descriptive analyses and meta-analyses of the data using Review Manager software. We used Cochrane's risk of bias tool to assess studies, and adapted it for non-randomised studies, and we evaluated the quality of the evidence using GRADE criteria. We included 11 cohort studies, evaluating a total of 6502 participants undergoing 7018 procedures: 2529 underwent a nipple-sparing mastectomy (NSM), 818 underwent skin-sparing mastectomy (SSM) and 3671 underwent traditional mastectomy, also known as modified radical

Community feedback on the JustMilk Nipple Shield Delivery System ...

African Journals Online (AJOL)

Background. Infant medication administration is a major public-health challenge, especially in rural or low-resource areas. The JustMilk Nipple Shield Delivery System (NSDS) is a novel method of infant medication delivery designed to address some of these challenges. Objective. To explore the acceptability of the JustMilk ...

An electron microscopic study of clinical Paget's disease of the nipple

DEFF Research Database (Denmark)

Jahn, H; Osther, P J; Nielsen, E H

1995-01-01

An ultrastructural study of the epidermis from eight patients with clinical Paget's disease of the nipple supports the epidermotropic theory. There was no evidence that the Paget's cells originated from keratinocytes. We propose the hypothesis that Paget's cells represent transformed ductal cells...

Favorable Outcome with Close Margins in Patients Undergoing Nipple/Skin Sparing Mastectomy with Immediate Breast Reconstruction: 5-year Follow-up

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Enver Özkurt1

2018-02-01

Full Text Available Background: Implant-based breast reconstruction after mastectomy has recently been reported to be the preferred type of surgery among breast-specific surgeons and plastic surgeons. Aims: To explore the significant clinicopathological factors associated with long-term outcome related to local recurrences of the nipple among patients who underwent immediate breast reconstruction with tissue expander or implant after mastectomy. Study Design: Retrospective cohort. Methods: From January 2007 to January 2013, 51 breast cancer patients who underwent immediate breast reconstruction with tissue expander or implant were retrospectively analysed. Patients’ demographic data, clinicopathological characteristics, and clinical outcome by disease-free survival and disease-specific survival analyses were determined. Results: The median follow-up was 64 (31-114 months. Of the 57 mastectomies, 41 were skin sparing mastectomy (72% and 16 were nipple-areola sparing mastectomy (28%. Immediate breast reconstruction surgery included tissue expander (n=46, 81% or implant (n=11, 19% placement. The molecular subgroups of 47 invasive cancers were as follows: luminal A (n=23, 49%, luminal B (n=16, 34%, non-luminal HER2 (n=5, 10.6, triple negative breast cancer (n=3, 6.4%. The 5-years disease-specific survival, disease-free survival, and locoregional recurrence-free survival rates were 96.8%, 90%, and 97.6% respectively. Patients with luminal A cancer were found to have an improved 5-year disease-free survival time than other (luminal A; 100% vs. non-luminal A; 78%; p=0.028. Of the 14 nipple-areola sparing mastectomy, 13 had a close median tumour distance to nipple-areola complex (<20 mm with a 5-year locoregional recurrence free survival of 100%. Conclusion: Immediate breast reconstruction with implant or tissue expander can be safely applied in patients undergoing skin sparing mastectomy or nipple-areola sparing mastectomy. Patients with luminal-A type show the most

Establishment of an immunocompetent nipple valve anastomosis to prevent faecal reflux after ileocolic resection in dogs.

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Ecker, K W; Pistorius, G; Menger, M D; Feifel, G

2000-05-01

To construct an immunocompetent nipple valve anastomosis (NVA) to exclude faecal reflux and compare it with an end-to-end anastomosis to see if it would prevent recurrent inflammation caused by intraluminal bacterial antigens in Crohn's disease. Laboratory study. Teaching hospital, Germany. Two groups of six beagle dogs each of which had NVA or end-to-end anastomosis. Construction of a NVA by stapling the telescoped nipple, and replacing the ileal mucosa on the valve by colonic mucosa; end-to-end anastomosis. Radiological, bacteriological, angiographic, and morphometric results. Absolute retrograde pressure-competence and free orthograde permeability of the NVA resulted in significantly lower intestinal bacterial counts compared with the end-to-end anastomosis (p < 0.05). Transposition of colonic mucosa was successful as demonstrated by revascularisation from the ileal nipple and looked normal on morphometry. If NVA were constructed in patients with Crohn's disease, recurrences should be prevented, which would verify the immunopathogenetic hypothesis of new inflammation.

Paget's disease of the nipple. A continuing enigma

DEFF Research Database (Denmark)

Osther, P J; Balslev, Erik; Blichert-Toft, M

1990-01-01

the multicentricity of breast cancer. The literature is reviewed. Clinical, histologic (including classification), histochemical and electron microscopy observations and diagnostic considerations are discussed. Diagnosis is often delayed, with adverse consequences for treatment. The nipple lesions may be accompanied...... by ductal carcinoma of local or more extensive in situ type, or invasive tumour. Lymph-node metastasis seems to be the most important prognostic factor. The merits of radical vs. modified radical mastectomy and local excision, with or without adjuvant radiotherapy, are considered. Major studies of breast...

A common cancer in an uncommon location: A case report of squamous cell carcinoma of the nipple

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Kelly Dye

2017-01-01

Conclusion: The cases of SCC of the Nipple demonstrate the importance of recognizing changes of the skin even in locations not typically associated with SCC (American Cancer Society, 2015; Scotto et al., 1983; Pendse and O’Connor, 2015; Loveland-Jones et al., 2010; Brookes et al., 2005; Sofos et al., 2013; King and Kremer, 2012; Venkataseshan et al., 1994; Hosaka et al., 2011 [1–9]. We concluded with a future suggestion of investigating possible risk factors specific to SCC of the breast or nipple.

Recipient vessel selection in immediate breast reconstruction with free abdominal tissue transfer after nipple-sparing mastectomy.

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Yang, Sung Jun; Eom, Jin Sup; Lee, Taik Jong; Ahn, Sei Hyun; Son, Byung Ho

2012-05-01

Nipple-sparing mastectomy (NSM) is gaining popularity due to its superior aesthetic results. When reconstructing the breast with free abdominal tissue transfer, we must readdress the recipient vessel, because NSM can cause difficulty in access to the chest vessel. Between June 2006 and March 2011, a total of 92 women underwent NSM with free abdominal tissue transfer. A lateral oblique incision was used for the nipple-sparing mastectomy. For recipient vessels, the internal mammary vessels were chosen if the mastectomy flap did not block access to the vessels. If it did, the thoracodorsal vessels were used. Age, degree of breast ptosis, weight of the mastectomy specimen, and related complications of the internal mammary vessel group and the thoracodorsal vessel group were compared. Thoracodorsal vessels were used as recipient vessels in 59 cases, and internal mammary vessels in 33 cases including 4 cases with perforators of the internal mammary vessels. Breast reconstruction was successful in all cases except one case involving a total flap failure, which was replaced by a silicone gel implant. The internal mammary group and the thoracodorsal group were similar in terms of age, height, breast weight, and degree of ptosis. The flap related complications such as flap loss and take-back operation rates were not significantly different between the two groups. The rate of nipple necrosis was higher in the internal mammary group. The thoracodorsal vessels could produce comparable outcomes in breast reconstruction after nipple-sparing mastectomies. If access to internal mammary vessels is difficult, the thoracodorsal vessel can be a better choice.

Recipient Vessel Selection in Immediate Breast Reconstruction with Free Abdominal Tissue Transfer after Nipple-Sparing Mastectomy

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Sung Jun Yang

2012-05-01

Full Text Available BackgroundNipple-sparing mastectomy (NSM is gaining popularity due to its superior aesthetic results. When reconstructing the breast with free abdominal tissue transfer, we must readdress the recipient vessel, because NSM can cause difficulty in access to the chest vessel.MethodsBetween June 2006 and March 2011, a total of 92 women underwent NSM with free abdominal tissue transfer. A lateral oblique incision was used for the nipple-sparing mastectomy. For recipient vessels, the internal mammary vessels were chosen if the mastectomy flap did not block access to the vessels. If it did, the thoracodorsal vessels were used. Age, degree of breast ptosis, weight of the mastectomy specimen, and related complications of the internal mammary vessel group and the thoracodorsal vessel group were compared.ResultsThoracodorsal vessels were used as recipient vessels in 59 cases, and internal mammary vessels in 33 cases including 4 cases with perforators of the internal mammary vessels. Breast reconstruction was successful in all cases except one case involving a total flap failure, which was replaced by a silicone gel implant. The internal mammary group and the thoracodorsal group were similar in terms of age, height, breast weight, and degree of ptosis. The flap related complications such as flap loss and take-back operation rates were not significantly different between the two groups. The rate of nipple necrosis was higher in the internal mammary group.ConclusionsThe thoracodorsal vessels could produce comparable outcomes in breast reconstruction after nipple-sparing mastectomies. If access to internal mammary vessels is difficult, the thoracodorsal vessel can be a better choice.

Bilateral DCIS following gynecomastia surgery. Role of nipple sparing mastectomy. A case report and review of literature☆

Science.gov (United States)

Noor, L.; McGovern, P.; Bhaskar, P.; Lowe, J.W.

2011-01-01

Bilateral ductal carcinoma in situ of breast is a very rare disease in men. Ductal carcinoma in situ (DCIS) is an abnormal proliferation that involves the ductal epithelium and it has the potential of evolving into an invasive tumour. Gynaecomastia (female like breast in men) is a benign condition though it is associated with a reported 3% incidence of unilateral invasive breast cancer.2 Synchronous bilateral breast cancer in association with gynaecomastia is exceptionally rare. The recommended treatment for DCIS in male is mastectomy. So far only 2 cases of bilateral DCIS in male patients has been reported in the literature treated with skin and nipple sparing mastectomies. We report another case of synchronous bilateral DCIS in a male treated with skin and nipple sparing mastectomies. A 44 year-old man with history of long-standing gynecomastia. He had no identifiable risk factor for the development of cancer. His pre operative assessment of breast including mammograms was normal. He underwent bilateral subcutaneous mastectomies, with subsequent incidental diagnosis of synchronous bilateral ductal carcinoma in situ. The case was discussed in multidisciplinary team meeting and the need for further surgery was felt including excision of nipple areola complex. However considering patient wishes, cosmetic outcome and recent literature it was decided to preserve nipple areola complex (NAC) with regular follow up evaluation. Our patient at completion of 18 months of treatment is doing well with no signs of local recurrence. PMID:22096697

Breastfeeding or nipple stimulation for reducing postpartum haemorrhage in the third stage of labour.

Science.gov (United States)

Abedi, Parvin; Jahanfar, Shayesteh; Namvar, Farideh; Lee, Jasmine

2016-01-27

Oxytocin and prostaglandin are hormones responsible for uterine contraction during the third stage of labour. Receptors in the uterine muscles are stimulated by exogenous or endogenous oxytocin leading to uterine contractions. Nipple stimulation or breastfeeding are stimuli that can lead to the secretion of oxytocin and consequent uterine contractions. Consequently, uterine contractions can reduce bleeding during the third stage of labour. To investigate the effects of breastfeeding or nipple stimulation on postpartum haemorrhage (PPH) during the third stage of labour. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (15 July 2015) and reference lists of retrieved studies. Randomised and quasi-randomised controlled trials comparing breast stimulation, breastfeeding or suckling for PPH in the third stage of labour were selected for this review. Two review authors independently assessed studies for inclusion in terms of risk of bias and independently extracted data. Disagreements were resolved by a third review author. We included four trials (4608 women), but only two studies contributed data to the review's analyses (n = 4472). The studies contributing data were assessed as of high risk of bias overall. One of these studies was cluster-randomised and conducted in a low-income country and the other study was carried out in a high-income country. All four included studies assessed blood loss in the third stage of labour. Birth attendants estimated blood loss in two trials. The third trial assessed the hematocrit level on the second day postpartum to determine the effect of the bleeding. The fourth study measured PPH ≥ 500 mL. Nipple stimulation versus no treatmentOne study (4385 women) compared the effect of suckling versus no treatment. Blood loss was not measured in 114 women (59 in control group and 55 in suckling group). After excluding twin pregnancies, stillbirths and neonatal deaths, the main analyses for this trial were performed on

Primary male neuroendocrine adenocarcinoma involving the nipple simulating Merkel cell carcinoma - a diagnostic pitfall.

Science.gov (United States)

Mecca, Patricia; Busam, Klaus

2008-02-01

Male breast cancer is a rare entity accounting for Nipple skin/subcutaneous tumors in men are even rarer. Likewise, true neuroendocrine carcinoma of the breast, defined as > 50% of tumor cells staining for either chromogranin or synaptophysin, is not a common entity, usually occurring in older women. We present the case of a 70-year-old man with a slowly growing nipple mass that had enlarged over the previous 1.5 years. The histology consisted of nests, trabeculae and sheets of basaloid cells with rare abortive gland formation and a pushing edge. The case was originally misdiagnosed as a Merkel cell carcinoma, based largely on histologic morphology. Strong staining for synaptophysin (in greater than 50% of cells), CD56, keratins AE1 : AE3 and Cam 5.2, as well as estrogen receptor and progesterone receptor was noted. Myoepithelial cells within in situ areas were identified using stains for calponin and 4A4, supporting a primary mammary duct origin. Additionally, a substantial portion of cells stained for Gross Cystic Disease Fluid Protein-15 (GCDFP-15), confirming some overlap with sweat duct differentiation. To the best of our knowledge, although reported in the male breast, no case of primary nipple neuroendocrine carcinoma in a male patient has been reported in the literature. The gender of the patient and association with the skin of the chest wall probably contributed to the original misdiagnosis of Merkel cell carcinoma in this patient.

Can Vascular Patterns on Preoperative Magnetic Resonance Imaging Help Predict Skin Necrosis after Nipple-Sparing Mastectomy?

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Bahl, Manisha; Pien, Irene J; Buretta, Kate J; Hwang, E Shelley; Greenup, Rachel A; Ghate, Sujata V; Hollenbeck, Scott T

2016-08-01

Nipple-areola complex (NAC) and skin flap ischemia and necrosis can occur after nipple-sparing mastectomy (NSM). The purpose of this study was to correlate vascular findings on MRI with outcomes in patients who underwent NSM. Female patients at a single institution who underwent NSM and had a preoperative breast MRI between 2010 and 2014 were identified. Medical records were reviewed for patient demographics, surgical factors, and complications. Magnetic resonance images were reviewed by 2 radiologists, blinded to outcomes, for the presence of dual vs single blood supply to the breast. The association between blood supply on MRI with ischemic and necrotic complications after NSM was analyzed. One hundred and sixty-four NSM procedures were performed in 105 patients (mean age 45.5 years, range 25 to 69 years) who had a preoperative MRI. The majority of procedures were performed for malignancy (89 of 164 [54.3%]) or prophylaxis (73 of 164 [44.5%]). Nipple-areola complex or skin flap ischemia or necrosis occurred in 40 (24.4%) breasts. Ischemia or necrosis after NSM was less likely to occur in breasts with dual compared with single blood supply (20.8% vs 38.2%; p = 0.03). There was no association between surgical complications and age, BMI, smoking history, previous radiation therapy, indication for NSM, surgical specimen weight, surgical incision type, reconstruction approach, or operating surgeon on univariate analysis. Preoperative MRI characterization of breast vascularity can be considered when planning NSM. The presence of a dual blood supply to the breast on MRI is associated with a decreased risk of nipple-areola complex and skin flap ischemia and necrosis after NSM. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

[Banana peel: a possible source of infection in the treatment of nipple fissures].

Science.gov (United States)

Novak, Franz Reis; de Almeida, João Aprígio Guerra; de Souza e Silva, Rosana

2003-01-01

To study the microbiology of banana peel being sold in the city of Rio de Janeiro, in an attempt to determine the possibility that the peel may represent a source of infection for women who use it to treat nipple fissures. The following microorganisms were studied in 20 banana peel samples: mesophiles, total coliforms, fecal coliforms, Pseudomonas aeruginosa, lipolytic and proteolytic microorganisms, molds and yeasts, lactic bacteria, and coagulase-positive staphylococcus. The microbiological analyses revealed the occurrence of several typical groups of microorganisms, with the following distribution of positive results being detected in banana peel samples: mesophiles, 100%; total coliforms, 20%; coagulase-positive staphylococcus, 25%; molds and yeasts, 30%; proteolytic microorganisms, 70%; lipolytic microorganisms, 30%, and lactic bacteria, 95%. Fecal coliforms and Pseudomonas aeruginosa were not isolated. The results show the presence of potentially pathogenic microorganisms in levels which could compromise the microbiological quality of the banana peel. Its use for the treatment of nipple fissures can initiate an infectious process.

X-Ray Polarization Imaging

Science.gov (United States)

2006-07-01

diagnosis of abnormal nipple discharge. The contrast agent is generally intro- duced via the orifice in the nipple that has been iden- tified as the...galactography intends to introduce contrast material only into the ductal lu- men . In this context, it is noteworthy that Cabioglu et al (25), in a study of the...differential diagnosis of nipple discharge, reported that one patient had “an unusual communication between the ductal system and a large mammary

Retention of a reconstructed nipple using a C-V flap with different layer thicknesses in the C-flap.

Science.gov (United States)

Sowa, Yoshihiro; Itsukage, Sizu; Sakaguchi, Kouichi; Taguchi, Tetsuya; Numajiri, Toshiaki

2018-04-01

The C-V flap for nipple reconstruction is now one of standard surgical techniques. But decreased projection is still a problem. In recent years, it has been suggested that projection can be more easily maintained when raising of the C-flap is performed with a split thickness dermis. In this study, we examined whether decrease of projection can be prevented by raising of a C-flap with a split dermis rather than with full dermis. A total of 49 consecutive patients who underwent reconstruction of a nipple using the C-V flap technique were enrolled. The patients included 22 who underwent surgery using a C-flap with a full thickness dermis (Group F), and 27 who underwent surgery with raising of a flap with a split thickness dermis (Group S). The size of the reconstructed nipple was measured at 2 weeks, 6 months and 1 year postoperatively for comparison between Groups F and S. Partial necrosis of the C-flap end occurred in 4 subjects in only Group S. The decrease in projection after 1 year postoperatively in Group S was significantly lower than that in Group F. In contrast, the teat base size in Group F tended to be greater than that in Group S, suggesting a tendency for an expanded base using a flap with a full dermis. Our results indicated that it is recommended to use a C-flap with a split dermis for cases with high projection of the nipple on the contralateral side.

Does Smoking History Confer a Higher Risk for Reconstructive Complications in Nipple-Sparing Mastectomy?

Science.gov (United States)

Frey, Jordan D; Alperovich, Michael; Levine, Jamie P; Choi, Mihye; Karp, Nolan S

2017-07-01

History of smoking has been implicated as a risk factor for reconstructive complications in nipple-sparing mastectomy (NSM), however there have been no direct analyses of outcomes in smokers and nonsmokers. All patients undergoing NSM at New York University Langone Medical Center from 2006 to 2014 were identified. Outcomes were compared for those with and without a smoking history and stratified by pack-year smoking history and years-to-quitting (YTQ). A total of 543 nipple-sparing mastectomies were performed from 2006 to 2014 with a total of 49 in patients with a history of smoking. Reconstructive outcomes in NSM between those with and without a smoking history were equivalent. Those with a smoking history were not significantly more likely to have mastectomy flap necrosis (p = 0.6251), partial (p = 0.8564), or complete (p = 0.3365) nipple-areola complex (NAC) necrosis. Likewise, active smokers alone did not have a higher risk of complications compared to nonsmokers or those with smoking history. Comparing nonsmokers and those with a less or greater than 10 pack-year smoking history, those with a > 10 pack-year history had significantly more complete NAC necrosis (p = 0.0114, smoking history or >5 YTQ prior to NSM were equivalent to those without a smoking history. We demonstrate that NSM may be safely offered to those with a smoking history although a > 10 pack-year smoking history or <5 YTQ prior to NSM may impart a higher risk of reconstructive complications, including complete NAC necrosis. © 2017 Wiley Periodicals, Inc.

Prophylactic Nipple-Sparing Mastectomy and Direct-to-Implant Reconstruction of the Large and Ptotic Breast: Is Preshaping of the Challenging Breast a Key to Success?

Science.gov (United States)

Gunnarsson, Gudjon L; Bille, Camilla; Reitsma, Laurens C; Wamberg, Peter; Thomsen, Jørn Bo

2017-09-01

Nipple-sparing mastectomy with simultaneous hammock technique direct-to-implant reconstruction is increasingly offered to patients opting for risk-reducing mastectomy. Despite this promising method, patients with macromastia and ptotic breasts remain a challenging group to treat satisfactorily and more often end up undergoing a difficult corrective procedure and experience an unacceptably high rate of failed reconstruction. The authors examined whether targeted preshaping mastopexy/reduction could prepare these patients for a successful nipple-sparing mastectomy/direct-to-implant reconstruction. Patients seeking risk-reducing nipple-sparing mastectomy/direct-to-implant reconstruction at the authors' institutions deemed unfit for a one-stage procedure based on their previous experience were offered a targeted two-stage, risk-reducing mastopexy/reduction followed by a delayed secondary nipple-sparing mastectomy and direct-to-implant reconstruction. Patients were followed up at 3 weeks and 6 or 12 months. Forty-four reconstructions were performed in 22 patients aged 43 years (range, 26 to 57 years). All 44 procedures were completed successfully without any failure or nipple-areola complex losses. Patients' median body mass index was 30 kg/m (range, 22 to 44 kg/m). Six patients were smokers and one had hypertension. Two patients underwent reoperation because of hematoma and fat necrosis. The authors' results demonstrate that a targeted preshaping mastopexy/reduction followed by nipple-sparing mastectomy/direct-to-implant reconstruction can be safely planned in women who opt for a risk-reducing mastectomy and can be performed successfully with a 3- to 4-month time span between operations. On the basis of these results and the superior cosmetic outcome, the two-stage approach has become the authors' standard of care in all such settings. Therapeutic, IV.

Quadrantectomy and Nipple Saving Mastectomy in Treatment of Early Breast Cancer: Feasibility and Aesthetic Results of Adjunctive Latissmus Dorsi Breast Reconstruction

International Nuclear Information System (INIS)

Bassiouny, M.; El-Marakby, H.H.; Saber, N.; Zayed, S.B.; Shokry, A.

2005-01-01

Breast conserving surgery has been a recognised method of treatment of early breast cancer. The treatment methods include quadrantectomy or skin sparing mastectomy combined with ipsilateral axillary nodal dissection followed by radiotherapy. In the current study we evaluate the feasibility and oncologic safety of the quadrantectomy and SSM operations with preservation of the nipple and areola, and the cosmetic results of immediate reconstruction by using the latissmus dorsi flap. Materials and Methods: A breast conservative surgery (quadrantectomy or nipple sparing mastectomy) was carried out in a group of 55 patients with invasive breast cancer treated at the Department of Surgical Oncology, NCl, between January 2001 and April 2004. The selection criteria included those patients who presented with TI or T2 breast cancer and were located at least 2 cm from the nipple as the centre for the nipple areola complex. The age of the patients ranged from 32 years to 65 years. The follow up period ranged from 2 to 33 months with an average of 21 months. Pathological assessment of the specimens showed a negative safety margin in all cases. Most of our cases were invasive duct carcinoma grade 1-2 (42) (75%). The complications of the flap reconstruction included one major sloughing of the Iatissmus dorsi flap, 4 partial flap sloughing, 4 sloughing of the nipple and fat necrosis in 6 patients. The donor site healed normally in all of our cases except for one patient who suffered from a hypertrophic scar which settled down during the follow up period. The aesthetic assessment of the patients, showed an excellent to good results in the majority of cases (42) (75%) while in 6 (12%) results were fair and in 7 (13%) results were poor. Breast conservative surgery with quadrantectomy or skin sparing technique with preservation of the nipple and areola combined with immediate LD flap reconstruction is a valid procedure for treatment of early breast cancer. Immediate reconstruction by

Prophylactic Nipple-Sparing Mastectomy and Direct-to-Implant Reconstruction of the Large and Ptotic Breast

DEFF Research Database (Denmark)

Gunnarsson, Gudjon L; Bille, Camilla; Reitsma, Laurens C

2017-01-01

BACKGROUND: Nipple-sparing mastectomy with simultaneous hammock technique direct-to-implant reconstruction is increasingly offered to patients opting for risk-reducing mastectomy. Despite this promising method, patients with macromastia and ptotic breasts remain a challenging group to treat satis...

Anti nutritional evaluation of the flour of the nipples of holm oak (quercus ilex) and oak cork (quercus suber) Raw and pressure-sealed

Energy Technology Data Exchange (ETDEWEB)

El Mahi, F. Z.

2009-07-01

The present study contributes to the development of the food potential of the nipples of oak like new resources likely to be exploited on an industrial scale for their use in animal feeds. Our work relates to two species S of nipples of oak, edible, the homl oak and the other fodder one, the oal cork known for their spontaneousness and their vey significant geographical distribution. (Author)

Anti nutritional evaluation of the flour of the nipples of holm oak (quercus ilex) and oak cork (quercus suber) Raw and pressure-sealed

International Nuclear Information System (INIS)

El Mahi, F. Z.

2009-01-01

The present study contributes to the development of the food potential of the nipples of oak like new resources likely to be exploited on an industrial scale for their use in animal feeds. Our work relates to two species S of nipples of oak, edible, the holm oak and the other fodder one, the oak cork known for their spontaneousness and their vey significant geographical distribution. (Author)

Nevoid hyperkeratosis of the nipple and the areola.

Science.gov (United States)

Alonso-Corral, Maria Jose; Garrido-Colmenero, Cristina; Martinez-Ortiz, Fernando; Ruiz-Villaverde, Ricado

2016-02-17

A 25-year-old woman presented to our dermatology unit with progressive diffuse thickening of the both areolas. A skin biopsy was taken from the right areola showing irregular filiform acanthosis with elongation and anastomosis of rete ridges, irregular orthokeratotic hyperkeratosis, pseudocyst formation, and hyperpigmentation of the basal layer. The cause of nevoid hyperkeratosis of the nipple and areola is unknown. Eighty percent of cases occur in women and are often manifested during puberty or pregnancy. The disease may also occur in men receiving hormonal therapy. There is no uniformly effective treatment. Dermatologists, gynecologists, and general practitioners have an important part to play in recognizing this condition that may be underdiagnosed because of lack of awareness.

The White Nipple Sign: Please Do Not Disturb

Directory of Open Access Journals (Sweden)

Naser M. Khan

2011-07-01

Full Text Available Blood spurting or oozing from a varix confirms the diagnosis of variceal hemorrhage. In most cases of variceal hemorrhage, however, the bleeding has ceased by the time endoscopy is performed. Endoscopists rely on identification of stigmata of recent hemorrhage to determine whether varices are the cause of bleeding and to predict the likelihood of rebleeding. Most of the attention has focused on red color signs, such as red wale markings, described by Beppu et al. [Gastrointest Endosc 1981;27:213–218] and well known to endoscopists. Here we describe our experience with a less recognized stigma of variceal hemorrhage known as the ‘white nipple sign’, which resulted in active hemorrhage when manipulated.

Breast disease in the male: galactographic evaluation.

Science.gov (United States)

Detraux, P; Benmussa, M; Tristant, H; Garel, L

1985-03-01

Seven men with unilateral nipple discharge underwent galactography. In two patients the diagnosis was carcinoma, two were benign papillomas, one was a breast abscess, and two were ductal ectasia. Galactography is useful in men and women with nipple discharge, especially when the discharge is bloody and there is no palpable tumor. The precise location of an intraductal lesion through the use of galactography guides the biopsy and makes conservative surgery easier.

Klinefelter's syndrome associated with breast carcinoma and Paget's disease of the nipple.

Science.gov (United States)

Moshakis, V; Fordyce, M J; Griffiths, J D

1983-09-01

We describe a patient with Klinefelter's syndrome associated with multi-focal breast carcinoma and Paget's disease of the nipple. Reviewing the 16 previously documented cases in the world literature, it is apparent that patients with this syndrome have an increased incidence of breast carcinoma. There is no evidence to date to suggest that such tumour is morphologically or biologically different from breast cancer in females and normal men.

Peroxide alkaline for cleansing the baby bottle nipple to prevent oral thrush relaps

Directory of Open Access Journals (Sweden)

Maharani Laillyza Apriasari

2013-06-01

Full Text Available Background: Oral candidiasis is the most prevalent opportunistic infection affecting the oral mucosa. A number of predisposing factors have the capacity to convert Candida from the normal commensal flora to a pathogenic organism. Oral candidiasis is divided into primary and secondary infection. The primary infections are restricted to the oral and perioral sites, where as secondary infections are accompanied by sistemic mucocutaneous manifestation. Oral thrush is one of the candidiasis primary infection. Some presdiposing factors of oral thrush are neonatal, old people, or where oral microflora is disturbed by the treatment with broad spectrum antibiotics. Final diagnosis is determined by fungal culture examination, although through clinical examination oral thrush can be determined by swabbing the white pseudomembran. Purpose: This case report presents about the importance of using the antiseptic cleanser for baby bottle nipple to prevent oral thrush relaps and shows about peroxide alkaline as the alternatif of antiseptic cleanser for baby bottle nipple that can substitute chlorhexidine gluconat 0.2%. Case: A baby girl, 15 months old, when she was suffering influenza the pediatry gave amoxycillin 125 mg three times a day for ten days. Then the white plaque appeared on her dorsum of tongue. The therapy was Gentian Violet 1% four times a day for ten days was applied on dorsum of the tongue. The patient was suspected to suffer alergy reaction after using nistatin oral suspension four times a day had applied for 1 day. The instruction was doing sterilization for the baby bottle nipple in boiling water. Three days after the baby was cured, the white plaque was appeared on upper n lower lips mucous. Case management: The diagnosis was Oral thrush. The therapy was Gentian violet 1% four times a day for ten days that applied on upper and lower lips mucous. The instruction was doing the sterilization for baby bottle nipple in denture cleanser contain

Reconstructive approach for patients with augmentation mammaplasty undergoing nipple-sparing mastectomy.

Science.gov (United States)

Alperovich, Michael; Choi, Mihye; Frey, Jordan D; Karp, Nolan S

2014-09-01

Nipple-sparing mastectomy (NSM) is a recent advance in the therapeutic and prophylactic management of breast cancer; however, the procedure is associated with increased reconstructive complications. Data on NSM after previous breast augmentation are limited. The authors compared reconstructive complications after NSM between patients with previously augmented breasts and a larger cohort that had not undergone prior augmentation. An approach to NSM that involves 2-stage reconstruction in augmented patients is also described. Medical records of NSMs performed at New York University Langone Medical Center from 2006 to 2013 were reviewed. Data points evaluated included patient characteristics, comorbidities, breast implant plane, and reconstructive complications. Fisher's exact and t tests were used for the comparisons. During the study period, NSMs were performed in 17 augmented breasts at this institution. After NSM, 15 of these breasts underwent implant-based reconstruction and 2 breasts underwent microvascular free flaps. Reconstructive complications included 1 hematoma managed nonoperatively (5.9%) and 1 partial necrosis of the nipple-areola complex (NAC) (5.9%). Compared with the larger nonaugmented cohort (n=332), patients with previously augmented breasts had fewer complications, and there were no statistically significant differences in the rates of mastectomy flap necrosis, partial NAC necrosis, complete NAC necrosis, hematoma, capsular contracture, explantation, implant displacement, seroma, or breast cellulitis. The results indicate that NSM reconstruction is associated with minimal complications in patients with previous augmentation mammaplasty. 4. © 2014 The American Society for Aesthetic Plastic Surgery, Inc.

Evaluation of oil-leakage of multi-layered resin-hose clamped with metal nipple and sleeve

Science.gov (United States)

Matsuoka, Kenta; Okubo, Kazuya; Fujii, Toru; Nakamura, Chihiro; Fujishita, Yushi; Kusu, Fuko; Matsushita, Masato; Yoshihara, Ryota

2018-03-01

The purpose of this study is to investigate the path of occurred oil-leakage of multi-layered resin-hose as one of multifunctional materials around the caulked joint with a metal nipple and sleeve when excessive cyclic internal pressure was applied onto the hose. Equivalent cyclic axial tensile force was substitutively applied to the hose, where same degree of normal stress was produced in longitudinal direction. Excessive 3 and 5 times of the standard load was applied to the hose. Cyclic loading was paused at every 1000 and 10000 cycles and then designed internal pressure was applied to the hose by a hand-operated pump with water in order to check whether the leakage was occurred around the joint and surface of the hose for safety evaluation. Cyclic fatigue life was defined as the number of loading cycles in which the leakage and the initial damage which was the passage of the ultrasonic wave was observed on the cyclic test. Test results showed the fatigue life at which leakage of water was observed was increased 20 times in case of K=3 compared to that in case of K=5. The cycles of initial damage detected by the ultrasonic wave were passed was increased 3.3 times in case of K=3 compared to that in case of K=5. The fluorescent agent penetrated from the core layer of resin hose to the reinforcement layer in which a half cross section along longitudinal direction in failed specimens was observed after the leak test. The original specimens had the gap between the resin-hose and the nipple and then the gap extended and connected during fatigue cyclic. In this study, it was observed that oil was leaked through narrow gap between the nipple and core layer of resin hose.

A 35-year-old woman presenting with an unusual post-traumatic leiomyoma of the nipple: a case report.

Science.gov (United States)

Pavlidis, Leonidas; Vakirlis, Efstratios; Spyropoulou, Georgia-Alexandra; Pramateftakis, Manousos Georgios; Dionyssiou, Dimitris; Demiri, Efterpi

2013-02-19

Leiomyoma of the mammary papilla is one of the most uncommon nipple tumors with only 50 cases reported in the literature until now. To the best of our knowledge we present the first report of a nipple leiomyoma that originated from a traumatic abrasion caused by breastfeeding. A 35-year-old healthy Caucasian female with a cauliflower-like tender and pink nodular mass that was approximately 10mm in diameter presented to our out-patients department. The patient suggested that the mass originated from a traumatic abrasion caused by breastfeeding three years ago and it has been slowly growing ever since.An excision biopsy was performed. The histological and immunohistochemical examination confirmed the diagnosis of leiomyoma. There were no postoperative complications or any sign of local recurrence four years postoperatively. Leiomyoma of the mammary papilla is a rare benign neoplasm that usually appears as a solid tender nodule. Differential diagnosis comprises breast carcinoma, leiomyosarcoma and myoid hamartoma. The recommended treatment is complete excision of the tumor with histologically confirmed tumor-free margins otherwise recurrence is possible. A detailed history of the patient's disease can reveal the original etiology. This is an original case report that will have particular interest to plastic surgeons, dermatologists, and pathologists. The pathogenetic mechanism was trauma of the nipple. According to our review of the literature this particular information has never been reported and we think that it may advance our knowledge of this very infrequent tumor.

Multiple primary syphilis on the lip, nipple-areola and penis: An immunohistochemical examination of Treponema pallidum localization using an anti-T. pallidum antibody.

Science.gov (United States)

Fukuda, Hidetsugu; Takahashi, Misaki; Kato, Keiichi; Oharaseki, Toshiaki; Mukai, Hideki

2015-05-01

Primary syphilis caused by Treponema pallidum usually develops after sexual contact as an initial solitary sclerosis or hard chancre in the genital region. We describe a case of primary syphilis at three sites in genital and extragenital regions of a man who had sex with men. A 29-year-old man visited our hospital for skin lesions on his lower lip, nipple-areola and penis. A positive syphilis serological test for rapid plasma reagin had a titer of 1:16; the patient also tested positive for specific antibodies against T. pallidum, with a cut-off index of 39.0. Histopathological examination of a nipple-areola biopsy specimen revealed a thickened epidermis and dense infiltration of inflammatory cells extending from the upper dermal layers to the deep dermis. The inflammatory cells were composed of abundant lymphocytes, plasma cells, histiocytes and neutrophils. Immunohistochemical staining for T. pallidum using an anti-T. pallidum antibody showed numerous spirochetes in the lower portion of the epidermis, scattered inside inflammatory cell infiltrate and perivascular sites throughout the dermis. Based on these findings, the patient was diagnosed with primary syphilis. Treatment with oral amoxicillin hydrate was started. Five days after starting treatment, a diffuse maculopapular rash (syphilitic roseola) occurred on his trunk and extremities. Perivascular cuffing due to T. pallidum was present throughout the dermis in the biopsy specimen of a localized lesion of primary syphilis. Moreover, syphilitic roseola, which indicates generalized dissemination of T. pallidum, developed during the course of treatment for primary syphilis. Therefore, we considered perivascular cuffing to be indicative of the dissemination phase. © 2015 Japanese Dermatological Association.

Promising results after single-stage reconstruction of the nipple and areola complex

DEFF Research Database (Denmark)

Børsen-Koch, Mikkel; Bille, Camilla; Thomsen, Jørn B

2013-01-01

Introduction: Reconstruction of the nipple-areola complex (NAC) traditionally marks the end of breast reconstruction. Several different surgical techniques have been described, but most are staged procedures. This paper describes a simple single-stage approach. Material and Methods: We used...... reconstruction was 43 min. (30-50 min.). Conclusion: This simple single-stage NAC reconstruction seems beneficial for both patient and surgeon as it seems to be associated with faster reconstruction and reduced procedure-related time without compromising the aesthetic outcome or the morbidity associated...

Robotic da Vinci Xi-assisted nipple-sparing mastectomy: First clinical report.

Science.gov (United States)

Sarfati, Benjamin; Honart, Jean-Francois; Leymarie, Nicolas; Rimareix, Francoise; Al Khashnam, Heba; Kolb, Frederic

2018-05-01

Nipple-sparing mastectomy (NSM) is increasingly popular for the treatment of selected breast cancers and prophylactic mastectomy. Surgical scarring and esthetic outcomes are important patient-related cosmetic considerations. Today, the concept of minimally invasive surgery has become popular, especially using robotic surgery. The authors report the first case of NSM using the latest version of the da Vinci Xi surgical system (Xi). The final incision used to remove the entire mammary gland was located behind the axillary line. In this position, hidden by the arm of the patient, the incision was not visible and was compatible with immediate breast reconstruction. © 2017 Wiley Periodicals, Inc.

Circumscribed breast carcinoma: Mammographic and sonographic findings

Energy Technology Data Exchange (ETDEWEB)

Chung, Soo Young; Lee, Yul; Park, Ki Soon; Lee, Ke Sook [College of Medicine, Hallym University, Seoul (Korea, Republic of)

1992-03-15

Circumscribe breast cancer is a well demarcated mass with or without a lobulated border simulating a benign tumor like fibroadenoma on mammography or breast US and is reported as approximate 10% of the incidence among primary breast carcinoma(1.2). Pathologically medullary, colloid, papillary, intraductal and rarely invasive ductal carcinomas are included in this group which show the less intense desmoplastic reaction than the scirrhous type cancer, resulting in the most favorable prognosis of all carcinoma of the breast. Among 214 primary breast carcinoma during the past 8 years, we experienced 6 case of pathologically proven circumscribed breast cancer(2 cases of medullary carcinoma, 1 of colloid carcinoma, 1 of intracystic papillary carcinoma, 2 of comedo type intraductal carcinoma). Clinically 2 cases showed bloody nipple discharge from one hole of a unilateral nipple orifice. Mammography showed a well circumscribed nodule with or without partial lobular contour and no pathologic calcification. Breast sonographic findings were a well defined heterogeneous hypoechoic nodule with weak posterior acoustic enhancement. Characteristically a thin dilated lactiferous duct between the mass and the nipple on US could be detected in 2 cases which clinically was accompanied by bloody nipple discharge. Although the mammographic criteria is promising as benign tumor, the possibility of circumscribed as benign tumor, the possibility of circumscribed breast carcinoma must be considered in heterogeneous hypoechoic nodule with weak posterior acoustic enhancement in US, especially in the presence of a dilated lactiferous duct between the mass and the nipple with bloody nipple discharge.

Medical Injury Identification Using Hospital Discharge Data

National Research Council Canada - National Science Library

Layde, Peter M; Meurer, Linda N; Guse, Clare; Meurer, John R; Yang, Hongyan; Laud, Prakash; Kuhn, Evelyn M; Brasel, Karen J; Hargarten, Stephen W

2005-01-01

.... The development, validation, and testing of screening criteria for medical injury was based on International Classification of Disease code discharge diagnoses using 2001 patient data from Wisconsin hospitals...

Study of the cathodic region of a hydrogen luminescent discharge: spectroscopic diagnoses

International Nuclear Information System (INIS)

Barbeau, Claude

1991-01-01

This research thesis addresses the study of the cathodic region of a hydrogen luminescent discharge in direct current, and belongs to the field of studies on plasma-surface interactions, notably in order to understand and optimise electric discharges in H_2CH_4 mixtures used for steel cementation and hard carbon deposition. The author first presents the main characteristics of the abnormal discharge, and details operation conditions as well as the characteristics of the different experimental assemblies. The experimental study of the cathodic region has been mainly performed by high resolution emission spectroscopy, and multi-photon laser spectroscopy (laser-induced fluorescence, optogalvanic effect). In the second part, the author reports an analysis of the Doppler broadening of emission profiles of atomic lines (notably the Balmer series). Experimental results are compared with those of Monte Carlo simulation which addresses mechanisms of creation of excited atoms as well as their energetic distribution. The next parts report the development of methods and techniques for the measurement of the electric field of the cathodic drop and of gas temperature, experimental results and their interpretation [fr

Pigmented Basal cell carcinoma of nipple and areola in a male breast - a case report with review of literature.

Science.gov (United States)

Kalyani, R; Vani, B R; Srinivas, Murthy V; Veda, P

2014-03-01

Basal cell carcinoma is a common skin cancer worldwide. However basal cell carcinoma of nipple and areola complex is rare, commonly seen in males in elderly age group. The tumor has aggressive behavior with increased tendency for metastasis. We present a case in a 78 year male in the left breast.

The Aesthetically Ideal Position of the Nipple-Areola Complex on the Breast.

Science.gov (United States)

Lewin, Richard; Amoroso, Matteo; Plate, Nikolina; Trogen, Clara; Selvaggi, Gennaro

2016-10-01

Several studies have attempted to identify an objective description of the aesthetically ideal breast, but they have all suffered in their reliability because of having several intrinsic limitations. It is therefore essential to design a template of ideal breast features in order to predict and evaluate aesthetic outcomes in both reconstructive and cosmetic breast surgery. The aim of this study was to determine the aesthetically preferred position of the nipple-areola complex on the breast. A questionnaire was sent by regular mail to 1000 men and 1000 women aged between 16 and 74 years. They were asked to rank the attractiveness of a series of breasts of women in images with different NAC positions. The images showed breasts from two different angles: 12 frontal-view images with both breasts shown, and five side-view images with only one breast shown. All of the breasts had equal dimensions and proportions, with the same areola size but different NAC positions. Statistical analysis of data was carried out. Eight hundred and thirteen of 2000 participants completed the questionnaire. The NAC placement preferred by both genders had a ratio of 40:60 x and 50:50 y, which means that it was best situated in the middle of the breast gland vertically and slightly lateral to the midpoint horizontally. Significant differences were found between the age and gender subgroup preferences. This study identified the preferred position of the nipple-areola complex on the female breast in the general population. This is an important information when planning breast reconstructive and cosmetic surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Afghanistan and Iraq War Veterans: Mental Health Diagnoses are Associated with Respiratory Disease Diagnoses.

Science.gov (United States)

Slatore, Christopher G; Falvo, Michael J; Nugent, Shannon; Carlson, Kathleen

2018-05-01

Many veterans of the wars in Afghanistan and Iraq have concomitant respiratory conditions and mental health conditions. We wanted to evaluate the association of mental health diagnoses with respiratory disease diagnoses among post-deployment veterans. We conducted a retrospective cohort study of all Afghanistan and Iraq War veterans who were discharged from the military or otherwise became eligible to receive Veterans Health Administration services. The primary exposure was receipt of a mental health diagnosis and the primary outcome was receipt of a respiratory diagnosis as recorded in the electronic health record. We used multivariable adjusted logistic regression to measure the associations of mental health diagnoses with respiratory diagnoses and conducted several analyses exploring the timing of the diagnoses. Among 182,338 post-deployment veterans, 14% were diagnosed with a respiratory condition, 77% of whom had a concomitant mental health diagnosis. The incidence rates were 5,363/100,000 person-years (p-y), 587/100,000 p-y, 1,450/100,000 p-y, and 233/100,000 p-y for any respiratory disease diagnosis, bronchitis, asthma, and chronic obstructive lung disease diagnoses, respectively, after the date of first Veterans Health Administration utilization. Any mental health diagnosis was associated with increased odds for any respiratory diagnosis (adjusted odds ratio 1.41, 95% confidence interval 1.37-1.46). The association of mental health diagnoses and subsequent respiratory disease diagnoses was stronger and more consistent than the converse. Many Afghanistan and Iraq War veterans are diagnosed with both respiratory and mental illnesses. Comprehensive plans that include care coordination with mental health professionals and treatments for mental illnesses may be important for many veterans with respiratory diseases.

An Adolescent Girl with Giant Fibroadenoma - A Case Report.

Science.gov (United States)

Ferdousee, Ishrat; Arafat, S M Yasir; Ahmed, Zuhayer

2016-09-01

Though fibroadenoma is the most common benign tumor of the breast and is more common under the age of 30, giant fibroadenoma is rare representing less than 4% of all fibroadenomas. A 12 years old girl presented with rapidly enlarging well-circumscribed firm, non-tender mass in right breast for 2 months which was painless and with no history of trauma, nipple discharge, fever, anorexia, weight loss or axillary lymphadenopathy. There was no family history of neoplasms. Clinically, the lump was about 12 × 12 cm and not fixed to skin or underlying structures with the absence of nipple retraction or discharge. There was no axillary lymphadenopathy. Fine needle aspiration cytology showed a benign proliferative breast disease. Total excision of mass was done preserving nipple and areola having weight of 535 gm with histopathological features suggestive of giant fibroadenoma. Giant fibroadenoma is a benign breast disease that may mimic rare malignant lesion. So, breast and nipple conserving surgery should always be performed irrespective of size of tumor as in this case.

"Seeing Is Believing": Dermatoscope Facilitated Breast Examination of the Breastfeeding Woman with Nipple Pain.

Science.gov (United States)

Naimer, Sody A; Silverman, William F

2016-09-01

It is well recognized that breastmilk provides optimal nutrition and immunological protection for infants. Many women, however, experience nipple pain while breastfeeding, leading to premature cessation of nursing. To overcome these difficulties, timely diagnosis is crucial to effectively treat the underlying pathology and permit resumption of breastfeeding. Examination of the superficial breast plays a key role in accurate diagnosis. Traditional direct inspection is clearly inadequate for this task. The dermatoscope is a useful tool, enlarging and illuminating an area of epidermis to obtain an optimal image. Improvements in dermoscopy involving polarization obviate the need for full contact with the examined surface, thereby providing anatomical detail in three dimensions. A novel practice presented in this article features clinical cases introducing this technique as it is applied to the lactating breast, conclusively distinguishing normal from abnormal and illustrating the efficacy and added diagnostic value of this approach. The dermoscope is shown to facilitate identification of the causes of nipple pain ranging from asymptomatic candidal infection to exquisitely painful, minute traumatic erosions, aiding, thereby, in diagnosis of the underlying causes of nursing difficulties. Improved wound surveillance and standardization for purposes of research documentation are additional benefits anticipated with the use of breast dermoscopy. We conclude that real-time, high-quality, magnified imaging of the lactating breast represents a recognizable advance in pursuit of a rapid and accurate technique that aids in the identification of the factors responsible for lesions affecting nursing women. Moreover, it features an already existing technology requiring little training at a reasonable cost.

[Anatomical study of men's nipple areola complex].

Science.gov (United States)

Vaucher, R; Dast, S; Assaf, N; Sinna, R

2016-06-01

The surgical approach of gynecomastia, sexual reassignment surgery in female-to-male transsexuals and the increase of number of obese wishing to turn to plastic surgery led us to deepen the anatomical knowledge of the nipple areola complex (NAC) in men, poorly retailed in the literature. By inspiring us of the methodology of a Japanese study, we studied 50 healthy volunteers male, from 18 to 55 years old, from July till August 2015. We measured various distances relative to the NAC to define its vertical and horizontal position, as well as the internipple distance according to the size, to the weight and to the body mass index (BMI). At the end of the analysis, we were able to underline a lower vertical thoracic position of the NAC in the tall category of person, a more side horizontal position to the subject presenting a high BMI and a linear relation between the BMI and the internipple (Em) defined by (Em)=8.96×BMI. The surgeon's judgment and the desires of the patient are essentials basis of therapeutics decisions that could be lean on this anatomical study, which allowed to establish an idea of the cartography of the NAC in man. It will be interesting and necessary to confront it with other studies with larger scale. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

A nationwide register study of the characteristics, incidence and validity of diagnosed Tourette syndrome and other tic disorders.

Science.gov (United States)

Leivonen, Susanna; Voutilainen, Arja; Hinkka-Yli-Salomäki, Susanna; Timonen-Soivio, Laura; Chudal, Roshan; Gissler, Mika; Huttunen, Jukka; Sourander, Andre

2014-09-01

The aim of this study was to describe the characteristics and incidence rates of diagnosed tic disorders in the Finnish Hospital Discharge Register, including changing incidence rates between 1991 and 2010. We also aimed to validate the diagnoses of Tourette's syndrome recorded in the register. Children born between January 1, 1991 and December 31, 2010, who were diagnosed with tic disorders, were identified from the Finnish Hospital Discharge Register (n = 3003). We studied the validity of the Tourette's syndrome diagnoses by reviewing the medical charts of 88 children born since 1997 and carrying out telephone interviews with 55 of their guardians. The incidence rates of all diagnosed tic disorders increased during the study period. A comorbid diagnosis of hyperkinetic disorder diagnosis was recorded in 28.2% of the children with Tourette's syndrome, and the validity of the register-based Tourette's syndrome diagnosis was approximately 95%. This is the first nationwide study to demonstrate the increasing incidence of all register-based tic disorder diagnoses. The validity of the Tourette's syndrome diagnoses in the Finnish Hospital Discharge Register was good, and the data provided are suitable for use in further register-based studies of tic disorders. ©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

[Early discharge of newborns: what problems should we anticipate?].

Science.gov (United States)

Straczek, H; Vieux, R; Hubert, C; Miton, A; Hascoet, J-M

2008-06-01

Following Nordic and Anglo-Saxon countries, France is directing towards an early discharge policy from maternity hospitals. French National Authority for Health has published recommendations focusing on the importance to highlight the dangers of such a policy so as to be able to anticipate them. To describe the complications diagnosed in the newborn infants from day 2 to the current hospital's discharge (noteworthy, if infants are discharged early, these complications may occur at home) to determine predictive factors and to validate those proposed by the French National Authority for Health. Prospective study conducted in the maternity ward of Nancy's level III facility, from January 6th to May 6th 2005. Nine hundred and three newborn infants were included. Forty-two (4.6%) presented with complications diagnosed from day 2 to hospital's discharge, among which 4 required urgent neonatal care. The most frequent complication was hyperbilirubinemia: 23 newborns were treated with phototherapy between day 2 and day 10. Statistically significant risk factors of hyperbilirubinemia after day 2 in multivariate analysis were instrumental vaginal delivery (OR=2.94; CI 95% [1.04-8.34]) and jaundice before day 2 (OR=7.39; CI 95% [2.66-20.55]). According to the French National Authority for Health's policy, 33 among 42 infants presenting with a complication would have been withdrawn from an early discharge program. In our population, French National Authority for Health's recommendations were relevant to guide an early discharge project.

Complications following Nipple-Sparing Mastectomy and Immediate Acellular Dermal Matrix Implant-based Breast Reconstruction—A Systematic Review and Meta-analysis

Directory of Open Access Journals (Sweden)

Lene Nyhøj Heidemann, MD

2018-01-01

Conclusion:. The use of acellular dermal matrix in nipple-sparing mastectomy and implant-based breast reconstruction can be done with acceptable complication rates in selected patients. We recommend future studies to include specific definitions when reporting complication rates. Furthermore, future studies should elaborate on demographic characteristics of the included study samples and include predictor analysis to enhance knowledge of high risk patients.

Reconstrucción del complejo areola-pezón: revisión de 60 casos Nipple-areola complex reconstruction: revision of 60 cases

Directory of Open Access Journals (Sweden)

R. Fernández García

2007-06-01

hay ninguna cuyos resultados se sobrepongan a las demás, pero sí una vez que se reconstruye la areola siendo la técnica que más satisface la del injerto inguinal. A pesar de ello, el aspecto más notable a mejorar está en la reconstrucción del pezón, dada la frecuente disconformidad de las pacientes con la proyección conseguida a lo largo del tiempo por la posible reabsorción del mismo.The creation of the nipple-areola complex is the latest time in breast reconstruction, transforming the reconstruction of the breast mound into a real breast. We have to consider the reconstruction of the areola and the nipple as the culmination of breast reconstruction. There are a lot of documented techniques for nipple-areola complex reconstruction. The aim of this study is to determine the grade of psychological satisfaction of patients after this reconstruction This study was designed as a retrospective clinic review of 60 patients. After reviewing medical histories, the patients were interviewed and asked to complete a questionnaire. The most common desired aspect was to correct the absence/lost of nipple projection. However, 22% of patients answered they would not change anything regarding their reconstruction. The satisfaction with the mammary mound was excellent or good for 68%, normal for 23 % and poor for 9 %. On the other hand, satisfaction for the nippleareola complex reconstruction was excellent or good for 50%, normal for 45% and poor for 5%. There were no statistical differences among the different techniques depending on the time between the mastectomy intervention and the third reconstruction (p=0,06. For nipple reconstruction, the contralateral nipple donation technique offered more satisfaction (2.67 points and projection (7.23 points. In spite of the differences in their means, there were no statistically significant differences. Taking into account the technique used for the areola reconstruction, the donation-graft of inguinal skin was the one that

Do coder characteristics influence validity of ICD-10 hospital discharge data?

Directory of Open Access Journals (Sweden)

Beck Cynthia A

2010-04-01

Full Text Available Abstract Background Administrative data are widely used to study health systems and make important health policy decisions. Yet little is known about the influence of coder characteristics on administrative data validity in these studies. Our goal was to describe the relationship between several measures of validity in coded hospital discharge data and 1 coders' volume of coding (≥13,000 vs. Methods This descriptive study examined 6 indicators of face validity in ICD-10 coded discharge records from 4 hospitals in Calgary, Canada between April 2002 and March 2007. Specifically, mean number of coded diagnoses, procedures, complications, Z-codes, and codes ending in 8 or 9 were compared by coding volume and employment status, as well as hospital type. The mean number of diagnoses was also compared across coder characteristics for 6 major conditions of varying complexity. Next, kappa statistics were computed to assess agreement between discharge data and linked chart data reabstracted by nursing chart reviewers. Kappas were compared across coder characteristics. Results 422,618 discharge records were coded by 59 coders during the study period. The mean number of diagnoses per record decreased from 5.2 in 2002/2003 to 3.9 in 2006/2007, while the number of records coded annually increased from 69,613 to 102,842. Coders at the tertiary hospital coded the most diagnoses (5.0 compared with 3.9 and 3.8 at other sites. There was no variation by coder or site characteristics for any other face validity indicator. The mean number of diagnoses increased from 1.5 to 7.9 with increasing complexity of the major diagnosis, but did not vary with coder characteristics. Agreement (kappa between coded data and chart review did not show any consistent pattern with respect to coder characteristics. Conclusions This large study suggests that coder characteristics do not influence the validity of hospital discharge data. Other jurisdictions might benefit from

Galactorrhea

Science.gov (United States)

... or in men, but is less common in men. Rarely, it can occur in newborns. Symptoms of galactorrhea The main symptom of galactorrhea is a milky white discharge from one of both nipples. Sometimes, the discharge is yellow or greenish in ...

Optimal Positioning of the Nipple-Areola Complex in Men Using the Mohrenheim-Estimated-Tangential-Tracking-Line (METT-Line): An Intuitive Approach.

Science.gov (United States)

Mett, Tobias R; Krezdorn, Nicco; Luketina, Rosalia; Boyce, Maria K; Henseler, Helga; Ipaktchi, Ramin; Vogt, Peter M

2017-12-01

The reconstruction of the body shape after post-bariatric surgery or high-grade gynecomastia involves, besides skin tightening, the repositioning of anatomical, apparent landmarks. The surgeon usually defines these during the preoperative planning. In particular, the positions of the nipple-areola complexes (NAC) should contribute to the gender-appropriate appearance. While in the female breast numerous methods have been developed to determine the optimal position of the NACs, there are only a few, metric and often impractical algorithms for positioning the nipples and areoles in the male. With this study, we show the accuracy of the intuitive positioning of the nipple-areola complex in men. From a pre-examined and measured quantity of 10 young and healthy men, six subjects were selected, which corresponded, on the basis of their chest and trunk dimensions, to the average of known data from the literature. The photographed frontal views were retouched in two steps. Initially, only the NACs were removed and the chest contours were left. In a second step, all contours and the navel were blurred. These pictures were submitted to resident and consultant plastic surgeons, who were asked to draw the missing NACs without any tools. The original positions of the nipples were compared with the inscriptions. Furthermore, the results were compared between the contoured and completely retouched pictures and between the residents and consultants. A total of 8 consultants and 7 residents were included. In the contoured and completely retouched images, a significant deviation of the marked positions of the missing features was found. The height of the NAC was determined somewhat more precisely than the vertical position. There was no significant difference between the contoured and completely retouched images, with a discretely more accurate tendency on the contoured images. In comparison with the professional experience, the consultants were tangentially more precise, but

Guinea pig (Cavia porcellus) drinking preferences: do nipple drinkers compensate for behaviourally deficient diets?

Science.gov (United States)

Balsiger, A; Clauss, M; Liesegang, A; Dobenecker, B; Hatt, J-M

2017-10-01

When offered diets with hay ad libitum, rabbits (Oryctolagus cuniculus) clearly prefer open dishes over nipple drinkers, but whether this preference also applies in guinea pigs (Cavia porcellus) is unsure. We tested the drinker preference of 10 guinea pigs when offered open dishes (OD) and nipple drinkers (ND) simultaneously and measured the amount of water consumed by each animal on four different diets (grass hay 100%, or as 10% of intake on diets of fresh parsley, seed mix or pelleted complete feed, respectively) on either of the drinking systems. All animals ingested the hay portion of the combined diets first. The amount of water consumed differed significantly between individual animals. Animals drank less water on parsley than on the other diets. Nine of 10 animals clearly preferred ND when having a choice, and eight of these drank more when on ND only. The difference between the drinking systems was not consistent across all diets: on hay, similar amounts of water were drunk when on OD or ND only. Differences in water intake were reflected in urine production. Because drinking from ND in guinea pigs involves jaw movements similar to those in chewing, the results could suggest that when motivation for oral processing behaviour is not satisfied by a diet, animals may respond in using ND beyond physiological water necessity. Whereas physiological water requirements are probably better investigated with other drinking systems due to a possible overestimation when using ND, offering ND to pet guinea pigs most likely offers a form of behavioural enrichment that at the same time may increase water intake and hence act as prophylaxis against urolithiasis. Journal of Animal Physiology and Animal Nutrition © 2016 Blackwell Verlag GmbH.

Maternal Clinical Diagnoses and Hospital Variation in the Risk of Cesarean Delivery: Analyses of a National US Hospital Discharge Database

Science.gov (United States)

Kozhimannil, Katy B.; Arcaya, Mariana C.; Subramanian, S. V.

2014-01-01

Background Cesarean delivery is the most common inpatient surgery in the United States, where 1.3 million cesarean sections occur annually, and rates vary widely by hospital. Identifying sources of variation in cesarean use is crucial to improving the consistency and quality of obstetric care. We used hospital discharge records to examine the extent to which variability in the likelihood of cesarean section across US hospitals was attributable to individual women's clinical diagnoses. Methods and Findings Using data from the 2009 and 2010 Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project—a 20% sample of US hospitals—we analyzed data for 1,475,457 births in 1,373 hospitals. We fitted multilevel logistic regression models (patients nested in hospitals). The outcome was cesarean (versus vaginal) delivery. Covariates included diagnosis of diabetes in pregnancy, hypertension in pregnancy, hemorrhage during pregnancy or placental complications, fetal distress, and fetal disproportion or obstructed labor; maternal age, race/ethnicity, and insurance status; and hospital size and location/teaching status. The cesarean section prevalence was 22.0% (95% confidence interval 22.0% to 22.1%) among women with no prior cesareans. In unadjusted models, the between-hospital variation in the individual risk of primary cesarean section was 0.14 (95% credible interval 0.12 to 0.15). The difference in the probability of having a cesarean delivery between hospitals was 25 percentage points. Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics (0.16 [95% credible interval 0.14 to 0.18]). A limitation is that these data, while nationally representative, did not contain information on parity or gestational age. Conclusions Variability across hospitals in the individual risk of cesarean section is not decreased by accounting for differences in maternal diagnoses. These findings highlight

Validation of hospital discharge diagnoses for hypertensive disorders of pregnancy

DEFF Research Database (Denmark)

Møller Luef, Birgitte; Andersen, Louise B; Renault, Kristina Martha

2016-01-01

INTRODUCTION: A correct diagnosis of preeclampsia and gestational hypertension is important for treatment and epidemiological studies. Changes in diagnostic criteria and underreporting in certain subsets of patients may hamper validity of the diagnoses. MATERIALS AND METHODS: We validated....... After validation, significantly more patients fulfilled criteria for diagnosis of preeclampsia (n = 163, 7.5%, p = 0.002); more had severe preeclampsia, 14 (0.6%) vs. 70 (3.2%), p hypertension, 62 (2.9%) vs. 46 (2.1%), p = 0.12. The diagnostic sensitivity for preeclampsia...... of hypertensive disorders in pregnancy for research purposes....

Patient input into the development and enhancement of ED discharge instructions: a focus group study.

Science.gov (United States)

Buckley, Barbara A; McCarthy, Danielle M; Forth, Victoria E; Tanabe, Paula; Schmidt, Michael J; Adams, James G; Engel, Kirsten G

2013-11-01

Previous research indicates that patients have difficulty understanding ED discharge instructions; these findings have important implications for adherence and outcomes. The objective of this study was to obtain direct patient input to inform specific revisions to discharge documents created through a literacy-guided approach and to identify common themes within patient feedback that can serve as a framework for the creation of discharge documents in the future. Based on extensive literature review and input from ED providers, subspecialists, and health literacy and communication experts, discharge instructions were created for 5 common ED diagnoses. Participants were recruited from a federally qualified health center to participate in a series of 5 focus group sessions. Demographic information was obtained and a Rapid Estimate of Adult Literacy in Medicine (REALM) assessment was performed. During each of the 1-hour focus group sessions, participants reviewed discharge instructions for 1 of 5 diagnoses. Participants were asked to provide input into the content, organization, and presentation of the documents. Using qualitative techniques, latent and manifest content analysis was performed to code for emergent themes across all 5 diagnoses. Fifty-seven percent of participants were female and the average age was 32 years. The average REALM score was 57.3. Through qualitative analysis, 8 emergent themes were identified from the focus groups. Patient input provides meaningful guidance in the development of diagnosis-specific discharge instructions. Several themes and patterns were identified, with broad significance for the design of ED discharge instructions. Copyright © 2013 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

A Supernumerary Nipple-Like Clinical Presentation of Lymphangioma Circumscriptum.

Science.gov (United States)

Taylor, Dustin; Kash, Natalie; Silapunt, Sirunya

2018-01-01

Lymphangioma circumscriptum is a superficially localized variant of lymphangioma. The characteristic clinical presentation is a "frogspawn" grouping of vesicles or papulovesicles on the proximal limb or limb girdle areas. Though most lymphangiomas develop congenitally, the lymphangioma circumscriptum subtype is known to present in adults. We report a case of lymphangioma circumscriptum on the left inframammary area of an African American female with an unusual supernumerary nipple-like clinical presentation. Our patient presented with a firm, smooth, hypopigmented papule, and the clinical diagnosis of keloid was made initially. However, she returned reporting growth of the lesion and was noted to have a firm, exophytic, lobulated, pink to skin-colored nodule. Histopathological examination demonstrated dilated lymphatic vessels, consistent with the diagnosis of lymphangioma. The presentation as a firm, hypopigmented papule and later exophytic, lobulated, skin-colored nodule in our case represents a clinical presentation of lymphangioma circumscriptum not previously described in the literature. Correct diagnosis in lymphangioma circumscriptum is vital, as recurrence following surgical resection and secondary development of lymphangiosarcoma and squamous cell carcinoma following treatment with radiation have been reported. Thus, it is important to consider lymphangioma circumscriptum in the differential of similar lesions in the future to allow appropriate diagnosis, treatment, and monitoring.

Sacrococcygeal Teratoma Presenting with Vaginal Discharge and Polyp in an Infant.

Science.gov (United States)

Ladenhauf, Hannah N; Brandtner, M Georgina; Schimke, Christa; Ardelean, Mircia A; Metzger, Roman

2018-06-01

Sacrococcygeal teratoma accounts for the most common solid tumor in neonates. Because of improved technology, 50%-70% of cases can be diagnosed antenatally during routine ultrasound screenings. If not diagnosed antenatally, clinical findings at birth are distinct in most cases including a palpable or visible mass. We report an unusual case of a 1-year-old girl who presented with persistent vaginal discharge leading to diagnosis of a mucosal polypoid lesion of the vagina, ultimately revealing a hidden sacrococcygeal teratoma. We suggest thorough investigation of all infants who present with purulent discharge and recurrent vaginal mass; sacrococcygeal teratoma should routinely be considered as a differential diagnosis. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Natural course of hypogonadism diagnosed during hospitalization in aged male patients.

Science.gov (United States)

Iglesias, P; Prado, F; Muñoz, A; Guerrero, M T; Macías, M C; Ridruejo, E; Tajada, P; García-Arévalo, C; Díez, J J

2015-04-01

Our aim was to assess short-term natural course of hypogonadism diagnosed during hospitalization for acute disease in aged male patients after discharge. A group of 43 hypogonadal males, aged 86.7±5.7 year, was studied. Serum concentrations of testosterone (T) and gonadotropins (follicle-stimulating hormone, FSH, and luteinizing hormone, LH) were measured in every patient both at admission and one month after discharge. Mean serum T at entry was 115.4±48.0 ng/dl. Hypogonadism was hyper-, hypo-, and normogonadotropic in 20 (46.5%), 20 (46.5%), and 3 (7.0%) patients, respectively. One month after discharge serum T concentrations increased significantly (230.9±135.6 ng/dl, phypogonadism (n=16, 32.7%; 82.8±51.6 ng/dl, phypogonadism discovered during hospitalization spontaneously normalize their serum T concentrations one month after discharge. Serum gonadotropin concentrations also increased after discharge. Serum T levels at admission was an independent predictor for the normalization of serum T concentrations.

Discharges to prison from medium secure psychiatric units in England and Wales.

Science.gov (United States)

Doyle, Michael; Coid, Jeremy; Archer-Power, Laura; Dewa, Lindsay; Hunter-Didrichsen, Alice; Stevenson, Rachel; Wainwright, Verity; Kallis, Costas; Ullrich, Simone; Shaw, Jenny

2014-09-01

Early findings from a national study of discharges from 32 National Health Service medium secure units revealed that nearly twice as many patients than expected were discharged back to prison. To compare the characteristics of those discharged back to prison with those discharged to the community, and consider the implications for ongoing care and risk. Prospective cohort follow-up design. All forensic patients discharged from 32 medium secure units across England and Wales over a 12-month period were identified. Those discharged to prison were compared with those who were discharged to the community. Nearly half of the individuals discharged to prison were diagnosed with a serious mental illness and over a third with schizophrenia. They were a higher risk, more likely to have a personality disorder, more symptomatic and less motivated than those discharged to the community. Findings suggest that alternative models of prison mental healthcare should be considered to reduce risks to the patient and the public. Royal College of Psychiatrists.

Can Concentration - Discharge Relationships Diagnose Material Source During Extreme Events?

Science.gov (United States)

Karwan, D. L.; Godsey, S.; Rose, L.

2017-12-01

Floods can carry >90% of the basin material exported in a given year as well as alter flow pathways and material sources. In turn, sediment and solute fluxes can increase flood damages and negatively impact water quality and integrate physical and chemical weathering of landscapes and channels. Concentration-discharge (C-Q) relationships are used to both describe export patterns as well as compute them. Metrics for describing C-Q patterns and inferring their controls are vulnerable to infrequent sampling that affects how C-Q relationships are interpolated and interpreted. C-Q relationships are typically evaluated from multiple samples, but because hydrological extremes are rare, data are often unavailable for extreme events. Because solute and sediment C-Q relationships likely respond to changes in hydrologic extremes in different ways, there is a pressing need to define their behavior under extreme conditions, including how to properly sample to capture these patterns. In the absence of such knowledge, improving load estimates in extreme floods will likely remain difficult. Here we explore the use of C-Q relationships to determine when an event alters a watershed system such that it enters a new material source/transport regime. We focus on watersheds with sediment and discharge time series include low-frequency and/or extreme events. For example, we compare solute and sediment patterns in White Clay Creek in southeastern Pennsylvania across a range of flows inclusive of multiple hurricanes for which we have ample ancillary hydrochemical data. TSS is consistently mobilized during high flow events, even during extreme floods associated with hurricanes, and sediment fingerprinting indicates different sediment sources, including in-channel remobilization and landscape erosion, are active at different times. In other words, TSS mobilization in C-Q space is not sensitive to the source of material being mobilized. Unlike sediments, weathering solutes in this watershed

Diagnosis of the local thermal equilibrium by optical emission spectroscopy in the evolution of electric discharge

International Nuclear Information System (INIS)

Valdivia B, R.; Pacheco S, J.; Pacheco P, M.; Ramos F, F.; Cruz A, A.; Velazquez P, S.

2008-01-01

In this work applies the technique of optical emission spectroscopy to diagnose the temperature of the species generated in plasma in the transition to glow discharge arc. Whit this diagnosis is possible to determine the local thermal equilibrium conditions of the discharge. (Author)

National Hospital Discharge Survey: 2001 annual summary with detailed diagnosis and procedure data.

Science.gov (United States)

Kozak, Lola Jean; Owings, Maria F; Hall, Margaret J

2004-06-01

This report presents 2001 national estimates and selected trend data on the use of non-Federal short-stay hospitals in the United States. Estimates are provided by selected patient and hospital characteristics, diagnoses, and surgical and nonsurgical procedures performed. Admission source and type, collected for the first time in the 2001 National Hospital Discharge Survey, are shown. The estimates are based on data collected through the National Hospital Discharge Survey (NHDS). The survey has been conducted annually since 1965. In 2001, data were collected for approximately 330,000 discharges. Of the 477 eligible non-Federal short-stay hospitals in the sample, 448 (94 percent) responded to the survey. Estimates of diagnoses and procedures are presented according to International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code numbers. Rates are computed with 2001 population estimates based on the 2000 census. The appendix includes a comparison of rates computed with 1990 and 2000 census-based population estimates. An estimated 32.7 million inpatients were discharged from non-Federal short-stay hospitals in 2001. They used 159.4 million days of care and had an average length of stay of 4.9 days. Common first-listed discharge diagnoses included delivery, psychoses, pneumonia, malignant neoplasm, and coronary atherosclerosis. Males had higher rates for procedures such as cardiac catheterization and coronary artery bypass graft, and females had higher rates for procedures such as cholecystectomy and total knee replacement. The rates of all cesarean deliveries, primary and repeat, rose from 1995 to 2001; the rate of vaginal birth after cesarean delivery dropped 37 percent during this period.

National Hospital Discharge Survey: 2002 annual summary with detailed diagnosis and procedure data.

Science.gov (United States)

Kozak, Lola J; Owings, Maria F; Hall, Margaret J

2005-03-01

This report presents 2002 national estimates and selected trend data on the use of non-Federal short-stay hospitals in the United States. Estimates are provided by selected patient and hospital characteristics, diagnoses, and surgical and nonsurgical procedures performed. Estimates of diagnoses and procedures are presented according to International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. The estimates are based on data collected through the National Hospital Discharge Survey (NHDS). The survey has been conducted annually since 1965. In 2002, data were collected for approximately 327,000 discharges. Of the 474 eligible non-Federal short-stay hospitals in the sample, 445 (94 percent) responded to the survey. An estimated 33.7 million inpatients were discharged from non-Federal short-stay hospitals in 2002. They used 164.2 million days of care and had an average length of stay of 4.9 days. Common first-listed discharge diagnoses included delivery, ischemic heart disease, psychoses, pneumonia, and malignant neoplasms. Inpatients had 6.8 million cardiovascular procedures and 6.6 million obstetric procedures. Males had higher rates for cardiac procedures such as cardiac catheterization and coronary artery bypass graft, but males and females had similar rates of pacemaker procedures. The number and rate of all cesarean deliveries, primary and repeat, rose from 1995 to 2002; the rate of vaginal birth after cesarean delivery dropped from 35.5 in 1995 to 15.8 in 2002.

Sigmoid-vaginal fistula during bevacizumab treatment diagnosed by fistulography.

Science.gov (United States)

Hayashi, C; Takada, S; Kasuga, A; Shinya, K; Watanabe, M; Kano, H; Takayama, T

2016-12-01

There have been several reports describing rectovaginal fistula development after bevacizumab treatment, and these fistulas were diagnosed by CT scan or colonoscopy. We report a case of sigmoid-vaginal fistula diagnosed by fistulography. The case is a 53-year-old woman who was treated for chronic myelogenous leukaemia and gynaecological cancers 8 years previously. At 52 years of age, she was diagnosed with colon cancer and had a partial colectomy performed. One year after surgery, colon cancer recurred, and she was treated with anticancer agents, including bevacizumab. During chemotherapy, she complained of a foul smelling discharge from the vagina. Fistulography revealed a sigmoid-vaginal fistula. This is the first report of vaginal fistulography performed on a patient who was treated with bevacizumab. Fistulography may be useful for detecting sigmoid-vaginal fistula. © 2016 John Wiley & Sons Ltd.

Using the Slug Mucosal Irritation Assay to Investigate the Tolerability of Tablet Excipients on Human Skin in the Context of the Use of a Nipple Shield Delivery System.

Science.gov (United States)

Kendall, Richard; Lenoir, Joke; Gerrard, Stephen; Scheuerle, Rebekah L; Slater, Nigel K H; Tuleu, Catherine

2017-04-01

Neonates are particularly challenging to treat. A novel patented drug delivery device containing a rapidly disintegrating tablet held within a modified nipple shield (NSDS) was designed to deliver medication to infants during breastfeeding. However concerns exist around dermatological nipple tolerability with no pharmaceutical safety assessment guidance to study local tissue tolerance of the nipple and the areola. This is the first Slug Mucosal Irritation (SMI) study to evaluate irritancy potential of GRAS excipients commonly used to manufacture rapidly disintegrating immediate release solid oral dosage form METHODS: Zinc sulphate selected as the antidiarrheal model drug that reduces infant mortality, was blended with functional excipients at traditional levels [microcrystalline cellulose, sodium starch glycolate, croscarmellose sodium, magnesium stearate]. Slugs were exposed to blends slurried in human breast milk to assess their stinging, itching or burning potential, using objective values such as mucus production to categorize irritation potency RESULTS: Presently an in vivo assay, previously validated for prediction of ocular and nasal irritation, was used as an alternative to vertebrate models to anticipate the potential maternal dermatological tolerability issues to NSDS tablet components. The excipients did not elicit irritancy. However, mild irritancy was observed when zinc sulphate was present in blends. These promising good tolerability results support the continued investigation of these excipients within NSDS rapidly disintegrating tablet formulations. Topical local tolerance effects being almost entirely limited to irritation, the slug assay potentially adds to the existing preformulation toolbox, and may sit in between the in vitro and existing in vivo assays.

Pituitary tumor

Science.gov (United States)

... than normal level of growth hormone in adults) Nipple discharge and irregular or absent menstrual periods in women Decreased sexual function in men Symptoms caused by pressure from a larger pituitary ...

National Hospital Discharge Survey: 2005 annual summary with detailed diagnosis and procedure data.

Science.gov (United States)

DeFrances, Carol J; Cullen, Karen A; Kozak, Lola Jean

2007-12-01

This report presents 2005 national estimates and selected trend data on the use of nonfederal short-stay hospitals in the United States. Estimates are provided by selected patient and hospital characteristics, diagnoses, and surgical and nonsurgical procedures performed. Estimates of diagnoses and procedures are presented according to International Classification of Diseases, Ninth Revision, Clinical Modification codes. The estimates are based on data collected through the National Hospital Discharge Survey. The survey has been conducted annually since 1965. In 2005, data were collected for approximately 375,000 discharges. Of the 473 eligible nonfederal short-stay hospitals in the sample, 444 (94 percent) responded to the survey. An estimated 34.7 million discharges from nonfederal short-stay hospitals occurred in 2005. Discharges used 165.9 million days of care and had an average length of stay of 4.8 days. Persons 65 years and over accounted for 38 percent of the hospital discharges and 44 percent of the days of care. The proportion of discharges whose status was described as routine discharge or discharged to the patient's home declined with age, from 91 percent for inpatients under 45 years of age to 41 percent for those 85 years and over. Hospitalization for malignant neoplasms decreased from 1990-2005. The hospitalization rate for asthma was the highest for children under 15 years of age and those 65 years of age and over. The rate was lowest for those 15-44 years of age. Thirty-eight percent of hospital discharges had no procedures performed, whereas 12 percent had four or more procedures performed. An episiotomy was performed during a majority of vaginal deliveries in 1980 (64 percent), but by 2005, it was performed during less than one of every five vaginal deliveries (19 percent).

In-hospital Mobility Variations across Primary Diagnoses among Older Adults

Science.gov (United States)

Valiani, Vincenzo; Gao, Shiyao; Chen, Zhiguo; Swami, Sunil; Harle, Christopher A.; Lipori, Gigi; Sourdet, Sandrine; Wu, Samuel; Nayfield, Susan G.; Sabbá, Carlo; Pahor, Marco; Manini, Todd M.

2016-01-01

Objectives To examine the relationship between primary diagnoses and mobility impairment and recovery among hospitalized older adults. Design Prospective cohort study. Setting UF Health Shands Hospital, an 852-bed level I trauma center located in Gainesville, Florida. Participants 18,551 older adults (≥65 years) with 29,148 hospitalizations between 1/2009 and 4/2014. Measurements Incident and discharge mobility impairment and recovery were assessed using the Braden activity subscale score that was recorded by the nursing staff at every shift change–approximately three times per day. Primary diagnosis ICD-9 codes were used as predictors and re-categorized by using the Agency for Health Care Research and Quality Clinical Classification Software. Results Out of the 15,498 hospital records where the patient was initially observed to “walk frequently”, 3,186 (20.6%) developed incident mobility impairment (chair-fast or bedfast). Primary diagnoses with a surgical or invasive procedure were the most prevalent (77.2 %) among the hospital observations with incident mobility impairment; otherwise primary diagnoses without surgery were much more associated with discharge mobility impairment (59%). The highest incidence of mobility impairment occurred in patients with heart valve disorders and aortic and peripheral/visceral artery aneurysms (6.24 and 6.05 events per 30 person-days, respectively); septicemia showed the highest incidence rate for mobility limitation at discharge (0.94 events per 30 person-days). Mobility impairment was observed in 13,650 (46.8% of total) records at admission and 5,930 (43.44%) were observed to recover to a state of walking occasionally or frequently. Osteoarthritis and cancer of gastrointestinal organs/peritoneum had the highest incidence rate for mobility recovery (7.68 and 5.63 events per 30 person-days respectively). Conclusions Approximately 1 out of 5 patients who were mobile at admission became significantly impaired during

National Hospital Discharge Survey: 2003 annual summary with detailed diagnosis and procedure data.

Science.gov (United States)

Kozak, Lola Jean; Lees, Karen A; DeFrances, Carol J

2006-05-01

This report presents 2003 national estimates and trend data on the use of non-Federal short-stay hospitals in the United States. Estimates are provided by patient and hospital characteristics, diagnoses, and surgical and nonsurgical procedures performed. Estimates of diagnoses and procedures are presented according to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. The estimates are based on data collected through the National Hospital Discharge Survey (NHDS). The survey has been conducted annually since 1965. In 2003, data were collected for approximately 320,000 discharges. Of the 479 eligible non-Federal short-stay hospitals in the sample, 426 (89 percent) responded to the survey. An estimated 34.7 million inpatients were discharged from non-Federal short-stay hospitals in 2003. They used 167.3 million days of care and had an average length of stay of 4.8 days. Females used almost one-third more days of hospital care than males. Patients with five or more diagnoses rose from 29 percent of discharges in 1990 to 57 percent in 2003. The leading diagnostic category was respiratory diseases for children under 15 years, childbirth for 15-44 year olds, and circulatory diseases for patients 45 years of age and over. Only surgical procedures were performed for 27 percent of discharges, 18 percent had surgical and nonsurgical procedures, and 16 percent had only nonsurgical procedures. A total of 664,000 coronary angioplasties were performed, and stents were inserted during 86 percent of these procedures with drug-eluting stents used in 28 percent. The number and rate of total and primary cesarean deliveries rose from 1995 to 2003. The rate of vaginal birth after cesarean delivery dropped 58 percent, from 35.5 in 1995 to 14.8 in 2003.

SVM-based Partial Discharge Pattern Classification for GIS

Science.gov (United States)

Ling, Yin; Bai, Demeng; Wang, Menglin; Gong, Xiaojin; Gu, Chao

2018-01-01

Partial discharges (PD) occur when there are localized dielectric breakdowns in small regions of gas insulated substations (GIS). It is of high importance to recognize the PD patterns, through which we can diagnose the defects caused by different sources so that predictive maintenance can be conducted to prevent from unplanned power outage. In this paper, we propose an approach to perform partial discharge pattern classification. It first recovers the PRPD matrices from the PRPD2D images; then statistical features are extracted from the recovered PRPD matrix and fed into SVM for classification. Experiments conducted on a dataset containing thousands of images demonstrates the high effectiveness of the method.

Rusty pipe syndrome in a 22-year-old primigravida at 26 weeks ...

African Journals Online (AJOL)

and fibrocystic disease. Ductal papilloma is the most common cause of bloody nipple discharge in women;4,5 the discharge is usually spontaneous and unilateral, comes from a single duct,4,5 is painless and is usually not associated with a palpable lesion. In fibrocystic disease the breast has areas of lumpiness, and the ...

The impact of three discharge coding methods on the accuracy of diagnostic coding and hospital reimbursement for inpatient medical care.

Science.gov (United States)

Tsopra, Rosy; Peckham, Daniel; Beirne, Paul; Rodger, Kirsty; Callister, Matthew; White, Helen; Jais, Jean-Philippe; Ghosh, Dipansu; Whitaker, Paul; Clifton, Ian J; Wyatt, Jeremy C

2018-07-01

Coding of diagnoses is important for patient care, hospital management and research. However coding accuracy is often poor and may reflect methods of coding. This study investigates the impact of three alternative coding methods on the inaccuracy of diagnosis codes and hospital reimbursement. Comparisons of coding inaccuracy were made between a list of coded diagnoses obtained by a coder using (i)the discharge summary alone, (ii)case notes and discharge summary, and (iii)discharge summary with the addition of medical input. For each method, inaccuracy was determined for the primary, secondary diagnoses, Healthcare Resource Group (HRG) and estimated hospital reimbursement. These data were then compared with a gold standard derived by a consultant and coder. 107 consecutive patient discharges were analysed. Inaccuracy of diagnosis codes was highest when a coder used the discharge summary alone, and decreased significantly when the coder used the case notes (70% vs 58% respectively, p coded from the discharge summary with medical support (70% vs 60% respectively, p coding with case notes, and 35% for coding with medical support. The three coding methods resulted in an annual estimated loss of hospital remuneration of between £1.8 M and £16.5 M. The accuracy of diagnosis codes and percentage of correct HRGs improved when coders used either case notes or medical support in addition to the discharge summary. Further emphasis needs to be placed on improving the standard of information recorded in discharge summaries. Copyright © 2018 Elsevier B.V. All rights reserved.

Changes in the in-hospital mortality and 30-day post-discharge mortality in acutely admitted older patients: retrospective observational study

NARCIS (Netherlands)

van Rijn, Marjon; Buurman, Bianca M.; MacNeil-Vroomen, Janet L.; Suijker, Jacqueline J.; ter Riet, Gerben; van Charante, Eric P. Moll; de Rooij, Sophia E.

2016-01-01

to compare changes over time in the in-hospital mortality and the mortality from discharge to 30 days post-discharge for six highly prevalent discharge diagnoses in acutely admitted older patients as well as to assess the effect of separately analysing the in-hospital mortality and the mortality

Inframammarial Giant Fibroadenoma Removing and a Nipple-sparing Breast Reconstruction in an Adolescent: A Case Report

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Ilhan Ciftci

2015-01-01

Full Text Available Fibroadenomas are common, benign breast tumors that usually affect women in the second and third decade of life. Giant fibroadenomas often cause significant concern for the patient or family regarding malignant potential and altered breast development. Most fibroadenomas are benign. Local excision of small lesions through a circumareolar or inframammary incision rather than radical surgery is appropriate. Breast ultrasound represents the most commonly used imaging modality for the study of pediatric female breast masses and fibroadenomas. Detailed descriptions of the sonographic appearances of fibroadenomas in young girls are sparse. We believe that surgical treatment for the patient should include tumor extirpation and immediate restoration of breast appearance, minimizing visible scars, protection of the developing breast bud, nipple, and areola. This modality reduces psychosocial comorbidity.

Inframammarial Giant Fibroadenoma Removing and a Nipple-sparing Breast Reconstruction in an Adolescent: A Case Report.

Science.gov (United States)

Ciftci, Ilhan; Sekmenli, Tamer; Ozbek, Seda; Karamese, Mehtap; Ugras, Serdar

2015-01-01

Fibroadenomas are common, benign breast tumors that usually affect women in the second and third decade of life. Giant fibroadenomas often cause significant concern for the patient or family regarding malignant potential and altered breast development. Most fibroadenomas are benign. Local excision of small lesions through a circumareolar or inframammary incision rather than radical surgery is appropriate. Breast ultrasound represents the most commonly used imaging modality for the study of pediatric female breast masses and fibroadenomas. Detailed descriptions of the sonographic appearances of fibroadenomas in young girls are sparse. We believe that surgical treatment for the patient should include tumor extirpation and immediate restoration of breast appearance, minimizing visible scars, protection of the developing breast bud, nipple, and areola. This modality reduces psychosocial comorbidity.

Efeito do estímulo mamário sobre o índice de Bishop em gestações a termo Effect of nipple stimulation on Bishop scores in term pregnancies

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Alexandre Faisal Cury

1999-01-01

Full Text Available Objetivo: avaliar se o estímulo mamário realizado por primigestas, a partir de 40 semanas de idade gestacional, modifica o índice de Bishop. Método: foram estudadas 64 primigestas, sem intercorrências clínicas e/ou obstétricas, divididas em dois grupos. Um deles, chamado de grupo do estímulo mamário (E.M., era composto por 29 gestantes e o outro, chamado de grupo controle (G.C., por 35 gestantes. O E.M. foi orientado a realizar a estimulação do mamilo bilateralmente, em "corda de relógio", com duração de dois minutos de estímulo e cinco de repouso, durante 30 minutos. O estímulo foi realizado três vezes ao dia até completarem-se as 41 semanas de idade gestacional ou a gestante entrar em trabalho de parto. Para análise estatística das diferenças encontradas, utilizou-se o teste t de Student, com nível de significância de 5%. Resultados: uma vez realizado o estímulo mamário no grupo experimental, comparações foram realizadas com o grupo controle, levando-se em conta a época do parto. Os resultados mostraram não haver diferença significativa entre os grupos, no que concerne ao amadurecimento do colo de acordo com o índice de Bishop. Conclusões: não houve diferença no índice de Bishop em primigestas, com 40 semanas de idade gestacional, submetidas ao estímulo mamário, quando comparadas ao grupo controle.Purpose: to evaluate if the nipple stimulation performed by primigravidae, at 40 weeks, modifies Bishop index. Method: 64 primigravidae, without clinical or obstetrical complications were studied, in two groups. One group, called nipple stimulation group (N.S.G. had 29 pregnant women. The other, named control group (C.G. included 35 pregnant women. The N.S.G. performed the nipple stimulation test, bilaterally, from left to right, for two minutes followed by five minutes of rest, during thirty minutes. The test was done three times a day up to 41 weeks of pregnancy or beginning of labor. Statistical analysis of the

Clinical Impact of Epileptiform Discharge in Children With Attention-Deficit/Hyperactivity Disorder (ADHD).

Science.gov (United States)

Lee, Eun Hye; Choi, Yong Sung; Yoon, Hoi Soo; Bahn, Geon Ho

2016-04-01

The aim of this study was to investigate the prevalence and clinical significance of epileptiform discharges in patients with attention-deficit/hyperactivity disorder (ADHD). The authors retrospectively reviewed 180 children who were diagnosed with ADHD and had an electroencephalography (EEG) recording. Epileptiform discharges were found in 29 (16.1%) of 180 patients with ADHD. Of these, 15 (8.3%) had generalized epileptiform discharges and 14 (7.7%) had focal epileptiform discharges. The focal epileptiform discharges were most prevalent from the frontal (5/14) and rolandic area (5/14). Among the 29 patients with epileptiform discharges and ADHD, 5 patients had previous history of epilepsy and 4 patients developed epilepsy later, whereas none of the normal EEG group developed epilepsy. The authors suggest that interictal epileptiform discharges appear to be associated with seizure occurrence in children with ADHD and might reflect maturational pathophysiology overlapping with epilepsy. © The Author(s) 2015.

Accuracy and Coverage of Diagnosis and Procedural Coding of Severely Injured Patients in the Finnish Hospital Discharge Register: Comparison to Patient Files and the Helsinki Trauma Registry.

Science.gov (United States)

Heinänen, M; Brinck, T; Handolin, L; Mattila, V M; Söderlund, T

2017-09-01

The Finnish Hospital Discharge Register data are frequently used for research purposes. The Finnish Hospital Discharge Register has shown excellent validity in single injuries or disease groups, but no studies have assessed patients with multiple trauma diagnoses. We aimed to evaluate the accuracy and coverage of the Finnish Hospital Discharge Register but at the same time validate the data of the trauma registry of the Helsinki University Hospital's Trauma Unit. We assessed the accuracy and coverage of the Finnish Hospital Discharge Register data by comparing them to the original patient files and trauma registry files from the trauma registry of the Helsinki University Hospital's Trauma Unit. We identified a baseline cohort of patients with severe thorax injury from the trauma registry of the Helsinki University Hospital's Trauma Unit of 2013 (sample of 107 patients). We hypothesized that the Finnish Hospital Discharge Register would lack valuable information about these patients. Using patient files, we identified 965 trauma diagnoses in these 107 patients. From the Finnish Hospital Discharge Register, we identified 632 (65.5%) diagnoses and from the trauma registry of the Helsinki University Hospital's Trauma Unit, 924 (95.8%) diagnoses. A total of 170 (17.6%) trauma diagnoses were missing from the Finnish Hospital Discharge Register data and 41 (4.2%) from the trauma registry of the Helsinki University Hospital's Trauma Unit data. The coverage and accuracy of diagnoses in the Finnish Hospital Discharge Register were 65.5% (95% confidence interval: 62.5%-68.5%) and 73.8% (95% confidence interval: 70.4%-77.2%), respectively, and for the trauma registry of the Helsinki University Hospital's Trauma Unit, 95.8% (95% confidence interval: 94.5%-97.0%) and 97.6% (95% confidence interval: 96.7%-98.6%), respectively. According to patient records, these patients were subjects in 249 operations. We identified 40 (16.1%) missing operation codes from the Finnish Hospital

Bromocriptine

Science.gov (United States)

... called prolactin in the body) including lack of menstrual periods, discharge from the nipples, infertility (difficulty becoming ... diabetes, ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

Is the transposition of the nipple-areolar complex necessary in Simon grade 2b gynecomastia operations using suction-assisted liposuction?

Science.gov (United States)

Özalp, Burhan; Berköz, Ömer; Aydınol, Mustafa

2018-02-01

The aim of this study was to assess the efficacy of suction-assisted liposuction (SAL) in Simon grade 2b gynecomastia and its effect on sternal notch to nipple areola (SNN) distance. A retrospective analysis was performed on 21 patients with grade 2b gynecomastia who underwent SAL. Preoperative and postoperative SNN distances of the patients were measured, the results were analysed using a Mann-Whitney U test and a p-value gynecomastia and shortens the SNN distance by 1 cm, but further clinical studies are required to support this conclusion.

Desenvolvimento de Órgãos da Digestão e Rendimento de Carcaça de Frangos de Corte de Diversas Origens Genéticas Criados com Bebedouros Pendular e Nipple Development of Digestive Organs and Carcass Yield of Broilers from Diverse Genetic Origin Raised with Regular or Nipple Drinkers

Directory of Open Access Journals (Sweden)

LM Fernandes

2002-01-01

Full Text Available O uso de linhas genéticas de diferentes fontes comerciais em programas de reprodução de frangos de corte permite produzir gerações comerciais mais bem adaptadas a realidades diversas e otimizar os potenciais de desempenho do frango de corte com os da reprodutora. Entretanto, a prática predominante no Brasil é o uso de pais e mães de mesma origem. O uso de bebedouros tipo "nipple" vem sendo difundido com a perspectiva de gerar benefícios ainda não comprovados inteiramente na prática. Esse estudo avaliou a evolução dos órgãos da digestão, o desempenho vivo e o rendimento de carcaça e das partes de frangos de corte de diferentes cruzamentos entre reprodutores machos de diversos cruzamentos entre linhagens comerciais (R, I, S, e H com fêmeas também de origem variável (R, I, e H em sistemas de produção com bebedouros pendular ou nipple. As aves dos diferentes cruzamentos apresentaram curvas de crescimento com diferentes intensidades em momentos distintos, determinando desempenhos em peso vivo sempre superiores para o cruzamento RR. O rendimento de peito, entretanto, foi maior para o cruzamento IH. O cruzamento SH, de mais baixo peso corporal, evidenciou rendimentos de carcaça inferiores a todos os demais. O tipo de bebedouro não influenciou nenhum resultado de desempenho vivo ou de rendimento de carcaça, independentemente da linhagem. Os órgãos da digestão apresentaram proporções do peso vivo decrescentes com a idade, mas não evidenciaram efeito de cruzamento entre linhagens ou tipo de bebedouro.Breeding programs using parents from different genetic companies allow the production of commercial generations of broilers directed to attend diverse market situations, but they also serve to optimize the performance of the breeder female. However, this is not a current practice in Brazil where most of the commercial broilers being raised are originated from crosses within the same genetic company. The use of nipple drinkers in

Dutasteride

Science.gov (United States)

... called 5-alpha reductase inhibitors. It works by blocking the production of a natural substance that enlarges ... lumps, pain, or nipple discharge swelling of the face, tongue, or throat difficulty breathing or swallowing peeling ...

Nigerian Journal of Surgical Research - Vol 8, No 3-4 (2006)

African Journals Online (AJOL)

The incidence of cancer in women presenting with bloody nipple discharge ... Pattern of skeletal metastases from breast cancer in an Asian population ... Outcome of undiagnosed traumatic diaphragmatic injuries: A review of our management ...

Validity of rheumatoid arthritis diagnoses in the Danish National Patient Registry

DEFF Research Database (Denmark)

Pedersen, M.; Klarlund, M.; Jacobsen, S.

2004-01-01

to RA satisfying the ACR 1987 classification criteria was estimated to 26%. Our conclusion is that with careful attention to the limitations in the data, discharge diagnoses for patients with records of RA in the Danish NPR can be used for epidemiological research purposes; however, our findings prompt...... general carefulness when using non-audited registries for research in RA....

Trajectories of Risk for Specific Readmission Diagnoses after Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia.

Science.gov (United States)

Krumholz, Harlan M; Hsieh, Angela; Dreyer, Rachel P; Welsh, John; Desai, Nihar R; Dharmarajan, Kumar

2016-01-01

The risk of rehospitalization is elevated in the immediate post-discharge period and declines over time. It is not known if the extent and timing of risk vary across readmission diagnoses, suggesting that recovery and vulnerability after discharge differ by physiologic system. We compared risk trajectories for major readmission diagnoses in the year after discharge among all Medicare fee-for-service beneficiaries hospitalized with heart failure (HF), acute myocardial infarction (AMI), or pneumonia from 2008-2010. We estimated the daily risk of rehospitalization for 12 major readmission diagnostic categories after accounting for the competing risk of death after discharge. For each diagnostic category, we identified (1) the time required for readmission risk to peak and then decline 50% from maximum values after discharge; (2) the time required for readmission risk to approach plateau periods of minimal day-to-day change; and (3) the extent to which hospitalization risks are higher among patients recently discharged from the hospital compared with the general elderly population. Among >3,000,000 hospitalizations, the yearly rate of rehospitalization was 67.0%, 49.5%, and 55.3% after hospitalization for HF, AMI, and pneumonia, respectively. The extent and timing of risk varied by readmission diagnosis and initial admitting condition. Risk of readmission for gastrointestinal bleeding/anemia peaked particularly late after hospital discharge, occurring 10, 6, and 7 days after hospitalization for HF, AMI, and pneumonia, respectively. Risk of readmission for trauma/injury declined particularly slowly, requiring 38, 20, and 38 days to decline by 50% after hospitalization for HF, AMI, and pneumonia, respectively. Patterns of vulnerability to different conditions that cause rehospitalization vary by time after hospital discharge. This finding suggests that recovery of various physiologic systems occurs at different rates and that post-discharge interventions to minimize

Trajectories of Risk for Specific Readmission Diagnoses after Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia.

Directory of Open Access Journals (Sweden)

Harlan M Krumholz

Full Text Available The risk of rehospitalization is elevated in the immediate post-discharge period and declines over time. It is not known if the extent and timing of risk vary across readmission diagnoses, suggesting that recovery and vulnerability after discharge differ by physiologic system.We compared risk trajectories for major readmission diagnoses in the year after discharge among all Medicare fee-for-service beneficiaries hospitalized with heart failure (HF, acute myocardial infarction (AMI, or pneumonia from 2008-2010.We estimated the daily risk of rehospitalization for 12 major readmission diagnostic categories after accounting for the competing risk of death after discharge. For each diagnostic category, we identified (1 the time required for readmission risk to peak and then decline 50% from maximum values after discharge; (2 the time required for readmission risk to approach plateau periods of minimal day-to-day change; and (3 the extent to which hospitalization risks are higher among patients recently discharged from the hospital compared with the general elderly population.Among >3,000,000 hospitalizations, the yearly rate of rehospitalization was 67.0%, 49.5%, and 55.3% after hospitalization for HF, AMI, and pneumonia, respectively. The extent and timing of risk varied by readmission diagnosis and initial admitting condition. Risk of readmission for gastrointestinal bleeding/anemia peaked particularly late after hospital discharge, occurring 10, 6, and 7 days after hospitalization for HF, AMI, and pneumonia, respectively. Risk of readmission for trauma/injury declined particularly slowly, requiring 38, 20, and 38 days to decline by 50% after hospitalization for HF, AMI, and pneumonia, respectively.Patterns of vulnerability to different conditions that cause rehospitalization vary by time after hospital discharge. This finding suggests that recovery of various physiologic systems occurs at different rates and that post-discharge interventions to

A holographic method for investigating cylindrical symmetry plasmas resulting from electric discharges

International Nuclear Information System (INIS)

Rosu, N.; Ralea, M.; Foca, M.; Iova, I.

1992-01-01

A new method based on holographic interferometry in real time with reference fringes for diagnosing gas electric discharges in cylindrical symmetry tubes is presented. A method for obtaining and quantitatively investigating interferograms obtained with a video camera is described. By studying the resulting images frame by frame and introducing the measurements into an adequate computer programme one gets a graphical recording of the radial distribution of the charged particle concentration in the plasma in any region of the tube at a given time, as well as their axial distribution. The real time evolution of certain phenomena occurring in the discharge tube can also be determined by this non-destructive method. The method is used for electric discharges in Ar at average pressures in a discharge tube with hollow cathode effect. (Author)

Same-day discharge after laparoscopic hysterectomy.

Science.gov (United States)

Perron-Burdick, Misa; Yamamoto, Miya; Zaritsky, Eve

2011-05-01

To estimate readmission rates and emergency care use by patients discharged home the same day after laparoscopic hysterectomy. This was a retrospective case series of patients discharged home the same-day after total or supracervical laparoscopic hysterectomy in a managed care setting. Chart reviews were performed for outcomes of interest which included readmission rates, emergency visits, and surgical and demographic characteristics. The two hysterectomy groups were compared using χ² tests for categorical variables and t tests or Wilcoxon rank-sum tests for continuously measured variables. One-thousand fifteen laparoscopic hysterectomies were performed during the 3-year study period. Fifty-two percent (n=527) of the patients were discharged home the same-day; of those, 46% (n=240) had total laparoscopic hysterectomies and 54% (n=287) had supracervical. Cumulative readmission rates were 0.6%, 3.6%, and 4.0% at 48 hours, 3 months, and 12 months, respectively. The most common readmission diagnoses included abdominal incision infection, cuff dehiscence, and vaginal bleeding. Less than 4% of patients presented for emergency care within 48 or 72 hours, most commonly for nausea or vomiting, pain, and urinary retention. Median uterine weight was 155 g, median blood loss was 70 mL, and median surgical time was 150 minutes. There was no difference in readmission rates or emergency visits for the total compared with the supracervical laparoscopic hysterectomy group. Same-day discharge after laparoscopic hysterectomy is associated with low readmission rates and minimal emergency visits in the immediate postoperative period. Same-day discharge may be a safe option for healthy patients undergoing uncomplicated laparoscopic hysterectomy.

Application of acoustic emission technique and friction welding for excavator hose nipple

International Nuclear Information System (INIS)

Kong, Yu Sik; Lee, Jin Kyung

2013-01-01

Friction welding is a very useful joining process to weld metals which have axially symmetric cross section. In this paper, the feasibility of industry application was determined by analyzing the mechanical properties of weld region for a specimen of tube-to-tube shape for excavator hose nipple with friction welding, and optimized welding variables were suggested. In order to accomplish this object, friction heating pressure and friction heating time were selected as the major process variables and the experiment was performed in three levels of each parameter. An acoustic emission(AE) technique was applied to evaluate the optimal friction welding conditions nondestructively. AE parameters of accumulative count and event were analyzed in terms of generating trend of AE signals across the full range of friction weld. The typical waveform and frequency spectrum of AE signals which is generated by friction weld were discussed. From this study the optimal welding variables could be suggested as rotating speed of 1300 rpm, friction heating pressure of 15 MPa, and friction heating time of 10 sec. AE event was a useful parameter to estimate the tensile strength of tube-to tube specimen with friction weld.

Measurement of the knowledge level about breast self-exam among the female employees of a university hospital, Turkey

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Hamide Şişman

2014-01-01

Full Text Available Objective: Periodic mammography, clinical breast examination and breast self-exam (BSE facilitate getting a therapeutic response and improve disease prognosis, by leading to early diagnosis of the breast cancer. Methods: The study included a total of 618 women working in Çukurova University, Faculty of Medicine, as technician, secretary, staff, midwife and doctor. They answered a 22-items questionnaire consisting of questions about general knowledge, 8 of these were about BSE. Results: While it was statistically significant that the education was not correlated with the age of onset of BSE and timing of BSE, the education was significantly efficient in terms of knowing the aim of the BSE, its frequency, post-menopausal BSE time, nipple discharge properties in the case of breast cancer, diagnostic methods and the risks. While it was statistically significant that the profession was not related to age of onset of BSE and knowing the right day of the month on which BSE should be performed, the education was likely to be efficient in knowing the frequency, post-menopausal BSE time, aim of the BSE, nipple discharge properties in the case of breast cancer, diagnostic methods and the risks. When the percentage of giving right answers to the questions and educational background and professional groups were compared, it was seen that the difference of the number of right answers and professional groups was significant. Conclusion: Based on our results, we concluded that the education about BSE is warranted in order to increase the likelihood of female healthcare personnel to diagnose breast cancer at an earlier stage, given their role in raising the awareness of the population.

False Labor at Term in Singleton Pregnancies: Discharge After a Standardized Assessment and Perinatal Outcomes.

Science.gov (United States)

Nelson, David B; McIntire, Donald D; Leveno, Kenneth J

2017-07-01

To evaluate perinatal outcomes in women sent home with a diagnosis of false labor at term and assess the time interval to return for delivery. This was a prospective observational cohort study of women at 37 0/7 to 41 6/7 weeks of gestation without pre-existing medical complications who presented to our hospital-based triage unit with symptoms of labor and underwent a standardized evaluation. Women diagnosed as having false labor with a live singleton fetus in cephalic presentation without a prior cesarean delivery and sent home were compared with a group of similar women diagnosed to be in spontaneous labor. Women with hypertension, diabetes, and known fetal malformations were excluded. Using a perinatal composite outcome of respiratory insufficiency, intraventricular hemorrhage, culture-proven sepsis, Apgar score 3 or less at 5 minutes, phototherapy, and perinatal death, we tested the noninferiority of being sent home compared with being admitted for labor. The relationship of cervical dilatation to the time interval from discharge home to delivery was also analyzed. Between October 2012 and March 2016, a total of 3,949 women met inclusion criteria and were diagnosed with false labor, discharged, and returned to deliver, whereas 2,592 similar women were admitted in early labor. The mean interval from discharge to return was 4.9 days. Cesarean delivery rates were not different between the study groups-11% for both (P=.69), and the perinatal composite outcome rates were not significantly different between those sent home and those admitted-3.2% compared with 3.1% (P=.79). Women with more advanced cervical dilatation at discharge returned and delivered significantly earlier than those with less dilatation regardless of parity. Discharge with false labor at term after a standardized assessment in a triage unit was not associated with increased rates of adverse perinatal composite outcomes or cesarean delivery. The time interval to return for delivery was

Rapid assessment breast clinics--evolution through audit.

Science.gov (United States)

Toomey, D P; Cahill, R A; Birido, N; Jeffers, M; Loftus, B; McInerney, D; Rothwell, J; Geraghty, J G

2006-11-01

This observational, cohort study aimed to examine the potential utility of Rapid Assessment Breast Clinics (RABC) beyond cancer detection at presentation. One thousand four hundred and twenty nine women were studied over an 18 month period. 154 (10.7%) had breast cancer - 87.7% of whom were seen expediently with 92.9% being diagnosed at one attendance. One hundred and forty three (10%) of those with a benign diagnosis were found by routine questioning to have significant familial risk separate to their reason for referral. Despite careful triage, considerable contamination of appointment allotment occurred with many who were correctly triaged as non-urgent being seen 'urgently'. One hundred and seventy six attendees (12.3%) had neither the symptom that triggered referral, nor breast lump, nipple discharge nor family history of breast cancer, while 283 (19.8%) had no objective clinical or radiological abnormality. Although RABC reliably categorise malignant versus non-malignant diagnoses despite cluttering by low risk women, a significant proportion of non-cancer patients still require address of future risk rather than reassurance of their present status alone.

Changes in the in-hospital mortality and 30-day post-discharge mortality in acutely admitted older patients : retrospective observational study

NARCIS (Netherlands)

van Rijn, Marjon; Buurman, Bianca M.; Vroomen, Janet L. Macneil; Suijker, Jacqueline J.; ter Riet, Gerben; van Charante, Eric P. Moll; de Rooij, Sophia E.

Objectives: to compare changes over time in the in-hospital mortality and the mortality from discharge to 30 days postdischarge for six highly prevalent discharge diagnoses in acutely admitted older patients as well as to assess the effect of separately analysing the in-hospital mortality and the

Sexually transmitted infections in women: A correlation of clinical and laboratory diagnosis in cases of vaginal discharge syndrome

Directory of Open Access Journals (Sweden)

Vidyalaxmi Chauhan

2014-01-01

Full Text Available Aims: This study compares the clinical and laboratory diagnosis of vaginal discharge syndrome. Settings and Design: This cross-sectional study was carried out at the gynaecology outpatient department of a tertiary care hospital in Gujarat, India. Material and Methods: Total of 180 females diagnosed as vaginal discharge or cervicitis based on syndromic approach and were recruited for the study. Their clinical profile was noted and they were investigated for bacterial vaginosis, trichomoniasis, candidiasis, gonorrhoea and chlamydia infection. Results: Lower abdominal pain (35% followed by burning micturition (23.9% were the common associated complaints. Bacterial vaginosis was the most common clinical diagnosis, while trichomoniasis was least common. Upon laboratory investigation, 35.6% of cases of vaginal discharge and 12% of cases of cervicitis tested positive. Percentage of cases confirmed by laboratory investigation was 50, 27.8 and 41.7 for bacterial vaginosis, trichomoniasis and candidiasis respectively. Conclusion: Among all the females diagnosed as vaginal discharge syndrome, a very small percentage actually turned out to be positive upon laboratory testing.

Angina - discharge

Science.gov (United States)

Chest pain - discharge; Stable angina - discharge; Chronic angina - discharge; Variant angina - discharge; Angina pectoris - discharge; Accelerating angina - discharge; New-onset angina - discharge; Angina-unstable - discharge; ...

[A study of home care needs of patients at discharge and effects of home care--centered on patients discharged from a rural general hospital].

Science.gov (United States)

Choi, Y S; Kim, D H; Storey, M; Kim, C J; Kang, K S

1992-01-01

The study was carried out at W. hospital, an affiliated hospital of Y university, involved a total of 163 patients who were discharged from the hospital between May 1990 and March 1991. Data collection was twice, just prior to discharge and a minimum of three months post discharge. Thirty patients who lived within a hour travel time of the hospital received home care during the three months post discharge. Nursing diagnoses and nursing interventions for these patients were analyzed in this study. The results of the study are summarized as follows: 1. Discharge needs for the subjects of the study were analyzed using Gordon's eleven functional categories and it was found that 48.3% of the total sample had identified nursing needs. Of these, the needs most frequently identified were in the categories of sexuality, 79.3%, health perception, 68.2% self concept, 62.5%, and sleep and rest 62.5%. Looking at the nursing diagnosis that were made for the 30 patients receiving home care, the following diagnoses were the most frequently given; alteration in sexual pattern 79.3%, alterations in health maintenance, 72.6%, alteration in comfort, 68.0%, depression, 64.0%, noncompliance with diet therapy, 63.7%, alteration in self concept, 55.6%, and alteration in sleep pattern, 53%. 2. In looking at the effects of home nursing care as demonstrated by changes in the functional categories over the three month period, it was found that of the 11 functional categories, the need level for health perception, nutrition, activity and self concept decreased slightly over the three month period. On the average sleep patterns improved, but restfulness was slightly less and bowel elimination patterns improved but satisfaction with urinary elimination was slightly less. On the other hand, role enactment, sexuality, stress management and spirituality decreased slightly. The only results that were statistically significant at the 0.05 level were improvement in digestion and decrease in pain. No

The data quality of splenomegaly ICD-10 diagnoses in a population-based hospital discharge registry

DEFF Research Database (Denmark)

Rotbain, E. C.; Lund Hansen, Dennis; Frederiksen, H.

2015-01-01

of our knowledge, accurate data on the risk of hematological malignancies, hepatic diseases and storage diseases among patients with splenomegaly have never been reported. The aim of this pilot study is to investigate the validity of the splenomegaly ICD-10 diagnoses, in order to ascertain...

Duct Ectasia and Periductal Mastitis in Indian Women.

Science.gov (United States)

Ramalingam, Kirithiga; Srivastava, Anurag; Vuthaluru, Seenu; Dhar, Anita; Chaudhry, Rama

2015-12-01

There is very little awareness of the general physicians and surgeons about the benign breast conditions such as duct ectasia (DE) and periductal mastitis (PDM) causing nipple discharge. Not only that these benign breast diseases ring a false alarm of cancer, they are also the second most common cause of benign breast diseases. The objective was to study the clinical and microbiological profiles of duct ectasia and periductal mastitis in Indian women for better understanding of the disease process, in order to be able to treat them well. Forty-one consecutive patients presenting to the Surgical Out-Patient Department with non-bloody nipple discharge with clinical and radiological features suggestive of DE or PDM were included. Microbial culture and cytopathological study of the nipple discharge were done. Histopathological studies and culture of the ductal tissue taken intraoperatively were carried out. There is no significant difference in the age distribution among women with DE and PDM. Smoking is not associated with DE and PDM of Indian patients in contrast to the Western literature evidence. Infective etiology was present in nearly 46 % of the patients in the study population more so in the periductal mastitis cases. The most common isolated pathogens were Staphylococcus aureus and Staphylococcus epidermidis, unlike in Western population where nearly 50 % were anaerobes. Since the isolated organisms were resistant to the routinely used antibiotics in high proportion of cases, culture and sensitivity should be done in all possible cases for appropriately treating the subareolar sepsis before proceeding with the definitive treatment in the form of duct excision.

Severe Tricuspid Regurgitation Diagnosed 13 Years after a Car Accident: A Case Report

Science.gov (United States)

Acar, Burak; Suleymanoglu, Muhammed; Burak, Cengiz; Demirkan, Burcu Mecit; Guray, Yesim; Tufekcioglu, Omac; Aydogdu, Sinan

2015-01-01

Abstract Blunt chest traumas mostly occur due to car accidents and can cause many cardiac complications such as septal rupture, free-wall rupture, coronary artery dissection or thrombosis, heart failure, arrhythmias, and chordae and papillary muscle rupture. One of the most serious complication is tricuspid regurgitation (TR), which can be simply diagnosed by physical examination and confirmed by echocardiography. We describe a 48-year-old female patient, diagnosed with severe TR 13 years after a blunt chest trauma due to a car accident. TR was diagnosed with transthoracic echocardiography and three dimensional transthoracic echocardiography had defined the exact pathology of the tricuspid valve. The patient underwent successful surgery with bioprosthetic valve implantation and was discharged at 6th postoperative day without any complication. The patient had no problem according to the follow-up one month and six months after operation. PMID:26157464

On-line Monitoring System Based on Principle of Electro-acoustic Monitoring for Transformer Partial Discharge

Directory of Open Access Journals (Sweden)

Guang Ya LIU

2014-02-01

Full Text Available Partial discharge inside a transformer is mainly responsible for the insulation aging and damage of the transformer. However, partial discharge is usually accompanied by external signals like sound, light and electrical signals and detectable physical phenomena such as characteristical gas and dielectric loss. Therefore, it is of great significance to monitor online the external signals and phenomena formed during partial discharge of the transformer when the transformer diagnoses faults. This paper gives a comprehensive overview of the electro-acoustic joint monitoring principles and its monitoring systems and the judgment skills concerned, on the basis of which the monitoring system is designed.

Clinicopathological pattern of benign breast diseases among female ...

African Journals Online (AJOL)

This study describes our experience in the management of benign ... assessment consisting of clinical evaluation, breast imaging and fine needle aspiration cytology. (FNAC) has been recommended as a diagnostic tool for evaluation of patients with .... week for breast pain, breast lump and nipple discharge, respectively.

Modeling fade patterns of nipple areola complex tattoos following breast reconstruction.

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Levites, Heather A; Fourman, Mitchell S; Phillips, Brett T; Fromm, Indira M; Khan, Sami U; Dagum, Alexander B; Bui, Duc T

2014-12-01

Nipple-areolar complex (NAC) tattoos are an effective cosmetic solution for creating a finished look following breast reconstruction procedures. NAC tattoos are prone to significant fading, leading patients to seek revisions. This study was designed to quantify changes in NAC tattoo appearance over time. A total of 71 images of 39 patients were analyzed for NAC tattoo color and shape by 5 blinded medical student graders using a customized scoring system. Subsequently, each image was analyzed using ColorPic software (Iconico, New York, NY). Red/green/blue and hue/saturation/value color parameters were collected. Color quantities were normalized to the individual patient's skin tone to control for variability in lighting. Spearman correlations and nonlinear regressions were calculated utilizing GraphPad Prism 6.0 (GraphPad, La Jolla, CA). The length of time after tattoo placement inversely correlated with color score (P tattoo placement was also inversely correlated with all quantitative color parameters. Each color parameter fit a 1-phase exponential decay model. The decline in qualitative color and shape score agrees with clinical experience of tattoo quality declining over time. The color qualities of the tattoo approach those of the patient's skin over time, ultimately reaching a plateau. This can be modeled using a 1-phase decay equation. In practice, tattoo colors may be selected that compensate for the predictable changes that will occur. The results of this study will help optimize tattoo color and may alleviate the need for NAC tattoo revisions.

National hospital discharge survey: 2004 annual summary with detailed diagnosis and procedure data.

Science.gov (United States)

Kozak, Lola Jean; DeFrances, Carol Jean; Hall, Margaret Jean

2006-10-01

This report presents 2004 national estimates and selected trend data on the use of nonfederal short-stay hospitals in the United States. Estimates are provided by selected patient and hospital characteristics, diagnoses, and surgical and nonsurgical procedures performed. Estimates of diagnoses and procedures are presented according to International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. The estimates are based on data collected through the National Hospital Discharge Survey (NHDS). The survey has been conducted annually since 1965. In 2004, data were collected for approximately 371,000 discharges. Of the 476 eligible nonfederal short-stay hospitals in the sample, 439 (92 percent) responded to the survey. An estimated 34.9 million inpatients were discharged from nonfederal short-stay hospitals in 2004. They used 167.9 million days of care and had an average length of stay of 4.8 days. Hospital use by age ranged from 4.3 million days of care for patients 5-14 years of age to 31.8 million days of care for 75-84 year olds. Almost a third of patients 85 years and over were discharged from hospitals to long-term care institutions. Diseases of the circulatory system was the leading diagnostic category for males. Childbirth was the leading category for females, followed by circulatory diseases. The proportion of HIV discharges who were 40 years of age and over increased from 40 percent in 1995 to 67 percent in 2004. The rate of cardiac catheterizations was higher for males than for females and higher for patients 65-74 and 75-84 years of age than for older or younger groups. The average length of stay for both vaginal and cesarean deliveries decreased from 1980 through 1995 but stays for vaginal deliveries increased 24 percent during the period from 1995 to 2004.

Using hospital discharge data for determining neonatal morbidity and mortality: a validation study

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Algert Charles S

2007-11-01

Full Text Available Abstract Background Despite widespread use of neonatal hospital discharge data, there are few published reports on the accuracy of population health data with neonatal diagnostic or procedure codes. The aim of this study was to assess the accuracy of using routinely collected hospital discharge data in identifying neonatal morbidity during the birth admission compared with data from a statewide audit of selected neonatal intensive care (NICU admissions. Methods Validation study of population-based linked hospital discharge/birth data against neonatal intensive care audit data from New South Wales, Australia for 2,432 babies admitted to NICUs, 1994–1996. Sensitivity, specificity and positive predictive values (PPV with exact binomial confidence intervals were calculated for 12 diagnoses and 6 procedures. Results Sensitivities ranged from 37.0% for drainage of an air leak to 97.7% for very low birthweight, specificities all exceeded 85% and PPVs ranged from 70.9% to 100%. In-hospital mortality, low birthweight (≤1500 g, retinopathy of prematurity, respiratory distress syndrome, meconium aspiration, pneumonia, pulmonary hypertension, selected major anomalies, any mechanical ventilation (including CPAP, major surgery and surgery for patent ductus arteriosus or necrotizing enterocolitis were accurately identified with PPVs over 92%. Transient tachypnea of the newborn and drainage of an air leak had the lowest PPVs, 70.9% and 83.6% respectively. Conclusion Although under-ascertained, routinely collected hospital discharge data had high PPVs for most validated items and would be suitable for risk factor analyses of neonatal morbidity. Procedures tended to be more accurately recorded than diagnoses.

Using hospital discharge data for determining neonatal morbidity and mortality: a validation study

Science.gov (United States)

Ford, Jane B; Roberts, Christine L; Algert, Charles S; Bowen, Jennifer R; Bajuk, Barbara; Henderson-Smart, David J

2007-01-01

Background Despite widespread use of neonatal hospital discharge data, there are few published reports on the accuracy of population health data with neonatal diagnostic or procedure codes. The aim of this study was to assess the accuracy of using routinely collected hospital discharge data in identifying neonatal morbidity during the birth admission compared with data from a statewide audit of selected neonatal intensive care (NICU) admissions. Methods Validation study of population-based linked hospital discharge/birth data against neonatal intensive care audit data from New South Wales, Australia for 2,432 babies admitted to NICUs, 1994–1996. Sensitivity, specificity and positive predictive values (PPV) with exact binomial confidence intervals were calculated for 12 diagnoses and 6 procedures. Results Sensitivities ranged from 37.0% for drainage of an air leak to 97.7% for very low birthweight, specificities all exceeded 85% and PPVs ranged from 70.9% to 100%. In-hospital mortality, low birthweight (≤1500 g), retinopathy of prematurity, respiratory distress syndrome, meconium aspiration, pneumonia, pulmonary hypertension, selected major anomalies, any mechanical ventilation (including CPAP), major surgery and surgery for patent ductus arteriosus or necrotizing enterocolitis were accurately identified with PPVs over 92%. Transient tachypnea of the newborn and drainage of an air leak had the lowest PPVs, 70.9% and 83.6% respectively. Conclusion Although under-ascertained, routinely collected hospital discharge data had high PPVs for most validated items and would be suitable for risk factor analyses of neonatal morbidity. Procedures tended to be more accurately recorded than diagnoses. PMID:18021458

Problems in accurately diagnosing and follow-up for a higher brain dysfunction after traumatic brain injury

International Nuclear Information System (INIS)

Hayakawa, Mineji; Ikoma, Katsunori; Oshiro, Akiko; Hoshino, Hirokatsu; Gando, Satoshi

2007-01-01

Recently, the occurrence of a higher brain dysfunction after brain injury has been socially noticed and epidemiological investigations have thus been performed. However, most of these previous investigations tended to be based on populations in a chronic stage after brain trauma. We hypothesized that some patients with a higher brain dysfunction were socially in extreme distress after being discharged from our hospital due to a lack of any follow-up treatment. We investigated this problem to identify possible problems in diagnosing and follow-up for a higher brain dysfunction after blunt traumatic brain injury at a tertiary emergency center. A questionnaire survey was performed for 204 blunt trauma patients who had been admitted during the period from January 2000 thorough December 2003. Clinical examinations were performed for patients suspected of having a higher brain dysfunction based on this questionnaire survey. Three patients had been already diagnosed to have a higher brain dysfunction while other 3 patients were newly diagnosed in this investigation. The newly diagnosed patients discharged from departments other than the neurosurgery department. Computed tomography (CT) was performed in 82% patients (65 patients) to diagnose major brain injury or bone fracture. No magnetic resonance image was performed to detect any minor brain injury in alert patients. Overlooking the occurrence of a higher brain dysfunction may result from an insufficient recognition of higher brain dysfunction and an insufficient sensitivity of the present diagnostic methods available for minor brain injury. An increased awareness regarding the potential of a higher brain dysfunction existing in such patients is therefore needed by the entire medical staff and the general public. (author)

Factors associated with exclusive breastfeeding of preterm infants. Results from a prospective national cohort study.

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Ragnhild Maastrup

Full Text Available BACKGROUND AND AIM: Evidence-based knowledge of how to guide the mothers of preterm infants in breastfeeding establishment is contradictive or sparse. The aim was to investigate the associations between pre-specified clinical practices for facilitating breastfeeding, and exclusive breastfeeding at discharge as well as adequate duration thereof. METHODS: A prospective survey based on questionnaires was conducted with a Danish national cohort, comprised of 1,221 mothers and their 1,488 preterm infants with a gestational age of 24-36 weeks. Adjusted for covariates, the pre-specified clinical practices were analysed by multiple logistic regression analyses. RESULTS: At discharge 68% of the preterm infants were exclusively breastfed and 17% partially. Test-weighing the infant, and minimizing the use of a pacifier, showed a protective effect to exclusive breastfeeding at discharge (OR 0.6 (95% CI 0.4-0.8 and 0.4 (95% CI 0.3-0.6, respectively. The use of nipple shields (OR 2.3 (95% CI 1.6-3.2 and the initiation of breast milk expression later than 48 hours postpartum (OR 4.9 (95% CI 1.9-12.6 were associated with failure of exclusive breastfeeding at discharge. The clinical practices associated with an inadequate breastfeeding duration were the initiation of breast milk expression at 12-24 hours (OR 1.6 (95% CI 1.0-2.4 and 24-48 hours (OR 1.8 (95% CI 1.0-3.1 vs. before six hours postpartum, and the use of nipple shields (OR 1.4 (95% CI 1.1-1.9. CONCLUSION: Early initiation of breast milk pumping before 12 hours postpartum may increase breastfeeding rates, and it seems that the use of nipple shields should be restricted. The use of test-weighing and minimizing the use of a pacifier may promote the establishment of exclusive breastfeeding, but more research is needed regarding adequate support to the mother when test-weighing is ceased, as more of these mothers ceased exclusive breastfeeding at an early stage after discharge.

Early hospital discharge of the healthy term neonate: the Italian perspective.

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Petrone, E; Mansi, G; Tosco, A; Capasso, L; Migliaro, F; Umbaldo, A; Romano, A; Paludetto, R; Raimondi, F

2008-06-01

An appropriate timing of hospital discharge of the healthy, term neonate represents a balance between birth medicalization and surveillance of immediate health hazards. In the absence of European recommendations, the authors have conducted a broad national survey on the current policies of neonatal discharge. A 13-item questionnaire was sent to 136 Italian birth centers. Quantitative variables were expressed as mean+/-range. Qualitative variables were expressed as frequencies. chi squared test was used for variables comparison. Mean age at discharge for a vaginally delivered neonate was 72 hours. Twelve percent of centres would not schedule a follow-up appointment. Neonates born after a cesarean section were discharged at a mean age of 97 hours. Almost all centres (95/98) would discharge an healthy infant without risk factors for hyperbilirubinemia with a total serum bilirubin (TSB) of 13 mg/dL at 72 hours but 14.7% of these centers would not recheck TSB. The same healthy neonate would be discharged at the age of 45 hours with a TSB=10 mg/dL in 67/98 centers and in 11.9% of cases would not be rechecked. Most Italian hospitals discharge healthy, term neonates born after spontaneous vaginal delivery (SVD) at over 72 hours of age. This policy should protect from missed diagnoses of clinical importance (e.g. hyperbilirubinemia). On the other hand, a prolonged hospitalization tends to increase maternal discomfort and medical costs. Implementing a protocol of home visits/clinic follow-up appointments after an earlier discharge may minimize health hazards and medical costs and optimizing the patient's feedback.

A New Bottle Design Decreases Hypoxemic Episodes during Feeding in Preterm Infants

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Alejandro Jenik

2012-01-01

Full Text Available Oxygen saturation is lower during bottle feeding than during breastfeeding in preterm infants. Our objective was to compare two different bottle systems in healthy preterm infants before discharge in terms of SpO2 and oral feeding efficiency (rate of milk intake. Infants without supplement oxygen needs were evaluated twice on the same day during two consecutive feeds, by the same nurse. Infants served as their own controls for comparison of two systems of bottles, the order of which was randomized. The new bottle's nipple design mimics mom's breast in shape and feel, and the bottle vents to air when the child sucks on the nipple. The other system was the hospital's standard plastic bottle with silicone nipple. The rate of milk intake was calculated as the total volume transferred minus volume lost divided by time of feeding, mL/min. Thirty-four infants (BW: 1,163±479.1 g were studied at 35.4±1.3 weeks after-conception. SpO2 was significantly higher in infants fed with the new bottle design. Milk intake rate was significantly higher with the new bottle than with the standard bottle design. The new bottle design improves oral feeding performance in preterm infants near to discharge when compared to that of a standard bottle.

Study of plasma characteristics in the cathode regime of a nitrogen glow discharge

International Nuclear Information System (INIS)

Margulis, Alvaro

1987-01-01

This research thesis reports the study of the cathode region, cathodic sheath and negative glow, of a nitrogen glow discharge. The author first presents general data regarding glow discharges, a description of the experimental installation, and measurements of discharge balancing. In the next part, he precisely describes spectroscopic methods, and the implementation of diagnoses from an experimental point of view as well as in terms of space resolution. Results are then presented and interpreted. Measurements concern space distributions of excited species, the determination of axial and radial concentrations of nitrogen ions, axial variations of rotational temperatures of the different species and variations of nitrogen ion vibrational temperature. The laser optogalvanic effect on the nitrogen molecular ion is resolved in time, and compared with the result of a theoretical model based on the mobility difference between the different nitrogen ions. Finally, the author compares experimental results on ion profiles along the discharge axis with results obtained with theoretical models [fr

Proteins and carbohydrates in nipple aspirate fluid predict the presence of atypia and cancer in women requiring diagnostic breast biopsy

International Nuclear Information System (INIS)

Qin, Wenyi; Gui, Gerald; Zhang, Ke; Twelves, Dominique; Kliethermes, Beth; Sauter, Edward R

2012-01-01

Herein we present the results of two related investigations. The first study determined if concentrations in breast nipple discharge (ND) of two proteins (urinary plasminogen activator, uPA and its inhibitor, PAI-1) predicted the presence of breast atypia and cancer in pre- and/or postmenopausal women requiring surgery because of a suspicious breast lesion. The second study assessed if these proteins increased the predictive ability of a carbohydrate (Thomsen Friedenreich, TF) which we previously demonstrated predicted the presence of disease in postmenopausal women requiring surgery. In the first study we prospectively enrolled 79 participants from whom we collected ND, measured uPA and PAI-1 and correlated expression with pathologic findings. In the second study we analyzed 35 (uPA and PAI-1 in 24, uPA in an additional 11) ND samples collected from different participants requiring breast surgery, all of whom also had TF results. uPA expression was higher in pre- and PAI-1 in postmenopausal women with 1) cancer (DCIS or invasive) vs. either no cancer (atypia or benign pathology, p = .018 and .025, respectively), or benign pathology (p = .017 and .033, respectively); and 2) abnormal (atypia or cancer) versus benign pathology (p = .018 and .052, respectively). High uPA and PAI-1 concentrations and age were independent predictors of disease in premenopausal women, with an area under the curve (AUC) of 83-87% when comparing diseased vs. benign pathology. uPA, TF, and age correctly classified 35 pre- and postmenopausal women as having disease or not 84-91% of the time, whereas combining uPA+PAI-1+TF correctly classified 24 women 97-100% of the time. uPA and PAI-1 concentrations in ND were higher in women with atypia and cancer compared to women with benign disease. Combining uPA, PAI-1 and TF in the assessment of women requiring diagnostic breast surgery maximized disease prediction. The assessment of these markers may prove useful in early breast cancer detection

Galactography (Ductography)

Science.gov (United States)

... Rather, the ducts lead to cysts in the breast, a sign of fibrocystic change. These cysts may cause a bloody discharge, but generally are not worrisome. top of page How is the ... or placed on her back with the breast exposed. The nipple is cleansed, and a tiny ...

Benign Breast Conditions

Science.gov (United States)

... breast condition refers to a lump, cyst, or nipple discharge (fluid) of the female or male breast that is not cancerous. There are numerous ... Intraductal papillomas. Small tumors can form in your nipple’s milk ducts. ... These are rare in men. Men do have undeveloped milk ducts. The most ...

Breast Cancer in Young Women

Science.gov (United States)

... Screenings Most Schools Can Do More to Help Students Stay Sun Safe Parents and Friends Can Influence ... Starts in Childhood Cancer, the Flu, and You Cervical Cancer ... notice a change in the size or shape of your breast, feel pain in your breast, have nipple discharge other than ...

Evaluation of breast symptoms with mammography and ultrasonography

Directory of Open Access Journals (Sweden)

Emine Devolli Disha

2011-12-01

Full Text Available Introduction: Aim of the study was to discern which are more frequent symptoms presented in malign and benign masses diagnosed by mammography and ultrasonography.Methods: Our study group consisted of 546 female patients, with breast symptoms such as palpable lumps (40.8%, pain in the breast (26%, localized lumpiness or nodularity (13.7%, nipple retraction (11.2%, nipplebloody discharge (5.1% and redness and swelling of the breast (3.1%. All 546 patients were examined by ultrasonography and mammography. Biopsy was performed according to the findings of mammography and ultrasonography.Results: In breast cancer detection ultrasonography showed an efficiency of 79.4% compared to 55.0% for mammography in detecting breast lump, in the case of nipple retraction mammography showed an efficiency of 89.1% compared to 80.4% for ultrasound, while the lowest efficiency for mammography was in the cases with localized lumpiness or nodularity 17.1% compared to 45.7% for ultrasound. In detecting fibrocystic changes where the most common symptoms was pain, ultrasonography showed an efficiency of 99.3 % compared to 84.2 % for mammography.Conclusions: Our study confirmed that breast lumps are detectable in the majority of patients with breast cancer. The most frequent symptoms in patient with benign lesions were pain or localized discomfort. The diagnostic accuracy for carcinomas of the breast and for benign lesions according to symptoms was higher for ultrasound than for mammography.

Pancreatitis - discharge

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Chronic pancreatitis - discharge; Pancreatitis - chronic - discharge; Pancreatic insufficiency - discharge; Acute pancreatitis - discharge ... You were in the hospital because you have pancreatitis. This is a swelling of the pancreas. You ...

Mammography in women under 35

International Nuclear Information System (INIS)

Panzarola, P.; Bellucci, M.C.

1991-01-01

The detection of breast cancer in women under 35 is quite an uncommon event, accounting only for 3.2-3.4% of all breast cancers. To determine the indications for mammography in women under 35, the authors correlated clinical, mammographic, and US findings with fine-needle aspiration/surgical biopsy and follow-up results in 1040 symptomatic women examined at the Center of Senology of the Istitute of Radiology - University of Perugia, Italy, from 1984 to June 1990. Of 1040 women, 482 (41.6%) had normal findings; benign disease was diagnosed in 558 (53.7%) cases, and malignant disease in 49 (4.7%). Mammography was very useful to diagnose malignancy in palpable breast lesions, as well as to suggest the need for biopsy, to detect metachronous cancer and to define lesion sizes. In inflammatory process - e.g., mastitis and abscesses - both mammography and US were capable as its remission after therapy. Galactography had a specific role in the evaluation of the mammary duct and demonstrated intraductal pathologic conditions. In the authors'experiences, mammography never showed occult breast cancers in women with no palpable breast lesions or hematic nipple discharge

Heart pacemaker - discharge

Science.gov (United States)

Cardiac pacemaker implantation - discharge; Artificial pacemaker - discharge; Permanent pacemaker - discharge; Internal pacemaker - discharge; Cardiac resynchronization therapy - discharge; CRT - discharge; ...

Multiple intraductal papillomas of breast clinically masquerading as malignancy

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Singh Pallavi

2010-01-01

Full Text Available Background: Intraductal papilloma is characterized by proliferation of epithelial and myoepithelial cells overlying fibro-vascular stalks creating an arborescent structure within the lumen of duct. Some times multiple papillomas with florid proliferation of epithelium may be confused with malignancy. A case of multiple intraductal papillomas of breast with ulceration of overlying skin and large lump leading to clinical diagnosis of malignancy is documented here. Case Report: A 45-year-old female presented with ulcerated mass of six months duration in the left breast. On examination, a firm, immobile lump of 8× 10 cm in size involving nipple with excoriation of surrounding skin and serosanguinous discharge from nipple was present. There was no axillary lymphadenopathy. No family history of carcinoma breast was present. Fine needle aspiration smears showed benign cellular changes with apocrine metaplasia. Biopsy from an area adjacent to nipple showed intraductal papilloma. Simple mastectomy showed lobulated dirty white mass with well circumscribed nodules below the nipple and areola. On histology with immunohistochemistry a diagnosis of multiple intraductal papillomas was made. Patient is on regular follow-up and doing well. Conclusion: The case highlights the problem in differentiating marked papillomatosis from a malignant lesion of breast and importance of biopsy with immunohistochemistry in such cases for proper management.

Shoulder replacement - discharge

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Total shoulder arthroplasty - discharge; Endoprosthetic shoulder replacement - discharge; Partial shoulder replacement - discharge; Partial shoulder arthroplasty - discharge; Replacement - shoulder - discharge; Arthroplasty - shoulder - discharge

Trichomonas vaginalis is very rare among women with vaginal discharge in Podlaskie province, Poland.

Science.gov (United States)

Serwin, Agnieszka Beata; Bulhak-Koziol, Violetta; Sokolowska, Marianna; Golparian, Daniel; Unemo, Magnus

2017-09-01

Trichomonas vaginalis is the most common curable sexually transmitted pathogen globally. However, in the European Union (EU), trichomoniasis appears to be a rare condition. The aim of this study was to examine the prevalence of T. vaginalis among females attending an STI centre in Bialystok, Poland, using the highly sensitive and specific APTIMA T. vaginalis assay. Consecutive females, referred by gynaecologists mainly because of abnormal vaginal discharge, were diagnosed using wet mount microscopy, culture and APTIMA T. vaginalis assay. Among 272 women studied, 82% were pre- and 18% postmenopausal. The average age was 36.0 ± 13.9 (range: 18-86) years. Abnormal discharge (alone or accompanied by itch or vulvovaginal burning) was the most frequent complain in both groups (66.2% and 48.0%). Erythema and discharge were the most frequent abnormal signs (58.6% and 56.0%). Not a single T. vaginalis-positive sample was detected using wet mount microscopy, culture or APTIMA T. vaginalis assay. Despite using the highly sensitive APTIMA T. vaginalis assay for detection, the pathogen could not be identified in females in the studied setting, similar to results from other EU settings. The need for general screening using NAAT for this pathogen while diagnosing vulvovaginal symptoms in females in Poland appears to be low. © 2017 APMIS. Published by John Wiley & Sons Ltd.

The Burden of Diagnosed and Undiagnosed Diabetes in Native Hawaiian and Asian American Hospitalized Patients.

Science.gov (United States)

Sentell, T L; Cheng, Y; Saito, E; Seto, T B; Miyamura, J; Mau, M; Juarez, D T

2015-12-01

Little is known about diabetes in hospitalized Native Hawaiians and Asian Americans. We determined the burden of diabetes (both diagnosed and undiagnosed) among hospitalized Native Hawaiian, Asian (Filipino, Chinese, Japanese), and White patients. Diagnosed diabetes was determined from discharge data from a major medical center in Hawai'i during 2007-2008. Potentially undiagnosed diabetes was determined by Hemoglobin A1c ≥6.5% or glucose ≥200 mg/dl values for those without diagnosed diabetes. Multivariable log-binomial models predicted diabetes (potentially undiagnosed and diagnosed, separately) controlling for socio-demographic factors. Of 17,828 hospitalized patients, 3.4% had potentially undiagnosed diabetes and 30.5% had diagnosed diabetes. In multivariable models compared to Whites, Native Hawaiian and all Asian subgroups had significantly higher percentages of diagnosed diabetes, but not of potentially undiagnosed diabetes. Potentially undiagnosed diabetes was associated with significantly more hospitalizations during the study period compared to both those without diabetes and those with diagnosed diabetes. In all racial/ethnic groups, those with potentially undiagnosed diabetes also had the longest length of stay and were more likely to die during the hospitalization. Hospitalized Native Hawaiians (41%) and Asian subgroups had significantly higher overall diabetes burdens compared to Whites (23%). Potentially undiagnosed diabetes was associated with poor outcomes. Hospitalized patients, irrespective of race/ethnicity, may require more effective inpatient identification and management of previously undiagnosed diabetes to improve clinical outcomes.

Plasma Discharge Process in a Pulsed Diaphragm Discharge System

Science.gov (United States)

Duan, Jianjin; Hu, Jue; Zhang, Chao; Wen, Yuanbin; Meng, Yuedong; Zhang, Chengxu

2014-12-01

As one of the most important steps in wastewater treatment, limited study on plasma discharge process is a key challenge in the development of plasma applications. In this study, we focus on the plasma discharge process of a pulsed diaphragm discharge system. According to the analysis, the pulsed diaphragm discharge proceeds in seven stages: (1) Joule heating and heat exchange stage; (2) nucleated site formation; (3) plasma generation (initiation of the breakdown stage); (4) avalanche growth and plasma expansion; (5) plasma contraction; (6) termination of the plasma discharge; and (7) heat exchange stage. From this analysis, a critical voltage criterion for breakdown is obtained. We anticipate this finding will provide guidance for a better application of plasma discharges, especially diaphragm plasma discharges.

Double discharges in unipolar-pulsed dielectric barrier discharge xenon excimer lamps

International Nuclear Information System (INIS)

Liu Shuhai; Neiger, Manfred

2003-01-01

Excitation of dielectric barrier discharge xenon excimer lamps by unipolar short square pulses is studied in this paper. Two discharges with different polarity are excited by each voltage pulse (double discharge phenomenon). The primary discharge occurs at the top or at the rising flank of the applied unipolar square pulse, which is directly energized by the external circuit. The secondary discharge with the reversed polarity occurs at the falling flank or shortly after the falling flank end (zero external voltage) depending on the pulse width, which is energized by the energy stored by memory charges deposited by the primary discharge. Fast-speed ICCD imaging shows the primary discharge has a conic discharge appearance with a channel broadening on the anode side. This channel broadening increases with increasing the pulse top level. Only the anode-side surface discharge is observed in the primary discharge. The surface discharge on the cathode side which is present in bipolar sine voltage excitation is not observed. On the contrary, the secondary discharge has only the cathode-side surface discharge. The surface discharge on the anode side is not observed. The secondary discharge is much more diffuse than the primary discharge. Time-resolved emission measurement of double discharges show the secondary discharge emits more VUV xenon excimer radiation but less infrared (IR) xenon atomic emission than the primary discharge. It was found that the IR xenon atomic emission from the secondary discharge can be reduced by shortening the pulse width. The energy efficiency of unipolar-pulsed xenon excimer lamps (the overall energy efficiency of double discharges) is much higher than that obtained under bipolar sine wave excitation. The output VUV spectrum under unipolar pulse excitation is found to be identical to that under sine wave excitation and independent of injected electric power

Increased mortality in the year following discharge from a paediatric ward in Bissau, Guinea-Bissau

DEFF Research Database (Denmark)

Veirum, Jens Erik; Sodeman, Morten; Biai, Sidu

2007-01-01

-hospital and 12-month posthospital mortality was 20%. Compared to the mortality level in the community and controlled for other determinants of childhood mortality, children discharged from hospital had 12 times higher risk of dying during the first 2 weeks after discharge. The mortality rate ratio (MR) was 6...... for postdischarge mortality included ethnic group, housing quality and maternal education, and were similar to risk factors for community mortality. The same diagnoses that had high acute mortality, including anaemia, diarrhoea and 'other', were also associated with high postdischarge mortality. CONCLUSION......BACKGROUND: Few studies in developing countries have examined posthospital mortality and little is known about the magnitude of posthospital mortality and risk factors for long-term survival. A better understanding of the determinants of posthospital mortality could help improve discharge policies...

Suicide mortality among male veterans discharged from Veterans Health Administration acute psychiatric units from 2005 to 2010.

Science.gov (United States)

Britton, Peter C; Bohnert, Kipling M; Ilgen, Mark A; Kane, Cathleen; Stephens, Brady; Pigeon, Wilfred R

2017-09-01

The purpose of this study was to calculate suicide rates and identify correlates of risk in the year following discharge from acute Veterans Health Administration psychiatric inpatient units among male veterans discharged from 2005 to 2010 (fiscal years). Suicide rates and standardized mortality ratios were calculated. Descriptive analyses were used to describe suicides and non-suicides and provide base rates for interpretation, and unadjusted and adjusted proportional hazard models were used to identify correlates of suicide. From 2005 to 2010, 929 male veterans died by suicide in the year after discharge and the suicide rate was 297/100,000 person-years (py). The suicide rate significantly increased from 234/100,000 py (95% CI = 193-282) in 2005 to 340/100,000 py (95% CI = 292-393) in 2008, after which it plateaued. Living in a rural setting, HR (95% CI) = 1.20 (1.05, 1.36), and being diagnosed with a mood disorder such as major depression, HR (95% CI) = 1.60 (1.36, 1.87), or other anxiety disorder, HR (95% CI) = 1.52 (1.24, 1.87), were associated with increased risk for suicide. Among male veterans, the suicide rate in the year after discharge from acute psychiatric hospitalization increased from 2005 to 2008, after which it plateaued. Prevention efforts should target psychiatrically hospitalized veterans who live in rural settings and/or are diagnosed with mood or other anxiety disorders.

Lung surgery - discharge

Science.gov (United States)

... Lung biopsy - discharge; Thoracoscopy - discharge; Video-assisted thoracoscopic surgery - discharge; VATS - discharge ... milk) for 2 weeks after video-assisted thoracoscopic surgery and 6 to 8 weeks after open surgery. ...

Patient-reported mental and physical health outcomes are independent predictors of one-year mortality and cardiac events across cardiac diagnoses. Findings from the national DenHeart survey."

DEFF Research Database (Denmark)

Berg, Selina Kikkenborg; Thorup, Charlotte Brun; Borregaard, Britt

2018-01-01

-reported outcomes at hospital discharge as a predictor of mortality and cardiac events. Design: A cross-sectional survey with register follow-up. Methods: Participants: All patients discharged from April 2013 to April 2014 from five national heart centres in Denmark. Main outcomes: Patient-reported outcomes......Aims: Patient-reported quality of life and anxiety/depression scores provide important prognostic information independently of traditional clinical data. The aims of this study were to describe: (a) mortality and cardiac events one year after hospital discharge across cardiac diagnoses; (b) patient...

Waiting list paradox: Danish cancer patients diagnosed fast have higher mortality after diagnosis

DEFF Research Database (Denmark)

Tørring, Marie Louise; Frydenberg, Morten; Hansen, Rikke Pilegaard

on hospital discharge diagnoses for the 2004-2005 period, extracted from population-based healthcare databases in the former County of Aarhus, Denmark, and subsequently validated in the National Danish Cancer Registry. All patients with a first-time diagnosis of colon, rectal, lung, skin, breast, or prostate...... with longer diagnostic interval until the reference point of 30 days. For colon, rectal, skin, and breast cancer mortality seemed to increase with diagnostic interval longer than 30 days. The waiting list paradox is manifest in Denmark. We speculate that medical professionals organise the diagnostic pathway......Studies often show that cancer patients diagnosed more rapidly have higher mortality rates than patients with longer waits in the primary and secondary health care sector. Our aim was to examine whether this paradox is manifest in the Danish health care system. The study was based on data...

Discharge Disposition After Stroke in Patients With Liver Disease.

Science.gov (United States)

Parikh, Neal S; Merkler, Alexander E; Schneider, Yecheskel; Navi, Babak B; Kamel, Hooman

2017-02-01

Liver disease is associated with both hemorrhagic and thrombotic processes, including an elevated risk of intracranial hemorrhage. We sought to assess the relationship between liver disease and outcomes after stroke, as measured by discharge disposition. Using administrative claims data, we identified a cohort of patients hospitalized with stroke in California, Florida, and New York from 2005 to 2013. The predictor variable was liver disease. All diagnoses were defined using validated diagnosis codes. Ordinal logistic regression was used to analyze the association between liver disease and worsening discharge disposition: home, nursing/rehabilitation facility, or death. Secondarily, multiple logistic regression was used to analyze the association between liver disease and in-hospital mortality. Models were adjusted for demographics, vascular risk factors, and comorbidities. We identified 121 428 patients with intracerebral hemorrhage and 703 918 with ischemic stroke. Liver disease was documented in 13 584 patients (1.7%). Liver disease was associated with worse discharge disposition after both intracerebral hemorrhage (global odds ratio, 1.28; 95% confidence interval, 1.19-1.38) and ischemic stroke (odds ratio, 1.23; 95% confidence interval, 1.17-1.29). Similarly, liver disease was associated with in-hospital death after both intracerebral hemorrhage (odds ratio, 1.33; 95% confidence interval, 1.23-1.44) and ischemic stroke (odds ratio, 1.60; 95% confidence interval, 1.51-1.71). Liver disease was associated with worse hospital discharge disposition and in-hospital mortality after stroke, suggesting worse functional outcomes. © 2016 American Heart Association, Inc.

Aspartame exacerbates EEG spike-wave discharge in children with generalized absence epilepsy: a double-blind controlled study.

Science.gov (United States)

Camfield, P R; Camfield, C S; Dooley, J M; Gordon, K; Jollymore, S; Weaver, D F

1992-05-01

There are anecdotal reports of increased seizures in humans after ingestion of aspartame. We studied 10 children with newly diagnosed but untreated generalized absence seizures. Ambulatory cassette recording of EEG allowed quantification of numbers and length of spike-wave discharges in a double-blind study on two consecutive days. On one day the children received 40 mg/kg aspartame and on the other day, a sucrose-sweetened drink. Baseline EEG was the same before aspartame and sucrose. Following aspartame compared with sucrose, the number of spike-wave discharges per hour and mean length of spike-wave discharges increased but not to a statistically significant degree. However, the total duration of spike-wave discharge per hour was significantly increased after aspartame (p = 0.028), with a 40% +/- 17% (SEM) increase in the number of seconds per hour of EEG recording that the children spent in spike-wave discharge. Aspartame appears to exacerbate the amount of EEG spike wave in children with absence seizures. Further studies are needed to establish if this effect occurs at lower doses and in other seizure types.

Vessel Sewage Discharges: No-Discharge Zones (NDZs)

Science.gov (United States)

States may petition the EPA to establish areas, called no discharge zones (NDZs), where vessel sewage discharges are prohibited. This page describes how NDZs are designated, the types of designations, who enforces them, and how to comply.

Lactation mastitis: occurrence and medical management among 946 breastfeeding women in the United States.

Science.gov (United States)

Foxman, Betsy; D'Arcy, Hannah; Gillespie, Brenda; Bobo, Janet Kay; Schwartz, Kendra

2002-01-15

In 1994-1998, the authors followed 946 breastfeeding women from Michigan and Nebraska for the first 3 months postpartum or until they stopped breastfeeding to describe mastitis incidence, mastitis treatment, and any associations between mastitis occurrence and hypothesized host characteristics and behaviors. Participants were interviewed by telephone at 3, 6, 9, and 12 weeks postpartum or until they ceased breastfeeding. A total of 9.5% reported provider-diagnosed lactation mastitis at least once during the 12-week period, with 64% diagnosed via telephone. After adjustment in a logistic regression model, history of mastitis with a previous child (odds ratio (OR) = 4.0, 95% confidence interval (CI): 2.64, 6.11), cracks and nipple sores in the same week as mastitis (OR = 3.4, 95% CI: 2.04, 5.51), using an antifungal nipple cream (presumably for nipple thrush) in the same 3-week interval as mastitis (OR = 3.4, 95% CI: 1.37, 8.54), and (for women with no prior mastitis history) using a manual breast pump (OR = 3.3, 95% CI: 1.92, 5.62) strongly predicted mastitis. Feeding fewer than 10 times per day was protective regardless of whether or not feeding frequency in the same week or the week before mastitis was included in the model (for the same week: 7-9 times: OR = 0.6, 95% CI: 0.41, 1.01; < or =6 times: OR = 0.4, 95% CI: 0.19, 0.82). Duration of feeding was not associated with mastitis risk.

What Did You Google? Describing Online Health Information Search Patterns of ED patients and Their Relationship with Final Diagnoses.

Science.gov (United States)

McCarthy, Danielle M; Scott, Grant N; Courtney, D Mark; Czerniak, Alyssa; Aldeen, Amer Z; Gravenor, Stephanie; Dresden, Scott M

2017-08-01

Emergency department (ED) patients' Internet search terms prior to arrival have not been well characterized. The objective of this analysis was to characterize the Internet search terms patients used prior to ED arrival and their relationship to final diagnoses. We collected data via survey; participants listed Internet search terms used. Terms were classified into categories: symptom, specific diagnosis, treatment options, anatomy questions, processes of care/physicians, or "other." We categorized each discharge diagnosis as either symptom-based or formal diagnosis. The relationship between the search term and final diagnosis was assigned to one of four categories of search/diagnosis combinations (symptom search/symptom diagnosis, symptom search/formal diagnosis, diagnosis search/symptom diagnosis, diagnosis search/formal diagnosis), representing different "trajectories." We approached 889 patients; 723 (81.3%) participated. Of these, 177 (24.5%) used the Internet prior to ED presentation; however, seven had incomplete data (N=170). Mean age was 47 years (standard deviation 18.2); 58.6% were female and 65.7% white. We found that 61.7% searched symptoms and 40.6% searched a specific diagnosis. Most patients received discharge diagnoses of equal specificity as their search terms (34% flat trajectory-symptoms and 34% flat trajectory-diagnosis). Ten percent searched for a diagnosis by name but received a symptom-based discharge diagnosis with less specificity. In contrast, 22% searched for a symptom and received a detailed diagnosis. Among those who searched for a diagnosis by name (n=69) only 29% received the diagnosis that they had searched. The majority of patients used symptoms as the basis of their pre-ED presentation Internet search. When patients did search for specific diagnoses, only a minority searched for the diagnosis they eventually received.

Statistical Analysis of Partial Discharge Characteristics in Transformer Oil at the “Point-Plane” Electrode at Alternating Voltage

Directory of Open Access Journals (Sweden)

Korobeynikov S.M.

2017-08-01

Full Text Available In this paper, we consider the problems related to measuring and analyzing the characteristics of partial discharges which are the main instrument for oil-filled high-voltage electrical equipment diagnosing. The experiments on recording of partial discharges in transformer oil have been carried out in the “point-plane” electrode system at alternating current. The instantaneous voltage and the apparent charge have been measured depending on the root-mean-square voltage and the phase angle of partial discharges. This paper aimes at carrying out a statistical analysis of the obtained experimental results, in particular, the construction of a parametric probabilistic model of the dependence of the partial discharge inception voltage distribution on the value of the root-mean-square voltage. It differs from usual discharges which occur in liquid dielectric materials in case of sharp inhomogeneous electrode system. It has been suggested that discharges of a different type are the discharges in gas bubbles that occur when partial discharges in a liquid emerge. This assumption is confirmed by the fact that the number of such discharges increases with increasing the root-mean-square voltage value. It is the main novelty of this paper. This corresponds to the nature of the occurrence of such discharges. After rejecting the observations corresponding to discharges in gas bubbles, a parametric probabilistic model has been constructed. The model obtained makes it possible to determine the probability of partial discharge occurrence in a liquid at a given value of the instantaneous voltage depending on the root-mean-square voltage.

Diagnosis of the local thermal equilibrium by optical emission spectroscopy in the evolution of electric discharge; Diagnostico del equilibrio termico local por espectroscopia optica de emision en la evolucion de una descarga electrica

Energy Technology Data Exchange (ETDEWEB)

Valdivia B, R.; Pacheco S, J.; Pacheco P, M.; Ramos F, F.; Cruz A, A. [ININ, Carretera Mexico-Toluca s/n, Ocoyoacac 52750, Estado de Mexico (Mexico); Velazquez P, S. [Instituto Tecnologico de Toluca, Av. Instituto Tecnologico s/n, Ex-Rancho la Virgen, Metepec 52140, Estado de Mexico (Mexico)

2008-07-01

In this work applies the technique of optical emission spectroscopy to diagnose the temperature of the species generated in plasma in the transition to glow discharge arc. Whit this diagnosis is possible to determine the local thermal equilibrium conditions of the discharge. (Author)

State waste discharge permit application for cooling water and condensate discharges

Energy Technology Data Exchange (ETDEWEB)

Haggard, R.D.

1996-08-12

The following presents the Categorical State Waste Discharge Permit (SWDP) Application for the Cooling Water and Condensate Discharges on the Hanford Site. This application is intended to cover existing cooling water and condensate discharges as well as similar future discharges meeting the criteria set forth in this document.

ECOULEMENT MAMELONNAIRE SANGLANT UNILATERAL ET ...

African Journals Online (AJOL)

22 déc. 2009 ... However malignant forms can be individualized and their short- term prognosis is very reserved. KEYS WORDS: Bloody nipple discharge - Breast cancer - Prognosis ... lever le doute de la malignité, sauf en cas d'association à des signes locaux suspects. Les pièces opératoires sont analysées, archivées et ...

Reliability of the minimum basic dataset for diagnoses of cerebrovascular disease.

Science.gov (United States)

Hernández Medrano, I; Guillán, M; Masjuan, J; Alonso Cánovas, A; Gogorcena, M A

2017-03-01

The minimum basic dataset is the largest available hospital care administrative database that is used in clinical studies and hospital management in association with diagnosis-related groups (DRGs). In 2011, the quality of the national MBDS in hospital discharges was audited, in order to assess its reliability. This paper presents a sub-analysis of the results from that analysis which are referred to cerebrovascular disease (CVD). Using all discharge reports from the Spanish MBDS in 2009, a representative sample was obtained by stratified sampling and 11 209 records were evaluated. Outcome indicators were obtained to measure any differences observed between the national MBDS being evaluated and the hospital's original MBDS. Analysis of codes for CVD as a primary diagnosis was performed for ICD-9-CM diagnostic categories 430 through 438. We evaluated error rates in the selection and classification of main diagnoses, as well as in DRG assignment. There were 397 discharges of cases of CVD which included 21 different DRGs. Diagnostic coding showed a concordance rate of 81.87%; the selection error rate was 2.26% and the classification error rate was 15.87%. The error rate in the DRG was 16.12% and associated with the greatest impact on the mortality risk level. While the errors we observed must be taken into account, data suggest that the quality of the MBDS for CVD is sufficient to ensure delivery of valid information. The hospital discharge registry serves as a valuable tool for use in studies of this disease. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

The transition mechanism from a symmetric single period discharge to a period-doubling discharge in atmospheric helium dielectric-barrier discharge

International Nuclear Information System (INIS)

Zhang, Dingzong; Wang, Yanhui; Wang, Dezhen

2013-01-01

Period-doubling and chaos phenomenon have been frequently observed in atmospheric-pressure dielectric-barrier discharges. However, how a normal single period discharge bifurcates into period-doubling state is still unclear. In this paper, by changing the driving frequency, we study numerically the transition mechanisms from a normal single period discharge to a period-doubling state using a one-dimensional self-consistent fluid model. The results show that before a discharge bifurcates into a period-doubling state, it first deviates from its normal operation and transforms into an asymmetric single period discharge mode. Then the weaker discharge in this asymmetric discharge will be enhanced gradually with increasing of the frequency until it makes the subsequent discharge weaken and results in the discharge entering a period-doubling state. In the whole transition process, the spatial distribution of the charged particle density and the electric field plays a definitive role. The conclusions are further confirmed by changing the gap width and the amplitude of the applied voltage

The transition mechanism from a symmetric single period discharge to a period-doubling discharge in atmospheric helium dielectric-barrier discharge

Energy Technology Data Exchange (ETDEWEB)

Zhang, Dingzong; Wang, Yanhui; Wang, Dezhen [School of Physics and Optoelectronic Technology, Dalian University of Technology, Dalian 116024 (China)

2013-06-15

Period-doubling and chaos phenomenon have been frequently observed in atmospheric-pressure dielectric-barrier discharges. However, how a normal single period discharge bifurcates into period-doubling state is still unclear. In this paper, by changing the driving frequency, we study numerically the transition mechanisms from a normal single period discharge to a period-doubling state using a one-dimensional self-consistent fluid model. The results show that before a discharge bifurcates into a period-doubling state, it first deviates from its normal operation and transforms into an asymmetric single period discharge mode. Then the weaker discharge in this asymmetric discharge will be enhanced gradually with increasing of the frequency until it makes the subsequent discharge weaken and results in the discharge entering a period-doubling state. In the whole transition process, the spatial distribution of the charged particle density and the electric field plays a definitive role. The conclusions are further confirmed by changing the gap width and the amplitude of the applied voltage.

Where Lies the Fault in Diagnosing Dhat Syndrome among Females? Understanding through a Case Study

OpenAIRE

Kar, Sujita Kumar; Singh, Amit

2017-01-01

Dhat syndrome is a culture-bound syndrome of South-East Asia, common in young men. However, similar entity has also been described in female patients who attribute their symptoms to nonpathological or physiological vaginal discharge. The current diagnostic system for psychiatric illnesses does not encompass Dhat syndrome in females, and so these group of patients receive alternative diagnoses such as somatoform disorder or depression. As a result of which the focus of unique Dhat syndrome-cen...

Hysterectomy - vaginal - discharge

Science.gov (United States)

Vaginal hysterectomy - discharge; Laparoscopically assisted vaginal hysterectomy - discharge; LAVH - discharge ... you were in the hospital, you had a vaginal hysterectomy. Your surgeon made a cut in your ...

fMRI activation during spike and wave discharges evoked by photic stimulation

DEFF Research Database (Denmark)

Moeller, Friederike; Siebner, Hartwig R; Ahlgrimm, Nils

2009-01-01

Photoparoxysmal response (PPR) is an electroencephalographic (EEG) trait characterized by the occurrence of epileptiform discharges in response to visual stimulation. Studying this trait helps to learn about mechanisms of epileptogenicity. While simultaneous recordings of EEG and functional MRI...... intermittent photic stimulation (IPS) in a 3 T MR scanner. PPR was elicited in 6 subjects, four diagnosed with idiopathic generalised epilepsy and two with tension-type headache. Because PPR is preceded by synchronization of cortical gamma oscillations, blood oxygenation level-dependent (BOLD) signal changes...

Hip fracture - discharge

Science.gov (United States)

... neck fracture repair - discharge; Trochanteric fracture repair - discharge; Hip pinning surgery - discharge ... in the hospital for surgery to repair a hip fracture, a break in the upper part of ...

Electromagnetic effects in high-frequency capacitive discharges used for plasma processing

International Nuclear Information System (INIS)

Chabert, P

2007-01-01

In plasma processing, capacitive discharges have classically been operated in the electrostatic regime, for which the excitation wavelength λ is much greater than the electrode radius, and the plasma skin depth δ is much greater than the electrode spacing. However, contemporary reactors are larger and excited at higher frequencies which leads to strong electromagnetic effects. This paper gives a review of the work that has recently been carried out to carefully model and diagnose these effects, which cause major uniformity problems in plasma processing for microelectronics and flat panel displays industries. (topical review)

Travelling-wave-sustained discharges

International Nuclear Information System (INIS)

Schlueter, Hans; Shivarova, Antonia

2007-01-01

This review is on discharges maintained by travelling waves: new plasma sources, discovered in 1974 and considered as a prototype of the gas discharges according to their definition as nonlinear systems which unify in a self-consistent manner plasmas and fields. In the presentation here of the fluid-plasma models of the diffusion-controlled regime of the travelling-wave-sustained discharges (TWSDs), the basic features of the discharge maintenance-the discharge self-consistency and the electron heating in the high-frequency field-are stressed. Operation of stationary and pulsed discharges, discharge maintenance without and in external magnetic fields as well as discharge production in different gases (argon, helium, helium-argon gas mixtures and hydrogen) are covered. Modulation instability of diffusion-controlled discharges and discharge filamentation at higher gas pressures are also included in the review. Experimental findings which motivate aspects of the reported modelling are pointed out

Ankle replacement - discharge

Science.gov (United States)

... total - discharge; Total ankle arthroplasty - discharge; Endoprosthetic ankle replacement - discharge; Osteoarthritis - ankle ... You had an ankle replacement. Your surgeon removed and reshaped ... an artificial ankle joint. You received pain medicine and were ...

Asthma - child - discharge

Science.gov (United States)

Pediatric asthma - discharge; Wheezing - discharge; Reactive airway disease - discharge ... Your child has asthma , which causes the airways of the lungs to swell and narrow. In the hospital, the doctors and nurses helped ...

Glow discharging device

International Nuclear Information System (INIS)

Maeno, Katsuki; Kawasaki, Kozo; Hiratsuka, Hajime; Kawashima, Shuichi.

1989-01-01

In a thermonuclear device, etc. impurities adsorbed to inner walls of a vacuum vessel by glow discharge are released to clean the vacuum vessel for preventing intrusion of the impurities into plasmas. The object of the present invention is to minimize the capacity of a power source equipment for the glow discharge device to the least extent. That is, a stabilization resistance is connected in series between each of a plurality of anodes which are inserted and arranged at the inside of a vacuum vessel as a cathode and a power source respectively. The resistance value R is selected so as to satisfy the relation: R < (Vi - Vm)/Ii, in which Vi: glow discharge starting voltage, Vm: glow discharge keeping voltage, Ii: glow discharge starting current. Accordingly, if a voltage is applied from a power source to a plurality of anodes, scattering of electric discharge between the anodes can be suppressed and the effect of voltage drop during discharge by the stabilization resistance can be eliminated. As a result, it is possible to provide an economically advantageous glow discharge device with the capacity for the power source facility being to the least extent. (K.M.)

Angioplasty and stent - heart - discharge

Science.gov (United States)

Drug-eluting stents - discharge; PCI - discharge; Percutaneous coronary intervention - discharge; Balloon angioplasty - discharge; Coronary angioplasty - discharge; Coronary artery angioplasty - discharge; Cardiac ...

Qualidade Higiênico-Sanitária e Demanda de Cloro da Água de Dessedentação de Galinhas de Postura Coletadas em Bebedouros Tipo Nipple e Taça

Directory of Open Access Journals (Sweden)

Amaral LA

2001-01-01

Full Text Available O objetivo deste estudo foi avaliar a influência de dois tipos de bebedouros nipple e taça, utilizados na dessedentação de aves de postura e o incremento da demanda de cloro na água oferecida pelos dois tipos de bebedouros estudados. Foram realizadas as contagens de coliformes totais, coliformes fecais, Escherichia coli, estreptococos fecais e microrganismos mesófilos. Os resultados obtidos figuraram que as amostras de água dos reservatórios, de ambos os bebedouros, apresentaram-se contaminadas microbiologicamente antes de passarem pelos bebedouros. A contaminação por bactérias de poluição fecal foi maior nas amostras colhidas nos bebedouros tipo taça, assim como eles foram responsáveis por um maior acúmulo de matéria orgânica, tendo então uma elevada demanda de cloro e uma maior influência na depreciação da qualidade da água fornecida às aves. Dos dois tipos de bebedouros estudados, o tipo nipple mostrou ser o menos deletério no que concerne à qualidade da água entretanto, independente do tipo de bebedouro utilizado na dessedentação das aves, a desinfecção da água é um ato imprescindível à manutenção de sua qualidade e à eliminação de futuros patógenos.

Diagnostic value of ductogalactography and cytology in the proliferative changes of the mammary ducts

International Nuclear Information System (INIS)

Sessa, M.; Cerroni, L.; Bertolotti, A.

1991-01-01

Three hundred and thiyrty-six patients with nipple discharge and neither physical signs at breast examination nor pathological findings at mammography, were observed from 1984 to 1988 and studied by means of ductogalactography and cytology of discharge. Of this group, 76 patients (22%) underwent surgery and histology. In 65/76 cases proliferative pathologic conditions were demonstrated: 51 single/ multiple papillomas and 14 carcinomas. Ductogalactography suggested proliferative pathologic conditions in 59 cases and cytology of discharge showed blood in 44 patients, papillary clusters in 23, and atypical cells in 15 (both as single occurrences and in association). In cancer patients discharge appeared to be mostly spontaneous, monoductal and blood-stained. In papillomas, induced discharge was almost as frequent as spontaneous discharge, and milky discharge was also present. Ductogalactography confirmed its value in the diagnosis of proliferative pathologic conditions of the mammary ducts, being especially useful to detect carcinomas without palpable tumors. Cytology of discharge had poorer diagnostic significance

Pediatric heart surgery - discharge

Science.gov (United States)

... discharge; Heart valve surgery - children - discharge; Heart surgery - pediatric - discharge; Heart transplant - pediatric - discharge ... Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 434. ...

Hospital Readmission Following Discharge From Inpatient Rehabilitation for Older Adults With Debility

Science.gov (United States)

Karmarkar, Amol M.; Graham, James E.; Tan, Alai; Raji, Mukaila; Granger, Carl V.; Ottenbacher, Kenneth J.

2016-01-01

Background Debility accounts for 10% of inpatient rehabilitation cases among Medicare beneficiaries. Debility has the highest 30-day readmission rate among 6 impairment groups most commonly admitted to inpatient rehabilitation. Objective The purpose of this study was to examine rates, temporal distribution, and factors associated with hospital readmission for patients with debility up to 90 days following discharge from inpatient rehabilitation. Design A retrospective cohort study was conducted using records for 45,424 Medicare fee-for-service beneficiaries with debility discharged to community from 1,199 facilities during 2006–2009. Methods Cox proportional hazard regression models were used to estimate hazard ratios for readmission. Schoenfeld residuals were examined to identify covariate-time interactions. Factor-time interactions were included in the full model for Functional Independence Measure (FIM) discharge motor functional status, comorbidity tier, and chronic pulmonary disease. Most prevalent reasons for readmission were summarized by Medicare severity diagnosis related groups. Results Hospital readmission rates for patients with debility were 19% for 30 days and 34% for 90 days. The highest readmission count occurred on day 3 after discharge, and 56% of readmissions occurred within 30 days. A higher FIM discharge motor rating was associated with lower hazard for readmissions prior to 60 days (30-day hazard ratio=0.987; 95% confidence interval=0.986, 0.989). Comorbidities with hazard ratios >1.0 included comorbidity tier and 11 Elixhauser conditions, 3 of which (heart failure, renal failure, and chronic pulmonary disease) were among the most prevalent reasons for readmission. Limitations Analysis of Medicare data permitted only use of variables reported for administrative purposes. Comorbidity data were analyzed only for inpatient diagnoses. Conclusions One-third of patients were readmitted to acute hospitals within 90 days following rehabilitation for

Impact of a telecare service for psichyatric patients at discharge

Directory of Open Access Journals (Sweden)

Sofía Martínez Villar

2012-11-01

Full Text Available Introduction: Suicide and self harm are two of the mental health problems that require more healthcare attention. When psychiatric patients are discharged back to their homes, must face multiple stress factors, which in many cases, are cause of readmissions, self harm and suicide. Objective: The aim of this study to assess whether a program of nursing telecare improves the adaptation of patient with risk of suicide and self harm at home. Methods: The design of this study is an experimental trial type, which generates two cohorts, an intervention one and a control one. The population of the study are patients diagnosed a major depression or borderline, antisocial, or histrionic personality disorder, admitted in the hospital because of symptom decompensation, and with a nursing diagnosis of risk of suicide, risk of self-harming and risk for self-directed violence. To data recollection, the levels of anxiety, suicidal ideation and the confrontation level at discharge and one month after discharge, the number of psychiatric emergency visits, number of readmissions and number of appointments to which the patient attended at the Mental Health Centre during the month at home, as well as the adherence to medication will be assessed. For the data analysis, the homogeneity of the groups will be eveluated, to then undertake a descriptive study of two cohorts, and then an analytical study for comparison.

Discharge current characteristics as an 'electrical method' for glow discharge plasma diagnosis

International Nuclear Information System (INIS)

Toma, M.; Paraschivescu, Alina; Morminches, Anisoara

2001-01-01

In its simplest form, the glow discharge can be established by passing an electric current through gas between two electrodes. The gas and the electrodes are contained in an insulating envelope. In many technological applications, and not only, the plasma devices are often treated like a black box. There is a series of external parameters or control variables which can be adjusted to obtain a desired effect, namely, the operating voltage, gas pressure, gas nature, gas flow rate, magnetic field strength and magnetic field configuration, electric field geometry, interelectrode distance, and cathode characteristics. The discharge current can be controlled by each of the above control variables. The core idea of this work is the following: a lot of information about the phenomena from the discharge volume, at electrodes or at the discharge bounding wall surface, can be obtained knowing how the change of one of the control parameters influences the discharge current. The following regimes were analyzed: dark discharges (background ionization, saturation regime, Townsend regime, corona regime), glow discharge (the normal and abnormal discharge) and arc discharge (glow to arc transition, non-thermal arcs, thermal arcs). It was concluded that the nonlinearity in the shape of the discharge current characteristics as a function of an external control parameter, can be correlated with the elementary processes and the dynamics of different space charge structures generated in plasma devices. (authors)

Heart attack - discharge

Science.gov (United States)

... and lifestyle Cholesterol - drug treatment Controlling your high blood pressure Deep vein thrombosis - discharge Dietary fats explained Fast food tips Heart attack - discharge Heart attack - what to ask your doctor Heart bypass ... pacemaker - discharge High blood pressure - what to ask your doctor How to read ...

Validity of International Classification of Diseases (ICD) coding for dengue infections in hospital discharge records in Malaysia.

Science.gov (United States)

Woon, Yuan-Liang; Lee, Keng-Yee; Mohd Anuar, Siti Fatimah Zahra; Goh, Pik-Pin; Lim, Teck-Onn

2018-04-20

Hospitalization due to dengue illness is an important measure of dengue morbidity. However, limited studies are based on administrative database because the validity of the diagnosis codes is unknown. We validated the International Classification of Diseases, 10th revision (ICD) diagnosis coding for dengue infections in the Malaysian Ministry of Health's (MOH) hospital discharge database. This validation study involves retrospective review of available hospital discharge records and hand-search medical records for years 2010 and 2013. We randomly selected 3219 hospital discharge records coded with dengue and non-dengue infections as their discharge diagnoses from the national hospital discharge database. We then randomly sampled 216 and 144 records for patients with and without codes for dengue respectively, in keeping with their relative frequency in the MOH database, for chart review. The ICD codes for dengue were validated against lab-based diagnostic standard (NS1 or IgM). The ICD-10-CM codes for dengue had a sensitivity of 94%, modest specificity of 83%, positive predictive value of 87% and negative predictive value 92%. These results were stable between 2010 and 2013. However, its specificity decreased substantially when patients manifested with bleeding or low platelet count. The diagnostic performance of the ICD codes for dengue in the MOH's hospital discharge database is adequate for use in health services research on dengue.

A girl of Klippel-Trenaunay Weber syndrome coexistence of recurrent bloody vaginal discharge.

Science.gov (United States)

Turkmen, Mehmet; Kavukçu, Salih; Çakmakci, Handan; Soylu, Alper; Aktan, Sebnem; Çağan, Yeliz

2010-09-01

Klippel-Trenaunay Weber syndrome (KTWS) is the coexistence of capillary vascular malformations, varicose veins, dilated arteries and arteriovenous fistulas, soft tissue and/or bone hypertrophy. We present a girl of KTWS associated with hypertrophied left kidney, enlargement in venous structures of the left kidney, recurrent bloody vaginal discharge and angiokeratomas. A 6-year-old girl was admitted to our department with complaints of recurrent bloody vaginal discharge and swelling in the left inguinal region. Physical examination revealed hypertrophy of the left lower extremity. Vaginoscopy and cystoscopy revealed normal findings. Abdominal ultrasound revealed an enlarged left kidney. Enlargement in the venous structures of the hypertrophied left kidney was detected by abdominal magnetic resonance imaging, and arteriovenous fistulas were revealed by conventional angiography. The patient was diagnosed KTWS. Ophthalmic examination was normal. Galactosidase A (GLA) level was found to be at the lower limit of the normal range, and mutation was not detected in the GLA gene. In conclusion, we have emphasized that the girls with recurrent vaginal discharge might be KTWS. Angiokeratoma may be considered as a dermatological finding of KTWS. KTWS may also have enlarged kidney and enlargement in venous structures of the kidney in hypertrophied side.

CO-AXIAL DISCHARGES

Science.gov (United States)

Luce, J.S.; Smith, L.P.

1960-11-22

A method and apparatus are given for producing coaxial arc discharges in an evacuated enclosure and within a strong, confining magnetic field. The arcs are maintained at a high potential difference. Electrons will diffuse to the more positive arc from the negative arc, and positive ions will diffuse from the more positive arc to the negative arc. Coaxial arc discharges have the advantage that ions which return to strike the positive arc discharge will lose no energy since they do not strike a solid wall or electrode. Those discharges are useful in confining an ionized plasma between the discharges, and have the advantage of preventing impurities from the walls of the enclosure from entering ihe plasma area because of the arc barrier set up bv the cylindrical outer arc.

Diagnosing Tic Disorders

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... Submit" /> Information For… Media Policy Makers Diagnosing Tic Disorders Language: English (US) Español (Spanish) Recommend on ... or postviral encephalitis). Persistent (Chronic) Motor or Vocal Tic Disorder To be diagnosed with a persistent tic ...

Discharge lamp technologies

Energy Technology Data Exchange (ETDEWEB)

Dakin, J. [GE Lighting, Cleveland, OH (United States)

1994-12-31

This talk is an overview of discharge lamp technology commonly employed in general lighting, with emphasis on issues pertinent to lighting for plant growth. Since the audience is primarily from the plant growth community, and this begins the light source part of the program, we will start with a brief description of the discharge lamps. Challenges of economics and of thermal management make lamp efficiency a prime concern in controlled environment agriculture, so we will emphasize science considerations relating to discharge lamp efficiency. We will then look at the spectra and ratings of some representative lighting products, and conclude with a discussion of technological advance. A general overview of discharge lighting technology can be found in the book of Waymouth (1971). A recent review of low pressure lighting discharge science is found in Dakin (1991). The pioneering paper of Reiling (1964) provides a good introduction to metal halide discharges. Particularly relevant to lighting for plant growth, a recent and thorough treatment of high pressure Na lamps is found in the book by deGroot and vanVliet (1986). Broad practical aspects of lighting application are thoroughly covered in the IES Lighting Handbook edited by Kaufman (1984).

Tennis elbow surgery - discharge

Science.gov (United States)

... epicondylitis surgery - discharge; Lateral tendinosis surgery - discharge; Lateral tennis elbow surgery - discharge ... long as you are told. This helps ensure tennis elbow will not return. You may be prescribed a ...

TOPICAL REVIEW: Electromagnetic effects in high-frequency capacitive discharges used for plasma processing

Science.gov (United States)

Chabert, P.

2007-02-01

In plasma processing, capacitive discharges have classically been operated in the electrostatic regime, for which the excitation wavelength λ is much greater than the electrode radius, and the plasma skin depth δ is much greater than the electrode spacing. However, contemporary reactors are larger and excited at higher frequencies which leads to strong electromagnetic effects. This paper gives a review of the work that has recently been carried out to carefully model and diagnose these effects, which cause major uniformity problems in plasma processing for microelectronics and flat panel displays industries.

Discharge Characteristics of Series Surface/Packed-Bed Discharge Reactor Diven by Bipolar Pulsed Power

International Nuclear Information System (INIS)

Hu Jian; Jiang Nan; Li Jie; Shang Kefeng; Lu Na; Wu Yan; Mizuno Akira

2016-01-01

The discharge characteristics of the series surface/packed-bed discharge (SSPBD) reactor driven by bipolar pulse power were systemically investigated in this study. In order to evaluate the advantages of the SSPBD reactor, it was compared with traditional surface discharge (SD) reactor and packed-bed discharge (PBD) reactor in terms of the discharge voltage, discharge current, and ozone formation. The SSPBD reactor exhibited a faster rising time and lower tail voltage than the SD and PBD reactors. The distribution of the active species generated in different discharge regions of the SSPBD reactor was analyzed by optical emission spectra and ozone analysis. It was found that the packed-bed discharge region (3.5 mg/L), rather than the surface discharge region (1.3 mg/L) in the SSPBD reactor played a more important role in ozone generation. The optical emission spectroscopy analysis indicated that more intense peaks of the active species (e.g. N2 and OI) in the optical emission spectra were observed in the packed-bed region. (paper)

Prostate brachytherapy - discharge

Science.gov (United States)

Implant therapy - prostate cancer - discharge; Radioactive seed placement - discharge ... You had a procedure called brachytherapy to treat prostate cancer. Your treatment lasted 30 minutes or more, ...

Reconstructing the history of 14C discharges from Sellafield. Part 2. Aquatic discharges

International Nuclear Information System (INIS)

Cook, G.T.; MacKenzie, A.B.; Naysmith, F.H.; Anderson, R.; Naysmith, P.; Kershaw, P.J.

2004-01-01

Prior to 1984, the reported marine 14 C discharges from Sellafield were estimates: 0.2 TBq per annum from 1952 to 1969 and 1 TBq per annum until 1984 when measurements commenced. The relationship between the net excess 14 C activity in annually collected Nori (Porphyra umbilicalis) seaweed samples and the annual discharges (estimated and measured) implies that the discharges were not as constant as the estimates. Based on the relationship between post-1984 measured discharges and the excess 14 C in the seaweed, two simple empirical models were used to re-calculate the discharges between 1967 and 1984. Gamma-spectrometry measurements on the seaweed also indicate that Porphyra is a sensitive indicator of changes in discharge of other radionuclides, brought about by the introduction of new waste clean-up technologies within Sellafield. (author)

Role of secondary emission on discharge dynamics in an atmospheric pressure dielectric barrier discharge

Energy Technology Data Exchange (ETDEWEB)

Tay, W. H.; Kausik, S. S.; Yap, S. L.; Wong, C. S., E-mail: cswong@um.edu.my [Plasma Technology Research Centre, Department of Physics, Faculty of Science, University of Malaya, 50603 Kuala Lumpur (Malaysia)

2014-04-15

The discharge dynamics in an atmospheric pressure dielectric barrier discharge (DBD) is studied in a DBD reactor consisting of a pair of stainless steel parallel plate electrodes. The DBD discharge has been generated by a 50 Hz ac high voltage power source. The high-speed intensified charge coupled device camera is used to capture the images of filaments occurring in the discharge gap. It is observed that frequent synchronous breakdown of micro discharges occurs across the discharge gap in the case of negative current pulse. The experimental results reveal that secondary emissions from the dielectric surface play a key role in the synchronous breakdown of plasma filaments.

Characterisation of zinc delivery from a nipple shield delivery system using a breastfeeding simulation apparatus.

Directory of Open Access Journals (Sweden)

Rebekah L Scheuerle

Full Text Available Zinc delivery from a nipple shield delivery system (NSDS, a novel platform for administering medicines to infants during breastfeeding, was characterised using a breastfeeding simulation apparatus. In this study, human milk at flow rates and pressures physiologically representative of breastfeeding passed through the NSDS loaded with zinc-containing rapidly disintegrating tablets, resulting in release of zinc into the milk. Inductively coupled plasma optical emission spectrometry was used to detect the zinc released, using a method that does not require prior digestion of the samples and that could be applied in other zinc analysis studies in breast milk. Four different types of zinc-containing tablets with equal zinc load but varying excipient compositions were tested in the NSDS in vitro. Zinc release measured over 20 minutes ranged from 32-51% of the loaded dose. Total zinc release for sets tablets of the same composition but differing hardness were not significantly different from one another with P = 0.3598 and P = 0.1270 for two tested pairs using unpaired t tests with Welch's correction. By the same test total zinc release from two sets of tablets having similar hardness but differing composition were also not significantly significant with P = 0.2634. Future zinc tablet composition and formulation optimisation could lead to zinc supplements and therapeutics with faster drug release, which could be administered with the NSDS during breastfeeding. The use of the NSDS to deliver zinc could then lead to treatment and prevention of some of the leading causes of child mortality, including diarrheal disease and pneumonia.

Modelling electric discharge chemistry

International Nuclear Information System (INIS)

McFarlane, J.; Wren, J.C.

1991-07-01

The chemistry occurring in a electric discharge was modelled to predict how it would be influenced by discharge conditions. The discharge was characterized by a calculated Boltzmann electron-energy distribution, from which rate constants for electron-molecule processes in air were determined. These rate constants were used in a chemical kinetics calculation that also included reactions between neutral molecules, ions, free radicals and electronically excited species. The model describes how the discharge chemistry was influenced by humidity, electric field, electron number density, and concentrations of key reagents identified in the study. The use of an electric discharge to destroy airborne contaminant molecules was appraised, the targeted contaminants being CF 2 Cl 2 , HCN, and SO 2 . The modelling results indicate that an electric discharge should be able to remove HCN and CF 2 Cl 2 effectively, especially if the discharge conditions have been optimized. Effective destruction is achieved with a moderate electric field (over 1 x 10 -15 V.cm 2 ), a substantial electron number density (over 1 x 10 12 cm -3 ), and the presence of H 2 0 in the process air. The residence time in the discharge was also shown to be important in contaminant destruction. An attempt was made to explain the results of the electric discharge abatement of SO 2 , a component of a simulated flue-gas mixture. Results from the model indicate that the discharge parameters that increase the concentration of hydroxyl radical also increase the rate of decomposition of SO 2 . An objective of the study was to explain the apparent enhancement of SO 2 destruction by the presence of a small amount of NO 2 . It was thought that a likely explanation would be the stabilization of HOSO 2 , an important intermediate in the oxidation of SO 2 by NO 2 . (49 figs., 14 tabs., 75 refs.)

Improvement of ozone yield by a multi-discharge type ozonizer using superposition of silent discharge plasma

International Nuclear Information System (INIS)

Song, Hyun-Jig; Chun, Byung-Joon; Lee, Kwang-Sik

2004-01-01

In order to improve ozone generation, we experimentally investigated the silent discharge plasma and ozone generation characteristics of a multi-discharge type ozonizer. Ozone in a multi-discharge type ozonizer is generated by superposition of a silent discharge plasma, which is simultaneously generated in separated discharge spaces. A multi-discharge type ozonizer is composed of three different kinds of superposed silent discharge type ozonizers, depending on the method of applying power to each electrode. We observed that the discharge period of the current pulse for a multi discharge type ozonizer can be longer than that of silent discharge type ozonizer with two electrodes and one gap. Hence, ozone generation is improved up to 17185 ppm and 783 g/kwh in the case of the superposed silent discharge type ozonizer for which an AC high voltages with a 180 .deg. phase difference were applied to the internal electrode and the external electrode, respectively, with the central electrode being grounded.

Fractures in Individuals With and Without a History of Infantile Autism. A Danish Register Study Based on Hospital Discharge Diagnoses

DEFF Research Database (Denmark)

Mouridsen, Svend-Erik; Rich, Bente; Isager, Torben

2012-01-01

observation time was 30.3 years (range 27.3-30.4 years), and mean age at follow-up was 42.7 years (range 27.3-57.3 years). Of the 118 individuals with IA, 14 (11.9%) were registered with at least one fracture diagnosis against 83 (24.7%) in the comparison group (p = 0.004; OR = 0.41; 95%CI 0......We compared the prevalence and types of fractures in a clinical sample of 118 individuals diagnosed as children with infantile autism (IA) with 336 matched controls from the general population. All participants were screened through the nationwide Danish National Hospital Register. The average.......22-0.76), but the nature of their fractures seems somewhat different. Epilepsy was a risk factor, but only in the comparison group. Our results lend no support to the notion that fracture is a common comorbid condition in a population of people diagnosed with IA as children....

Risk perception of future cardiovascular disease in women diagnosed with a hypertensive disorder of pregnancy.

Science.gov (United States)

Traylor, Jessica; Chandrasekaran, Suchitra; Limaye, Meghana; Srinivas, Sindhu; Durnwald, Celeste P

2016-01-01

The objective of this study is to evaluate a woman's risk perception for future cardiovascular disease (CVD) after being diagnosed with a hypertensive disorder of pregnancy. A prospective cohort of women diagnosed with a hypertensive disorder of pregnancy (HDP) was studied. Each woman completed two surveys, one prior to hospital discharge and one 2 weeks later, designed to assess knowledge of and risk perception for future CVD based on their recent diagnosis of a HDP. Rates of postpartum depression were also assessed. Of the 146 subjects included, 28% were diagnosed with preeclampsia with severe features, 52.1% with preeclampsia with mild features, and 19.9% had chronic hypertension. Women with severe features and those delivering preterm were more likely to report a perception of increased risk of both recurrent HDP in a future pregnancy (p = 0.004 and 0.005, respectively) and hypertension later in life (p = 0.01 and 0.03, respectively). Women delivering preterm were more likely to report an accurate perception of increased risk of myocardial infarction and stroke compared to those delivering at term (p = 0.006 and 0.002, respectively). Disease severity and preterm delivery were associated with a higher likelihood of the perception of an increased risk for both recurrent HDP and hypertension in the future. Only preterm delivery was associated with a higher risk perception for stroke and myocardial infarction. Interventions targeted at improved health awareness in women diagnosed with HDP are warranted.

Retrospective Analysis of 513 Cases Diagnosed with Rib Fracture Secondary to Blunt Thorax Trauma

Directory of Open Access Journals (Sweden)

Serdar Ozkan

2017-05-01

Full Text Available Aim: This study aimed to analyze blunt chest trauma cases who were diagnosed with rib fracture and to examine the regional differences likely to appear in trauma cases and treatment approaches. Material and Method: 513 cases who applied to the Emergency Service and Department of Thoracic Surgery between October 2013 and December 2014 due to blunt trauma and were diagnosed with rib fracture were retrospectively examined. The cases were evaluated in terms of etiological factors, thoracic, and other system injuries accompanying the rib fracture, prognosis, and the treatments applied. Results: Isolated rib fracture was present in 266 of the cases. Thoracic organ injuries such as pneumothorax, hemothorax, hemopneumothorax, lung contusion, or laceration and sternal fracture accompanying the rib fracture were present in 247 of the cases. While one or two rib fractures were detected in 298 cases, six or more rib fractures were present in 28 cases. 78.2% of hemothorax cases, 85.3% of pneumothorax cases, 95.4% of hemopneumothorax cases, 81.8% of bilateral pneumothorax cases, 26% of bilateral hemothorax cases, and 71.4% of bilateral hemopneumothorax cases were treated by applying tube thoracostomy. 129 cases diagnosed with thoracic organ injury in addition to rib fracture but not subjected to surgical intervention, and 266 cases diagnosed with isolated rib fracture were discharged with full recovery after appropriate medical treatment. Discussion: Most of the rib fractures occurring due to blunt trauma are treated successfully with medical treatments and conservative approaches and do not need advanced surgical treatments.

Clinical and EEG features of ischemic stroke patients with abnormal discharges

Directory of Open Access Journals (Sweden)

Jia-lei YANG

2016-05-01

Full Text Available Objective To investigate the clinical and EEG features of ischemic stroke patients with abnormal discharges.  Methods Clinical data and 24-hour EEG monitoring of 162 ischemic stroke patients were analyzed retrospectively. One-year follow-up was carried out and post-ischemic epilepsy was diagnosed.  Results Among 162 ischemic stroke patients, 24-hour EEG was abnormal in 87 cases (53.70%. According to the correspondence of site of infarcts and abnormal discharges, these 87 cases were classified into 2 groups: matched group (N = 24, 27.59% and unmatched group (N = 63, 72.41%. There was no significant difference between 2 groups in terms of Oxfordshire Community Stroke Project (OCSP and TOAST classification (P = 0.792, 0.111, while there was significant difference between 2 groups on the site of infarcts (P = 0.000. In matched group, the infarcts were mainly located in cortex (N = 23, 95.83%. However, in unmatched group, the infarcts were mainly located in cortex and basal ganglia (N = 27, 42.86%, or in basal ganglia only (N = 24, 38.10%. In matched group, 24-hour EEG showed slowing of background activities, and sharp waves and sharp and slow wave complex which were corresponding to the infarct sites. The abnormal discharges could only be recorded around the infarct unilaterally. In unmatched group, the epileptiform discharges were recorded in both contralateral and ipsilateral ischemic hemispheres, usually with widespread slow waves and asymmetric background. The infarcts were limited, but abnormal discharges were widespread. For example, the infarct was located in deep brain, while scalp abnormal discharges were recorded. Although there was no significant difference in terms of epilepsy incidence between 2 groups (P = 0.908, the types of epilepsy were statistically different between 2 groups (P = 0.000. In matched group, the main type was partial seizure. But in unmatched group, the main types of epilepsy were secondary generalized seizure and

Pending laboratory tests and the hospital discharge summary in patients discharged to sub-acute care.

Science.gov (United States)

Walz, Stacy E; Smith, Maureen; Cox, Elizabeth; Sattin, Justin; Kind, Amy J H

2011-04-01

Previous studies have noted a high (41%) prevalence and poor discharge summary communication of pending laboratory (lab) tests at the time of hospital discharge for general medical patients. However, the prevalence and communication of pending labs within a high-risk population, specifically those patients discharged to sub-acute care (i.e., skilled nursing, rehabilitation, long-term care), remains unknown. To determine the prevalence and nature of lab tests pending at hospital discharge and their inclusion within hospital discharge summaries, for common sub-acute care populations. Retrospective cohort study. Stroke, hip fracture, and cancer patients discharged from a single large academic medical center to sub-acute care, 2003-2005 (N = 564) Pending lab tests were abstracted from the laboratory information system (LIS) and from each patient's discharge summary, then grouped into 14 categories and compared. Microbiology tests were sub-divided by culture type and number of days pending prior to discharge. Of sub-acute care patients, 32% (181/564) were discharged with pending lab tests per the LIS; however, only 11% (20/181) of discharge summaries documented these. Patients most often left the hospital with pending microbiology tests (83% [150/181]), particularly blood and urine cultures, and reference lab tests (17% [30/181]). However, 82% (61/74) of patients' pending urine cultures did not have 24-hour preliminary results, and 19% (13/70) of patients' pending blood cultures did not have 48-hour preliminary results available at the time of hospital discharge. Approximately one-third of the sub-acute care patients in this study had labs pending at discharge, but few were documented within hospital discharge summaries. Even after considering the availability of preliminary microbiology results, these omissions remain common. Future studies should focus on improving the communication of pending lab tests at discharge and evaluating the impact that this improved

Discharge Characteristics of Series Surface/Packed-Bed Discharge Reactor Diven by Bipolar Pulsed Power

Science.gov (United States)

Hu, Jian; Jiang, Nan; Li, Jie; Shang, Kefeng; Lu, Na; Wu, Yan; Mizuno, Akira

2016-03-01

The discharge characteristics of the series surface/packed-bed discharge (SSPBD) reactor driven by bipolar pulse power were systemically investigated in this study. In order to evaluate the advantages of the SSPBD reactor, it was compared with traditional surface discharge (SD) reactor and packed-bed discharge (PBD) reactor in terms of the discharge voltage, discharge current, and ozone formation. The SSPBD reactor exhibited a faster rising time and lower tail voltage than the SD and PBD reactors. The distribution of the active species generated in different discharge regions of the SSPBD reactor was analyzed by optical emission spectra and ozone analysis. It was found that the packed-bed discharge region (3.5 mg/L), rather than the surface discharge region (1.3 mg/L) in the SSPBD reactor played a more important role in ozone generation. The optical emission spectroscopy analysis indicated that more intense peaks of the active species (e.g. N2 and OI) in the optical emission spectra were observed in the packed-bed region. supported by National Natural Science Foundation of China (No. 51177007), the Joint Funds of National Natural Science Foundation of China (No. U1462105), and Dalian University of Technology Fundamental Research Fund of China (No. DUT15RC(3)030)

Investigation of airflow effects on the dielectric barrier discharge with single/double discharge channel arrangement

Science.gov (United States)

Fan, Zhihui; Yan, Huijie; Liu, Yidi; Guo, Hongfei; Wang, Yuying; Ren, Chunsheng

2018-05-01

Atmospheric-pressure dielectric barrier discharge (DBD) with airflow participation has been widely used in recent years. In this paper, effects of airflow on DBD characteristics are experimentally investigated by single/double pin-to-plate DBD arrangements with an AC exciting source. The discharge electrical characteristics and the movements of discharge channels in airflow are investigated with a single pin electrode arrangement. The current intensities increase in positive cycles and decrease in negative cycles with the increase in airflow velocity. The transition from a filamentary discharge to a diffuse discharge is observed under certain airflow conditions, and the discharge channels move with the airflow with a movement velocity less than the corresponding airflow velocity. In the cases of double pin electrode arrangements, the repulsion between double pin discharge channels is apparent at a 10 mm distance but is not obvious at a 20 mm distance. When the airflow is introduced into the discharge gap, not as in the case of single pin electrode arrangement, the movements of discharge channels in airflow are affected by adjacent discharge channels. The corresponding reasons are analyzed in the paper.

[Use of hospital discharge records to estimate the incidence of malignant mesotheliomas].

Science.gov (United States)

Stura, Antonella; Gangemi, Manuela; Mirabelli, Dario

2007-01-01

cancer registries usually adopt strategies for active case finding. Interest in using administrative sources of data is rising to assess the usefullness of Hospital discharge records (HDR) to supplement the traditional methods of case finding of the malignant mesothelioma (MM) Registry of the Piedmont Region. HDRs have been used since 1996. We assessed the number of cases identified only through HDRs and their influence on MM incidence. cases identified through HDRs were about 10% of those with histologic confirmation of the diagnosis, 34% of those with cytologic confirmation, and 72% of those without morphologic examination. Cases diagnosed in hospitals located outside the region would have been easily (50%) missed. The age-standardised (standard: Italian pop. at the 1981 census) incidence rate of pleural MM increases from 2.2 to 2.7 per 100,000 per year among men, and from 1.1 to 1.2 among women, when including all cases identified from HDRs, irrespective of their diagnostic confirmation. Peritoneal MM incidence estimates are unaffected. Overall without access to the hospital discharge files, 179 cases out of 954 would not have been registered between 1996 and 2001. In the same calendar period 59 cases identified by means of active search by the Registry have not been found in the hospital discharge files. HDRs are useful in addition, but not in substitution, to active search of MM cases.

Diffusion of condenser water discharge

International Nuclear Information System (INIS)

Iwakiri, Toshio

1977-01-01

Thermal and nuclear power stations in Japan are mostly located in coastal area, and the cooling water is discharged into sea as warm water. Recently, large interest is taken in this matter, and it is desirable to predict the diffusion of warm discharge accurately and to take effective measures for lowering the temperature. As for the methods of predicting the diffusion of warm discharge, simplified estimation, mathematical analysis and hydrographical model experiment are used corresponding to objects and conditions. As for the measures to lower temperature, the method of discharging warm water into deep sea bottom was confirmed to be very effective. In this paper, the phenomena of diffusion of warm discharge in sea, the methods of predicting the diffusion of warm discharge, and the deep sea discharge as the measure for lowering temperature are outlined. The factors concerning the diffusion of warm discharge in sea are the conditions of discharge, topography and sea state, and the diffusion is roughly divided into mixing diffusion in the vicinity of warm water outlet and eddy diffusion in distant region. It is difficult to change artificially the conditions of diffusion in distant region, and the measures of raising the rate of dilution in near region are effective, therefore the deep sea discharge is adopted. (Kako, I.)

Vessel Sewage Discharges

Science.gov (United States)

Vessel sewage discharges are regulated under Section 312 of the Clean Water Act, which is jointly implemented by the EPA and Coast Guard. This homepage links to information on marine sanitation devices and no discharge zones.

Capacitor discharge engineering

CERN Document Server

Früngel, Frank B A

1976-01-01

High Speed Pulse Technology, Volume III: Capacitor Discharge Engineering covers the production and practical application of capacitor dischargers for the generation and utilization of high speed pulsed of energy in different forms. This nine-chapter volume discusses the principles of electric current, voltage, X-rays, gamma rays, heat, beams of electrons, neutrons and ions, magnetic fields, sound, and shock waves in gases and liquids. Considerable chapters consider the applications of capacitor discharges, such as impulse hardening of steel, ultrapulse welding of precision parts, X-ray flash t

Effectiveness of structured planned post discharge support to patients with chronic obstructive pulmonary disease for reducing readmission rates

DEFF Research Database (Denmark)

Pedersen, Preben Ulrich; Ersgard, Karen Bagger; Soerensen, Tina Brandt

2017-01-01

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease, characterized by airflow limitation. The disease has a significant impact on the lives of patients and is a challenge for the health care due to readmissions to hospitals. OBJECTIVES: This review aimed...... exacerbation. TYPES OF INTERVENTIONS: Studies that evaluated discharge interventions that supported patients managing symptoms of COPD. TYPES OF STUDIES: Randomized controlled trials, non-randomized controlled trials, quasi-experimental or cohort studies. OUTCOMES: Readmission, defined as hospitalization...... to identify, appraise and synthesize the best available evidence on the effectiveness of discharge interventions that can reduce readmission of patients with COPD. TYPES OF PARTICIPANTS: Hospitalized patients, aged 18 years or over, who had been diagnosed with COPD and were admitted to hospital due to acute...

Discharge Planning in Chronic Conditions

Science.gov (United States)

McMartin, K

2013-01-01

Background Chronically ill people experience frequent changes in health status accompanied by multiple transitions between care settings and care providers. Discharge planning provides support services, follow-up activities, and other interventions that span pre-hospital discharge to post-hospital settings. Objective To determine if discharge planning is effective at reducing health resource utilization and improving patient outcomes compared with standard care alone. Data Sources A standard systematic literature search was conducted for studies published from January 1, 2004, until December 13, 2011. Review Methods Reports, randomized controlled trials, systematic reviews, and meta-analyses with 1 month or more of follow-up and limited to specified chronic conditions were examined. Outcomes included mortality/survival, readmissions and emergency department (ED) visits, hospital length of stay (LOS), health-related quality of life (HRQOL), and patient satisfaction. Results One meta-analysis compared individualized discharge planning to usual care and found a significant reduction in readmissions favouring individualized discharge planning. A second meta-analysis compared comprehensive discharge planning with postdischarge support to usual care. There was a significant reduction in readmissions favouring discharge planning with postdischarge support. However, there was significant statistical heterogeneity. For both meta-analyses there was a nonsignificant reduction in mortality between the study arms. Limitations There was difficulty in distinguishing the relative contribution of each element within the terms “discharge planning” and “postdischarge support.” For most studies, “usual care” was not explicitly described. Conclusions Compared with usual care, there was moderate quality evidence that individualized discharge planning is more effective at reducing readmissions or hospital LOS but not mortality, and very low quality evidence that it is more

Hydrogen discharges operating at atmospheric pressure in a semiconductor gas discharge system

Energy Technology Data Exchange (ETDEWEB)

Aktas, K; Acar, S; Salamov, B G [Physics Department, Faculty of Arts and Sciences, Gazi University, 06500 Ankara (Turkey)

2011-08-15

Analyses of physical processes which initiate electrical breakdown and spatial stabilization of current and control it with a photosensitive cathode in a semiconductor gas discharge system (SGDS) are carried out in a wide pressure range up to atmospheric pressure p, interelectrode distance d and diameter D of the electrode areas of the semiconductor cathode. The study compares the breakdown and stability curves of the gas discharge in the planar SGDS where the discharge gap is filled with hydrogen and air in two cases. The impact of the ionizing component of the discharge plasma on the control of the stable operation of the planar SGDS is also investigated at atmospheric pressure. The loss of stability is primarily due to modification of the semiconductor-cathode properties on the interaction with low-energy hydrogen ions and the formation of a space charge of positive ions in the discharge gap which changes the discharge from Townsend to glow type. The experimental results show that the discharge current in H{sub 2} is more stable than in air. The breakdown voltages are measured for H{sub 2} and air with parallel-plane electrodes, for pressures between 28 and 760 Torr. The effective secondary electron emission (SEE) coefficient is then determined from the breakdown voltage results and compared with the experimental results. The influence of the SEE coefficient is stated in terms of the differences between the experimental breakdown law.

Discharges from nuclear power stations

International Nuclear Information System (INIS)

1991-02-01

HM Inspectorate of Pollution commissioned, with authorising responsibilities in England and Wales, a study into the discharges of radioactive effluents from Nuclear Power Stations. The study considered arisings from nuclear power stations in Europe and the USA and the technologies to treat and control the radioactive discharges. This report contains details of the technologies used at many nuclear power stations to treat and control radioactive discharges and gives, where information was available, details of discharges and authorised discharge limits. (author)

Early discharge following birth

DEFF Research Database (Denmark)

Nilsson, Ingrid M. S.; Kronborg, Hanne; Knight, Christopher H.

2017-01-01

.26–0.48) and primiparous compared to multiparous had an OR of 0.22 (CI 0.17–0.29) for early discharge. Other predictors for early discharge were: no induction of labour, no epidural painkiller, bleeding less than 500 ml during delivery, higher gestational age, early expected discharge and positive breastfeeding experience...

VALIDITY OF PARACENTESIS IN DIAGNOSING BLUNT TRAUMA ABDOMEN

Directory of Open Access Journals (Sweden)

Fahad Bin Abdul Majeed

2017-03-01

Full Text Available BACKGROUND Blunt abdominal trauma is a common case that comes to an emergency department and it is the most easily missed diagnosis resulting in catastrophic consequences. Delay in diagnosing a case is due to the nonspecific character of the symptoms with which it presents. Clinical signs that could be elicited in blunt trauma abdomen are equally nonspecific. Thus, to avoid delay and save the life of the patient, a doctor has to depend on various investigations to rule out blunt trauma abdomen. The modalities which help include paracentesis, diagnostic peritoneal lavage, Focused Abdominal Sonography for Trauma (FAST and ContrastEnhanced Computed Tomography (CECT. To choose the right investigation for the right patient helps in saving precious lives. Validity of each investigation, availability, condition of the patient are the main points to look into before deciding on the right investigative modality. Paracentesis is the simplest investigation that could be done in emergency department and also at the site of accident to triage the patient. Paracentesis has low sensitivity to detect blunt trauma. FAST is a better investigation with higher validity rates than paracentesis. This study aims to validate paracentesis, which is the simplest and commonest investigation used to identify blunt abdominal trauma. MATERIALS AND METHODS In this study, 106 patients who fulfilled the inclusion and exclusion criteria were followed up by detailed history, clinical examination, paracentesis and FAST to identify blunt abdominal trauma and then compared with a gold standard investigation, which was assigned as CECT for haemodynamically stable patients and laparotomy for haemodynamically unstable patients. Commonest organs injured in blunt trauma and their management was noted. Patients were followed up till discharge or death. Subsequently, the data were compiled using excel sheet and evaluated using tables and charts. RESULTS Paracentesis is found to have a

Fractures in Individuals with and without a History of Infantile Autism. A Danish Register Study Based on Hospital Discharge Diagnoses

Science.gov (United States)

Mouridsen, Svend Erik; Rich, Bente; Isager, Torben

2012-01-01

We compared the prevalence and types of fractures in a clinical sample of 118 individuals diagnosed as children with infantile autism (IA) with 336 matched controls from the general population. All participants were screened through the nationwide Danish National Hospital Register. The average observation time was 30.3 years (range 27.3-30.4…

Neuroblastoma in Children: Just Diagnosed Information

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... Financial Reports Watchdog Ratings Feedback Contact Select Page Neuroblastoma in Children – Just Diagnosed Home > Cancer Resources > Types ... Diagnosed Just Diagnosed In Treatment After Treatment Diagnosing Neuroblastoma Depending on the location of the tumor and ...

Modified PADSS (Post Anaesthetic Discharge Scoring System) for monitoring outpatients discharge.

Science.gov (United States)

Palumbo, Piergaspare; Tellan, Guglielmo; Perotti, Bruno; Pacilè, Maria Antonietta; Vietri, Francesco; Illuminati, Giulio

2013-01-01

The decision to discharge a patient undergoing day surgery is a major step in the hospitalization pathway, because it must be achieved without compromising the quality of care, thus ensuring the same assistance and wellbeing as for a long-term stay. Therefore, the use of an objective assessment for the management of a fair and safe discharge is essential. The authors propose the Post Anaesthetic Discharge Scoring System (PADSS), which considers six criteria: vital signs, ambulation, nausea/vomiting, pain, bleeding and voiding. Each criterion is given a score ranging from 0 to 2. Only patients who achieve a score of 9 or more are considered ready for discharge. Furthermore, PADSS has been modified to ensure a higher level of safety, thus the "vital signs" criteria must never score lower than 2, and none of the other five criteria must ever be equal to 0, even if the total score reaches 9. The effectiveness of PADSS was analyzed on 2432 patients, by recording the incidence of postoperative complications and the readmission to hospital. So far PADDS has proved to be an efficient system that guarantees safe discharge.

Application of an antenna excited high pressure microwave discharge to compact discharge lamps

International Nuclear Information System (INIS)

Kando, M; Fukaya, T; Ohishi, Y; Mizojiri, T; Morimoto, Y; Shido, M; Serita, T

2008-01-01

A novel type of high pressure microwave discharge has been investigated to feed the microwave power at the centre of the compact high pressure discharge lamps using the antenna effect. This method of microwave discharge is named as the antenna excited microwave discharge (AEMD). The 2.45 GHz microwave of around 50 W from the solid state microwave generator can sustain a stable plasma column in the small gap between a couple of antennas fitted on the compact lamp filled with discharge gases at a pressure higher than atmosphere. The AEMD has been applied to a compact metal halide lamp and an extremely high pressure mercury discharge lamp. As a result, the metal halide lamp showed high luminous efficacy of around 130 lm W -1 . The excellent lamp properties obtained here can be explained by the low heating loss at the antennas and the lamp wall. The profiles of the microwave electric field in the lamp and the microwave launcher have been numerically calculated to consider the microwave power supply into the lamp

Fertility Preservation for Children Diagnosed with Cancer

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Full Text Available ... for Women Diagnosed with Cancer Fertility Preservation for Men Diagnosed with Cancer Fertility Preservation for Children Diagnosed ... for Women Diagnosed with Cancer Fertility Preservation for Men Diagnosed with Cancer Fertility Preservation for Children Diagnosed ...

Dementia and Risk of 30-Day Readmission in Older Adults After Discharge from Acute Care Hospitals.

Science.gov (United States)

Sakata, Nobuo; Okumura, Yasuyuki; Fushimi, Kiyohide; Nakanishi, Miharu; Ogawa, Asao

2018-02-20

To assess the association between dementia and risk of hospital readmission and to evaluate whether the effect of dementia on hospital readmission varies according to primary diagnosis. Retrospective cohort study. Nationwide discharge database of acute care hospitals in Japan. Individuals aged 65 and older diagnosed with one of the 30 most common diagnoses and discharged from 987 hospitals between April 2014 and September 2015 (N = 1,834,378). The primary outcome was unplanned hospital readmission within 30 days. Poisson generalized estimating equation models were fitted to assess the risks of readmission for individuals with and without dementia, using primary diagnosis as a possible effect modifier and clinical factors as potential confounders. The overall prevalence of dementia was 14.7% and varied according to primary diagnosis, ranging from 3.0% in individuals with prostate cancer to 69.4% in those with aspiration pneumonia. Overall, individuals with dementia had a higher risk of hospital readmission (8.3%) than those without (4.1%) (adjusted risk ratio (aRR])=1.46, 95% confidence interval (CI)=1.44-1.49), although diagnostic category substantially modified the relationship between dementia and hospital readmission. For hip fracture, dementia was associated with greater risk of hospital readmission (adjusted risk 11.5% vs 7.9%; aRR=1.46; 95% CI=1.28-1.68); this risk was attenuated for cholecystitis (adjusted risk 12.8% vs 12.4%; aRR=1.03; 95% CI=0.90-1.18). Risk of hospital readmission associated with dementia varied according to primary diagnosis. Healthcare providers could enforce interventions to minimize readmission by focusing on comorbid conditions in individuals with dementia and specific primary diagnoses that increase their risk of readmission. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

Aluminium, carbonyls and cytokines in human nipple aspirate fluids: Possible relationship between inflammation, oxidative stress and breast cancer microenvironment.

Science.gov (United States)

Mannello, F; Ligi, D; Canale, M

2013-11-01

The human breast is likely exposed to Al (aluminium) from many sources including diet and personal care products. Underarm applications of aluminium salt-based antiperspirant provide a possible long-term source of exposure, especially after underarm applications to shaved and abraded skin. Al research in breast fluids likely reflects the intraductal microenvironment. We found increased levels of aluminium in noninvasively collected nipple aspirate fluids (NAF) from 19 breast cancer patients compared with 16 healthy control subjects (268 vs 131 μg/l, respectively; p Aluminium content and carbonyl levels showed a significant positive linear correlation (r(2) 0.6628, p aluminium salts) we also found a significantly increased levels of pro-inflammatory cytokines (IL-1β, IL-6, IL-12 p70, and TNF-α) and chemoattractant CC and CXC chemokines (IL-8, MIP-1α and MCP-1). In 12 invasive cancer NAF samples we found a significant positive linear correlation among aluminium, carbonyls and pro-inflammatory IL-6 cytokine (Y = 64.79x-39.63, r(2) 0.8192, p aluminium ions in oxidative and inflammatory status perturbations of breast cancer microenvironment, suggesting aluminium accumulation in breast microenvironment as a possible risk factor for oxidative/inflammatory phenotype of breast cells. © 2013.

A retrospective observational study of functional outcomes, length of stay, and discharge disposition after an inpatient stroke rehabilitation program in Saudi Arabia.

Science.gov (United States)

Bindawas, Saad M; Mawajdeh, Hussam; Vennu, Vishal; Alhaidary, Hisham

2016-08-01

Functional outcomes, length of stay (LOS), and discharge disposition have become frequent outcome measures among stroke patients after rehabilitation programs. To examine the trends of changes in functional outcomes, LOS, and discharge disposition in stroke patients discharged from an inpatient rehabilitation facility.All patients (n = 432) were admitted to a tertiary inpatient rehabilitation hospital in Riyadh, Saudi Arabia with stroke diagnoses from November 2008 to December 2014. The functional independence measure (FIM) instrument used to assess the patient's functional status. The LOS was measured as the number of days the patients spent in the hospital from the day of admission to the day of discharge. The FIM efficiency was used to measure the patient's rehabilitation progress. All of the variables of the prospectively collected data were retrospectively analyzed.There were significant changes by years in the total FIM ranging from 23 to 29 (P stroke have improved after an inpatient stroke rehabilitation program between 2008 and 2014 even with a constant LOS. Discharge disposition has remained unstable over this period. To improve the efficiency of the stroke rehabilitation program in Saudi Arabia, there is a need to decrease the LOS and emphasize a comprehensive interdisciplinary approach.

Current Trends in Discharge Disposition and Post-discharge Care After Total Joint Arthroplasty.

Science.gov (United States)

Tarity, T David; Swall, Marion M

2017-09-01

The purpose of this manuscript is to review published literature over the last 5 years to assess recent trends and influencing factors regarding discharge disposition and post-discharge care following total joint arthroplasty. We evaluated instruments proposed to predict a patient's discharge disposition and summarize reports investigating the safety in sending more patients home by reviewing complications and readmission rates. Current literature supports decreased length of hospital stay and increased discharge to home with cost savings and stable readmission rates. Surgeons with defined clinical pathways and those who shape patient expectations may more effectively control costs than those without defined pathways. Further research is needed analyzing best practices in care coordination, managing patient expectations, and cost-effective analysis of home discharge while at the same time ensuring patient outcomes are optimized following total joint arthroplasty.

Localization of intraductal mass through the ostium of the duct using wire guided ductography technique

International Nuclear Information System (INIS)

Aslam, M.

2014-01-01

To localize intraductal mass (Papilloma) before surgery Materials Guide wire 10-15 cm length of 2/3-0 Prolene/Surgipro Plastic 26G to 20G I/V cannulas Kopans breast lesion localization hook wire Disposable syringe heaving 2ml non-ionic contrast High intensity light and magnified glass. Methods: Prepare patient in sitting or lying position adjust high intensity light clean the nipple with antiseptic lotion. Elicit the discharge with gentle periareolar pressure or ask the patient to bring the discharge. If the opening with discharge is not clearly visualize use magnified glass or loop. Slowly inserted the wire into the duct orifice, it should pass freely into the duct. Introduce the 26G I/V plastic cannula coaxially over the guide wire and remove the guide wire. Gently inject 0.2-0.4 ml contrast, remove and the syringe and apply stopper. The cannula stopper assembly is secured to the breast with tape. Magnified craniocaudal view of the breast is taken, the 26G cannula removed and bigger length 22/20G cannula gradually passed over the guide wire according to distance of lesion from the ostium. Intraductal mass location is verified the hook wire is replaced with guide wire, the position of hook confirmed by mammographic film. The wire is cut 2cms from the nipple and pt. send to operation theater Results:Hook localization has been successfully carried out in six patients. Conclusion:This is a new method of localization of intraductal mass it enables the surgeon to do microductectomy with minimal cosmetic effects to the breast. (author)

Diagnosing Dementia—Positive Signs

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... Navigation Bar Home Current Issue Past Issues Diagnosing Dementia—Positive Signs Past Issues / Fall 2007 Table of ... easy, affordable blood test that could accurately diagnose Alzheimer's disease (AD)—even before symptoms began to show? Researchers ...

Being publicly diagnosed

DEFF Research Database (Denmark)

Konradsen, Hanne; Lillebaek, Troels; Wilcke, Torgny

2014-01-01

a patient with TB, and finally being in medical treatment. Before being diagnosed with TB, patients were weighing between biding their time and deciding to undergo an examination. Social pressure and feelings of social responsibility tended to affect the decision. Having undergone the examination......INTRODUCTION: Tuberculosis (TB) is a disease which affects people worldwide, but there is knowledge lacking about patients' experiences in low-prevalence and high-income countries. AIM: To provide a theoretical framework for the process of being diagnosed with tuberculosis in a Danish setting....... METHOD: A grounded theory design with field studies and qualitative interviews, following the recommendations from Glaser and Strauss. RESULT: A process of being publicly diagnosed was identified, which developed during the patient's trajectory from being on the way to becoming a patient, becoming...

New discharge tube with virtual cathode

International Nuclear Information System (INIS)

Seidelmann, L.; Aubrecht, L.

2003-01-01

Till this time known methods of the excitation of the discharge between electrodes are using either secondary or thermo emission of electrons by the cathode. Usually we speak about the self-maintained discharge. Lifetime of the cathode, that is shortened by the emission, limits in principle, the lifetime of the whole discharge tube. The discharge can, according to the present state of the art, be induced also by the inductive way. Arrangement for excitation of such discharge is rather expensive. The construction of the inductive excited discharge tube is considerably influenced by the necessity of the limitation of the losses in excitation magnetic circuits. Especially length of the discharge and pressure of the working gas are limited by the economic standpoints. Function of the discharge is always connected with unwanted electromagnetic radiation, whose restraint is expensive and represents limiting factor for arrangement of the discharge tube (Authors)

Cytologic features of nipple aspirate fluid using an automated non-invasive collection device: a prospective observational study

Directory of Open Access Journals (Sweden)

Rowe Leslie R

2005-08-01

Full Text Available Abstract Background Detection of cytologic atypia in nipple aspirate fluid (NAF has been shown to be a predictor of risk for development of breast carcinoma. Manual collection of NAF for cytologic evaluation varies widely in terms of efficacy, ease of use, and patient acceptance. We investigated a new automated device for the non-invasive collection of NAF in the office setting. Methods A multi-center prospective observational clinical trial involving asymptomatic women designed to assess fluid production, adequacy, safety and patient acceptance of the HALO NAF Collection System (NeoMatrix, Irvine, CA. Cytologic evaluation of all NAF samples was performed using previously described classification categories. Results 500 healthy women were successfully enrolled. Thirty-eight percent (190/500 produced fluid and 187 were available for cytologic analysis. Cytologic classification of fluid producers showed 50% (93/187 Category 0 (insufficient cellular material, 38% (71/187 Category I (benign non-hyperplastic ductal epithelial cells, 10% (18/187 Category II (benign hyperplastic ductal epithelial cells, 3% (5/187 Category III (atypical ductal epithelial cells and none were Category IV (unequivocal malignancy. Overall, 19% of the subjects produced NAF with adequate cellularity and 1% were found to have cytologic atypia. Conclusion The HALO system is a simple, safe, rapid, automated method for standardized collection of NAF which is acceptable to patients. Cytologic assessment of HALO-collected NAF showed the ability to detect benign and pre-neoplastic ductal epithelial cells from asymptomatic volunteers.

Heart bypass surgery - minimally invasive - discharge

Science.gov (United States)

... invasive direct coronary artery bypass - discharge; MIDCAB - discharge; Robot assisted coronary artery bypass - discharge; RACAB - discharge; Keyhole ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

Discharge lamp technologies

Science.gov (United States)

Dakin, James

1994-01-01

This talk is an overview of discharge lamp technology commonly employed in general lighting, with emphasis on issues pertinent to lighting for plant growth. Since the audience is primarily from the plant growth community, and this begins the light source part of the program, we will start with a brief description of the discharge lamps. Challenges of economics and of thermal management make lamp efficiency a prime concern in controlled environment agriculture, so we will emphasize science considerations relating to discharge lamp efficiency. We will then look at the spectra and ratings of some representative lighting products, and conclude with a discussion of technological advances.

Where Lies the Fault in Diagnosing Dhat Syndrome among Females? Understanding through a Case Study.

Science.gov (United States)

Kar, Sujita Kumar; Singh, Amit

2017-01-01

Dhat syndrome is a culture-bound syndrome of South-East Asia, common in young men. However, similar entity has also been described in female patients who attribute their symptoms to nonpathological or physiological vaginal discharge. The current diagnostic system for psychiatric illnesses does not encompass Dhat syndrome in females, and so these group of patients receive alternative diagnoses such as somatoform disorder or depression. As a result of which the focus of unique Dhat syndrome-centered management gets weakened, affecting the clinical outcome. This case study focuses on the diagnostic dilemmas related to Dhat syndrome in females and pitfalls in the current diagnostic system.

Vaginal Discharge: What's Normal, What's Not

Science.gov (United States)

... Staying Safe Videos for Educators Search English Español Vaginal Discharge: What's Normal, What's Not KidsHealth / For Teens / ... Discharge: What's Normal, What's Not Print What Is Vaginal Discharge? Vaginal discharge is fluid that comes from ...

Taser X26 discharges in swine: ventricular rhythm capture is dependent on discharge vector.

Science.gov (United States)

Valentino, Daniel J; Walter, Robert J; Dennis, Andrew J; Margeta, Bosko; Starr, Frederic; Nagy, Kimberly K; Bokhari, Faran; Wiley, Dorion E; Joseph, Kimberly T; Roberts, Roxanne R

2008-12-01

Data from our previous studies indicate that Taser X26 stun devices can acutely alter cardiac function in swine. We hypothesized that most transcardiac discharge vectors would capture ventricular rhythm, but that other vectors, not traversing the heart, would fail to capture the ventricular rhythm. Using an Institutional Animal Care and Use Committee (IACUC) approved protocol, four Yorkshire pigs (25-36 kg) were anesthetized, paralyzed with succinylcholine (2 mg/kg), and then exposed to 10 second discharges from a police-issue Taser X26. For most discharges, the barbed darts were pushed manually into the skin to their full depth (12 mm) and were arranged in either transcardiac (such that a straight line connecting the darts would cross the region of the heart) or non-transcardiac vectors. A total of 11 different vectors and 22 discharge conditions were studied. For each vector, by simply rotating the cartridge 180-degrees in the gun, the primary current-emitting dart was changed and the direction of current flow during the discharge was reversed without physically moving the darts. Echocardiography and electrocardiograms (ECGs) were performed before, during, and after all discharges. p values captured immediately in 52.5% (31 of 59) of the discharges on the ventral surface of the animal. In each of these cases, capture of the ventricular rhythm with rapid ventricular contractions consistent with ventricular tachycardia (VT) or flutter was seen throughout the discharge. A total of 27 discharges were administered with transcardiac vectors and ventricular capture occurred in 23 of these discharges (85.2% capture rate). A total of 32 non-transcardiac discharges were administered ventrally and capture was seen in only eight of these (25% capture rate). Ventricular fibrillation (VF) was seen with two vectors, both of which were transcardiac. In the remaining animals, VT occurred postdischarge until sinus rhythm was regained spontaneously. For most transcardiac vectors

Identification of nursing management diagnoses.

Science.gov (United States)

Morrison, R S

1997-02-01

Theories from nursing and management provide frameworks for enhancing effectiveness of nursing management practice. The concept nursing management diagnosis has been developed by integrating nursing diagnosis and organizational diagnosis as a basis for nurse manager decision-making. Method triangulation was used to identify problems of managing nursing units, to validate those problems for relevancy to practice, to generate nursing management diagnoses, and to validate the diagnoses. Diagnoses were validated according to a definition of nursing management diagnosis provided. Of the 72 nursing management diagnoses identified, 66 were validated at a 70% level of agreement by nurse managers participating in the study.

Boundary Effect of Planar Glow Dielectric Barrier Discharge and Its Influence on the Discharge Structure

International Nuclear Information System (INIS)

Xu Shaowei; Li Lulu; Ouyang Jiting

2015-01-01

The dielectric barrier discharge (DBD) in the glow regime in neon has been investigated by experiment and two-dimensional (2D) fluid modeling. The discharge was carried out in a planar DBD system with segmented-electrodes driven by square-wave voltage. The results show that the glow DBD originates in the center of the electrode and expands outward to the electrode edge during each half cycle of the voltage, forming a radial structure. The discharge decays firstly in the inner area but sustains longer in the edge area, showing a reversed discharge area. The discharge cannot completely cover the entire electrode surface, but remains a border of non- or weak discharge. The fluid modeling shows a similar result in agreement with the experiments. The simulations indicate that the electric field in the edge area is distorted due to the boundary effect so that the electric field and charge distribution are different from that in the inner part. The distorted field reduces the longitudinal component near the edge and causes the local field to be lower than that in the center, and hence makes the discharge behindhand. It also induces a transverse field that makes the discharge extend radially outward to the edge. The boundary effect plays an important role in the glow DBD structure. (paper)

Numerical study on the discharge characteristics and nonlinear behaviors of atmospheric pressure coaxial electrode dielectric barrier discharges

International Nuclear Information System (INIS)

Zhang Ding-Zong; Wang Yan-Hui; Wang De-Zhen

2017-01-01

The discharge characteristics and temporal nonlinear behaviors of the atmospheric pressure coaxial electrode dielectric barrier discharges are studied by using a one-dimensional fluid model. It is shown that the discharge is always asymmetrical between the positive pulses and negative pulses. The gas gap severely affects this asymmetry. But it is hard to acquire a symmetrical discharge by changing the gas gap. This asymmetry is proportional to the asymmetric extent of electrode structure, namely the ratio of the outer electrode radius to the inner electrode radius. When this ratio is close to unity, a symmetrical discharge can be obtained. With the increase of frequency, the discharge can exhibit a series of nonlinear behaviors such as period-doubling bifurcation, secondary bifurcation and chaotic phenomena. In the period-doubling bifurcation sequence the period- n discharge becomes more and more unstable with the increase of n . The period-doubling bifurcation can also be obtained by altering the discharge gas gap. The mechanisms of two bifurcations are further studied. It is found that the residual quasineutral plasma from the previous discharges and corresponding electric field distribution can weaken the subsequent discharge, and leads to the occurrence of bifurcation. (paper)

The effect of an auxiliary discharge on anode sheath potentials in a transverse discharge

International Nuclear Information System (INIS)

Foster, J.E.; Gallimore, A.D.

1997-01-01

A novel scheme that employs the use of an auxiliary discharge has been shown to reduce markedly anode sheath potentials in a transverse discharge. An 8.8 A low-pressure argon discharge in the presence of a transverse magnetic field was used as the plasma source in this study. In such discharges, the transverse flux that is collected by the anode is severely limited due to marked reductions in the transverse diffusion coefficient. Findings of this study indicate that the local electron number density and the transverse flux increase when the auxiliary discharge is operated. Changes in these parameters are reflected in the measured anode sheath voltage. Anode sheath potentials, estimated by using Langmuir probes, were shown to be reduced by over 33% when the auxiliary discharge is operated. These reductions in anode sheath potentials translated into significant reductions in anode power flux as measured using water calorimeter techniques. The reductions in anode power flux also correlate well with changes in the electron transverse flux. Finally, techniques implementing these positive effects in real plasma accelerators are discussed. copyright 1997 American Institute of Physics

Gas-discharge sources with charged particle emission from the plasma of glow discharge with a hollow cathode

CERN Document Server

Semenov, A P

2001-01-01

One studied properties of a magnetron discharge with a cold hollow and uncooled rod cathodes. One demonstrated the dominant effect of thermoelectron emission of a rod cathode heated in a discharge on characteristics of discharge and on emission properties of a gas-discharge plasma and the possibility pf a smooth transition of glow discharge to diffusion mode of arc discharge combustion. Paper describes sources of ions and electrons with improved physical and generalized design and engineering parameters. One shows the promise of the electrode structure of a hollow cathode magnetron discharge to be used as a source, in particular, of the atomic hydrogen and of atom flow of a working rod cathode

Pragmatic approach to chest pain patients discharged with undetectable high-sensitivity troponin T and normal electrocardiogram: the STABS + CT protocol.

Science.gov (United States)

Bishop, Warrick; Girao, Gary

2017-06-01

A strategy that discharges chest pain patients with negative high-sensitivity troponin and non-ischaemic electrocardiography changes may still result in 0.44% of patients experiencing myocardial infarction within 30 days. We observed that a pragmatic approach that systematically discharged 25 patients on cardio-protective medications of aspirin, metoprolol and atorvastatin followed with prompt (<10 days) coronary computed tomography angiography resulted in no major adverse cardiac event and adverse drug reaction 30 days post-presentation. The strategy resulted in three patients (12%) ultimately diagnosed with likely unstable angina, which required planned coronary intervention in two patients and medical management in one patient. No unplanned readmissions for chest pains were noted from initial presentation through to 6-month follow up. © 2017 Royal Australasian College of Physicians.

Discharge cleaning for a tokamak

International Nuclear Information System (INIS)

Ishii, Shigeyuki

1983-01-01

Various methods of discharge cleaning for tokamaks are described. The material of the first walls of tokamaks is usually stainless steel, inconel, titanium and so on. Hydrogen is exclusively used as the discharge gas. Glow discharge cleaning (GDC), Taylor discharge cleaning (TDC), and electron cyclotron resonance discharge cleaning (ECR-DC) are discussed in this paper. The cleaning by GDC is made by moving a movable anode to the center of a tokamak vassel. Taylor found the good cleaning effect of induced discharge by high pressure and low power discharge. This is called TDC. When the frequency of high frequency discharge in a magnetic field is equal to that of the electron cyclotron resonance, the break down potential is lowered if the pressure is sufficiently low. The ECR-CD is made by using this effect. In TDC and ECR-DC, the electron temperature, which has a close relation to the production rate of H 0 , can be controlled by the pressure. In GDC, the operating pressure was improved by the radio frequency glow (RG) method. However, there is still the danger of arcing. In case of GDC and ECR-DC, the position of plasma can be controlled, but not in case of TDC. The TDC is accepted by most of takamak devices in the world. (Kato, T.)

Fatal Gastrointestinal Hemorrhage in a Young Boy with Newly Diagnosed Metastatic Medulloblastoma on High Dose Dexamethasone

Directory of Open Access Journals (Sweden)

Victor Wong

2014-01-01

Full Text Available A 10-year-old boy with newly diagnosed metastatic medulloblastoma was placed on high dose dexamethasone and ranitidine prior to surgery. The child underwent subtotal resection and was discharged 5 days postoperatively with an uneventful hospital course on a tapering dose of dexamethasone and ranitidine. Over the next 2 days the patient complained of mild abdominal distension with flatulence, without pain, vomiting, or dysmotility. On follow-up in clinic 5 days after discharge, he had normal vital signs when he suddenly became pale and had loss of consciousness. Emergent computerized tomography of the head showed no acute hemorrhage and complete blood count revealed hemoglobin of 4.2 gm/dL. In spite of maximum resuscitation with copious blood products the patient died. Autopsy revealed evidence of duodenal perforation with intraluminal hemorrhage. This case demonstrates a rare fatal complication of high dose dexamethasone therapy even with concurrent gastrointestinal prophylactic therapy. We provide a review of the limited literature on steroid use in pediatric neurooncology with regard to gastrointestinal bleeding.

Improving Posthospital Discharge Telephone Reach Rates Through Prehospital Discharge Face-to-Face Meetings.

Science.gov (United States)

Vergara, Franz H; Sheridan, Daniel J; Sullivan, Nancy J; Budhathoki, Chakra

The purpose of this study was to determine whether a face-to-face meeting with patients by a telephonic case manager prehospital discharge would result in increased telephone follow-up (TFU) reach rates posthospital discharge. Acute care adult medicine inpatient units. A quasiexperimental design was utilized. Two adult inpatient medicine units were selected as the intervention and comparison groups. The framework of the study is the transitions theory. A convenience sampling technique was used, whereby 88 eligible patients on the intervention unit received face-to-face meetings prehospital discharge whereas 123 patients on the comparison unit received standard care (no face-to-face meetings). Cross-tabulation and chi-square tests were employed to examine the association of face-to-face meeting intervention and TFU reach rates. Implementing brief (face-to-face meetings by a telephonic case manager prehospital discharge resulted in a TFU reach rate of 87% on the intervention unit, whereas the comparison unit only had a 58% TFU reach rate (p communication with more patients posthospital discharge. A brief prehospital discharge face-to-face meeting with patients assisted them to understand the reasons for a posthospital discharge telephone call, identified the best times to call using accurate telephone numbers, and taught patients how best to prepare for the call. In addition, by meeting patients face-to-face, the telephonic case manager was no longer an unknown person on the telephone asking them questions about their medical condition. These factors combined may have significantly helped to increase TFU reach rates.

Validation of nursing management diagnoses.

Science.gov (United States)

Morrison, R S

1995-01-01

Nursing management diagnosis based on nursing and management science, merges "nursing diagnosis" and "organizational diagnosis". Nursing management diagnosis is a judgment about nursing organizational problems. The diagnoses provide a basis for nurse manager interventions to achieve outcomes for which a nurse manager is accountable. A nursing organizational problem is a discrepancy between what should be happening and what is actually happening that prevents the goals of nursing from being accomplished. The purpose of this study was to validate 73 nursing management diagnoses identified previously in 1992: 71 of the 72 diagnoses were considered valid by at least 70% of 136 participants. Diagnoses considered to have high priority for future research and development were identified by summing the mean scores for perceived frequency of occurrence and level of disruption. Further development of nursing management diagnoses and testing of their effectiveness in enhancing decision making is recommended.

Filamentary and diffuse barrier discharges

International Nuclear Information System (INIS)

Kogelschatz, U.

2001-01-01

Barrier discharges, sometimes also referred to as dielectric-barrier discharges or silent discharges, are characterized by the presence of at least one insulating layer in contact with the discharge between two planar or cylindrical electrodes connected to an ac power supply. The main advantage of this type of electrical discharge is, that non-equilibrium plasma conditions in atmospheric-pressure gases can be established in an economic and reliable way. This has led to a number of important applications including industrial ozone generation, surface modification of polymers, plasma chemical vapor deposition, excitation of CO 2 lasers, excimer lamps and, most recently, large-area flat plasma display panels. Depending on the application, the width of the discharge gap can range from less than 0.1 mm to about 100 mm and the applied frequency from below line frequency to several gigahertz. Typical materials used for the insulating layer (dielectric barrier) are glass, quartz, ceramics but also thin enamel or polymer layers

Waste water discharges into natural waters

International Nuclear Information System (INIS)

Marri, P.; Barsanti, P.; Mione, A.; Posarelli, M.

1996-12-01

The aqueous discharges into natural waters is a very technical solution expecially for surface buoyant discharges. It is not only convenient to limit the concentration levels of the discharges, but also to improve the turbolent processes that diluite the discharge. Mostly these processes depend by some geometric parameters of the discharge and by some physical parameters of the effluent and of the receiving water body. An appropriate choice of some parameters, using also suitable mathematical models, allows to design discharges with a very high dilution; so the decreasing of the pollutant levels is improved and the environmental impact can be reduced versus a not diluted effluent. The simulations of a mathematical model, here described, prove that in some circumstances, expecially in case of discharges of fresh water into saline water bodies with a low velocity of the current, the dilution is poor; the effluent can be trapped in a narrow water surface layer where the pollutant concentrations remain high. also far away from the discharge point

Chaos in gas discharges

International Nuclear Information System (INIS)

Piel, A.

1993-01-01

Many gas discharges exhibit natural oscillations which undergo a transition from regular to chaotic behavior by changing an experimental parameter or by applying external modulation. Besides several isolated investigations, two classes of discharge phenomena have been studied in more detail: ionization waves in medium pressure discharges and potential relaxation oscillations in filament cathode discharges at very low pressure. The latter phenomenon will be discussed by comparing experimental results from different discharge arrangements with particle-in-cell simulations and with a model based on the van-der-Pol equation. The filament cathode discharge has two stable modes of operation: the low current anode-glow-mode and the high current temperature-limited-mode, which form the hysteresis curve in the I(U) characteristics. Close to the hysteresis point of the AGM periodic relaxation oscillations occur. The authors demonstrate that the AGM can be understood by ion production in the anode layer, stopping of ions by charge exchange, and trapping in the virtual cathode around the filament. The relaxation oscillations consist of a slow filling phase and a rapid phase that invokes formation of an unstable double-layer, current-spiking, and ion depletion from the cathodic plasma. The relaxation oscillations can be mode-locked by external modulation. Inside a mode-locked state, a period doubling cascade is observed at high modulation degree

The effect of discharge chamber geometry on the characteristics of low-pressure RF capacitive discharges

Energy Technology Data Exchange (ETDEWEB)

Lisovskiy, V.A. [Ecole Polytech, Lab Phys and Technol Plasmas, F-91128 Palaiseau, (France); Booth, J.P. [Lam Res Corp, Fremont, CA 94538 (United States); Landry, K. [Unaxis, F-38100 Grenoble, (France); Douai, D. [CEA Cadarache, Dept Rech Fus Controlee, EURATOM Assoc, F-13108 St Paul Les Durance, (France); Cassagne, V. [Riber, F-95873 Bezons, (France); Yegorenkov, V.D. [Kharkov Natl Univ, Dept Phys, UA-61077 Kharkov, (Ukraine)

2007-07-01

We report the measured extinction curves and current voltage characteristics (CVCs) in several gases of RF capacitive discharges excited at 13.56 MHz in chambers of three different geometries: 1) parallel plates surrounded by a dielectric cylinder ('symmetric parallel plate'); 2) parallel plates surrounded by a metallic cylinder ('asymmetric confined'); and 3) parallel plates inside a much larger metallic chamber ('asymmetric unconfined'), similar to the gaseous electronics conference reference cell. The extinction curves and the CVCs show differences between the symmetric, asymmetric confined, and asymmetric unconfined chamber configurations. In particular, the discharges exist over a much broader range of RF voltages and gas pressures for the asymmetric unconfined chamber. For symmetric and asymmetric confined discharges, the extinction curves are close to each other in the regions near the minima and at lower pressure, but at higher pressure, the extinction curve of the asymmetric confined discharge runs at a lower voltage than the one for the discharge in a symmetric chamber. In the particular cases of an 'asymmetric unconfined chamber' discharge or 'asymmetric confined' one, the RF discharge experiences the transition from a 'weak-current' mode to a 'strong-current' one at lower RF voltages than is the case for a 'symmetric parallel-plate' discharge. (authors)

Ignition Features of Plasma-Beam Discharge in Gas-Discharge Electron Gun Operation

Directory of Open Access Journals (Sweden)

Valery A. Tutyk

2013-01-01

Full Text Available The current paper presents the results of experimental researches to determine the mode features of plasma-beam discharge (PBD generation by an electron beam injected by a low-vacuum gasdischarge electron gun (LGEG with the cold cathode and hollow anode on the basis of the high-voltage glow discharge and in the range of helium pressure of P ? 10 ÷ 130 Pa. The PBD boundaries and their dependences on parameters of an electron beam are found. The influence of PBD on parameters of low-vacuum gas-discharge electron gun is revealed. It causes an avalanche increase of electron beam current and burning of plasma-beam discharge in the whole space of the vacuum chamber volume and generation of electromagnetic radiation is revealed. Achieved results will be used for implementation of various vacuum technologies in the medium of reaction gas and generated electromagnetic radiation.

Classification of electrical discharges in DC Accelerators

Energy Technology Data Exchange (ETDEWEB)

Banerjee, Srutarshi, E-mail: sruban.stephens@gmail.com [Accelerator and Pulse Power Division, Bhabha Atomic Research Centre, Trombay, Mumbai 400085 (India); Deb, A.K. [Department of Electrical Engineering, Indian Institute of Technology Kharagpur, Kharagpur 721302 (India); Rajan, Rehim N. [Accelerator and Pulse Power Division, Bhabha Atomic Research Centre, Trombay, Mumbai 400085 (India); Kishore, N.K. [Department of Electrical Engineering, Indian Institute of Technology Kharagpur, Kharagpur 721302 (India)

2016-08-11

Controlled electrical discharge aids in conditioning of the system while uncontrolled discharges damage its electronic components. DC Accelerator being a high voltage system is no exception. It is useful to classify electrical discharges according to the severity. Experimental prototypes of the accelerator discharges are developed. Photomultiplier Tubes (PMTs) are used to detect the signals from these discharges. Time and Frequency domain characteristics of the detected discharges are used to extract features. Machine Learning approaches like Fuzzy Logic, Neural Network and Least Squares Support Vector Machine (LSSVM) are employed to classify the discharges. This aids in detecting the severity of the discharges.

Space and Temporal Correlation between the Moving Virtual Anode and the Ionization Growth in a Transient Hollow Cathode Discharge

International Nuclear Information System (INIS)

Zambra, M.; Moreno, J.; Soto, L.; Silva, P.; Sylvester, G.; Alarcon, H.

2001-01-01

A Transient Hollow Cathode Discharge is a low-pressure high-voltage electric discharge between plane parallel electrodes with an axial hole in the cathode. There are essential ionization events which lead to final electrical breakdown, between them the enhanced ionization processes taking place inside the Hollow Cathode Region (HCR) and the virtual anode moving in the interelectrode region, which extends the anode potential to within the HCR. In previous works it was studied the virtual anode speed in the A-K gap and the temporal evolution of the ionization growth in the HCR separately. In this paper, the virtual anode speed has been studied temporal and space correlated with the ionization growth inside the HCR. The presence of the moving virtual anode and the ionization growth has been diagnosed by means of capacitive probes and observing the light emission at 656 nm (H-α) from a point behind the cathode aperture respectively. The discharge was operated in hydrogen gas, at pressure in the range 100-300 mTorr, with 5 mm cathode aperture and at 30 kV maximum voltage. (author)

State Waste Discharge Permit application, 183-N Backwash Discharge Pond

Energy Technology Data Exchange (ETDEWEB)

1994-06-01

As part of the Hanford Federal Facility Agreement and Consent Order negotiations (Ecology et al. 1994), the US Department of Energy, Richland Operations Office, the US Environmental Protection Agency, and the Washington State Department of Ecology agreed that liquid effluent discharges to the ground on the Hanford Site which affect groundwater or have the potential to affect groundwater would be subject to permitting under the structure of Chapter 173--216 (or 173--218 where applicable) of the Washington Administrative Code, the State Waste Discharge Permit Program. As a result of this decision, the Washington State Department of Ecology and the US Department of Energy, Richland Operations Office entered into Consent Order No. DE91NM-177, (Ecology and DOE-RL 1991). The Consent Order No. DE91NM-177 requires a series of permitting activities for liquid effluent discharges. Liquid effluents on the Hanford Site have been classified as Phase I, Phase II, and Miscellaneous Streams. The Consent Order No. DE91NM-177 establishes milestones for State Waste Discharge Permit application submittals for all Phase I and Phase II streams, as well as the following 11 Miscellaneous Streams as identified in Table 4 of the Consent Order No. DE91NM-177.

A Minority of Patients Newly Diagnosed with AIDS Are Started on Antiretroviral Therapy at the Time of Diagnosis in a Large Public Hospital in the Southeastern United States.

Science.gov (United States)

Goswami, Neela D; Colasanti, Jonathan; Khoubian, Jonathan J; Huang, Yijian; Armstrong, Wendy S; Del Rio, Carlos

Prompt antiretroviral therapy (ART) initiation after AIDS diagnosis, in the absence of certain opportunistic infections such as tuberculosis and cryptococcal meningitis, delays disease progression and death, but system barriers to inpatient ART initiation at large hospitals in the era of modern ART have been less studied. We reviewed hospitalizations for persons newly diagnosed with AIDS at Grady Memorial Hospital in Atlanta, Georgia in 2011 and 2012. Individual- and system-level variables were collected. Logistic regression models were used to estimate the odds ratios (ORs) for ART initiation prior to discharge. With Georgia Department of Health surveillance data, we estimated time to first clinic visit, ART initiation, and viral suppression. In the study population (n = 81), ART was initiated prior to discharge in 10 (12%) patients. Shorter hospital stay was significantly associated with lack of ART initiation at the time of HIV diagnosis (8 versus 24 days, OR: 1.14, 95% confidence interval: 1.04-1.25). Reducing barriers to ART initiation for newly diagnosed HIV-positive patients with short hospital stays may improve time to viral suppression.

Recurrent vaginal discharge in children.

Science.gov (United States)

McGreal, Sharon; Wood, Paul

2013-08-01

Childhood vaginal discharge remains a frequent reason for referral from primary to secondary care. The Pediatric and Adolescent Gynecology (PAG) service at Kettering General Hospital was established in 1993 and provides a specialized service that meets the needs of children with gynaecological conditions. To investigate recurrent vaginal discharge noting symptomatology, defining pathogens, common and rarer causes, exploring management regimes, and any changes in practice over time. Retrospective review spanning 15 years identifying prepubertal children attending the outpatient PAG clinic with recurrent vaginal discharge. We reviewed the medical notes individually. 110 patients were identified; 85% were referred from primary care. The age distribution was bimodal at four and eight years. Thirty-five percent of our patients were discharged after the initial consultation. The commonest cause of discharge was vulvovaginitis (82%). Other important causes included suspected sexual abuse (5%), foreign body (3%), labial adhesions (3%), vaginal agenesis (2%). 35% of patients were admitted for vaginoscopy. Vaginal discharge is the most common gynecological symptom in prepubertal girls and can cause repeated clinical episodes. Vulvovaginitis is the most common cause and often responds to simple hygiene measures. Awareness of the less common causes of vaginal discharge is essential. Copyright © 2013 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Radiological discharges

International Nuclear Information System (INIS)

Woodliffe, J.

1990-01-01

Current practice of North Sea States on the discharge and disposal of liquid radioactive wastes to the North Sea are based on the declaration issued at the Second International Conference on the Protection of the North Sea, known as the London Declaration. This has three main points the first of which emphasises the application of the Best Available Technology to protect the North Sea, the second provides a framework on which future controls on radioactive discharges should be based. The third identifies two parts of the framework; to take into account the recommendations of international organizations and that any repositories of radioactive waste which are built should not pollute the North Sea. This chapter looks at how the concensus based on the London Declaration is working, gauges the progress made in the implementation of the policy goal, identifies existing and future areas for concern and proposes ways of strengthening the control of radioactive discharges. The emphasis is on the United Kingdom practice and regulations for liquid wastes, most of which comes from the Sellafield Reprocessing Plant. (author)

Evolución de los principales diagnósticos al alta hospitalaria de la población penitenciaria de la provincia de Valencia, 2000-2009 Evolution of the main diagnoses of hospital discharges amongst the prison population in Valencia, 2000-2009

Directory of Open Access Journals (Sweden)

I. Abad-Pérez

2011-10-01

Full Text Available El objetivo de nuestro trabajo ha sido cuantificar la demanda hospitalaria de origen penitenciario y caracterizar los principales diagnósticos como una medida de prevalencia y las patologías transmisibles y su evolución durante el periodo 2000-09. A partir del registro de altas del Consorcio Hospital General Universitario que atiende por convenio la demanda hospitalaria de los centros penitenciarios de Valencia provincia, se realizo un estudio transversal de las frecuencias de los diagnósticos y su distribución de acuerdo a las características personales. Se recuperaron 2.415 altas que tras la eliminación de inconsistencias aportaron 2.332 episodios de hospitalización. La edad media de los sujetos evolucionó desde 32,8 a 39,7 años. Los diagnósticos principales y secundarios agrupados (tabla 2 más frecuentes fueron: 1º. VIH (34,05%, 2º. Hepatitis C (14,67%, 3º. Dependencia Drogas (10,25%, 4º. Neumonías (8,58%, 5º. TBC (7,46%. A lo largo de la década se ha producido un cambio en el patrón infeccioso de la población penitenciaria que podemos considerar relacionado con: el envejecimiento relativo de la población reclusa, la sustitución de la vía intravenosa por otras vías no invasivas, el cambio relativo del origen nacional de los reclusos y los avances terapéuticos en el tratamiento de la infección por VIH.The aim of our study was to quantify the hospital demand originating from prisons and describe the main diagnoses as a measure of prevalence, as well as communicable diseases and their evolution during the period 2000-09. Using the discharge records of the University General Hospital under the terms of an agreement that meets the demand for hospitals from prisons in the province of Valencia, we carried out a cross-sectional study of the frequency distribution of diagnoses and their distribution according to personal characteristics. More than 2,415 discharges were recovered, which, after the removal of inconsistencies

Discharge against medical advice at a tertiary center in southeastern Nigeria: sociodemographic and clinical dimensions

Directory of Open Access Journals (Sweden)

Boniface Eze

2010-09-01

Full Text Available Boniface Eze1, Kenneth Agu2, Jones Nwosu31Department of Ophthalmology, 2Department of Surgery, 3Department of Otorhinolaryngology, University of Nigeria Teaching Hospital (UNTH, Ituku-Ozalla, Enugu, Enugu State, Nigeria Objective: To assess the sociodemographic and clinical characteristics of patients discharged against medical advice (DAMA at the University of Nigeria Teaching Hospital (UNTH, Enugu, Nigeria.Methods: The UNTH’s admission and discharge records between 1997 and 2006 were examined. Patients DAMA were identified; relevant sociodemographic and clinical data were extracted from their recalled clinical charts. Data were analyzed to generate rates, percentages, and proportions, and a level of P < 0.05 (one degree of freedom was considered statistically significant.Results: Of the 64,856 admissions (45.2% male, 54.8% female, 113 (0.002%; males: 54%, females: 46% were discharged against medical advice. DAMA rate was highest in Surgery (0.4%, and lowest in Obstetrics and Gynecology (0.1% and Pediatrics (0.1%. Infections (32.7%, trauma (29.2%, and cancer (16.8% were the leading diagnoses in patients DAMA. Financial constraints (37.2%, unsatisfactory response to treatment (17.7%, and dissatisfaction with hospital environment (15.0% were the main reasons for patients choosing to discharge themselves. DAMA was associated with a short admission period (P < 0.05, patients having high levels of formal education (P < 0.05, and those who had not been previously hospitalized (P < 0.05; but not with age (P = 0.398, gender (P = 0.489, or employment (P = 0.091.Conclusion: Comparatively, the rate of DAMA at UNTH is low. The causes of DAMA are preventable; for example, strengthening of the national health insurance scheme, enhancement of doctor-patient communication, and improvement of hospital environment would further reduce DAMA rate. Keywords: discharge against medical advice, tertiary center, sociodemographic characteristics, clinical

Validity of preeclampsia-related diagnoses recorded in a national hospital registry and in a postpartum interview of the women

DEFF Research Database (Denmark)

Klemmensen, Ase K; Olsen, Sjurdur F; Osterdal, Marie Louise

2007-01-01

In a population-based sample, the authors examined the validity of preeclampsia and related diagnoses recorded in a mandatory Danish national hospital discharge registry and in a standardized telephone interview of women who gave birth between 1998 and 2002. Using a "gold standard" for preeclamps...... defined in accordance with the guidelines from the American College of Obstetricians and Gynecologists, the authors reviewed hospital charts of 3,039 women and found that 61 of 88 preeclampsia cases (69.3%) and 24 of 55 cases of serious subtypes of preeclampsia (43.6%) were recorded...

Electric discharge during electrosurgery.

Science.gov (United States)

Shashurin, Alexey; Scott, David; Zhuang, Taisen; Canady, Jerome; Beilis, Isak I; Keidar, Michael

2015-04-16

Electric discharge utilized for electrosurgery is studied by means of a recently developed method for the diagnostics of small-size atmospheric plasma objects based on Rayleigh scattering of microwaves on the plasma volume. Evolution of the plasma parameters in the near-electrode sheaths and in the positive column is measured and analyzed. It is found that the electrosurgical system produces a glow discharge of alternating current with strongly contracted positive column with current densities reaching 10(3) A/cm(2). The plasma electron density and electrical conductivities in the channel were found be 10(16) cm(-3) and (1-2) Ohm(-1) cm(-1), respectively. The discharge interrupts every instance when the discharge-driving AC voltage crosses zero and re-ignites again every next half-wave at the moment when the instant voltage exceeds the breakdown threshold.

Fertility Preservation for Children Diagnosed with Cancer

Medline Plus

Full Text Available ... Provider Pocket Guides Provider Guides Fertility Preservation for Women Diagnosed with Cancer Fertility Preservation for Men Diagnosed ... Patient Pocket Guides Patient Guides Fertility Preservation for Women Diagnosed with Cancer Fertility Preservation for Men Diagnosed ...

Hospital discharge diagnostic and procedure codes for upper gastro-intestinal cancer: how accurate are they?

Directory of Open Access Journals (Sweden)

Stavrou Efty

2012-09-01

Full Text Available Abstract Background Population-level health administrative datasets such as hospital discharge data are used increasingly to evaluate health services and outcomes of care. However information about the accuracy of Australian discharge data in identifying cancer, associated procedures and comorbidity is limited. The Admitted Patients Data Collection (APDC is a census of inpatient hospital discharges in the state of New South Wales (NSW. Our aim was to assess the accuracy of the APDC in identifying upper gastro-intestinal (upper GI cancer cases, procedures for associated curative resection and comorbidities at the time of admission compared to data abstracted from medical records (the ‘gold standard’. Methods We reviewed the medical records of 240 patients with an incident upper GI cancer diagnosis derived from a clinical database in one NSW area health service from July 2006 to June 2007. Extracted case record data was matched to APDC discharge data to determine sensitivity, positive predictive value (PPV and agreement between the two data sources (κ-coefficient. Results The accuracy of the APDC diagnostic codes in identifying site-specific incident cancer ranged from 80-95% sensitivity. This was comparable to the accuracy of APDC procedure codes in identifying curative resection for upper GI cancer. PPV ranged from 42-80% for cancer diagnosis and 56-93% for curative surgery. Agreement between the data sources was >0.72 for most cancer diagnoses and curative resections. However, APDC discharge data was less accurate in reporting common comorbidities - for each condition, sensitivity ranged from 9-70%, whilst agreement ranged from κ = 0.64 for diabetes down to κ  Conclusions Identifying incident cases of upper GI cancer and curative resection from hospital administrative data is satisfactory but under-ascertained. Linkage of multiple population-health datasets is advisable to maximise case ascertainment and minimise false

Predicting tile drainage discharge

DEFF Research Database (Denmark)

Iversen, Bo Vangsø; Kjærgaard, Charlotte; Petersen, Rasmus Jes

used in the analysis. For the dynamic modelling, a simple linear reservoir model was used where different outlets in the model represented tile drain as well as groundwater discharge outputs. This modelling was based on daily measured tile drain discharge values. The statistical predictive model...... was based on a polynomial regression predicting yearly tile drain discharge values using site specific parameters such as soil type, catchment topography, etc. as predictors. Values of calibrated model parameters from the dynamic modelling were compared to the same site specific parameter as used...

Estimating sediment discharge: Appendix D

Science.gov (United States)

Gray, John R.; Simões, Francisco J. M.

2008-01-01

Sediment-discharge measurements usually are available on a discrete or periodic basis. However, estimates of sediment transport often are needed for unmeasured periods, such as when daily or annual sediment-discharge values are sought, or when estimates of transport rates for unmeasured or hypothetical flows are required. Selected methods for estimating suspended-sediment, bed-load, bed- material-load, and total-load discharges have been presented in some detail elsewhere in this volume. The purposes of this contribution are to present some limitations and potential pitfalls associated with obtaining and using the requisite data and equations to estimate sediment discharges and to provide guidance for selecting appropriate estimating equations. Records of sediment discharge are derived from data collected with sufficient frequency to obtain reliable estimates for the computational interval and period. Most sediment- discharge records are computed at daily or annual intervals based on periodically collected data, although some partial records represent discrete or seasonal intervals such as those for flood periods. The method used to calculate sediment- discharge records is dependent on the types and frequency of available data. Records for suspended-sediment discharge computed by methods described by Porterfield (1972) are most prevalent, in part because measurement protocols and computational techniques are well established and because suspended sediment composes the bulk of sediment dis- charges for many rivers. Discharge records for bed load, total load, or in some cases bed-material load plus wash load are less common. Reliable estimation of sediment discharges presupposes that the data on which the estimates are based are comparable and reliable. Unfortunately, data describing a selected characteristic of sediment were not necessarily derived—collected, processed, analyzed, or interpreted—in a consistent manner. For example, bed-load data collected with

From Patient Discharge Summaries to an Ontology for Psychiatry.

Science.gov (United States)

Richard, Marion; Aimé, Xavier; Jaulent, Marie-Christine; Krebs, Marie-Odile; Charlet, Jean

2017-01-01

Psychiatry aims at detecting symptoms, providing diagnoses and treating mental disorders. We developed ONTOPSYCHIA, an ontology for psychiatry in three modules: social and environmental factors of mental disorders, mental disorders, and treatments. The use of ONTOPSYCHIA, associated with dedicated tools, will facilitate semantic research in Patient Discharge Summaries (PDS). To develop the first module of the ontology we propose a PDS text analysis in order to explicit psychiatry concepts. We decided to set aside classifications during the construction of the modu le, to focus only on the information contained in PDS (bottom-up approach) and to return to domain classifications solely for the enrichment phase (top-down approach). Then, we focused our work on the development of the LOVMI methodology (Les Ontologies Validées par Méthode Interactive - Ontologies Validated by Interactive Method), which aims to provide a methodological framework to validate the structure and the semantic of an ontology.

Discharge Dialogue

DEFF Research Database (Denmark)

Horsbøl, Anders

2012-01-01

For several years, efforts have been made to strengthen collaboration between health professionals with different specializations and to improve patient transition from hospital to home (care). In the Danish health care system, these efforts have concentrated on cancer and heart diseases, whereas...... coordinator, employed at the hospital, is supposed to anticipate discharge and serve as mediator between the hospital and the municipal home care system. Drawing on methods from discourse and interaction analysis, the paper studies the practice of the discharge coordinator in two encounters between patients...... how the home context provides different resources for identification of patient needs and mutual decision making....

Discharge residence of TLD tagged fish

International Nuclear Information System (INIS)

Romberg, G.P.; Prepejchal, W.

1974-01-01

Although visual observations suggested that fish remained in the discharge for considerable periods, temperature-sensitive tags indicated the majority of fish spend less than 50 hr or 10 percent of the time at discharge temperatures. During 1974 a second fish tagging study was conducted, using temperature-sensitive tags to yield discharge residence times of Lake Michigan salmonids at Point Beach thermal discharge. Preliminary results revealed that many fish tag values were close to Unit I line indicating that calculated maximum discharge residence times for these fish will be nearly 100 percent of the elapsed time

Expansion of a nitrogen discharge by sound

International Nuclear Information System (INIS)

Antinyan, M.A.; Galechyan, G.A.; Tavakalyan, L.B.

1992-01-01

When the background pressure and the discharge current in a gas discharge are raised the plasma column is tightened up into a filament. Then the discharge occupies a region of the discharge tube whose transverse dimensions are substantially less than those of the tube. This contraction phenomenon in discharges restricts the range of parameters used in various devices to the range of relatively low discharge currents and low gas pressures. This contraction interferes with creating high-power gas lasers, since it acts destructively on the lasing process. In order to suppress filamentation of discharges the working gas has been pumped through the system at high speed, with considerable success. The turbulent mixing in the stream plays an important role in creating an uncontracted discharge at high pressures. The purpose of the present work is to study the possibility of undoing the contraction of a nitrogen discharge, which is one of the main components in the operation of a CO 2 laser, by introducing an intense sound wave in the discharge tube. Discharge contraction and the effect of a sound wave propagating along the plasma column have been investigated experimentally in nitrogen by studying the current-voltage characteristics of a contracted discharge. 6 refs., 3 figs

Factors associated with discharge to home versus discharge to institutional care after inpatient stroke rehabilitation.

Science.gov (United States)

Nguyen, Vu Q C; PrvuBettger, Janet; Guerrier, Tami; Hirsch, Mark A; Thomas, J George; Pugh, Terrence M; Rhoads, Charles F

2015-07-01

To examine sociodemographic and clinical characteristics independently associated with discharge home compared with discharge to a skilled nursing facility (SNF) after acute inpatient rehabilitation. Retrospective cohort study. Three tertiary accredited acute care rehabilitation facilities. Adult patients with stroke (N=2085). Not applicable. Not applicable. Of 2085 patients with stroke treated at 3 centers over a 4-year period, 78.2% (n=1631) were discharged home and 21.8% (n=454) discharged to an SNF. Findings from a multivariable logistic regression analysis indicated that patients were less likely to be discharged home if they were older (odds ratio [OR], .98; 95% confidence interval [CI], .96-.99), separated or divorced (compared with married; OR, .61; 95% CI, .48-.79), or with Medicare health insurance (compared with private insurance; OR, .69; 95% CI, .55-.88), or had dysphagia (OR, .83; 95% CI, .71-.98) or cognitive deficits (OR, .79; 95% CI, .77-.81). The odds of being discharged home were higher for those admitted with a higher motor FIM score (OR, 1.10; 95% CI, 1.09-1.11). The following were not associated with discharge disposition: sex, race, prestroke vocational status, availability of secondary health insurance, number of days from stroke onset to rehabilitation facility admission, stroke type, impairment group, cognitive FIM on admission, other stroke deficits (aphasia, ataxia, neglect, or speech disturbance), stroke complications of hyponatremia or urinary tract infection, or comorbid conditions. One in 5 patients with stroke were discharged to an SNF after inpatient rehabilitation. On admission, several sociodemographic and clinical characteristics were identified that could be considered as important factors in early discussions for discharge planning. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Feasibility of wear compensation in micro EDM milling based on discharge counting and discharge population characterization

DEFF Research Database (Denmark)

Bissacco, Giuliano; Hansen, Hans Nørgaard; Tristo, G.

2011-01-01

This paper investigates the applicability of real time wear compensation in micro EDM milling based on discharge counting and discharge population characterization. Experiments were performed involving discharge counting and tool electrode wear measurement in a wide range of process parameters...

Chronic obstructive pulmonary disease - adults - discharge

Science.gov (United States)

... coughing up dark mucus Your fingertips or the skin around your fingernails are blue Alternative Names COPD - adults - discharge; Chronic obstructive airways disease - adults - discharge; Chronic obstructive lung disease - adults - discharge; ...

[Severe vaginal discharge following rectal surgery].

Science.gov (United States)

Burg, L C; Bremers, A J A; Heesakkers, J P F A; Kluivers, K B

2018-01-01

Almost 50% of women who have had rectal surgery subsequently develop vaginal discharge. Due to the recurrent and unexpected nature of this heavy discharge, they often experience it as very distressing. Many of these women undergo extensive diagnostic tests that are mainly focused on identifying fistula formation. If no fistula is found, in most cases no other cause for severe vaginal discharge can be demonstrated. In our practice, we saw three patients (49-, 54- and 74-years-old, respectively) with similar severe vaginal discharge after rectal surgery and in whom no explanation for the vaginal discharge could be found. For this reason we conducted a literature search into this condition. Anatomical changes appear to be responsible for heavy vaginal discharge following rectal surgery. Changes in pelvic floor muscles and compression of the distal part of the vagina may lead to pooling of fluid in the proximal part of the vagina, resulting in severe discharge. Symptomatic treatment may reduce the symptoms.

Stage-discharge relationship in tidal channels

Science.gov (United States)

Kearney, W. S.; Mariotti, G.; Deegan, L.; Fagherazzi, S.

2016-12-01

Long-term records of the flow of water through tidal channels are essential to constrain the budgets of sediments and biogeochemical compounds in salt marshes. Statistical models which relate discharge to water level allow the estimation of such records from more easily obtained records of water stage in the channel. While there is clearly structure in the stage-discharge relationship, nonlinearity and nonstationarity of the relationship complicates the construction of statistical stage-discharge models with adequate performance for discharge estimation and uncertainty quantification. Here we compare four different types of stage-discharge models, each of which is designed to capture different characteristics of the stage-discharge relationship. We estimate and validate each of these models on a two-month long time series of stage and discharge obtained with an Acoustic Doppler Current Profiler in a salt marsh channel. We find that the best performance is obtained by models which account for the nonlinear and time-varying nature of the stage-discharge relationship. Good performance can also be obtained from a simplified version of these models which approximates the fully nonlinear and time-varying models with a piecewise linear formulation.

Basic Studies of Distributed Discharge Limiters

Science.gov (United States)

2014-02-10

electron avalanche ionization discharges induced by a focused 110 GHz millimeter-wave beam in atmospheric air. Discharges take place in a free volume of...plasma. 3.1.7 Vacuum Ultraviolet emission from pulsed discharges at atmospheric pressure. Fig. 6. Energy level diagram for molecular and...the utilized spectral simulation software, SPECTRAPLOT. 3.1.8 Non-intrusive diagnostic method for dissociation degree in pulsed discharges

Diagnosing Flu

Science.gov (United States)

... Types Seasonal Avian Swine Variant Pandemic Other Diagnosing Flu Questions & Answers Language: English (US) Español Recommend on ... How do I know if I have the flu? Your respiratory illness might be the flu if ...

Supersonic CO electric-discharge lasers

Science.gov (United States)

Hason, R. K.; Mitchner, M.; Stanton, A.

1975-01-01

Laser modeling activity is described which involved addition of an option allowing N2 as a second diatomic gas. This option is now operational and a few test cases involving N2/CO mixtures were run. Results from these initial test cases are summarized. In the laboratory, a CW double-discharge test facility was constructed and tested. Features include: water-cooled removable electrodes, O-ring construction to facilitate cleaning and design modifications, increased discharge length, and addition of a post-discharge observation section. Preliminary tests with this facility using N2 yielded higher power loadings than obtained in the first-generation facility. Another test-section modification, recently made and as yet untested, will permit injection of secondary gases into the cathode boundary layer. The objective will be to vary and enhance the UV emission spectrum from the auxiliary discharge, thereby influencing the level of photoionization in the main discharge region.

The ASDEX Upgrade discharge schedule

International Nuclear Information System (INIS)

Neu, G.; Engelhardt, K.; Raupp, G.; Treutterer, W.; Zasche, D.; Zehetbauer, T.

2007-01-01

ASDEX Upgrade's recently commissioned discharge control system (DCS) marks the transition from a traditional programmed system to a highly flexible 'data driven' one. The allocation of application processes (APs) to controllers, the interconnection of APs through uniquely named signals, and AP control parameter values are all defined as data, and can easily be adapted to the requirements of a particular discharge. The data is laid down in a set of XML documents which APs request via HTTP from a configuration server before a discharge. The use of XML allows for easy parsing, and structural validation through (XSD) schemas. The central input to the configuration process is the discharge schedule (DS), which embodies the dynamic behaviour of a planned discharge as reference trajectories grouped in segments, concatenated through transition conditions. Editing, generation and validation tools, and version control through CVS allow for efficient management of DSs

The practice of terminal discharge.

Science.gov (United States)

Radha Krishna, Lalit Kumar; Murugam, Vengadasalam; Quah, Daniel Song Chiek

2017-01-01

'Terminal discharges' are carried out in Singapore for patients who wish to die at home. However, if due diligence is not exercised, parallels may be drawn with euthanasia. We present a theoretical discussion beginning with the definition of terminal discharges and the reasons why they are carried out in Singapore. By considering the intention behind terminal discharges and utilising a multidisciplinary team to deliberate on the clinical, social and ethical intricacies with a patient- and context-specific approach, euthanasia is avoided. It is hoped that this will provide a platform for professionals in palliative medicine to negotiate challenging issues when arranging a terminal discharge, so as to avoid the pitfall of committing euthanasia in a country such as Singapore where euthanasia is illegal. It is hoped that a set of guidelines for terminal discharges may someday be realised to assist professionals in Singapore and around the world.

Inadequate recording of alcohol-drinking, tobacco-smoking and discharge diagnosis in medical in-patients: failure to recognize risks including drug interactions.

Science.gov (United States)

Bairstow, B M; Burke, V; Beilin, L J; Deutscher, C

1993-11-01

The records of 62 men and 43 women, 14-88 years old, admitted to general medical wards in a public teaching hospital during 1991 were examined for discharge medications and for the recording of alcohol-drinking, tobacco-smoking and discharge diagnosis. Drinking and smoking status was unrecorded in 22.9% and 21.9% of patients respectively. Twenty-four patients had 31 potential drug interactions which were related to the number of drugs prescribed and to drinking alcohol; 10.5% of the patients had interactions involving alcohol and 2.9% tobacco. Six patients received relatively or absolutely contraindicated drugs, including one asthmatic given two beta-blockers. The drugs prescribed indicated that some patients had conditions such as gastro-oesophageal disorders, diabetes and obstructive airways disease which had not been recorded. Inadequate recording of diagnoses, alcohol and smoking status creates risks to patients and may cause opportunities for preventive care to be missed. This study provides the basis for the development of undergraduate and postgraduate education programmes to address these issues and so decrease risks to patients which arise from inadequate recording practices. Incomplete diagnoses also adversely affect hospital funding where this depends on case-mix diagnostic groups. Quality assurance programmes and other strategies are being implemented to improve medical recording and prescribing habits.

FDX: a fast discharge homopolar generator

International Nuclear Information System (INIS)

Weldon, W.F.; Rylander, H.G.; Woodson, H.H.

1977-01-01

A study was undertaken to determine the fundamental limitations to the discharge times of homopolar generators. As a result of the study, a Fast Discharge Experiment (FDX) was proposed. FDX is a small (365 kJ), counterrotating disk type homopolar generator designed to explore the limits to homopolar generator discharge times. The FDX rotors are forged aluminum alloy with flame sprayed copper slip rings. Solid copper graphite brushes are used with a 95% packing factor on the slip rings. The high magnetic field required for fast discharge (3.6 T average) is provided by discharging the CEM 5.0 MJ homopolar generator into a four-turn, graphite-reinforced, room temperature copper coil. Since the field is pulsed and FDX rotors cannot be self motored, they are brought up to speed with two 37 kW air turbines. The two aluminum rotors are 30 cm in diameter and of a rimmed, modified constant stress configuration. They are designed for a maximum operating speed of 28,000 r/min at which point they each store 182.5 kJ and develop 104 V. The aluminum discharge coax is approximately 38 cm in diameter and is designed to carry the 1.88 MA anticipated from a half speed (14,000 r/min) short circuit discharge which would stop the rotors in 1.0 ms. It is predicted that the machine will ring on its own internal impedance for approximately five cycles in this mode. The discharge coax is shorted by four very fast making switches. Additional impedance can be introduced into the discharge circuit by extending the switch coaxes to allow full speed 1.4 MA discharges in approximately 3.5 ms

Early hospital discharge and early puerperal complications.

Science.gov (United States)

Ramírez-Villalobos, Dolores; Hernández-Garduño, Adolfo; Salinas, Aarón; González, Dolores; Walker, Dilys; Rojo-Herrera, Guadalupe; Hernández-Prado, Bernardo

2009-01-01

To evaluate the association between time of postpartum discharge and symptoms indicative of complications during the first postpartum week. Women with vaginal delivery at a Mexico City public hospital, without complications before the hospital discharge, were interviewed seven days after delivery. Time of postpartum discharge was classified as early (25 hours). The dependent variable was defined as the occurrence and severity of puerperal complication symptoms. Out of 303 women, 208 (68%) were discharged early. However, women with early discharge and satisfactory prenatal care had lower odds of presenting symptoms in early puerperium than women without early discharge and inadequate prenatal care (OR 0.36; 95% confidence intervals = 0.17-0.76). There was no association between early discharge and symptoms of complications during the first postpartum week; the odds of complications were lower for mothers with early discharge and satisfactory prenatal care.

Treatment of Patients in the Vulnerable Phase (at Discharge or Early After Discharge

Directory of Open Access Journals (Sweden)

Yuri Lopatin

2017-01-01

Full Text Available The clinical course of heart failure includes a period in which the patient is at increased risk of death or rehospitalisation for HF. This period is termed the “vulnerable phase” and occurs during the peri-acute HF phase, due to microenvironmental changes in the cardiovascular system. Typically, the vulnerability phase starts from the onset of an acute HF event leading to admission, continues through a peri-discharge period and lasts up to 6 months after discharge.These poor post-discharge outcomes also represent a significant socioeconomic burden. This articles reviews treatments that are beneficial in this important phase.

Clinical and ultrasonographic features of male breast tumors: A retrospective analysis.

Science.gov (United States)

Yuan, Wei-Hsin; Li, Anna Fen-Yau; Chou, Yi-Hong; Hsu, Hui-Chen; Chen, Ying-Yuan

2018-01-01

The purpose of this study was to determine clinical and ultrasonographic characteristics of male breast tumors. The medical records of male patients with breast lesions were retrieved from an electronic medical record database and a pathology database and retrospectively reviewed. A total of 112 men (125 breast masses) with preoperative breast ultrasonography (US) were included (median age, 59.50 years; age range, 15-96 years). Data extracted included patient age, if the lesions were bilateral, palpable, and tender, and the presence of nipple discharge. Breast lesion features on static US images were reviewed by three experienced radiologists without knowledge of physical examination or pathology results, original breast US image interpretations, or surgical outcomes. The US features were documented according to the BI-RADS (Breast Imaging-Reporting and Data System) US lexicons. A forth radiologist compiled the data for analysis. Of the 125 breast masses, palpable tender lumps and bilateral synchronous masses were more likely to be benign than malignant (both, 100% vs 0%, P nipples were common in malignant lesions (P nipple, irregular shape, the presence of an echogenic halo, predominantly internal vascularity, and rich color flow signal on color Doppler ultrasound were significantly related to malignancy (all, P < 0.05). An echogenic halo and the presence of rich color flow signal were independent predictors of malignancy. Specific clinical and US characteristics of male breast tumors may help guide treatment, and determine if surgery or conservative treatment is preferable.

Some fibrocystic breast change may be caused by sexually transmitted H. pylori during oral nipple contact: supporting literature and case report of resolution after gut H. pylori eradication treatment.

Science.gov (United States)

Kast, R E

2007-01-01

To briefly review previously published evidence for Helicobacter pylori (Hp), colonization of extra-intestinal sites and suggest an hypothesis that breast acini and ducts be added to this list, concluding such breast colonization is not rare and is a sexually transmitted infection. PubMed literature search and review with a case report. (1) Evidence indicates oral Hp is common and can remain in the mouth after successful eradication in stomach and duodenum. (2) Evidence indicates that the breast is also occasionally colonized by Hp. (3) Hp may be injected retrograde up into ducts of the breast during oral nipple stimulation during sexual activity and this Hp may give rise to some cases of fibrocystic breast change. (4) A case of painful fibrocystic change that had been present for two years in a 27 year old female, resolved after gastrointestinal Hp treatment.

Microwave discharges in capillary tubes

International Nuclear Information System (INIS)

Dervisevic, Emil

1984-01-01

This research thesis aims at being a contribution to the study of microwave discharge by a surface wave, and more precisely focusses on the discharge in capillary tubes filled with argon. The author first present theoretical models which describe, on the one hand, the propagation of the surface wave along the plasma column, and, on the other hand, longitudinal and radial profiles of the main discharge characteristics. The second part addresses the study of the influence of parameters (gas pressure and tube radius) on discharge operation and characteristics. Laws of similitude as well as empirical relationships between argon I and argon II emission line intensities, electron density, and electric field in the plasma have been established [fr

Comparison of glow discharge cleaning with Taylor-type discharge cleaning on JFT-2

International Nuclear Information System (INIS)

Yokokura, Kenji; Matsuzaki, Yoshimi; Tani, Takashi

1983-01-01

Method of glow discharge cleaning (GDC) was applied to JFT-2 tokamak and the cleaning effect of GDC was compared with that of taylor-type discharge cleaning (TDC) on the same machin. Results show clearly their individual characteristics to remove light impurities. Their abilities of surface cleaning were compared each other by observing cleanliness of sample surfaces with a AES and by measuring decay times of produced gas pressures during discharge cleanings with a mass-analyser. It was shown that TDC method is better by several times than GDC method from a mass-analyser measurement. Moreover discharge cleaning time necessary to reduce light impurities in the normal plasma to a certain level was compared by monitoring time evolution of radiation loss power with a bolometer, and the time by TDC was only one fifth of that by GDC. The advantage of TDC may come from the excellently high hydrogen flux which interacts with the limiter and the wall. (author)

Self-stabilized discharge filament in plane-parallel barrier discharge configuration: formation, breakdown mechanism, and memory effects

Science.gov (United States)

Tschiersch, R.; Nemschokmichal, S.; Bogaczyk, M.; Meichsner, J.

2017-10-01

Single self-stabilized discharge filaments were investigated in the plane-parallel electrode configuration. The barrier discharge was operated inside a gap of 3 mm shielded by glass plates to both electrodes, using helium-nitrogen mixtures and a square-wave feeding voltage at a frequency of 2 kHz. The combined application of electrical measurements, ICCD camera imaging, optical emission spectroscopy and surface charge diagnostics via the electro-optic Pockels effect allowed the correlation of the discharge development in the volume and on the dielectric surfaces. The formation criteria and existence regimes were found by systematic variation of the nitrogen admixture to helium, the total pressure and the feeding voltage amplitude. Single self-stabilized discharge filaments can be operated over a wide parameter range, foremost, by significant reduction of the voltage amplitude after the operation in the microdischarge regime. Here, the outstanding importance of the surface charge memory effect on the long-term stability was pointed out by the recalculated spatio-temporally resolved gap voltage. The optical emission revealed discharge characteristics that are partially reminiscent of both the glow-like barrier discharge and the microdischarge regime, such as a Townsend pre-phase, a fast cathode-directed ionization front during the breakdown and radially propagating surface discharges during the afterglow.

Ballooning stability of JET discharges

International Nuclear Information System (INIS)

Huysmans, G.T.A.; Goedbloed, J.P.; Galvao, R.M.O.; Lazzaro, E.; Smeulders, P.

1989-01-01

Conditions under which ballooning modes are expected to be excited have recently been obtained in two different types of discharges in JET. In the first type, extremely large pressure gradients have been produced in the plasma core through pellet injections in the current rise phase followed by strong additional heating. In the second type, the total pressure of the discharge is approaching the Troyon limit. The stability of these discharges with respect to the ideal MHD ballooning modes has been studied with the stability code HBT. The equilibria are reconstructed with the IDENTC code using the external magnetic measurements and the experimental pressure profile. The results show that the evaluated high beta discharge is unstable in the central region of the plasma. This instability is related to the low shear and not to a large pressure gradient, as expected at the Troyon limit. In the pellet discharges the regions with the large pressure gradients are unstable to ballooning modes at the time of the beta decay, which ends the period of enhanced performance. The maximum pressure gradient in these discharges is limited by the boundary of the first region of stability. The observed phenomena at the beta decay are similar to those observed at the beta limit in DIII-D and TFTR. (author)

On regulation of radioactive airborne discharge

International Nuclear Information System (INIS)

Stroganov, A.A.; Kuryndin, A.V.; Shapovalov, A.S.; Orlov, M.Yu.

2013-01-01

Authors present the Russian regulatory basis of radioactive airborne discharges which was updated after enactment of the Methodology for airborne discharge limits development. Criteria for establishing of airborne discharge limits, scope and other features of methodology are also considered in the article [ru

Numerical simulation of transitions between back discharge regimes

International Nuclear Information System (INIS)

Jansky, Jaroslav; Lemont, Florent; Bessieres, Delphine; Paillol, Jean

2014-01-01

This paper presents numerical simulations of transitions between back discharge regimes. Back discharge refers to any discharge initiated at or near a dielectric layer covering a passive electrode. In this work, a pinhole in a dielectric layer on a plane anode serves as a model for back discharge activity. We have studied transitions between back discharge regimes by varying the surface charge density on the dielectric layer and the electric field in front of the pinhole. From the variation of these two independent parameters, the back discharge regimes have been depicted as a mode diagram inspired by the experimental study of Masuda and Mizuno. The resulting diagram includes the different discharge regimes that are commonly observed in experiments. The propagation of a positive ionizing wave inside the pinhole toward its edge, and the resulting formation of a plasma zone at its exit constitute the onset stage of back discharge. From this stage, the transitions to volume discharge or surface discharge can occur. The volume discharge regime consists of the propagation of a discharge in space toward the cathode which can be superimposed with the propagation of a discharge above the dielectric layer surface. The diagram reveals the conditions for transitions between back discharge regimes. (authors)

Capacitor discharges, magnetohydrodynamics, X-rays, ultrasonics

CERN Document Server

Früngel, Frank B A

1965-01-01

High Speed Pulse Technology, Volume 1: Capacitor Discharges - Magnetohydrodynamics - X-Rays - Ultrasonics deals with the theoretical and engineering problems that arise in the capacitor discharge technique.This book discusses the characteristics of dielectric material, symmetrical switch tubes with mercury filling, and compensation conductor forms. The transformed discharge for highest current peaks, ignition transformer for internal combustion engines, and X-ray irradiation of subjects in mechanical motion are also elaborated. This text likewise covers the transformed capacitor discharge in w

Correlation of antemortem diagnoses and postmortem diagnoses in ...

African Journals Online (AJOL)

Background: The postmortem examination is a veritable means of ascertaining the correct diagnoses. Over the years, there has been a severe drop in the number of requests for postmortem examination despite its numerous advantages and benefits. The study is aimed at showing the pivotal role of the autopsy in medical ...

Record linkage between hospital discharges and mortality registries for motor neuron disease case ascertainment for the Spanish National Rare Diseases Registry.

Science.gov (United States)

Ruiz, Elena; Ramalle-Gómara, Enrique; Quiñones, Carmen

2014-06-01

Our objective was to analyse the coverage of hospital discharge data and the mortality registry (MR) of La Rioja to ascertain motor neuron disease (MND) cases to be included in the Spanish National Rare Diseases Registry. MND cases that occurred in La Rioja during the period 1996-2011 were selected from hospital discharge data and the MR by means of the International Classification of Diseases. Review of the medical histories was carried out to confirm the causes of death reported. Characteristics of the population with MND were analysed. A total of 133 patients with MND were detected in La Rioja during the period 1996-2011; 30.1% were only recorded in the hospital discharges data, 12.0% only in the MR, and 57.9% were recorded by both databases. Medical records revealed a miscoding of patients who had been diagnosed with progressive supranuclear palsy but were recorded in the MR with an MND code. In conclusion, the hospital discharges data and the MR appear to be complementary and are valuable databases for the Spanish National Rare Diseases Registry when MNDs are properly codified. Nevertheless, it would be advisable to corroborate the validity of the MR as data source since the miscoding of progressive supranuclear palsy has been corrected.

Factors Associated with Exclusive Breastfeeding of Preterm Infants. Results from a Prospective National Cohort Study

DEFF Research Database (Denmark)

Maastrup, Ragnhild; Hansen, Bo Moelholm; Kronborg, Hanne

2014-01-01

BACKGROUND AND AIM: Evidence-based knowledge of how to guide the mothers of preterm infants in breastfeeding establishment is contradictive or sparse. The aim was to investigate the associations between pre-specified clinical practices for facilitating breastfeeding, and exclusive breastfeeding...... were analysed by multiple logistic regression analyses. RESULTS: At discharge 68% of the preterm infants were exclusively breastfed and 17% partially. Test-weighing the infant, and minimizing the use of a pacifier, showed a protective effect to exclusive breastfeeding at discharge (OR 0.6 (95% CI 0.......4-0.8) and 0.4 (95% CI 0.3-0.6), respectively). The use of nipple shields (OR 2.3 (95% CI 1.6-3.2)) and the initiation of breast milk expression later than 48 hours postpartum (OR 4.9 (95% CI 1.9-12.6)) were associated with failure of exclusive breastfeeding at discharge. The clinical practices associated...

32 CFR 724.117 - Discharge review.

Science.gov (United States)

2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false Discharge review. 724.117 Section 724.117 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL NAVAL DISCHARGE REVIEW BOARD Definitions § 724.117 Discharge review. A nonadversary administrative reappraisal at the level of...

Discharges for lighting

International Nuclear Information System (INIS)

Stoffels, W W; Nimalasuriya, T; Flikweert, A J; Mulders, H C J

2007-01-01

The most common man-made discharge is a lamp. Even though lamps are often considered a mature technology, the discharge physics is often poorly understood. Two recent initiatives discussed here show that plasma research can help to make significant improvements. First we discuss color separation in metal halide lamps, which is a problem that prevents these highly efficient lamps from being used in more applications. Secondly a novel lamp concept is presented that may replace the current mercury based fluorescent lamps

Ion source of discharge type

Energy Technology Data Exchange (ETDEWEB)

Enchevich, I.B. [TRIUMF, Cyclotron Div., Vancouver, British Columbia (Canada); Korenev, S.A. [JINR, Hihg Energy Physics Lab., Dubna, Moscow (Russian Federation)

1992-07-01

A new scheme of ion source based on a dielectric surface sliding discharge is described. The conditions to form this type of discharge are analyzed and experimental results are shown. The main parameters of this ion source are: accelerating voltage U = 1/20kV; continuous extracted ion beam; current density j = 0.01/0.5 A/cm{sup 2}; ions of Cl, F, C, H; residual gas pressure P = 10{sup -6} Torr. A magnetic system is used to separate the different types of ions. The dielectric material in the discharge circuit (anode plasma emitter) defines the type of ions. The emission characteristics of plasma emitter and the discharge parameters are presented. The ion current yield satisfies the Child-Langmuir law. (author)

Ion source of discharge type

International Nuclear Information System (INIS)

Enchevich, I.B.; Korenev, S.A.

1992-07-01

A new scheme of ion source based on a dielectric surface sliding discharge is described. The conditions to form this type of discharge are analyzed and experimental results are shown. The main parameters of this ion source are: accelerating voltage U = 1/20kV; continuous extracted ion beam; current density j = 0.01/0.5 A/cm 2 ; ions of Cl, F, C, H; residual gas pressure P = 10 -6 Torr. A magnetic system is used to separate the different types of ions. The dielectric material in the discharge circuit (anode plasma emitter) defines the type of ions. The emission characteristics of plasma emitter and the discharge parameters are presented. The ion current yield satisfies the Child-Langmuir law. (author)

Dicarboxylic acids from electric discharge

Science.gov (United States)

Zeitman, B.; Chang, S.; Lawless, J. G.

1974-01-01

An investigation was conducted concerning the possible synthesis of a suite of dicarboxylic acids similar to that found in the Murchison meteorite. The investigation included the conduction of a chemical evolution experiment which simulated electric discharge through the primitive atmosphere of the earth. The suite of dicarboxylic acids obtained in the electric discharge experiment is similar to that of the Murchison meteorite, except for the fact that 2-chlorosuccinic acid is present in the spark discharge.

Subareolar breast abscess in male patients: a report of two patients with a literature review.

Science.gov (United States)

Kazama, Takashi; Tabei, Isao; Sekine, Chikako; Funamizu, Naotake; Onda, Shinji; Okamoto, Tomoyoshi; Takeyama, Hiroshi; Morikawa, Toshiaki

2017-12-19

Subareolar breast abscess (SBA) is a rare infectious disease of the breast in male patients. Herein, we report two male patients with SBA. Patient 1 was initially diagnosed with a malignant tumor based on imaging findings; ultrasonography revealed a hypoechoic mass with blood flow. Patient 2 was diagnosed with inflammatory changes to his nipple; ultrasonography findings supported the diagnosis with an irregular hypoechoic mass with blood flow. Both patients received a cytological or histological biopsy preoperatively, which showed an abscess without malignant cells. These cases serve as an important reminder to consider complete resection of the tumor including the responsible mammary duct (tumor and duct resection (TDR)) for curative therapy of SBA.

Classification of Partial Discharge Measured under Different Levels of Noise Contamination.

Directory of Open Access Journals (Sweden)

Wong Jee Keen Raymond

Full Text Available Cable joint insulation breakdown may cause a huge loss to power companies. Therefore, it is vital to diagnose the insulation quality to detect early signs of insulation failure. It is well known that there is a correlation between Partial discharge (PD and the insulation quality. Although many works have been done on PD pattern recognition, it is usually performed in a noise free environment. Also, works on PD pattern recognition in actual cable joint are less likely to be found in literature. Therefore, in this work, classifications of actual cable joint defect types from partial discharge data contaminated by noise were performed. Five cross-linked polyethylene (XLPE cable joints with artificially created defects were prepared based on the defects commonly encountered on site. Three different types of input feature were extracted from the PD pattern under artificially created noisy environment. These include statistical features, fractal features and principal component analysis (PCA features. These input features were used to train the classifiers to classify each PD defect types. Classifications were performed using three different artificial intelligence classifiers, which include Artificial Neural Networks (ANN, Adaptive Neuro-Fuzzy Inference System (ANFIS and Support Vector Machine (SVM. It was found that the classification accuracy decreases with higher noise level but PCA features used in SVM and ANN showed the strongest tolerance against noise contamination.

Radio frequency discharge with dust particles

NARCIS (Netherlands)

Chutov, Y. I.; W. J. Goedheer,; Kravchenko, O. Y.; Zuz, V. M.; Yan, M.; Martins, R.; Ferreira, I.; Fortunato, E.; Kroesen, G.

2000-01-01

A 1D PIC/MCC method has been developed for computer simulations of low-pressure RF discharges with dust particles using the method for dust-free discharges. A RF discharge in argon with dust particles distributed uniformly in the interelectrode gap is simulated at parameters providing a possibility

Glow discharge in singlet oxygen

International Nuclear Information System (INIS)

Vagin, N.P.; Ionin, A.A.; Klimachev, Yu.M.; Sinitsyn, D.V.; Yuryshev, N.N.; Kochetov, I.V.; Napartovich, A.P.

2003-01-01

Currently, there is no experimental data on the plasma balance in gas mixtures with a high content of singlet delta oxygen O 2 ( 1 Δ g ). These data can be obtained by studying the parameters of an electric discharge in singlet oxygen produced by a chemical generator. The O 2 ( 1 Δ g ) molecules significantly change the kinetics of electrons and negative ions in plasma. Hence, the discharge conditions at low and high O 2 ( 1 Δ g ) concentrations are very different. Here, the parameters of the positive column of a glow discharge in a gas flow from a chemical singlet-oxygen generator are studied. It is experimentally shown that, at an O 2 ( 1 Δ g ) concentration of 50% and at pressures of 1.5 and 2 torr, the electric field required to sustain the discharge is considerably lower than in the case when all of the oxygen molecules are in the ground state. A theoretical model of the glow discharge is proposed whose predictions are in good agreement with the experimental data

Recent trends on electrical discharge technologies

International Nuclear Information System (INIS)

Nakano, Toshiki

2007-01-01

Recent trends on the research activities of electrical-discharge-related technologies are summarized as well as the policies of the technical committee on electrical discharges (TC-ED) of IEEJ. First, the present situation of electrical discharge research is mentioned by referring to the major subjects which TC-ED is responsible to cover. As an example of the increasingly widespread use of electrical discharge technologies, vacuum electrical insulation in a neutral beam injection system of the International Thermonuclear Experimental Reactor (ITER) device is presented. (author)

Investigations into electrical discharges in gases

CERN Document Server

Klyarfel'D, B N

2013-01-01

Investigations into Electrical Discharges in Gases is a compilation of scientific articles that covers the advances in the investigation of the fundamental processes occurring in electrical discharges in gases and vapors. The book details the different aspects of the whole life cycle of an arc, which include the initiation of a discharge, its transition into an arc, the lateral spread of the arc column, and the recovery of electric strength after extinction of an arc. The text also discusses the methods for the dynamic measurement of vapor density in the vicinity of electrical discharges, alon

The Development of Prostate Palpation Skills through Simulation Training May Impact Early Detection of Prostate Abnormalities and Early Management

Science.gov (United States)

2011-05-01

has a high incidence rate (one in six for men in the U.S.), with an estimated 192,280 new cases in 2009. When diagnosed in an early and less...converges in a vector toward the nipple . Study results indicate that use of the vertical strip leads to an increased detection of abnormalities [10], [16...Palpation, Clinical prostate examination. Prostate cancer is one of the most common causes of death in American men , with an estimated 189,280 new cases

CMS ECAL Endcap (EE) Electronics Cables Coming from HE

CERN Multimedia

Collaboration, CMS

2008-01-01

Comment: HV REDEL connectors. The nipple points towards the I.P. Pin 1 is on the top right hand corner, near the nipple, looking into the connector, with nipple on top. Pin 51 is on the bottom left hand corner looking into the connector, with nipple on top. Male fixing pin is near pin 1. Female fixing pin is near pin 51.

Development of Partial Discharging Simulation Test Equipment

Science.gov (United States)

Kai, Xue; Genghua, Liu; Yan, Jia; Ziqi, Chai; Jian, Lu

2017-12-01

In the case of partial discharge training for recruits who lack of on-site work experience, the risk of physical shock and damage of the test equipment may be due to the limited skill level and improper operation by new recruits. Partial discharge simulation tester is the use of simulation technology to achieve partial discharge test process simulation, relatively true reproduction of the local discharge process and results, so that the operator in the classroom will be able to get familiar with and understand the use of the test process and equipment.The teacher sets up the instrument to display different partial discharge waveforms so that the trainees can analyze the test results of different partial discharge types.

Review of medical discharge summaries and medical documentation in a metropolitan hospital: impact on diagnostic-related groups and Weighted Inlier Equivalent Separation.

Science.gov (United States)

Chin, N; Perera, P; Roberts, A; Nagappan, R

2013-07-01

Accurate and comprehensive clinical documentation is crucial for effective ongoing patient care, follow up and to optimise case mix-based funding. Each Diagnostic Related Group (DRG) is assigned a 'weight', leading to Weighted Inlier Equivalent Separation (WIES), a system many public and private hospitals in Australia subscribe to. To identify the top DRG in a general medical inpatient service, the completeness of medical discharge documentation, commonly missed comorbidities and system-related issues and subsequent impact on DRG and WIES allocation. One hundred and fifty completed discharge summaries were randomly selected from the top 10 medical DRG in our health service. From a detailed review of the clinical documentation, principal diagnoses, associated comorbidities and complications, where appropriate, the DRG and WIES were modified. Seventy-two (48%) of the 150 reviewed admissions resulted in a revision of DRG and WIES equivalent to an increase of AUD 142,000. Respiratory-based DRG generated the largest revision of DRG and WIES, while 'Cellulitis' DRG had the largest relative change. Twenty-seven per cent of summaries reviewed necessitated a change in coding with no subsequent change in DRG allocation or WIES. Acute renal failure, anaemia and electrolyte disturbances were the most commonly underrepresented entities in clinical discharge documentation. Seven patients had their WIES downgraded. Comprehensive documentation of principal diagnosis/diagnoses, comorbidities and their complications is imperative to optimal DRG and WIES allocation. Regular meetings between clinical and coding staff improve the quality and timeliness of medical documentation, ensure adequate communication with general practitioners and lead to appropriate funding. © 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.

Influence of increased velocity on the statistical discharge characteristics of He and air barrier discharges

International Nuclear Information System (INIS)

Reichen, P; Sonnenfeld, A; Rohr, Rudolf Ph von

2010-01-01

A detailed study of a description method for microdischarges based on the statistical analysis of single discharge bursts is presented and applied for small electrode arrays. As such, the electrical properties derived from the collective behaviour of the current bursts for microdischarges in helium and synthetic air for different pressure levels and variable voltage gradients are elaborately discussed. Motivated by the possible prolongation of the displacement distance of active species and thus the improved development of an atmospheric afterglow in a low frequency discharge, the interaction between high-speed gas flows and microdischarges in small ducts has been approached presenting first results. Intentionally, gases with different discharge mechanisms known as streamer (synthetic air) and Townsend (helium) have been considered. Similar velocity dependences of the discharge behaviour could be observed in both gases. For helium, subsonic channel velocity is sufficient to distinctively alter the discharge characteristics whereas transonic flow is needed to alter those of synthetic air. Subsequently, a simple model is proposed to explain these findings for elevated velocities in a dielectric setup.

Numerical investigation of dielectric barrier discharges

Science.gov (United States)

Li, Jing

1997-12-01

A dielectric barrier discharge (DBD) is a transient discharge occurring between two electrodes in coaxial or planar arrangements separated by one or two layers of dielectric material. The charge accumulated on the dielectric barrier generates a field in a direction opposite to the applied field. The discharge is quenched before an arc is formed. It is one of the few non-thermal discharges that operates at atmospheric pressure and has the potential for use in pollution control. In this work, a numerical model of the dielectric barrier discharge is developed, along with the numerical approach. Adaptive grids based on the charge distribution is used. A self-consistent method is used to solve for the electric field and charge densities. The Successive Overrelaxation (SOR) method in a non-uniform grid spacing is used to solve the Poisson's equation in the cylindrically-symmetric coordinate. The Flux Corrected Transport (FCT) method is modified to solve the continuity equations in the non-uniform grid spacing. Parametric studies of dielectric barrier discharges are conducted. General characteristics of dielectric barrier discharges in both anode-directed and cathode-directed streamer are studied. Effects of the dielectric capacitance, the applied field, the resistance in external circuit and the type of gases (O2, air, N2) are investigated. We conclude that the SOR method in an adaptive grid spacing for the solution of the Poisson's equation in the cylindrically-symmetric coordinate is convergent and effective. The dielectric capacitance has little effect on the g-factor of radical production, but it determines the strength of the dielectric barrier discharge. The applied field and the type of gases used have a significant role on the current peak, current pulse duration and radical generation efficiency, discharge strength, and microstreamer radius, whereas the external series resistance has very little effect on the streamer properties. The results are helpful in

Hazardous gas treatment by atmospheric discharges

International Nuclear Information System (INIS)

Mizeraczyk, J.

2005-01-01

The emissions of NO x ; SO x , CO 2 and volatile organic compounds (VOCs) including fluorocarbons to the atmosphere influence heavily our environment, NO x and SO x emitted to the atmosphere are the major cause of acid rains, while CO 2 and VOCs emissions cause the greenhouse effect which leads to abnormal global heating of the atmosphere and creating in a temperature inversion layer that traps gaseous pollutants. Therefore, there is an increasing interest in controlling these emissions. A new technique, which uses the plasma processes induced by energetic electrons, emerges as one of the most effective methods of reducing concentrations of the emitted gaseous pollutants. Various plasma techniques have been tested for gaseous pollution control. The electron bean irradiation was found to be physically and economically efficient for NO x and SO x reduction in the exhaust gases from electrical and heat power plants. The capability of the non-thermal plasmas, produced in atmospheric pressure electrical discharges, for decomposition of the gaseous pollutants has been widely tested. These atmospheric pressure electrical discharges are dielectric barrier discharges, pulsed and de corona discharges (in the reactors with the point-to-plate, wire-cylinder and wire-plate geometries, in the reactors with flow stabilized corona torch and corona radical shower), gliding discharges, inductively coupled high-frequency discharges, ac surface discharges, ac discharges in the packed bed reactors, and microwave torch discharges. In this paper, after reviewing the methods and devices used for producing the non-thermal plasmas for gaseous pollutant control, some results of the laboratory experiments on the plasmas abatement of NO x ; SO x and various VOCs will be presented, followed by a discussion on the energy efficiency and by-products. Also some results obtained in the pilot-plants will be given. finally other possible applications of the presented plasma devices for controlling

Multipactor discharge apparatus

International Nuclear Information System (INIS)

1976-01-01

The invention deals with a multipactor discharge apparatus which can be used for tuning microwave organs such as magnetron oscillators and other cavity resonators. This apparatus is suitable for delivering an improved tuning effect in a resonation organ wherefrom the working frequency must be set. This apparatus is equipped with two multipactor discharge electrodes set in a configuration such to that a net current flows from one electrode to another. These electrodes are parallel and flat. The apparatus can be used in magnetron devices as well for continuous waves as for impulses

Effects of discharge parameters on the micro-hollow cathode sustained glow discharge

Science.gov (United States)

Shoujie, HE; Peng, WANG; Jing, HA; Baoming, ZHANG; Zhao, ZHANG; Qing, LI

2018-05-01

The effects of parameters such as pressure, first anode radius, and the cavity diameter on the micro-hollow cathode sustained glow discharge are investigated by using a two-dimensional self-consistent fluid model in pure argon. The results indicate that the three parameters influence the discharge in the regions inside and outside of the cavity. Under a fixed voltage on each electrode, a larger volume of high density plasma can be produced in the region between the first and the second anodes by selecting the appropriate pressure, the higher first anode, and the appropriate cavity diameter. As the pressure increases, the electron density inside the hollow cathode, the high density plasma volume between the first anode and second anodes, and the radial electric field in the cathode cavity initially increase and subsequently decrease. As the cavity diameter increases, the high-density plasma volume between the first and second anodes initially increases and subsequently decreases; whereas the electron density inside the hollow cathode decreases. As the first anode radius increases, the electron density increases both inside and outside of the cavity. Moreover, the increase of the electron density is more obvious in the microcathode sustained region than in the micro cavity region. The results reveal that the discharge inside the cavity interacts with that outside the cavity. The strong hollow cathode effect and the high-density plasma inside the cavity favor the formation of a sustained discharge between the first anode and the second anodes. Results also show that the radial boundary conditions exert a considerably weaker influence on the discharge except for a little change in the region close to the radial boundary.

(1, 3)-β-D-glucan assay for diagnosing invasive fungal infections in critically ill patients with hematological malignancies.

Science.gov (United States)

Azoulay, Elie; Guigue, Nicolas; Darmon, Michael; Mokart, Djamel; Lemiale, Virginie; Kouatchet, Achille; Mayaux, Julien; Vincent, François; Nyunga, Martine; Bruneel, Fabrice; Rabbat, Antoine; Bretagne, Stéphane; Lebert, Christine; Meert, Anne-Pascale; Benoit, Dominique; Pene, Frédéric

2016-04-19

Invasive fungal infections (IFIs) are life-threatening complications of hematological malignancies that must be diagnosed early to allow effective treatment. Few data are available on the performance of serum (1-3)-β-D-glucan (BG) assays for diagnosing IFI in patients with hematological malignancies admitted to the intensive care unit (ICU). In this study, 737 consecutive patients with hematological malignancies admitted to 17 ICUs routinely underwent a BG assay at ICU admission. IFIs were diagnosed using standard criteria applied by three independent specialists. Among the 737 patients, 439 (60%) required mechanical ventilation and 273 (37%) died before hospital discharge. Factors known to alter BG concentrations were identified in most patients. IFIs were documented in 78 (10.6%) patients (invasive pulmonary aspergillosis, n = 54; Pneumocystis jirovecii pneumonia, n = 13; candidemia, n = 13; and fusarium infections, n = 3). BG concentrations (pg/mL) were higher in patients with than without IFI (144 (77-510) vs. 50 (30-125), 80 pg/mL were IFI, admission SOFA score, autologous bone-marrow or hematopoietic stem-cell transplantation, and microbiologically documented bacterial infection. In conclusion, in unselected critically ill hematology patients with factors known to affect serum BG, this biomarker showed only moderate diagnostic performance and rarely detected IFI. However, the negative predictive value was high. Studies are needed to assess whether a negative BG test indicates that antifungal de-escalation is safe.

Determination of optimal diagnostic criteria for purulent vaginal discharge and cytological endometritis in dairy cows.

Science.gov (United States)

Denis-Robichaud, J; Dubuc, J

2015-10-01

cows; odds ratios were 0.33 and 0.69 for PVD and ENDO, respectively, when LE was used. Kappa value (agreement) of the pairwise comparison for the PMNL percentage and LE was 0.43. Vaginal discharge, endometrial cytology, and LE can be used to diagnose PVD and ENDO, and to predict pregnancy status at first service. The use of LE could be a good alternative to endometrial cytology for on-farm testing. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

48 CFR 1352.271-81 - Discharge of liens.

Science.gov (United States)

2010-10-01

...) The contractor shall immediately discharge or cause to be discharged any lien or right in rem of any... done or materials furnished under the contract. If any such lien or right in rem is not immediately discharged, the Government may discharge or cause to be discharged such lien or right at the expense of the...

Effects of electric discharges on polymers

International Nuclear Information System (INIS)

Bagirov, M.A.

2002-01-01

Full text: One of the reasons for the worsening of electrical properties of polymeric isolation in use in the effect of the electric discharges which developing in the gas inclusions and in the interlayer inside the isolation itself. The electrical discharges in the gas gap lead to the electrical growing old and the worsening of its electro physical qualities. We have learned the changes of electrical properties (dielectrical permeability and dielectrical loss, and electrical conductivity, electrical strength) of polymer films under the influence of electrical discharges. This paper shows the ways of increase of stability of polymers to the electrical discharges

TBI Patient, Injury, Therapy, and Ancillary Treatments Associated with Outcomes at Discharge and 9 Months Post-discharge

Science.gov (United States)

Horn, Susan D.; Corrigan, John D.; Beaulieu, Cynthia L.; Bogner, Jennifer; Barrett, Ryan S.; Giuffrida, Clare G.; Ryser, David K.; Cooper, Kelli; Carroll, Deborah M.; Deutscher, Daniel

2015-01-01

Objective To examine associations of patient and injury characteristics, inpatient rehabilitation therapy activities, and neurotropic medications with outcomes at discharge and 9 months post-discharge for patients with traumatic brain injury (TBI) Design Prospective, longitudinal observational study Setting 10 inpatient rehabilitation centers (9 US, 1 Canada) Participants Consecutive patients (n=2130) enrolled between 2008 and 2011, admitted for inpatient rehabilitation after an index TBI injury Interventions Not applicable Main Outcome Measures Rehabilitation length of stay, discharge to home, and Functional Independence Measure (FIM) at discharge and 9 months post-discharge Results The admission FIM Cognitive score was used to create 5 relatively homogeneous subgroups for subsequent analysis of treatment outcomes. Within each subgroup, significant associations were found between outcomes and patient and injury characteristics, time spent in therapy activities, and medications used. Patient and injury characteristics explained on average 35.7% of the variation in discharge outcomes and 22.3% in 9-month outcomes. Adding time spent and level of effort in therapy activities, as well as percent of stay using specific medications, explained approximately 20.0% more variation for discharge outcomes and 12.9% for 9-month outcomes. After patient, injury, and treatment characteristics were used to predict outcomes, center differences added only approximately 1.9% additional variance explained. Conclusions At discharge, greater effort during therapy sessions, time spent in more complex therapy activities, and use of specific medications were associated with better outcomes for patients in all admission FIM Cognitive subgroups. At 9 months post-discharge, similar but less pervasive associations were observed for therapy activities, but not classes of medications. Further research is warranted to examine more specific combinations of therapy activities and medications that

Surgical discharge summaries: improving the record.

Science.gov (United States)

Adams, D C; Bristol, J B; Poskitt, K R

1993-03-01

The problem area of communication between hospital and general practitioners may potentially be improved by the advent of new information technology. The introduction of a regional computer database for general surgery allows the rapid automated production of discharge summaries and has provided us with the opportunity for auditing the quality of old and new styles of discharge communication. A total of 118 general practitioners were sent a postal questionnaire to establish their views on the relative importance of various aspects of patient information and management after discharge. A high response rate (97%) indicated the interest of general practitioners in this topic. The majority (73%) believed that summaries should be delayed no more than 3 days. The structured and shortened new format was preferred to the older style of discharge summary. The older format rarely arrived within an appropriate time and its content was often felt to be either inadequate (35%) or excessive (7%) compared with the new format (8% and 1%, respectively). The diagnosis, information given to the patient, clinic date, list of medications and investigations were considered the more important details in the summary. Improvements in the discharge information were suggested and have subsequently been incorporated in our discharge policy. The use of new information technology, intended to facilitate clinical audit, has improved our ability to generate prompt, well-structured discharge summaries which are accepted by the general practitioners.

Effects of intrauterine infusion of Escherichia coli lipopolysaccharide on uterine health, resolution of purulent vaginal discharge, and reproductive performance of lactating dairy cows.

Science.gov (United States)

Moraes, João G N; Silva, Paula R B; Mendonça, Luís G D; Scanavez, Alexandre A; Silva, Joseane C C; Chebel, Ricardo C

2017-06-01

The objectives of the current experiment were to evaluate the effects of intrauterine infusion of Escherichia coli lipopolysaccharide (LPS) in cows diagnosed with purulent vaginal discharge (PVD) on intrauterine cell population, resolution of PVD, uterine health, and reproductive performance. Jersey cows (n = 3,084) were examined using the Metricheck device to diagnose PVD at 35 ± 6 d postpartum. Purulent vaginal discharge was defined as the presence of purulent (≥50% pus) discharge detectable in the vagina. Of the 310 cows positive for PVD, 267 cows were enrolled in the current experiment. To ensure proper timing of treatment and collection of samples, only 9 PVD-positive cows were treated per day. Selected cows were balanced at 35 ± 6 d postpartum for lactation number, body condition score, and milk yield and were randomly assigned to receive an intrauterine infusion of 20 mL of phosphate-buffered saline (PBS; control, n = 87), 20 mL of PBS with 150 µg LPS (LPS150, n = 91), or 20 mL of PBS with 300 µg of LPS (LPS300, n = 89). Uterine cytology was performed immediately before treatment and 1, 2, and 7 d after treatment to evaluate the effect of LPS treatment on intrauterine cell population. Cows were examined with the Metricheck device at 7 and 28 d after treatment to evaluate the effects of treatment on resolution of PVD. Reproductive status was recorded up to 200 d postpartum. Cows diagnosed with PVD had greater incidence of twinning, dystocia, retained placenta, and metritis after calving than cows without PVD. Count of polymorphonuclear leukocytes (PMNL) in uterine cytology 1, 2, and 7 d after intrauterine infusion was not statistically different among treatments. From d 0 to 1, however, PMNL count in uterine cytology of PBS cows increased by 5%, whereas the PMNL count in uterine cytology of LPS150 and LPS300 cows increased by 54 and 48%, respectively. Treatment did not affect the likelihood of cows being diagnosed with PVD 7 and 28 d after intrauterine

Correlates of improvement in substance abuse among dually diagnosed veterans with post-traumatic stress disorder in specialized intensive VA treatment.

Science.gov (United States)

Coker, Kendell L; Stefanovics, Elina; Rosenheck, Robert

2016-01-01

Substantial rates of substance use comorbidity have been observed among veterans with Post-Traumatic Stress Disorder (PTSD), highlighting the need to identify patient and program characteristics associated with improved outcomes for substance abuse. Data were drawn from 12,270 dually diagnosed veterans who sought treatment from specialized intensive Veterans Health Administration PTSD programs between 1993 and 2011. The magnitude of the improvement in Addiction Severity Index (ASI) alcohol and drug use composite scores from baseline was moderate, with effect sizes (ES) of -.269 and -.287, respectively. Multivariate analyses revealed that treatment in longer-term programs, being prescribed psychiatric medication, and planned participation in reunions were all associated with slightly improved outcomes. Reductions in substance use measures were associated with robust improvements in PTSD symptoms and violent behavior. These findings suggest not only synergistic treatment effects linking improvement in PTSD symptoms with substance use disorders among dually diagnosed veterans with PTSD, but also to reductions in violent behavior. Furthermore, the findings indicate that proper discharge planning in addition to intensity and duration of treatment for dually diagnosed veterans with severe PTSD may result in better outcomes. Further dissemination of evidence-based substance abuse treatment may benefit this population. (c) 2016 APA, all rights reserved).

Factors Associated With the Increasing Rates of Discharges Directly Home From Intensive Care Units-A Direct From ICU Sent Home Study.

Science.gov (United States)

Lau, Vincent I; Priestap, Fran A; Lam, Joyce N H; Ball, Ian M

2018-02-01

To evaluate the relationship between rates of discharge directly to home (DDH) from the intensive care unit (ICU) and bed availability (ward and ICU). Also to identify patient characteristics that make them candidates for safe DDH and describe transfer delay impact on length of stay (LOS). Retrospective cohort study of all adult patients who survived their stay in our medical-surgical-trauma ICU between April 2003 and March 2015. Median age was 49 years (interquartile range [IQR]: 33.5-60.4), and the majority of the patients were males (54.8%). Median number of preexisting comorbidities was 5 (IQR: 2-7) diagnoses. Discharge directly to home increased from 28 (3.1% of all survivors) patients in 2003 to 120 (12.5%) patients in 2014. The mean annual rate of DDH was between 11% and 12% over the last 6 years. Approximately 62% (n = 397) of patients waited longer than 4 hours for a ward bed, with a median delay of 2.0 days (IQR: 0.5-4.7) before being DDH. There was an inverse correlation between ICU occupancy and DDH rates ( r P = -.55, P < .0001, 95% confidence interval [CI] = -0.36 to -0.69, R 2 = .29). There was no correlation with ward occupancy and DDH rates ( r s = -.055, P = .64, 95% CI = -0.25 to 0.21). The DDH rates have been increasing over time at our institution and were inversely correlated with ICU bed occupancy but were not associated with ward occupancy. The DDH patients are young, have few comorbidities on admission, and few discharge diagnoses, which are usually reversible single system problems with low disease burden. Transfers to the ward are delayed in a majority of cases, leading to increased ICU LOS and likely increased overall hospital LOS as well.

Ileostomy - discharge

Science.gov (United States)

... dried fruits (such as raisins), mushrooms, chunky relishes, coconut, and some Chinese vegetables. Tips for when no ... ask your doctor Living with your ileostomy Low-fiber diet Small bowel resection - discharge Total colectomy or ...

Numerical modelling of ozone production in a wire-cylinder corona discharge and comparison with a wire-plate corona discharge

International Nuclear Information System (INIS)

Wang Pengxiang; Chen Junhong

2009-01-01

The effect of electrode configuration on ozone production in the direct-current corona discharge of dry and humid air is studied by a numerical model that combines the electron distribution in the corona plasma, plasma chemistry and transport phenomena. Two electrode configurations are considered: wire-cylinder discharge with air flowing along the wire axis and wire-plate discharge with air flowing transverse to the wire. The ozone distributions in both types of discharges are compared. For both electrode configurations, the ozone production rate is higher in the negative corona than in the positive corona and it decreases with an increase in relative humidity. More importantly, the detailed ozone distribution in the neighbourhood of the discharge wire, together with the ozone kinetics, reveals the possible difference in the ozone production from the two discharges. With the same operating conditions and sufficiently short flow residence time, the ozone production rate is nearly the same for both electrode configurations. When the flow residence time is longer than the characteristic time for homogeneous ozone destruction, the net ozone production is higher in the wire-cylinder discharge than in the wire-plate discharge due to relatively less ozone destruction.

Numerical modelling of ozone production in a wire-cylinder corona discharge and comparison with a wire-plate corona discharge

Science.gov (United States)

Wang, Pengxiang; Chen, Junhong

2009-02-01

The effect of electrode configuration on ozone production in the direct-current corona discharge of dry and humid air is studied by a numerical model that combines the electron distribution in the corona plasma, plasma chemistry and transport phenomena. Two electrode configurations are considered: wire-cylinder discharge with air flowing along the wire axis and wire-plate discharge with air flowing transverse to the wire. The ozone distributions in both types of discharges are compared. For both electrode configurations, the ozone production rate is higher in the negative corona than in the positive corona and it decreases with an increase in relative humidity. More importantly, the detailed ozone distribution in the neighbourhood of the discharge wire, together with the ozone kinetics, reveals the possible difference in the ozone production from the two discharges. With the same operating conditions and sufficiently short flow residence time, the ozone production rate is nearly the same for both electrode configurations. When the flow residence time is longer than the characteristic time for homogeneous ozone destruction, the net ozone production is higher in the wire-cylinder discharge than in the wire-plate discharge due to relatively less ozone destruction.

77 FR 47380 - Final National Pollutant Discharge Elimination System (NPDES) General Permit for Discharges From...

Science.gov (United States)

2012-08-08

... test fluids, sanitary waste, domestic waste and miscellaneous discharges is authorized. More stringent... permit. Major changes also include definition of ``operator'', acute toxicity test for produced water, spill prevention best management practices, and electronic reporting requirements. To obtain discharge...

Acoustic effects of single electrostatic discharges

International Nuclear Information System (INIS)

Orzech, Łukasz

2015-01-01

Electric discharges, depending on their character, can emit different types of energy, resulting in different effects. Single electrostatic discharges besides generation of electromagnetic pulses are also the source of N acoustic waves. Their specified parameters depending on amount of discharging charge enable determination of value of released charge in a function of acoustic descriptor (e.g. acoustic pressure). Presented approach is the basics of acoustic method for measurement of single electrostatic discharges, enabling direct and contactless measurement of value of charge released during ESD. Method for measurement of acoustic effect of impact of a single electrostatic discharge on the environment in a form of pressure shock wave and examples of acoustic descriptors in a form of equation Q=f(p a ) are described. The properties of measuring system as well as the results of regression static analyses used to determine the described relationships are analysed in details. (paper)

Plasma deposition by discharge in powder

International Nuclear Information System (INIS)

El-Gamal, H.A.; El-Tayeb, H.A.; Abd El-Moniem, M.; Masoud, M.M.

2000-01-01

Different types of material powders have been fed to the breach of a coaxial discharge. The coaxial discharge is powered from a 46.26 mu F, 24 KV capacitor bank. When the discharge takes place at the breach, the powder is heated and ionized to form a sheath of its material. The plasma sheath is ejected from the discharge zone with high velocity. The plasma sheath material is deposited on a glass substrate. It has been found from scanning electron microscope (SEM) analysis that the deposited material is almost homogenous for ceramic and graphite powders. The grain size is estimated to be the order of few microns. To measure the deposited material thickness the microdensitometer and a suitable arrangement of a laser interferometer and an optical microscope are used. It has also been found that deposited material thickness depends on the discharge number of shots and the capacitor bank energy

Readiness for hospital discharge: A concept analysis.

Science.gov (United States)

Galvin, Eileen Catherine; Wills, Teresa; Coffey, Alice

2017-11-01

To report on an analysis on the concept of 'readiness for hospital discharge'. No uniform operational definition of 'readiness for hospital discharge' exists in the literature; therefore, a concept analysis is required to clarify the concept and identify an up-to-date understanding of readiness for hospital discharge. Clarity of the concept will identify all uses of the concept; provide conceptual clarity, an operational definition and direction for further research. Literature review and concept analysis. A review of literature was conducted in 2016. Databases searched were: Academic Search Complete, CINAHL Plus with Full Text, PsycARTICLES, Psychology and Behavioural Sciences Collection, PsycINFO, Social Sciences Full Text (H.W. Wilson) and SocINDEX with Full Text. No date limits were applied. Identification of the attributes, antecedents and consequences of readiness for hospital discharge led to an operational definition of the concept. The following attributes belonging to 'readiness for hospital discharge' were extracted from the literature: physical stability, adequate support, psychological ability, and adequate information and knowledge. This analysis contributes to the advancement of knowledge in the area of hospital discharge, by proposing an operational definition of readiness for hospital discharge, derived from the literature. A better understanding of the phenomenon will assist healthcare professionals to recognize, measure and implement interventions where necessary, to ensure patients are ready for hospital discharge and assist in the advancement of knowledge for all professionals involved in patient discharge from hospital. © 2017 John Wiley & Sons Ltd.

Discharge models through the pressurizer valves

International Nuclear Information System (INIS)

Madeira, A.A.

1985-01-01

A reliable estimate of discharge through the pressurizer relief and safety valves is of concern to adequately predict the behaviour of RCS pressure during transients. It's investigated the discharge models used by the ALMOD code, and to implement alternative models from the available literature, which are recommended for different conditions of flow that shall exist during transients requiring discharge through the relief and safety valves. (Author) [pt

Secondary mechanisms in a gas discharge

International Nuclear Information System (INIS)

Fletcher, J.; Blevin, H.A.

1978-05-01

The technique for studying swarms of electrons in a gas discharge by observing the photon flux from the discharge has been adapted to investigate the role of the secondary mechanisms. First results, reported here, show that, contrary to previous indications, ion bombardment of the cathode plays only a negligible, if any, part in the low pressure discharge in hydrogen at E/N approx. less than 200Td

Acoustic signal analysis in the creeping discharge

International Nuclear Information System (INIS)

Nakamiya, T; Sonoda, Y; Tsuda, R; Ebihara, K; Ikegami, T

2008-01-01

We have previously succeeded in measuring the acoustic signal due to the dielectric barrier discharge and discriminating the dominant frequency components of the acoustic signal. The dominant frequency components appear over 20kHz of acoustic signal by the dielectric barrier discharge. Recently surface discharge control technology has been focused from practical applications such as ozonizer, NO X reactors, light source or display. The fundamental experiments are carried to examine the creeping discharge using the acoustic signal. When the high voltage (6kV, f = 10kHz) is applied to the electrode, the discharge current flows and the acoustic sound is generated. The current, voltage waveforms of creeping discharge and the sound signal detected by the condenser microphone are stored in the digital memory scope. In this scheme, Continuous Wavelet Transform (CWT) is applied to discriminate the acoustic sound of the micro discharge and the dominant frequency components are studied. CWT results of sound signal show the frequency spectrum of wideband up to 100kHz. In addition, the energy distributions of acoustic signal are examined by CWT

An introduction to gas discharges

CERN Document Server

Howatson, A M

2013-01-01

An Introduction to Gas Discharges: Second Edition aims to provide a compact introduction to the subject of gas discharges, which continues to make both scientific and industrial progress. In this second edition, the author has made minor corrections, rewritten and expanded some sections, used SI units and modernized notions, in hopes of making the book more up to date. Included in the book is a short history of the subject, an introduction that enumerates the types of gas discharges, the fundamental processes, and then moves on to the more specific areas such as the breakdown, the self-sustai

CQI project improves discharge process.

Science.gov (United States)

1998-08-01

At Gibson Rehab Center in Williamsport, PA, a continuous quality improvement project to bolster the institution's discharge planning process has resulted in increased satisfaction and an award for quality. The 15-month project was spearheaded by a multidisciplinary team charged with identifying areas that had a significant impact on customer service and suggesting better ways of delivering that service. Among the changes the group suggested were establishing a weekly discharge planning group for new neuro patients, assigning a discharge coordinator for each treatment team, and creating an interdisciplinary communication sheet for the home health therapy staff.

Stage-discharge rating curves based on satellite altimetry and modeled discharge in the Amazon basin

Science.gov (United States)

Paris, Adrien; Dias de Paiva, Rodrigo; Santos da Silva, Joecila; Medeiros Moreira, Daniel; Calmant, Stephane; Garambois, Pierre-André; Collischonn, Walter; Bonnet, Marie-Paule; Seyler, Frederique

2016-05-01

In this study, rating curves (RCs) were determined by applying satellite altimetry to a poorly gauged basin. This study demonstrates the synergistic application of remote sensing and watershed modeling to capture the dynamics and quantity of flow in the Amazon River Basin, respectively. Three major advancements for estimating basin-scale patterns in river discharge are described. The first advancement is the preservation of the hydrological meanings of the parameters expressed by Manning's equation to obtain a data set containing the elevations of the river beds throughout the basin. The second advancement is the provision of parameter uncertainties and, therefore, the uncertainties in the rated discharge. The third advancement concerns estimating the discharge while considering backwater effects. We analyzed the Amazon Basin using nearly one thousand series that were obtained from ENVISAT and Jason-2 altimetry for more than 100 tributaries. Discharge values and related uncertainties were obtained from the rain-discharge MGB-IPH model. We used a global optimization algorithm based on the Monte Carlo Markov Chain and Bayesian framework to determine the rating curves. The data were randomly allocated into 80% calibration and 20% validation subsets. A comparison with the validation samples produced a Nash-Sutcliffe efficiency (Ens) of 0.68. When the MGB discharge uncertainties were less than 5%, the Ens value increased to 0.81 (mean). A comparison with the in situ discharge resulted in an Ens value of 0.71 for the validation samples (and 0.77 for calibration). The Ens values at the mouths of the rivers that experienced backwater effects significantly improved when the mean monthly slope was included in the RC. Our RCs were not mission-dependent, and the Ens value was preserved when applying ENVISAT rating curves to Jason-2 altimetry at crossovers. The cease-to-flow parameter of our RCs provided a good proxy for determining river bed elevation. This proxy was validated

The revolving door syndrome in internal medicine: a study on 11,846 subjects discharged from all Internal Medicine Departments of Tuscany with diagnosis of heart failure and pneumonia

Directory of Open Access Journals (Sweden)

Matteo Tellini

2015-05-01

Full Text Available Rehospitalization is the return of a patient to a surgical or medical department within 30 days from discharge. We have limited information on the frequency and patterns of rehospitalization in Italy. Our purpose is to describe this phenomenon in Tuscany. We analyzed regional hospital discharge abstract data in Tuscany 2012, to describe 30-day all cause readmissions. We studied patients aged 18 or more (11,846 discharged with diagnoses of heart failure and pneumonia from Internal Medicine Departments. Relationships between 30-day readmission rates, demographic and clinical characteristics have been analyzed. 18% and 15% of subjects respectively discharged with diagnosis of heart failure and pneumonia were readmitted within 30 days. Risk factors significantly related to readmissions were longer length of stay, increasing number of different medications taken during the year preceding hospitalization and greater number of hospitalizations during the semester preceding admission. From the analysis of risk factors we found that frailty and complexity of patients (identified by long hospitalization stays, high number of drugs and previous admissions are the most important factors for unplanned readmissions.

Study of the metastable singlet of molecular nitrogen and of oxygen atoms in discharges and post-discharges

International Nuclear Information System (INIS)

Magne, Lionel

1991-01-01

Whereas discharges in nitrogen, in oxygen and in their mixtures are used in many different industrial processes (surface treatment, nitridation, oxidation, and so on), in order to get a better knowledge on nitrogen electronic states, this research thesis reports the study of the metastable singlet state of molecular nitrogen, and of oxygen atoms in their fundamental state. The molecular metastable has been observed by far-UV optical emission spectroscopy, in the positive column of a continuous discharge and in time post-discharge. As far as continuous discharge is concerned, the author measured the vibrational distribution of this state. A kinetic model has been developed, and calculated vibrational distributions are in good agreement with measurements. The density of oxygen atoms in fundamental state in time post-discharge has been measured by far-UV absorption optical spectroscopy. The probability of atom re-association of glass walls is deduced from the obtained results [fr

Computing discharge using the index velocity method

Science.gov (United States)

Levesque, Victor A.; Oberg, Kevin A.

2012-01-01

Application of the index velocity method for computing continuous records of discharge has become increasingly common, especially since the introduction of low-cost acoustic Doppler velocity meters (ADVMs) in 1997. Presently (2011), the index velocity method is being used to compute discharge records for approximately 470 gaging stations operated and maintained by the U.S. Geological Survey. The purpose of this report is to document and describe techniques for computing discharge records using the index velocity method. Computing discharge using the index velocity method differs from the traditional stage-discharge method by separating velocity and area into two ratings—the index velocity rating and the stage-area rating. The outputs from each of these ratings, mean channel velocity (V) and cross-sectional area (A), are then multiplied together to compute a discharge. For the index velocity method, V is a function of such parameters as streamwise velocity, stage, cross-stream velocity, and velocity head, and A is a function of stage and cross-section shape. The index velocity method can be used at locations where stage-discharge methods are used, but it is especially appropriate when more than one specific discharge can be measured for a specific stage. After the ADVM is selected, installed, and configured, the stage-area rating and the index velocity rating must be developed. A standard cross section is identified and surveyed in order to develop the stage-area rating. The standard cross section should be surveyed every year for the first 3 years of operation and thereafter at a lesser frequency, depending on the susceptibility of the cross section to change. Periodic measurements of discharge are used to calibrate and validate the index rating for the range of conditions experienced at the gaging station. Data from discharge measurements, ADVMs, and stage sensors are compiled for index-rating analysis. Index ratings are developed by means of regression

Diagnosing Diabetes and Learning about Prediabetes

Science.gov (United States)

... Listen En Español Diagnosing Diabetes and Learning About Prediabetes There are several ways to diagnose diabetes. Each ... or equal to 200 mg/dl What is Prediabetes? Before people develop type 2 diabetes, they almost ...

Electric-discharge-pumped nitrogen ion laser

Science.gov (United States)

Laudenslager, J. B.; Pacala, T. J.; Wittig, C.

1976-01-01

The routine operation is described of an N2(+) laser oscillating on the first negative band system of N2(+) which is produced in a preionized transverse discharge device. The discharge design incorporates features which favor the efficient production of the excitation transfer reaction of He2(+) with N2. A capacitive discharge switched by means of a high-current grounded grid thyratron is used to meet the design requirement of a volumetric discharge in high-pressure gas mixtures where the electric discharge need not have an ultrafast rise time (greater than 10 nsec) but should be capable of transferring large quantities of stored electric energy to the gas. A peak power of 180 kW in an 8-nsec laser pulse was obtained with a 0.1% mixture of N2 in helium at a total pressure of 3 atm. The most intense laser oscillations were observed on the (0,1) vibrational transition at 427.8 microns.

Gas temperature of capacitance spark discharge in air

International Nuclear Information System (INIS)

Ono, Ryo; Nifuku, Masaharu; Fujiwara, Shuzo; Horiguchi, Sadashige; Oda, Tetsuji

2005-01-01

Capacitance spark discharge has been widely used for studying the ignition of flammable gas caused by electrostatic discharge. In the present study, the gas temperature of capacitance spark discharge is measured. The gas temperature is an important factor in understanding the electrostatic ignition process because it influences the reaction rate of ignition. Spark discharge is generated in air with a pulse duration shorter than 100 ns. The discharge energy is set to 0.03-1 mJ. The rotational and vibrational temperatures of the N 2 molecule are measured using the emission spectrum of the N 2 second positive system. The rotational and vibrational temperatures are estimated to be 500 and 5000 K, respectively, which are independent of the discharge energy. This result indicates that most of the electron energy is consumed in the excitation of vibrational levels of molecules rather than the heating of the gas. The gas temperature after discharge is also measured by laser-induced fluorescence of OH radicals. It is shown that the gas temperature increases after discharge and reaches approximately 1000 K at 3 μs after discharge. Then the temperature decreases at a rate in the range of 8-35 K/μs depending on the discharge energy

Effect of volume and surface charges on discharge structure of glow dielectric barrier discharge

Energy Technology Data Exchange (ETDEWEB)

Xu, Shao-Wei; He, Feng; Wang, Yu; Li, Lulu; Ouyang, Ji-Ting [School of Physics, Beijing Institute of Technology, Beijing 100081 (China)

2013-08-15

The effect of volume and surface charges on the structure of glow dielectric barrier discharge (DBD) has been investigated numerically by using two-dimensional (2D) fluid modeling. The local increase of volume or surface charges induces a kind of activation-inhibition effect, which enhances the local volume discharge and inhibits the discharge in neighborhoods, resulting in non-uniform discharge. The activation-inhibition effect due to the non-uniform volume and/or surface charges depends on the non-uniformity itself and the applied voltage. The activation-inhibition of non-uniform charges has different effects on the volume charges and the accumulated surface charges. The distribution of remaining free charges (seed electrons) in volume at the beginning of voltage pulse plays a key role for the glow DBD structure, resulting in a patterned DBD, when the seed electrons are non-uniform at higher frequency and moderate voltage or uniform DBD, when the seed electrons are uniform at lower frequency or high voltage. The distribution of surface charges is not the determining factor but a result of the formed DBD structure.

Discharge characteristics of copper vapor laser

International Nuclear Information System (INIS)

Nemoto, Koshichi; Fujii, Takashi

1988-01-01

This report describes about the copper vapor laser and experimental results of it's discharge characteristics. We measured time varing of plasma regist, and analyzed electron density. (1) The plasma regist is larger than 100Ω at the beginning of discharge, and is rapidly reduced to about 10Ω. (2) The electron density is estimated about 1∼2 x 10 12 /cc at the begining of discharge. (author)

Gas Discharge Produced by Strong Microwaves of Nanosecond Duration

International Nuclear Information System (INIS)

Vikharev, A.L.

2000-01-01

The results of the investigation of nanosecond microwave discharge are reviewed. Nanosecond microwave discharge is a new branch of gas discharge physics. The paper lists base types of microwave generators used to produce nanosecond discharge and classifies the discharges relative to their base parameters: the way the discharge gets localized in a limited space, amplitude and frequency of microwave field, gas pressure, duration of microwave pulses. The laboratory experiments performed and the new effects which appear in nanosecond microwave discharge are briefly summarized. Different applications of such a discharge are analyzed on the basis of the experimental modelling. (author)

[Study on Square Super-Lattice Pattern with Surface Discharge in Dielectric Barrier Discharge by Optical Emission Spectra].

Science.gov (United States)

Niu, Xue-jiao; Dong, Li-fang; Liu, Ying; Wang, Qian; Feng, Jian-yu

2016-02-01

Square super-lattice pattern with surface discharge consisting of central spots and dim spots is firstly observed in the mixture of argon and air by using a dielectric barrier discharge device with water electrodes. By observing the image, it is found that the central spot is located at the centriod of its surrounding four dim spots. The short-exposure image recorded by a high speed video camera shows that the dim spot results from the surface discharges (SDs). The brightness of the central spot and is quite different from that of the dim spot, which indicates that the plasma states of the central spot and the dim spot may be differentiated. The optical emission spectrum method is used to further study the several plasma parameters of the central spot and the dim spot in different argon content. The emission spectra of the N₂ second positive band (C³IIu --> B³ IIg) are measured, from which the molecule vibration temperatures of the central spot and the dim spot are calculated respectively. The broadening of spectral line 696.57 nm (2P₂-->1S₅) is used to study the electron densities of the central spot and the dim spot. It is found that the molecule vibration temperature and electron density of the dim spot are higher than those of the central spot in the same argon content The molecule vibration temperature and electron density of the central spot and the dim spot increase with the argon content increasing from 90% to 99.9%. The surface discharge induced by the volume discharge (VD) has the determinative effect on the formation of the dim spot The experimental results above play an important role in studying the formation mechanism of surface discharg&of square super-lattice pattern with surface discharge. In addition, the studies exert an influence on the application of surface discharge and volume discharge in different fields.

Numerical simulation of the sustaining discharge in radio frequency hollow cathode discharge in argon

Energy Technology Data Exchange (ETDEWEB)

Jiang, Xin-Xian; He, Feng, E-mail: hefeng@bit.edu.cn; Ouyang, Ji-Ting [School of Physics, Beijing Institute of Technology, Beijing 100081 (China); Chen, Qiang, E-mail: lppmchenqiang@hotmail.com; Ge, Teng [Laboratory of Plasma Physics and Materials, Beijing Institute of Graphic Communication, Beijing 10081 (China)

2014-03-15

In this paper, a two-dimensional fluid model was developed to study the radio frequency (RF) hollow cathode discharge (HCD) in argon at 1 Torr. The evolutions of the particle density distribution and the ionization rate distribution in RF HCD at 13.56 MHz indicate that the discharge mainly occurs inside the hollow cathode. The spatio-temporal distributions of the ionization rate and the power deposition within the hollow cathode imply that sheath oscillation heating is the primary mechanism to sustain the RF HCD, whereas secondary electron emission plays a negligible role. However, as driving frequency decreases, secondary electron heating becomes a dominant mechanism to sustain the discharge in RF hollow cathode.

The Consistency Between Clinical and Electrophysiological Diagnoses

Directory of Open Access Journals (Sweden)

Esra E. Okuyucu

2009-09-01

Full Text Available OBJECTIVE: The aim of this study was to provide information concerning the impact of electrophysiological tests in the clinical management and diagnosis of patients, and to evaluate the consistency between referring clinical diagnoses and electrophysiological diagnoses. METHODS: The study included 957 patients referred to the electroneuromyography (ENMG laboratory from different clinics with different clinical diagnoses in 2008. Demographic data, referring clinical diagnoses, the clinics where the requests wanted, and diagnoses after ENMG testing were recorded and statistically evaluated. RESULTS: In all, 957 patients [644 (67.3% female and 313 (32.7% male] were included in the study. Mean age of the patients was 45.40 ± 14.54 years. ENMG requests were made by different specialists; 578 (60.4% patients were referred by neurologists, 122 (12.8% by orthopedics, 140 (14.6% by neurosurgeons, and 117 (12.2% by physical treatment and rehabilitation departments. According to the results of ENMG testing, 513 (53.6% patients’ referrals were related to their referral diagnosis, whereas 397 (41.5% patients had normal ENMG test results, and 47 (4.9% patients had a diagnosis that differed from the referring diagnosis. Among the relation between the referral diagnosis and electrophysiological diagnosis according to the clinics where the requests were made, there was no statistical difference (p= 0.794, but there were statistically significant differences between the support of different clinical diagnoses, such as carpal tunnel syndrome, polyneuropathy, radiculopathy-plexopathy, entrapment neuropathy, and myopathy based on ENMG test results (p< 0.001. CONCLUSION: ENMG is a frequently used neurological examination. As such, referrals for ENMG can be made to either support the referring diagnosis or to exclude other diagnoses. This may explain the inconsistency between clinical referring diagnoses and diagnoses following ENMG

Mammographic appearances of male breast disease.

Science.gov (United States)

Appelbaum, A H; Evans, G F; Levy, K R; Amirkhan, R H; Schumpert, T D

1999-01-01

Various male breast diseases have characteristic mammographic appearances that can be correlated with their pathologic diagnoses. Male breast cancer is usually subareolar and eccentric to the nipple. Margins of the lesions are more frequently well defined, and calcifications are rarer and coarser than those occurring in female breast cancer. Gynecomastia usually appears as a fan-shaped density emanating from the nipple, gradually blending into surrounding fat. It may have prominent extensions into surrounding fat and, in some cases, an appearance similar to that of a heterogeneously dense female breast. Although there are characteristic mammographic features that allow breast cancer in men to be recognized, there is substantial overlap between these features and the mammographic appearance of benign nodular lesions. The mammographic appearance of gynecomastia is not similar to that of male breast cancer, but in rare cases, it can mask malignancy. Gynecomastia can be mimicked by chronic inflammation. All mammographically lucent lesions of the male breast appear to be benign, similar to such lesions in the female breast.

Thermal discharge residence by Lake Michigan Salmonids

International Nuclear Information System (INIS)

Romberg, G.P.; Prepejchal, W.

1975-01-01

Lake Michigan salmon and trout were tagged with a thermoluminescent dosimeter (TLD) temperature tag to estimate their thermal exposure and residence time at a warm water discharge. Fish were collected, tagged, and released at the Point Beach Nuclear Plant, Two Rivers, Wisconsin, in the fall of 1973 and 1974. Tags were recovered during the same season, primarily from fish recaptured at Point Beach. Average uniform temperature exposure and maximum possible discharge residence time were determined. Appropriate hourly intake and discharge temperatures were averaged to calculate mean temperature exposure for the case of maximum discharge residence. Lowest discharge temperature not included within the period of maximum residence was identified to serve as a possible indicator of avoidance temperature. Mean values for the above parameters were calculated for fish species for each tagging year and are reported with the accompanying range of intake and discharge temperatures

Behaviour of multiple lightning dischargers under a tropical ...

African Journals Online (AJOL)

... discharger from surrounding dischargers, instead of incre-asing with the average spacing between dischargers. The point of strike of lightning discharge depended on the line of least stress rather than the height clearance from the cloud; which determined the charge structure and dynamics of the cloud particulates.

Use of bayesian operations for diagnosing accidents

International Nuclear Information System (INIS)

Kang, K.M.; Jae, M.; Suh, K.Y.

2005-01-01

In complex systems, it is necessary to model a logical representation of the overall system interaction with respect to the individual subsystems. Operators are allowed to follow EOPs (Emergency Operating Procedures) when reactor tripped because of accidents. But, it's very difficult to diagnose accidents and find out appropriate procedures to mitigate current accidents in a given short time. Even if they diagnose accidents, it also has possibility to misdiagnose. TMI accident is a good example of operators' errors. Methodology using Influence Diagrams has been developed and applied for representing the dependency behaviors and uncertain behaviors of complex systems. An example to diagnose the accidents such as SLOCA and SGTR with similar symptoms has been introduced. From the constructed model, operators could diagnose accidents at any states of accidents. This model can offer the information about accidents with given symptoms. This model might help operators to diagnose correctly and rapidly. It might be very useful to support operators to reduce human error. Also, from this study, it is applicable to diagnose other accidents with similar symptoms and to analyze causes of reactor trip. (authors)

Pulse electrical discharges in water and their applications

International Nuclear Information System (INIS)

Sunka, Pavel

2001-01-01

Partial electrical discharges in a water solution as a function of conductivity have been studied experimentally. Using needle-plate electrodes it has been demonstrated that the discharge evolves in two phases. During the first streamer-like phase, the discharge propagated with a velocity of 10 6 cm/s, while during the second arc-like phase the length of the discharge remained almost constant although the current still increased. Higher solution conductivity resulted in the generation of shorter channels, in larger discharge current, and in a higher plasma electron density. Degradation of phenol by the discharge has also been demonstrated. A special metallic electrode covered by a thin layer of porous ceramic has been developed and used for generation of a multichannel discharge. At comparable solution conductivity the ceramic-coated electrode produced plasma with very similar parameters as the needle-plate electrode configuration. Generation of strong focused shock waves by the multichannel discharge in a highly conductive solution has also been demonstrated

State waste discharge permit application: Hydrotest, maintenance and construction discharges. Revision 0

International Nuclear Information System (INIS)

1995-11-01

On December 23, 1991, the US DOE< Richland Operation Office (RL) and the Washington State Department of Ecology (Ecology) agreed to adhere to the provisions of the Department of Ecology Consent Order No. DE91NM-177 (216 Consent Order) (Ecology and US DOE 1991). The 216 Consent Order list regulatory milestones for liquid effluent streams at the Hanford Site and requires compliance with the permitting requirements of Washington Administrative Code. Hanford Site liquid effluent streams discharging to the soil column have been categorized on the 216 Consent Order as follows: Phase I Streams; Phase II Streams; Miscellaneous Streams. Phase I and Phase II Streams were initially addressed in two report. Miscellaneous Streams are subject to the requirements of several milestones identified in the 216 Consent Order. This document constitutes the Categorical State Waste Discharge Permit application for hydrotest,maintenance and construction discharges throughout the Hanford Site. This categorical permit application form was prepared and approved by Ecology

Influence of discharge parameters on capillary discharge-pumped soft X-ray laser

International Nuclear Information System (INIS)

Peng Huimin; Zheng Wudi; Yang Dawei; Zhao Yongpeng; Cheng Yuanli; Wang Qi

2005-01-01

Based on the wave shape of Marx device at National Key Laboratory of Tunable Laser Technology, Harbin Institute of Technology, the influence of discharge parameters upon the temporal evolvement of capillary discharge produced plasmas conditions and the gain coefficient of 3p-3s transition in Neon-like Ar was simulated. In the simulation, argon with a density of 1.07 x 10 -6 g·cm -3 was filled into a ceramic capillary with an inner diameter of 3.1 mm, the peak of the discharge current pulse was 27.81 kA, and the width of the current pulse was 61.4 ns. The results show that the shorter the pulse rise time is, the higher the gain coefficient is. When the pulse rise time is 20-40 ns, the peak of the current pulse is 25-40 ns, and the current pulse width is 50-70 ns, the higher gain coefficient can be obtained. (authors)

State waste discharge permit application: Hydrotest, maintenance and construction discharges. Revision 0

Energy Technology Data Exchange (ETDEWEB)

NONE

1995-11-01

On December 23, 1991, the US DOE< Richland Operation Office (RL) and the Washington State Department of Ecology (Ecology) agreed to adhere to the provisions of the Department of Ecology Consent Order No. DE91NM-177 (216 Consent Order) (Ecology and US DOE 1991). The 216 Consent Order list regulatory milestones for liquid effluent streams at the Hanford Site and requires compliance with the permitting requirements of Washington Administrative Code. Hanford Site liquid effluent streams discharging to the soil column have been categorized on the 216 Consent Order as follows: Phase I Streams; Phase II Streams; Miscellaneous Streams. Phase I and Phase II Streams were initially addressed in two report. Miscellaneous Streams are subject to the requirements of several milestones identified in the 216 Consent Order. This document constitutes the Categorical State Waste Discharge Permit application for hydrotest,maintenance and construction discharges throughout the Hanford Site. This categorical permit application form was prepared and approved by Ecology.

Modeling and optimization of the multichannel spark discharge

International Nuclear Information System (INIS)

Zhang Zhi-Bo; Wu Yun; Jia Min; Song Hui-Min; Li Ying-Hong; Sun Zheng-Zhong

2017-01-01

This paper reports a novel analytic model of this multichannel spark discharge, considering the delay time in the breakdown process, the electric transforming of the discharge channel from a capacitor to a resistor induced by the air breakdown, and the varying plasma resistance in the discharge process. The good agreement between the experimental and the simulated results validated the accuracy of this model. Based on this model, the influence of the circuit parameters on the maximum discharge channel number (MDCN) is investigated. Both the input voltage amplitude and the breakdown voltage threshold of each discharge channel play a critical role. With the increase of the input voltage and the decrease of the breakdown voltage, the MCDN increases almost linearly. With the increase of the discharge capacitance, the MDCN first rises and then remains almost constant. With the increase of the circuit inductance, the MDCN increases slowly but decreases quickly when the inductance increases over a certain value. There is an optimal value of the capacitor connected to the discharge channel corresponding to the MDCN. Finally, based on these results, to shorten the discharge time, a modified multichannel discharge circuit is developed and validated by the experiment. With only 6-kV input voltage, 31-channels discharge is achieved. The breakdown voltage of each electrode gap is larger than 3 kV. The modified discharge circuit is certain to be widely used in the PSJA flow control field. (paper)

The perchlorate discharge test with {sup 123}I for the diagnosis of the Pendred syndrome in children; Der Depletionstest mit {sup 123}Iod zur Diagnose des Pendred-Syndroms bei Kindern

Energy Technology Data Exchange (ETDEWEB)

Hahn, K.; Fischer, S. [Klinik und Poliklinik fuer Nuklearmedizin, Klinikum der Ludwig-Maximilians-Univ. Muenchen (Germany)

2009-03-15

The method for the diagnosis of the Pendred Syndrome in children by the Perchlorate discharge test using {sup 123}I is described. The older child, who has the Pendred Syndrome and the obligatory hearing deficit, frequently has neither a goitre nor hypothyroidism, but other investigations (bone growth, scars and function tests) can also show changes. However a more certain diagnosis of this disorder in children is possible by the perchlorate discharge test using {sup 123}I. (orig.)

Note: A phase synchronization photography method for AC discharge

Science.gov (United States)

Wu, Zhicheng; Zhang, Qiaogen; Ma, Jingtan; Pang, Lei

2018-05-01

To research discharge physics under AC voltage, a phase synchronization photography method is presented. By using a permanent-magnet synchronous motor to drive a photography mask synchronized with a discharge power supply, discharge images in a specific phase window can be recorded. Some examples of discharges photographed by this method, including the corona discharge in SF6 and the corona discharge along the air/epoxy surface, demonstrate the feasibility of this method. Therefore, this method provides an effective tool for discharge physics researchers.

Modeling of Pulsed Direct-Current Glow Discharge

International Nuclear Information System (INIS)

Du Mu; Zheng Yaru; Fan Yujia; Zhang Nan; Liu Chengsen; Wang Dezhen

2010-01-01

A self-consistent model was adopted to study the time evolution of low-voltage pulsed DC glow discharge. The distributions of electric field, ion density and electron density in nitrogen were investigated in our simulation, and the temporal shape of the discharge current was also obtained. Our results show that the dynamic behaviors of the discharge depends strongly on the applied pulse voltage, and the use of higher pulse voltages results in a significantly increase of discharge current and a decrease of discharge delay time. The current-voltage characteristic calculated by adjusting secondary electron emission coefficient for different applied pulse voltage under the gas pressure of 1 Torr is found in a reasonable agreement with the experimental results.

Paschen like behavior in argon RF discharge

International Nuclear Information System (INIS)

Al-Jwaady, Y. I.

2011-01-01

A 13.56 MHz radio frequency inductively coupled discharge system is used in this work to study the relation between Argon gas pressure in the discharge chamber and the threshold breakdown RF power needed to create the discharge. Experimental results indicated that although the data involve some features related to the traditional Paschen relation used in Dc discharge, this relation cannot provide a quantitative description of experimental data. For such reason, a modified from Paschen relation is suggested. The modified relation provides good agreement with experimental data. Furthermore, it seems that the Paschen relation will have significant reflections on the behavior of the transit process from capacitive to inductive discharge. This is demonstrated by studying the transit region. (author)

Evaluating Hospital Readmission Rates After Discharge From Inpatient Rehabilitation.

Science.gov (United States)

Daras, Laura Coots; Ingber, Melvin J; Carichner, Jessica; Barch, Daniel; Deutsch, Anne; Smith, Laura M; Levitt, Alan; Andress, Joel

2017-08-09

To examine facility-level rates of all-cause, unplanned hospital readmissions for 30 days after discharge from inpatient rehabilitation facilities (IRFs). Observational design. Inpatient rehabilitation facilities. Medicare fee-for-service beneficiaries (N=567,850 patient-stays). Not applicable. The outcome is all-cause, unplanned hospital readmission rates for IRFs. We adapted previous risk-adjustment and statistical approaches used for acute care hospitals to develop a hierarchical logistic regression model that estimates a risk-standardized readmission rate for each IRF. The IRF risk-adjustment model takes into account patient demographic characteristics, hospital diagnoses and procedure codes, function at IRF admission, comorbidities, and prior hospital utilization. We presented national distributions of observed and risk-standardized readmission rates and estimated confidence intervals to make statistical comparisons relative to the national mean. We also analyzed the number of days from IRF discharge until hospital readmission. The national observed hospital readmission rate by 30 days postdischarge from IRFs was 13.1%. The mean unadjusted readmission rate for IRFs was 12.4%±3.5%, and the mean risk-standardized readmission rate was 13.1%±0.8%. The C-statistic for our risk-adjustment model was .70. Nearly three-quarters of IRFs (73.4%) had readmission rates that were significantly different from the mean. The mean number of days to readmission was 13.0±8.6 days and varied by rehabilitation diagnosis. Our results demonstrate the ability to assess 30-day, all-cause hospital readmission rates postdischarge from IRFs and the ability to discriminate between IRFs with higher- and lower-than-average hospital readmission rates. Published by Elsevier Inc.

Aircrew Sizing Survey 2011

Science.gov (United States)

2014-10-01

nipple on men . - Procedure: Place dot over center of nipple on men . For women, ask subject to place dot over nipple . 40. Tragion, left and right...distribution unlimited. Release #88ABW-2014-5033, dated 31 October 2014. was reduced to 646 men and 708 women who were identified as falling within...Description: Circumference of the torso measured at level of nipple . Undrawn landmarks: For males, right and left thelion; for females, right and

At få en diagnose

DEFF Research Database (Denmark)

Olesen, Birgitte Ravn; Jansbøl, Kirsten

I dette hæfte ligger fokus på døvblindblevnes fortællinger om at have et handicap uden at kende sin diagnose og om at håndtre at få diagnosen RP eller Usher syndrom. Det er karakteristisk for fortællingerne, at det har stor betydning - hvornår i livet, man får sin diagnose - under hvilke...

Flywheel Charge/Discharge Control Developed

Science.gov (United States)

Beach, Raymond.F.; Kenny, Barbara H.

2001-01-01

A control algorithm developed at the NASA Glenn Research Center will allow a flywheel energy storage system to interface with the electrical bus of a space power system. The controller allows the flywheel to operate in both charge and discharge modes. Charge mode is used to store additional energy generated by the solar arrays on the spacecraft during insolation. During charge mode, the flywheel spins up to store the additional electrical energy as rotational mechanical energy. Discharge mode is used during eclipse when the flywheel provides the power to the spacecraft. During discharge mode, the flywheel spins down to release the stored rotational energy.

Legal aspects of thermal discharges

International Nuclear Information System (INIS)

Martin, A.J.

1974-01-01

An overview of those legal areas which directly affect technical and planning decisions is presented in the form of 2 legal approaches which constrain the indiscriminate release of thermal discharges to receiving waters. One takes the form of private remedies which have traditionally been available to aggrieved parties who are in some way damaged by the harmful discharge. The 2nd approach utilizes the various statutory constraints leading to direct governmental action. It appears that statutory law is playing the prominent role in restricting the temperature to which receiving waters may be raised as a result of such discharges by using effluent limitations and water quality standards. (Water Resour. Abstr.)

CT-MPR invaluable in diagnosing odontogenic maxillary sinusitis

International Nuclear Information System (INIS)

Aoki, Hideaki; Shimazu, Kaoru; Kamada, Morito; Shiroyama, Akihiro; Mouri, Daisuke; Yamashita, Masashi; Kawasaki, Yasunori; Koseki, Takakazu; Mouri, Manabu

2001-01-01

In everyday examination, it is usual to encounter odontogenic maxillary sinusitis patients. Odontogenic maxillary sinusitis is generally best diagnosed by dental X-ray imaging. Many medical facilities not having a dental X-ray unit use coronal computed tomography (CT) images to diagnose odontogenic maxillary sinusitis. Coronal CT imaging causes artifacts, however due to dental prosthesises. Computed tomography-Multiplanar reformation (CT-MPR) imaging has proved useful in evaluating the paranasal sinus because it is not influenced by dental prosthesises. We evaluated the usefulness of CT-MPR for diagnosing odontogenic maxillary sinusitis by retrospectively analyzing 16 patients, with the following results. We couldn't diagnose all cases of odontogenic maxillary sinusitis in posteroanterior and Waters projection images. Panoramic radiography is needed to diagnose odontogenic maxillary sinusitis. Dental X-ray imaging missed some cases, but all cases were diagnosed by CT-MPR imaging, giving a 100% diagnosestic rate. CT-MPR imaging is thus at least as valuable or better than dental X-ray imaging in diagnosing odontogenic maxillary sinusitis. (author)

The making of local hospital discharge arrangements

DEFF Research Database (Denmark)

Burau, Viola; Bro, Flemming

2015-01-01

Background Timely discharge is a key component of contemporary hospital governance and raises questions about how to move to more explicit discharge arrangements. Although associated organisational changes closely intersect with professional interests, there are relatively few studies in the lite......Background Timely discharge is a key component of contemporary hospital governance and raises questions about how to move to more explicit discharge arrangements. Although associated organisational changes closely intersect with professional interests, there are relatively few studies...... in the literature on hospital discharge that explicitly examine the role of professional groups. Recent contributions to the literature on organisational studies of the professions help to specify how professional groups in hospitals contribute to the introduction and routinisation of discharge arrangements...... for patients with prostate cancer in two hospitals in Denmark. This represents a typical case that involves changes in professional practice without being first and foremost a professional project. The multiple case design also makes the findings more robust. The analysis draws from 12 focus groups...

Validation studies of nursing diagnoses in neonatology

Directory of Open Access Journals (Sweden)

Pavlína Rabasová

2016-03-01

Full Text Available Aim: The objective of the review was the analysis of Czech and foreign literature sources and professional periodicals to obtain a relevant comprehensive overview of validation studies of nursing diagnoses in neonatology. Design: Review. Methods: The selection criterion was studies concerning the validation of nursing diagnoses in neonatology. To obtain data from relevant sources, the licensed professional databases EBSCO, Web of Science and Scopus were utilized. The search criteria were: date of publication - unlimited; academic periodicals - full text; peer-reviewed periodicals; search language - English, Czech and Slovak. Results: A total of 788 studies were found. Only 5 studies were eligible for content analysis, dealing specifically with validation of nursing diagnoses in neonatology. The analysis of the retrieved studies suggests that authors are most often concerned with identifying the defining characteristics of nursing diagnoses applicable to both the mother (parents and the newborn. The diagnoses were validated in the domains Role Relationship; Coping/Stress tolerance; Activity/Rest, and Elimination and Exchange. Diagnoses represented were from the field of dysfunctional physical needs as well as the field of psychosocial and spiritual needs. The diagnoses were as follows: Parental role conflict (00064; Impaired parenting (00056; Grieving (00136; Ineffective breathing pattern (00032; Impaired gas exchange (00030; and Impaired spontaneous ventilation (00033. Conclusion: Validation studies enable effective planning of interventions with measurable results and support clinical nursing practice.

Effects of pulse-to-pulse residual species on discharges in repetitively pulsed discharges through packed bed reactors

Science.gov (United States)

Kruszelnicki, Juliusz; Engeling, Kenneth W.; Foster, John E.; Kushner, Mark J.

2016-09-01

Atmospheric pressure dielectric barrier discharges (DBDs) sustained in packed bed reactors (PBRs) are being investigated for conversion of toxic and waste gases, and CO2 removal. These discharges are repetitively pulsed having varying flow rates and internal geometries, which results in species from the prior pulse still being in the discharge zone at the time the following discharge pulse occurs. A non-negligible residual plasma density remains, which effectively acts as preionization. This residual charge changes the discharge properties of subsequent pulses, and may impact important PBR properties such as chemical selectivity. Similarly, the residual neutral reactive species produced during earlier pulses will impact the reaction rates on subsequent pulses. We report on results of a computational investigation of a 2D PBR using the plasma hydrodynamics simulator nonPDPSIM. Results will be discussed for air flowing though an array of dielectric rods at atmospheric pressure. The effects of inter-pulse residual species on PBR discharges will be quantified. Means of controlling the presence of residual species in the reactor through gas flow rate, pulse repetition, pulse width and geometry will be described. Comparisons will be made to experiments. Work supported by US DOE Office of Fusion Energy Science and the National Science Foundation.

48 CFR 252.217-7014 - Discharge of liens.

Science.gov (United States)

2010-10-01

... discharged, any lien or right in rem of any kind, other than in favor of the Government, that exists or...) If any lien or right in rem is not immediately discharged, the Government, at the expense of the Contractor, may discharge, or cause to be discharged, the lien or right. (End of clause) ...

EPA Region 1 No Discharge Zones

Data.gov (United States)

U.S. Environmental Protection Agency — This dataset details No Discharge Zones (NDZ) for New England. Boaters may not discharge waste into these areas. Boundaries were determined mostly by Federal...

Plasma breakdown of low-pressure gas discharges

NARCIS (Netherlands)

Wagenaars, E.

2006-01-01

Natural gas discharges like lightning and polar light are spectacular phenomena that have impressed and fascinated people for a long time. During the last two centuries, people have learned how to create their own gas discharges and how to make use of them. Nowadays, man-made gas discharges are

Oxygen discharge and post-discharge kinetics experiments and modeling for the electric oxygen-iodine laser system.

Science.gov (United States)

Palla, A D; Zimmerman, J W; Woodard, B S; Carroll, D L; Verdeyen, J T; Lim, T C; Solomon, W C

2007-07-26

Laser oscillation at 1315 nm on the I(2P1/2)-->I(2P3/2) transition of atomic iodine has been obtained by a near resonant energy transfer from O2(a1Delta) produced using a low-pressure oxygen/helium/nitric oxide discharge. In the electric discharge oxygen-iodine laser (ElectricOIL) the discharge production of atomic oxygen, ozone, and other excited species adds levels of complexity to the singlet oxygen generator (SOG) kinetics which are not encountered in a classic purely chemical O2(a1Delta) generation system. The advanced model BLAZE-IV has been introduced to study the energy-transfer laser system dynamics and kinetics. Levels of singlet oxygen, oxygen atoms, and ozone are measured experimentally and compared with calculations. The new BLAZE-IV model is in reasonable agreement with O3, O atom, and gas temperature measurements but is under-predicting the increase in O2(a1Delta) concentration resulting from the presence of NO in the discharge and under-predicting the O2(b1Sigma) concentrations. A key conclusion is that the removal of oxygen atoms by NOX species leads to a significant increase in O2(a1Delta) concentrations downstream of the discharge in part via a recycling process; however, there are still some important processes related to the NOX discharge kinetics that are missing from the present modeling. Further, the removal of oxygen atoms dramatically inhibits the production of ozone in the downstream kinetics.

Fundamental Study on Electrical Discharge Machining

OpenAIRE

Uno, Yoshiyuki; Nakajima, Toshikatsu; Endo, Osamu

1989-01-01

The generation mechanism of crater in electrical discharge machining is analyzed with a single pulse discharge device for alloy tool steel, black alumina ceramics, cermet and cemented carbide, investigating the gap voltage, the discharge current, the shape of crater, the wear of electrode and so on. The experimental analysis makes it clear that the shape of crater has a characteristic feature for the kind of workpiece. The shape of electrode, which changes with the wear by an electric spark, ...

Groundwater Discharge along a Channelized Coastal Plain Stream

Energy Technology Data Exchange (ETDEWEB)

LaSage, Danita M [Ky Dept for natural resources, Div of Mine Permits; Sexton, Joshua L [JL Sexton and Son; Mukherjee, Abhijit [Univ of Tx, Jackson School of Geosciences, Bur of Econ. Geology; Fryar, Alan E [Univ of KY, Dept of Earth and Geoligical Sciences; Greb, Stephen F [Univ of KY, KY Geological Survey

2015-10-01

In the Coastal Plain of the southeastern USA, streams have commonly been artificially channelized for flood control and agricultural drainage. However, groundwater discharge along such streams has received relatively little attention. Using a combination of stream- and spring-flow measurements, spring temperature measurements, temperature profiling along the stream-bed, and geologic mapping, we delineated zones of diffuse and focused discharge along Little Bayou Creek, a channelized, first-order perennial stream in western Kentucky. Seasonal variability in groundwater discharge mimics hydraulic-head fluctuations in a nearby monitoring well and spring-discharge fluctuations elsewhere in the region, and is likely to reflect seasonal variability in recharge. Diffuse discharge occurs where the stream is incised into the semi-confined regional gravel aquifer, which is comprised of the Mounds Gravel. Focused discharge occurs upstream where the channel appears to have intersected preferential pathways within the confining unit. Seasonal fluctuations in discharge from individual springs are repressed where piping results in bank collapse. Thereby, focused discharge can contribute to the morphological evolution of the stream channel.

Dielectric barrier discharge in a two-phase mixture

Energy Technology Data Exchange (ETDEWEB)

Ye Qizheng; Zhang Ting; Lu Fei; Li Jin; He Zhenghao; Lin Fuchang [College of Electrical and Electronic Engineering, Huazhong University of Science and Technology, Wuhan 430074 (China)

2008-01-21

This paper reports the experimental investigation of the dielectric barrier discharge in which the gap area is filled with a two-phase mixture (TPM), air and solid particles. We found that there are two kinds of discharges in the TPM. One is the surface discharge generated on the surface of the solid particles and the other is the filament discharge generated in the air void. For the case of low volume fraction of solid particles, the surface discharge starts to occur when the applied voltage is higher than the onset voltage. At a further voltage increase, the filament discharge takes place at the same time. For the case of high volume fraction, such as the packed-bed reactor, only the surface discharge exists. Under the condition of the same volume fraction, the larger the diameter of the solid particles, the lower the surface discharge onset voltage. As a conclusion, we think that the plasma reactor using the form of low volume fraction of solid particles may be a better choice for waste-gas treatment enhanced by catalysts.