Examination of several pre-oxidation procedures and their effect as hydrogen permeation-barrier

International Nuclear Information System (INIS)

Heimes, E.

1986-03-01

Several pre-oxidation procedures have been tested with respect to their effect as a hydrogen permeation barrier at the high temperature alloys Hastelloy X and Inconel 617. By outside coating of Hastelloy X samples with alumina the determined impeding effects were very low. A surface aluminium enrichment by different procedures were accomplished before selective oxidation. The method of Aluminium-Hot-Dipping generated oxide layers with a four- to fivefold higher impeding effect compared to specimens fabricated by a standard procedure. With the aid of a metallographical follow-up examination it was shown that the higher impeding effects are due to an improved adhesion between the oxide layer and the high temperature material, whereby in the cooling period after manufacturing a smaller amount of oxide cracking is obtainable. (orig./PW) [de

Revision Arthroscopic Repair Versus Latarjet Procedure in Patients With Recurrent Instability After Initial Repair Attempt: A Cost-Effectiveness Model.

Science.gov (United States)

Makhni, Eric C; Lamba, Nayan; Swart, Eric; Steinhaus, Michael E; Ahmad, Christopher S; Romeo, Anthony A; Verma, Nikhil N

2016-09-01

To compare the cost-effectiveness of arthroscopic revision instability repair and Latarjet procedure in treating patients with recurrent instability after initial arthroscopic instability repair. An expected-value decision analysis of revision arthroscopic instability repair compared with Latarjet procedure for recurrent instability followed by failed repair attempt was modeled. Inputs regarding procedure cost, clinical outcomes, and health utilities were derived from the literature. Compared with revision arthroscopic repair, Latarjet was less expensive ($13,672 v $15,287) with improved clinical outcomes (43.78 v 36.76 quality-adjusted life-years). Both arthroscopic repair and Latarjet were cost-effective compared with nonoperative treatment (incremental cost-effectiveness ratios of 3,082 and 1,141, respectively). Results from sensitivity analyses indicate that under scenarios of high rates of stability postoperatively, along with improved clinical outcome scores, revision arthroscopic repair becomes increasingly cost-effective. Latarjet procedure for failed instability repair is a cost-effective treatment option, with lower costs and improved clinical outcomes compared with revision arthroscopic instability repair. However, surgeons must still incorporate clinical judgment into treatment algorithm formation. Level IV, expected value decision analysis. Copyright © 2016. Published by Elsevier Inc.

A Survey Comparing Delegation of Cosmetic Procedures Between Dermatologists and Nondermatologists.

Science.gov (United States)

Austin, Molly B; Srivastava, Divya; Bernstein, Ira H; Dover, Jeffrey S

2015-07-01

How delegation of procedures varies among cosmetic specialties in the United States is not well described. To better describe current practices in delegation of procedures to nonphysicians among physicians of different cosmetic specialties in the United States. An Internet-based survey was administered to physician members of the American Society for Dermatologic Surgery (ASDS), the American Society for Aesthetic Plastic Surgery (ASAPS), and the American Society for Laser Medicine and Surgery (ASLMS). A total of 823 responses were collected. Two hundred ninety-one of the 521 dermatologists (55.9%) reported delegating cosmetic procedures compared with 223 of the 302 nondermatologists (73.8%) (p delegation occurred, dermatologists were more likely than nondermatologists to delegate the following procedures to higher level non-physician providers (NPP): chemical peels, neuromodulator and filler injections, laser hair removal, pulsed dye laser, tattoo removal, intense pulsed light, nonablative fractional laser, and sclerotherapy. No difference in delegation rate was noted between dermatologists and non-dermatologist physicians with respect to microdermabrasion, ablative fractional laser, cryolipolysis, radiofrequency skin tightening, focused ultrasound skin tightening, and focused ultrasound fat reduction. Dermatologists delegate procedures to NPP less frequently than non-dermatologist physicians, and when they do, it is typically to higher level NPP.

Estimation of effective dose during hysterosalpingography procedures

International Nuclear Information System (INIS)

Alzimamil, K.; Babikir, E.; Alkhorayef, M.; Sulieman, A.; Alsafi, K.; Omer, H.

2014-08-01

Hysterosalpingography (HSG) is the most frequently used diagnostic tool to evaluate the endometrial cavity and fallopian tube by using conventional x-ray or fluoroscopy. Determination of the patient radiation doses values from x-ray examinations provides useful guidance on where best to concentrate efforts on patient dose reduction in order to optimize the protection of the patients. The aims of this study were to measure the patients entrance surface air kerma doses (ESA K), effective doses and to compare practices between different hospitals in Sudan. ESA K were measured for patient using calibrated thermo luminance dosimeters (TLDs, Gr-200A). Effective doses were estimated using National Radiological Protection Board (NRPB) software. This study was conducted in five radiological departments: Two Teaching Hospitals (A and D), two private hospitals (B and C) and one University Hospital (E). The mean ESD was 20.1 mGy, 28.9 mGy, 13.6 mGy, 58.65 mGy, 35.7, 22.4 and 19.6 mGy for hospitals A,B,C,D, and E), respectively. The mean effective dose was 2.4 mSv, 3.5 mSv, 1.6 mSv, 7.1 mSv and 4.3 mSv in the same order. The study showed wide variations in the ESDs with three of the hospitals having values above the internationally reported values. Number of x-ray images, fluoroscopy time, operator skills x-ray machine type and clinical complexity of the procedures were shown to be major contributors to the variations reported. Results demonstrated the need for standardization of technique throughout the hospital. The results also suggest that there is a need to optimize the procedures. Local DRLs were proposed for the entire procedures. (author)

Intravenous ketamine is as effective as midazolam/fentanyl for procedural sedation and analgesia in the emergency department.

Science.gov (United States)

Jamal, S M; Fathil, S M; Nidzwani, M M; Ismail, A K; Yatim, F M

2011-08-01

The study compared the effectiveness of ketamine and midazolam/fentanyl as procedural sedation and analgesia agents for reduction of fractures and dislocated joints. Forty-one adult patients were enrolled by convenience sampling. They were randomized to receive ketamine or midazolam/fentanyl. Depth of sedation, pain score, procedural outcome and memory of the procedure were documented. The ketamine group had deeper sedation, but there was no statistical difference in other variables between the two groups. Three patients in the midazolam/fentanyl group had oxygen desaturation. More adverse effects were associated with ketamine. Intravenous ketamine is as effective as midazolam/fentanyl for procedural sedation.

The operators' non-compliance behavior to conduct emergency operating procedures--comparing with the work experience and the complexity of procedural steps

International Nuclear Information System (INIS)

Park, Jinkyun; Jung, Wondea

2003-01-01

Many kinds of procedures have been used to reduce the operators' workload throughout various industries, such as in the aviation, the chemical and the nuclear industry. It is remarkable that, however, significant portion of accidents or incidents was caused by procedure related human error due to non-compliance of procedures. In this study, to investigate the operators' non-compliance behavior, emergency-training records were collected using a full scope simulator. And three types of the operators' behavior (such as strict adherence, skipping redundant actions and modifying action sequences) observed from collected emergency training records were compared with both their work experience and the complexity of procedural steps. As the results, three remarkable relationships are obtained. They are: (1) the operators who have an intermediate work experience seem to frequently adopt non-compliance behavior to conduct the procedural steps, (2) the operators seem to frequently adopt non-compliance behavior to conduct the procedural steps that have an intermediate procedural complexity, and (3) the senior reactor operators seem to accommodate their non-compliance behavior based on the complexity of procedural steps. Therefore, it is expected that these relationships can be used as meaningful clues not only to scrutinize the reason for non-compliance behavior but also to suggest appropriate remedies for the reduction of non-compliance behavior that can result in procedure related human error

Valve-Sparing Root Replacement Compared With Composite Valve Graft Procedures in Patients With Aortic Root Dilation.

Science.gov (United States)

Ouzounian, Maral; Rao, Vivek; Manlhiot, Cedric; Abraham, Nachum; David, Carolyn; Feindel, Christopher M; David, Tirone E

2016-10-25

Although aortic valve-sparing (AVS) operations are established alternatives to composite valve graft (CVG) procedures for patients with aortic root aneurysms, comparative long-term outcomes are lacking. This study sought to compare the results of patients undergoing AVS procedures with those undergoing CVG operations. From 1990 to 2010, a total of 616 patients age Marfan syndrome and lower rates of bicuspid aortic valve than those undergoing bio-CVG or m-CVG procedures. In-hospital mortality (0.3%) and stroke rate (1.3%) were similar among groups. After adjusting for clinical covariates, both bio-CVG and m-CVG procedures were associated with increased long-term major adverse valve-related events compared with patients undergoing AVS (hazard ratio [HR]: 3.4, p = 0.005; and HR: 5.2, p valve-related complications when compared with bio-CVG and m-CVG. AVS is the treatment of choice for young patients with aortic root aneurysm and normal or near-normal aortic cusps. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Effective and efficient learning in the operating theater with intraoperative video-enhanced surgical procedure training.

Science.gov (United States)

van Det, M J; Meijerink, W J H J; Hoff, C; Middel, B; Pierie, J P E N

2013-08-01

INtraoperative Video Enhanced Surgical procedure Training (INVEST) is a new training method designed to improve the transition from basic skills training in a skills lab to procedural training in the operating theater. Traditionally, the master-apprentice model (MAM) is used for procedural training in the operating theater, but this model lacks uniformity and efficiency at the beginning of the learning curve. This study was designed to investigate the effectiveness and efficiency of INVEST compared to MAM. Ten surgical residents with no laparoscopic experience were recruited for a laparoscopic cholecystectomy training curriculum either by the MAM or with INVEST. After a uniform course in basic laparoscopic skills, each trainee performed six cholecystectomies that were digitally recorded. For 14 steps of the procedure, an observer who was blinded for the type of training determined whether the step was performed entirely by the trainee (2 points), partially by the trainee (1 point), or by the supervisor (0 points). Time measurements revealed the total procedure time and the amount of effective procedure time during which the trainee acted as the operating surgeon. Results were compared between both groups. Trainees in the INVEST group were awarded statistically significant more points (115.8 vs. 70.2; p < 0.001) and performed more steps without the interference of the supervisor (46.6 vs. 18.8; p < 0.001). Total procedure time was not lengthened by INVEST, and the part performed by trainees was significantly larger (69.9 vs. 54.1 %; p = 0.004). INVEST enhances effectiveness and training efficiency for procedural training inside the operating theater without compromising operating theater time efficiency.

Plastic freezer bags: a cost-effective method to protect extraction sites in laparoscopic colorectal procedures?

Science.gov (United States)

Huynh, Hai P; Musselman, Reilly P; Trottier, Daniel C; Soto, Claudia M; Poulin, Eric C; Mamazza, Joseph; Boushey, Robin P; Auer, Rebecca C; Moloo, Husein

2013-10-01

To review surgical-site infection (SSI) and retrieval-site tumor recurrence rates in laparoscopic colorectal procedures when using a plastic freezer bag as a wound protector. Laparoscopic colorectal procedures where a plastic freezer bag used as a wound protector at the extraction site were reviewed between 1991 and 2008 from a prospectively collected database. χ test was used to compare SSI and tumor recurrence rates between groups. Costing data were obtained from the operating room supplies department. A total of 936 cases with 51 (5.45%) surgical-site infections were identified. SSI rates did not differ when comparing groups based on demographic factors, diagnosis, or location of procedure. Retrieval-site tumor recurrence rate was 0.21% (1/474). Cost of plastic freezer bags including sterilization ranged from $0.25 to $3. Plastic freezer bags as wound protectors in laparoscopic colorectal procedures are cost effective and have SSI and retrieval-site tumor recurrence rates that compare favorably to published data.

Societal and Economic Effect of Meniscus Scaffold Procedures for Irreparable Meniscus Injuries.

Science.gov (United States)

Rongen, Jan J; Govers, Tim M; Buma, Pieter; Grutters, Janneke P C; Hannink, Gerjon

2016-07-01

Meniscus scaffolds are currently evaluated clinically for their efficacy in preventing the development of osteoarthritis as well as for their efficacy in treating patients with chronic symptoms. Procedural costs, therapeutic consequences, clinical efficacy, and future events should all be considered to maximize the monetary value of this intervention. To examine the socioeconomic effect of treating patients with irreparable medial meniscus injuries with a meniscus scaffold. Economic and decision analysis; Level of evidence, 2. Two Markov simulation models for patients with an irreparable medial meniscus injury were developed. Model 1 was used to investigate the lifetime cost-effectiveness of a meniscus scaffold compared with standard partial meniscectomy by the possibility of preventing the development of osteoarthritis. Model 2 was used to investigate the short-term (5-year) cost-effectiveness of a meniscus scaffold compared with standard partial meniscectomy by alleviating clinical symptoms, specifically in chronic patients with previous meniscus surgery. For both models, probabilistic Monte Carlo simulations were applied. Treatment effectiveness was expressed as quality-adjusted life-years (QALYs), while costs (estimated in euros) were assessed from a societal perspective. We assumed €20,000 as a reference value for the willingness to pay per QALY. Next, comprehensive sensitivity analyses were performed to identify the most influential variables on the cost-effectiveness of meniscus scaffolds. Model 1 demonstrated an incremental cost-effectiveness ratio of a meniscus scaffold treatment of €54,463 per QALY (€5991/0.112). A threshold analysis demonstrated that a meniscus scaffold should offer a relative risk reduction of at least 0.34 to become cost-effective, assuming a willingness to pay of €20,000. Decreasing the costs of the meniscus scaffold procedure by 33% (€10,160 instead of €15,233; an absolute change of €5073) resulted in an incremental

Co-Creation Learning Procedures: Comparing Interactive Language Lessons for Deaf and Hearing Students.

Science.gov (United States)

Hosono, Naotsune; Inoue, Hiromitsu; Tomita, Yutaka

2017-01-01

This paper discusses co-creation learning procedures of second language lessons for deaf students, and sign language lessons by a deaf lecturer. The analyses focus on the learning procedure and resulting assessment, considering the disability. Through questionnaires ICT-based co-creative learning technologies are effective and efficient and promote spontaneous learning motivation goals.

Health and environmental impacts of electricity generation systems: procedures for comparative assessments

International Nuclear Information System (INIS)

Demin, V.F.

2002-01-01

The IAEA technical report involving description of the Manual for procedure of comparison risk assessment (CRA) and external cost (ECA) of environmental and public health effect from nuclear energetics and other power generation is treated. CRA and ECA results depend on national and regional social-economic, geographic, medical and demographic, and other features. When using CRA and ECA procedures developed in concrete countries their adaptation is necessary for conditions of other countries [ru

The step complexity measure for emergency operating procedures - comparing with simulation data

International Nuclear Information System (INIS)

Park, Jinkyun; Jung, Wondea; Kim, Jaewhan; Ha, Jaejoo; Shin, Yunghwa

2001-01-01

In complex systems, such as nuclear power plants (NPPs) or airplane control systems, human errors play a major role in many accidents. Therefore, to prevent occurrences of accidents or to ensure system safety, extensive effort has been made to identify significant factors that cause human errors. According to related studies, written manuals or operating procedures are revealed as one of the most important factors, and complexity or understandability of a procedure is pointed out as one of the major reasons that make procedure-related human errors. Many qualitative checklists are suggested to evaluate emergency operating procedures (EOPs) of NPPs. However, since qualitative evaluations using checklists have some drawbacks, a quantitative measure that can quantify the complexity of EOPs is imperative to compensate for them. In order to quantify the complexity of EOPs, Park et al. suggested the step complexity (SC) measure to quantify the complexity of a step included in EOPs. In this paper, to ensure the appropriateness of the SC measure, SC scores are compared with averaged step performance time data obtained from emergency training records. The total number of available records is 36, and training scenarios are the loss of coolant accident and the excess steam dump event. The number of scenario is 18 each. From these emergency training records, step performance time data for 39 steps are retrieved, and they are compared with estimated SC scores of them. In addition, several questions that are needed to clarify the appropriateness of the SC measure are also discussed. As a result, it was observed that estimated SC scores and step performance time data have a statistically meaningful correlation. Thus, it can be concluded that the SC measure can quantify the complexity of steps included in EOPs

Effect of ventilation procedures on the behaviour of a fire compartment scenario

Energy Technology Data Exchange (ETDEWEB)

Pretrel, H. [Institut de Radioprotection et de Surete Nucleaire (IRSN), Service d' Etude et de Recherches Experimentales sur les Accidents (SEREA), Laboratoire d' Experimentation des Feux -LEF, Centre de Cadarache, 13108 Cedex Saint Paul-lez-Durance (France)]. E-mail: hugues.pretrel@irsn.fr; Such, J.M. [Institut de Radioprotection et de Surete Nucleaire (IRSN), Service d' Etude et de Recherches Experimentales sur les Accidents (SEREA), Laboratoire d' Experimentation des Feux - LEF, Centre de Cadarache, 13108 Cedex Saint Paul-lez-Durance (France)

2005-09-01

This contribution presents a study on the consequences of applying ventilation procedures during a fire scenario involving a TPH/TBP pool fire in a ventilated enclosure. This research is addressed to fire safety in the nuclear industry in which ventilated enclosures remain a configuration frequently encountered. This work presents experiments comprising a 300 kW liquid pool fire in a 400 m{sup 3} vessel connected to an industrial ventilation system featuring one inlet and one exhaust branch. The investigated ventilation procedures consist in closing the inlet branch only or closing both inlet and exhaust branches. The analysis compares fire behaviour with and without the implementation of a ventilation procedure and points out the effects of said procedures on the combustion rate, fire duration and gas temperature within the vessel. It highlights pressure variations within the vessel when both the inlet and exhaust ventilation branches are closed. Conclusions provide practical answers that would be useful when designing appropriate ventilation strategies limiting fire hazards.

Effect of ventilation procedures on the behaviour of a fire compartment scenario

International Nuclear Information System (INIS)

Pretrel, H.; Such, J.M.

2005-01-01

This contribution presents a study on the consequences of applying ventilation procedures during a fire scenario involving a TPH/TBP pool fire in a ventilated enclosure. This research is addressed to fire safety in the nuclear industry in which ventilated enclosures remain a configuration frequently encountered. This work presents experiments comprising a 300 kW liquid pool fire in a 400 m 3 vessel connected to an industrial ventilation system featuring one inlet and one exhaust branch. The investigated ventilation procedures consist in closing the inlet branch only or closing both inlet and exhaust branches. The analysis compares fire behaviour with and without the implementation of a ventilation procedure and points out the effects of said procedures on the combustion rate, fire duration and gas temperature within the vessel. It highlights pressure variations within the vessel when both the inlet and exhaust ventilation branches are closed. Conclusions provide practical answers that would be useful when designing appropriate ventilation strategies limiting fire hazards

Critical Emergency Medicine Procedural Skills: A Comparative Study of Methods for Teaching and Assessment.

Science.gov (United States)

Chapman, Dane M.; And Others

Three critical procedural skills in emergency medicine were evaluated using three assessment modalities--written, computer, and animal model. The effects of computer practice and previous procedure experience on skill competence were also examined in an experimental sequential assessment design. Subjects were six medical students, six residents,…

Procedure automation: the effect of automated procedure execution on situation awareness and human performance

International Nuclear Information System (INIS)

Andresen, Gisle; Svengren, Haakan; Heimdal, Jan O.; Nilsen, Svein; Hulsund, John-Einar; Bisio, Rossella; Debroise, Xavier

2004-04-01

As advised by the procedure workshop convened in Halden in 2000, the Halden Project conducted an experiment on the effect of automation of Computerised Procedure Systems (CPS) on situation awareness and human performance. The expected outcome of the study was to provide input for guidance on CPS design, and to support the Halden Project's ongoing research on human reliability analysis. The experiment was performed in HAMMLAB using the HAMBO BWR simulator and the COPMA-III CPS. Eight crews of operators from Forsmark 3 and Oskarshamn 3 participated. Three research questions were investigated: 1) Does procedure automation create Out-Of-The-Loop (OOTL) performance problems? 2) Does procedure automation affect situation awareness? 3) Does procedure automation affect crew performance? The independent variable, 'procedure configuration', had four levels: paper procedures, manual CPS, automation with breaks, and full automation. The results showed that the operators experienced OOTL problems in full automation, but that situation awareness and crew performance (response time) were not affected. One possible explanation for this is that the operators monitored the automated procedure execution conscientiously, something which may have prevented the OOTL problems from having negative effects on situation awareness and crew performance. In a debriefing session, the operators clearly expressed their dislike for the full automation condition, but that automation with breaks could be suitable for some tasks. The main reason why the operators did not like the full automation was that they did not feel being in control. A qualitative analysis addressing factors contributing to response time delays revealed that OOTL problems did not seem to cause delays, but that some delays could be explained by the operators having problems with the freeze function of the CPS. Also other factors such as teamwork and operator tendencies were of importance. Several design implications were drawn

Comparative analysis of lockout programs and procedures applied to industrial machines

Energy Technology Data Exchange (ETDEWEB)

Chinniah, Y.; Champoux, M.; Burlet-Vienney, D.; Daigle, R. [Institut de recherche Robert-Sauve en sante et en securite du travail, Montreal, PQ (Canada)

2008-09-15

In 2005, approximately 20 workers in Quebec were killed by dangerous machines. Approximately 13,000 accidents in the province were linked to the use of machines. The resulting cost associated with these accidents was estimated to be $70 million to the Quebec Occupational Health and Safety Commission (CSST) in compensation and salary replacement. According to article 185 of the Quebec Occupational Health and Safety Regulation (RSST), workers intervening in hazardous zones of machines and processes during maintenance, repairs, and unjamming activities must apply lockout procedures. Lockout is defined as the placement of a lock or tag on an energy-isolating device in accordance with an established procedure, indicating that the energy-isolating device is not to be operated until removal of the lock or tag in accordance with an established procedure. This report presented a comparative analysis of lockout programs and procedures applied to industrial machines. The study attempted to answer several questions regarding the concept of lockout and its definition in the literature; the differences between legal lockout requirements among provinces and countries; different standards on lockout; the contents of lockout programs as described by different documents; and the compliance of lockout programs in a sample of industries in Quebec in terms of Canadian standard on lockout, the CSA Z460-05 (2005). The report discussed the research objectives, methodology, and results of the study. It was concluded that the concept of lockout has different meanings or definitions in the literature, especially in regulations. However, definitions of lockout which are found in standards have certain similarities. 50 refs., 52 tabs., 2 appendices.

A comparative assessment of alternative waste management procedures for selected reprocessing wastes

International Nuclear Information System (INIS)

Hickford, G.E.; Plews, M.J.

1983-07-01

This report, which has been prepared by Associated Nuclear Services for the Department of the Environment, presents the results of a study and comparative assessment of management procedures for low and intermediate level solid waste streams arising from current and future fuel reprocessing operations on the Sellafield site. The characteristics and origins of the wastes under study are discussed and a reference waste inventory is presented, based on published information. Waste management strategy in the UK and its implications for waste conditioning, packaging and disposal are discussed. Wastes currently arising which are not suitable for Drigg burial or sea dumping are stored in an untreated form. Work is in hand to provide additional and improved disposal facilities which will accommodate all the waste streams under study. For each waste stream viable procedures are identified for further assessment. The procedures comprise a series of on-site operations-recovery from storage, pre-treatment, treatment, encapsulation, and packaging, prior to storage or disposal of the conditioned waste form. Assessments and comparisons of each procedure for each waste are presented. These address various process, operational, economic, radiological and general safety factors. The results are presented in a series of tables with supporting text. For the majority of wastes direct encapsulation with minimal treatment appears to be a viable procedure. Occupational exposure and general safety are not identified as significant factors governing the choice of procedures. The conditioned wastes meet the general requirements for safe handling during storage and transportation. The less active wastes suitable for disposal by currently available routes meet the appropriate disposal criteria. It is not possible to consider in detail the suitability for disposal of the more active wastes for which disposal facilities are not yet available. (Author)

Failure mode and effects analysis: an empirical comparison of failure mode scoring procedures.

Science.gov (United States)

Ashley, Laura; Armitage, Gerry

2010-12-01

To empirically compare 2 different commonly used failure mode and effects analysis (FMEA) scoring procedures with respect to their resultant failure mode scores and prioritization: a mathematical procedure, where scores are assigned independently by FMEA team members and averaged, and a consensus procedure, where scores are agreed on by the FMEA team via discussion. A multidisciplinary team undertook a Healthcare FMEA of chemotherapy administration. This included mapping the chemotherapy process, identifying and scoring failure modes (potential errors) for each process step, and generating remedial strategies to counteract them. Failure modes were scored using both an independent mathematical procedure and a team consensus procedure. Almost three-fifths of the 30 failure modes generated were scored differently by the 2 procedures, and for just more than one-third of cases, the score discrepancy was substantial. Using the Healthcare FMEA prioritization cutoff score, almost twice as many failure modes were prioritized by the consensus procedure than by the mathematical procedure. This is the first study to empirically demonstrate that different FMEA scoring procedures can score and prioritize failure modes differently. It found considerable variability in individual team members' opinions on scores, which highlights the subjective and qualitative nature of failure mode scoring. A consensus scoring procedure may be most appropriate for FMEA as it allows variability in individuals' scores and rationales to become apparent and to be discussed and resolved by the team. It may also yield team learning and communication benefits unlikely to result from a mathematical procedure.

Effect of music in endoscopy procedures: systematic review and meta-analysis of randomized controlled trials.

Science.gov (United States)

Wang, Man Cai; Zhang, Ling Yi; Zhang, Yu Long; Zhang, Ya Wu; Xu, Xiao Dong; Zhang, You Cheng

2014-10-01

Endoscopies are common clinical examinations that are somewhat painful and even cause fear and anxiety for patients. We performed this systematic review and meta-analysis of randomized controlled trials to determine the effect of music on patients undergoing various endoscopic procedures. We searched the Cochrane Library, Issue 6, 2013, PubMed, and EMBASE databases up to July 2013. Randomized controlled trials comparing endoscopies, with and without the use of music, were included. Two authors independently abstracted data and assessed risk of bias. Subgroup analyses were performed to examine the impact of music on different types of endoscopic procedures. Twenty-one randomized controlled trials involving 2,134 patients were included. The overall effect of music on patients undergoing a variety of endoscopic procedures significantly improved pain score (weighted mean difference [WMD] = -1.53, 95% confidence interval [CI] [-2.53, -0.53]), anxiety (WMD = -6.04, 95% CI [-9.61, -2.48]), heart rate (P = 0.01), arterial pressure (P music group, compared with the control group. Furthermore, music had little effect for patients undergoing colposcopy and bronchoscopy in the subanalysis. Our meta-analysis suggested that music may offer benefits for patients undergoing endoscopy, except in colposcopy and bronchoscopy. Wiley Periodicals, Inc.

Cocaine Versus Food Choice Procedure in Rats: Environmental Manipulations and Effects of Amphetamine

Science.gov (United States)

Thomsen, Morgane; Barrett, Andrew C.; Negus, S. Stevens; Caine, S. Barak

2014-01-01

We have adapted a nonhuman primate model of cocaine versus food choice to the rat species. To evaluate the procedure, we tested cocaine versus food choice under a variety of environmental manipulations as well as pharmacological pretreatments. Complete cocaine-choice dose-effect curves (0–1.0 mg/kg/infusion) were obtained for each condition under concurrent fixed ratio schedules of reinforcement. Percentage of responding emitted on the cocaine-reinforced lever was not affected significantly by removal of cocaine-associated visual or auditory cues, but it was decreased after removal of response-contingent or response-independent cocaine infusions. Cocaine choice was sensitive to the magnitude and fixed ratio requirement of both the cocaine and food reinforcers. We also tested the effects of acute (0.32, 0.56, 1.0, 1.8 mg/kg) and chronic (0.1, 0.32 mg/kg/hr) d-amphetamine treatment on cocaine choice. Acute and chronic d-amphetamine had opposite effects, with acute increasing and chronic decreasing cocaine choice, similar to observations in humans and in nonhuman primates. The results suggest feasibility and utility of the choice procedure in rats and support its comparability to similar procedures used in humans and monkeys. PMID:23319458

To evaluate and compare the efficacy of combined sucrose and non-nutritive sucking for analgesia in newborns undergoing minor painful procedure: a randomized controlled trial.

Science.gov (United States)

Thakkar, P; Arora, K; Goyal, K; Das, R R; Javadekar, B; Aiyer, S; Panigrahi, S K

2016-01-01

The objective of this study was to evaluate and compare the efficacy of combined sucrose and non-nutritive sucking (NNS) for analgesia in newborn infants undergoing heel-stick procedures. This randomized control trial was conducted in the neonatal intensive care unit of a tertiary care hospital over a period of 1 year. One hundred and eighty full-term neonates with birth weight >2200 g and age >24 h were randomized to one of four interventions administered 2 min before the procedure: 2 ml of 30% sucrose (group I, n=45) or NNS (group II, n=45) or both (group III, n=45) or none (group IV, n=45). Primary outcome was composite score based on Premature Infant Pain Profile (PIPP) score. Baseline variables were comparable among the groups. Median (interquartile range) PIPP score was 3 (2 to 4) in group III as compared with 7 (6.5 to 8) in group I, 9 (7 to 11) in group II and 13 (10.5 to 15) in group IV. Group III had significant decrease in the median PIPP score compared with other groups (P=0.000). Median PIPP score also decreased significantly with any intervention as compared with no intervention (P=0.000). Sucrose and/or NNS are effective in providing analgesia in full-term neonates undergoing heel-stick procedures, with the combined intervention being more effective compared with any single intervention.

A randomized clinical trial comparing cervical dysplasia treatment with cryotherapy vs loop electrosurgical excision procedure in HIV-seropositive women from Johannesburg, South Africa.

Science.gov (United States)

Smith, Jennifer S; Sanusi, Busola; Swarts, Avril; Faesen, Mark; Levin, Simon; Goeieman, Bridgette; Ramotshela, Sibongile; Rakhombe, Ntombiyenkosi; Williamson, Anna L; Michelow, Pam; Omar, Tanvier; Hudgens, Michael G; Firnhaber, Cynthia

2017-08-01

Mortality associated with cervical cancer is a public health concern for women, particularly in HIV-seropositive women in resource-limited countries. HIV-seropositive women are at a higher risk of high-grade cervical precancer, which can eventually progress to invasive carcinoma as compared to HIV-seronegative women. It is imperative to identify effective treatment methods for high-grade cervical precursors among HIV-seropositive women. Randomized controlled trial data are needed comparing cryotherapy vs loop electrosurgical excision procedure treatment efficacy in HIV-seropositive women. Our primary aim was to compare the difference in the efficacy of loop electrosurgical excision procedure vs cryotherapy for the treatment of high-grade cervical intraepithelial neoplasia (grade ≥2) among HIV-seropositive women by conducting a randomized clinical trial. HIV-seropositive women (n = 166) aged 18-65 years with histology-proven cervical intraepithelial neoplasia grade ≥2 were randomized (1:1) to cryotherapy or loop electrosurgical excision procedure treatment at a government hospital in Johannesburg. Treatment efficacy was compared using 6- and 12-month cumulative incidence posttreatment of: (1) cervical intraepithelial neoplasia grade ≥2; (2) secondary endpoints of histologic cervical intraepithelial neoplasia grade ≥3 and grade ≥1; and (3) high-grade and low-grade cervical cytology. The study was registered (ClinicalTrials.govNCT01723956). From January 2010 through August 2014, 166 participants were randomized (86 loop electrosurgical excision procedure; 80 cryotherapy). Cumulative cervical intraepithelial neoplasia grade ≥2 incidence was higher for cryotherapy (24.3%; 95% confidence interval, 16.1-35.8) than loop electrosurgical excision procedure at 6 months (10.8%; 95% confidence interval, 5.7-19.8) (P = .02), although by 12 months, the difference was not significant (27.2%; 95% confidence interval, 18.5-38.9 vs 18.5%; 95% confidence interval, 11

Postoperative pain in complex ophthalmic surgical procedures: comparing practice with guidelines.

Science.gov (United States)

Lesin, Mladen; Sundov, Zeljka Duplancic; Jukic, Marko; Puljak, Livia

2014-06-01

To analyze the management of postoperative pain after complex ophthalmic surgery and to compare it to the guidelines. A retrospective study. University Hospital Split, Croatia. Patients (N = 447) who underwent complex ophthalmic surgical procedures from 2008 to 2012. The following data were extracted from patient medical records: age, gender, type and dosage of premedication, preoperative patient's physical status, type of procedure, duration of procedure-surgical and anesthesia time, type and dosage of anesthesia, the type and dosage of postoperative analgesia for each postoperative day. None of the patients had information about pain intensity in their records. There were 90% patients who did not receive any medication the night before surgery, 54% did not receive any premedication immediately before surgery, 19% did not receive any pain medication after the surgery in the operating room and 46% of patients did not receive any analgesics after being released to the ophthalmology department. Among those who received analgesia after surgery, 98% received only one dose of an analgesic, and 93% of patients received analgesia only on the day of the surgery. Furthermore, patients were returned to the department immediately after surgery, without intensive monitoring. During the analyzed five years there were no educational session organized by anesthesiologist to the ophthalmic surgeons. Postoperative pain management and perioperative care of patients undergoing major ophthalmic surgery indicates lack of attention towards pain intensity and postoperative analgesia. Appropriate interventions should be employed to improve postoperative pain management, to facilitate patient recovery. Wiley Periodicals, Inc.

Randomised controlled trial to assess the effect of a Just-in-Time training on procedural performance: a proof-of-concept study to address procedural skill decay.

Science.gov (United States)

Branzetti, Jeremy B; Adedipe, Adeyinka A; Gittinger, Matthew J; Rosenman, Elizabeth D; Brolliar, Sarah; Chipman, Anne K; Grand, James A; Fernandez, Rosemarie

2017-11-01

A subset of high-risk procedures present significant safety threats due to their (1) infrequent occurrence, (2) execution under time constraints and (3) immediate necessity for patient survival. A Just-in-Time (JIT) intervention could provide real-time bedside guidance to improve high-risk procedural performance and address procedural deficits associated with skill decay. To evaluate the impact of a novel JIT intervention on transvenous pacemaker (TVP) placement during a simulated patient event. This was a prospective, randomised controlled study to determine the effect of a JIT intervention on performance of TVP placement. Subjects included board-certified emergency medicine physicians from two hospitals. The JIT intervention consisted of a portable, bedside computer-based procedural adjunct. The primary outcome was performance during a simulated patient encounter requiring TVP placement, as assessed by trained raters using a technical skills checklist. Secondary outcomes included global performance ratings, time to TVP placement, number of critical omissions and System Usability Scale scores (intervention only). Groups were similar at baseline across all outcomes. Compared with the control group, the intervention group demonstrated statistically significant improvement in the technical checklist score (11.45 vs 23.44, p<0.001, Cohen's d effect size 4.64), the global rating scale (2.27 vs 4.54, p<0.001, Cohen's d effect size 3.76), and a statistically significant reduction in critical omissions (2.23 vs 0.68, p<0.001, Cohen's d effect size -1.86). The difference in time to procedural completion was not statistically significant between conditions (11.15 min vs 12.80 min, p=0.12, Cohen's d effect size 0.65). System Usability Scale scores demonstrated excellent usability. A JIT intervention improved procedure perfromance, suggesting a role for JIT interventions in rarely performed procedures. © Article author(s) (or their employer(s) unless otherwise stated in

Cocaine versus food choice procedure in rats: environmental manipulations and effects of amphetamine.

Science.gov (United States)

Thomsen, Morgane; Barrett, Andrew C; Negus, S Stevens; Caine, S Barak

2013-03-01

We have adapted a nonhuman primate model of cocaine versus food choice to the rat species. To evaluate the procedure, we tested cocaine versus food choice under a variety of environmental manipulations as well as pharmacological pretreatments. Complete cocaine-choice dose-effect curves (0-1.0 mg/kg/infusion) were obtained for each condition under concurrent fixed ratio schedules of reinforcement. Percentage of responding emitted on the cocaine-reinforced lever was not affected significantly by removal of cocaine-associated visual or auditory cues, but it was decreased after removal of response-contingent or response-independent cocaine infusions. Cocaine choice was sensitive to the magnitude and fixed ratio requirement of both the cocaine and food reinforcers. We also tested the effects of acute (0.32, 0.56, 1.0, 1.8 mg/kg) and chronic (0.1, 0.32 mg/kg/hr) d-amphetamine treatment on cocaine choice. Acute and chronic d-amphetamine had opposite effects, with acute increasing and chronic decreasing cocaine choice, similar to observations in humans and in nonhuman primates. The results suggest feasibility and utility of the choice procedure in rats and support its comparability to similar procedures used in humans and monkeys. © Society for the Experimental Analysis of Behavior.

Comparing the 810nm diode laser with conventional surgery in orthodontic soft tissue procedures.

Science.gov (United States)

Ize-Iyamu, I N; Saheeb, B D; Edetanlen, B E

2013-09-01

To compare the use of the 810nm diode laser with conventional surgery in the management of soft tissue mucogingival problems associated with orthodontic treatment. Orthodontic patients requiring different soft tissue surgical procedures were randomly assigned to receive conventional surgery or soft tissue diode laser, (wavelength 810 nm). Parameters documented include the type of anaesthesia used, intra and post operative pain, bleeding, the use of scalpel and sutures. The chi-squared test was used to test for significance at 95% confidence level. Probability values (p-values) less than 0.05 were regarded as significant. Only 2(16.7%) of the procedures carried out with the soft tissue laser required infiltration anaesthesia compared to 10 (90.9%) with conventional surgery and this was significant (Pdiode laser (Pdiode laser. No sutures were used in all soft tissue cases managed with the diode laser and this was significant (Plaser compared with conventional surgery. Orthodontic patients treated with the diode laser required less infiltration anaesthesia, had reduced bleeding during and after surgery, rapid postoperative haemostasis, elimination of the need for sutures and an improved postoperative comfort and healing.

HYPNOSIS FOR ACUTE PROCEDURAL PAIN: A Critical Review

Science.gov (United States)

Kendrick, Cassie; Sliwinski, Jim; Yu, Yimin; Johnson, Aimee; Fisher, William; Kekecs, Zoltán; Elkins, Gary

2015-01-01

Clinical evidence for the effectiveness of hypnosis in the treatment of acute, procedural pain was critically evaluated based on reports from randomized controlled clinical trials (RCTs). Results from the 29 RCTs meeting inclusion criteria suggest that hypnosis decreases pain compared to standard care and attention control groups and that it is at least as effective as comparable adjunct psychological or behavioral therapies. In addition, applying hypnosis in multiple sessions prior to the day of the procedure produced the highest percentage of significant results. Hypnosis was most effective in minor surgical procedures. However, interpretations are limited by considerable risk of bias. Further studies using minimally effective control conditions and systematic control of intervention dose and timing are required to strengthen conclusions. PMID:26599994

Hypnosis for Acute Procedural Pain: A Critical Review.

Science.gov (United States)

Kendrick, Cassie; Sliwinski, Jim; Yu, Yimin; Johnson, Aimee; Fisher, William; Kekecs, Zoltán; Elkins, Gary

2016-01-01

Clinical evidence for the effectiveness of hypnosis in the treatment of acute procedural pain was critically evaluated based on reports from randomized controlled clinical trials (RCTs). Results from the 29 RCTs meeting inclusion criteria suggest that hypnosis decreases pain compared to standard care and attention control groups and that it is at least as effective as comparable adjunct psychological or behavioral therapies. In addition, applying hypnosis in multiple sessions prior to the day of the procedure produced the highest percentage of significant results. Hypnosis was most effective in minor surgical procedures. However, interpretations are limited by considerable risk of bias. Further studies using minimally effective control conditions and systematic control of intervention dose and timing are required to strengthen conclusions.

HIFU procedures at moderate intensities-effect of large blood vessels

International Nuclear Information System (INIS)

Hariharan, P; Myers, M R; Banerjee, R K

2007-01-01

A three-dimensional computational model is presented for studying the efficacy of high-intensity focused ultrasound (HIFU) procedures targeted near large blood vessels. The analysis applies to procedures performed at intensities below the threshold for cavitation, boiling and highly nonlinear propagation, but high enough to increase tissue temperature a few degrees per second. The model is based upon the linearized KZK equation and the bioheat equation in tissue. In the blood vessel the momentum and energy equations are satisfied. The model is first validated in a tissue phantom, to verify the absence of bubble formation and nonlinear effects. Temperature rise and lesion-volume calculations are then shown for different beam locations and orientations relative to a large vessel. Both single and multiple ablations are considered. Results show that when the vessel is located within about a beam width (few mm) of the ultrasound beam, significant reduction in lesion volume is observed due to blood flow. However, for gaps larger than a beam width, blood flow has no major effect on the lesion formation. Under the clinically representative conditions considered, the lesion volume is reduced about 40% (relative to the no-flow case) when the beam is parallel to the blood vessel, compared to about 20% for a perpendicular orientation. Procedures involving multiple ablation sites are affected less by blood flow than single ablations. The model also suggests that optimally focused transducers can generate lesions that are significantly larger (>2 times) than the ones produced by highly focused beams

HIFU procedures at moderate intensities-effect of large blood vessels

Energy Technology Data Exchange (ETDEWEB)

Hariharan, P [Mechanical, Industrial, and Nuclear Engineering Department, University of Cincinnati, Cincinnati, OH (United States); Myers, M R [Division of Solid and Fluid Mechanics, Center for Devices and Radiological Health, US Food and Drug Administration, 10903 New Hampshire Avenue, Building 62, Silver Spring, MD 20993-0002 (United States); Banerjee, R K [Mechanical, Industrial, and Nuclear Engineering Department, University of Cincinnati, Cincinnati, OH (United States)

2007-07-21

A three-dimensional computational model is presented for studying the efficacy of high-intensity focused ultrasound (HIFU) procedures targeted near large blood vessels. The analysis applies to procedures performed at intensities below the threshold for cavitation, boiling and highly nonlinear propagation, but high enough to increase tissue temperature a few degrees per second. The model is based upon the linearized KZK equation and the bioheat equation in tissue. In the blood vessel the momentum and energy equations are satisfied. The model is first validated in a tissue phantom, to verify the absence of bubble formation and nonlinear effects. Temperature rise and lesion-volume calculations are then shown for different beam locations and orientations relative to a large vessel. Both single and multiple ablations are considered. Results show that when the vessel is located within about a beam width (few mm) of the ultrasound beam, significant reduction in lesion volume is observed due to blood flow. However, for gaps larger than a beam width, blood flow has no major effect on the lesion formation. Under the clinically representative conditions considered, the lesion volume is reduced about 40% (relative to the no-flow case) when the beam is parallel to the blood vessel, compared to about 20% for a perpendicular orientation. Procedures involving multiple ablation sites are affected less by blood flow than single ablations. The model also suggests that optimally focused transducers can generate lesions that are significantly larger (>2 times) than the ones produced by highly focused beams.

The Ross procedure offers excellent survival compared with mechanical aortic valve replacement in a real-world setting.

Science.gov (United States)

Andreas, Martin; Wiedemann, Dominik; Seebacher, Gernot; Rath, Claus; Aref, Tandis; Rosenhek, Raphael; Heinze, Georg; Eigenbauer, Ernst; Simon, Paul; Ruetzler, Kurt; Hiesmayr, Joerg-Michael; Moritz, Anton; Laufer, Guenther; Kocher, Alfred

2014-09-01

The ideal prosthesis for young patients requiring aortic valve replacement has not been defined to date. Although the Ross procedure provides excellent survival, its application is still limited. We compared the long-term survival after the Ross procedure with mechanical aortic valve replacement. All consecutive Ross procedures and mechanical aortic valve replacements performed between 1991 and 2008 at a single centre were analysed. Only adult patients between 18 and 50 years of age were included in the study. Survival and valve-related complications were evaluated. Furthermore, survival was compared with the age- and sex-matched Austrian population. A total of 159 Ross patients and 173 mechanical valve patients were included. The cumulative survival for the Ross procedure was significantly better, with survival rates of 96, 94 and 93% at 5, 10 and 15 years, respectively, in comparison to 90, 84 and 75% (P Ross group but was significantly reduced in the mechanical valve group. In a real-world setting, the Ross procedure is associated with a long-term survival benefit in young adults in comparison to mechanical aortic valve replacement. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

25 CFR 291.15 - How long do Class III gaming procedures remain in effect?

Science.gov (United States)

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false How long do Class III gaming procedures remain in effect... ENTERPRISES CLASS III GAMING PROCEDURES § 291.15 How long do Class III gaming procedures remain in effect? Class III gaming procedures remain in effect for the duration specified in the procedures or until...

Comparing imaging procedures: techniques and examples. Gastroenterology

International Nuclear Information System (INIS)

Malmud, L.S.

1982-01-01

The distinct advantages of nuclear medicine procedures, in comparison to radiography, contrast studies, computerized tomography and ultrasound, are emphasized. Scintigraphic methods offer quantitative data regarding function which competing imaging modalities are unable to provide, and make them the studies of choice in the evaluation of gastrointestinal physiology and functional abnormalities

COMPARATIVE ANALYSIS OF QUANTUM EFFECTS IN NANOSCALE MULTIGATE MOSFETS USING VARIATIONAL APPROACH

Directory of Open Access Journals (Sweden)

V. PALANICHAMY

2015-02-01

Full Text Available In this work, the performance of multiple-gate SOI MOSFETs is analysed using variational approach including quantum effects. An analytical model is derived to accounting the quantum effects at the silicon (Si/silicon dioxide (SiO2 interface. A general procedure is used for calculating the quantum inversion charge density. Using this inversion charge density, the drain current is obtained. Our model results are compared with the simulation results and its shows very good agreement. Our results highlighted that cylindrical surrounding gate MOSFET is a good candidate to obtain the high drain current compared with other two devices.

[Cognitive aging mechanism of signaling effects on the memory for procedural sentences].

Science.gov (United States)

Yamamoto, Hiroki; Shimada, Hideaki

2006-08-01

The aim of this study was to clarify the cognitive aging mechanism of signaling effects on the memory for procedural sentences. Participants were 60 younger adults (college students) and 60 older adults. Both age groups were assigned into two groups; half of each group was presented with procedural sentences with signals that highlighted their top-level structure and the other half with procedural sentences without them. Both groups were requested to perform the sentence arrangement task and the reconstruction task. Each task was composed of procedural sentences with or without signals. Results indicated that signaling supported changes in strategy utilization during the successive organizational processes and that changes in strategy utilization resulting from signaling improved the memory for procedural sentences. Moreover, age-related factors interfered with these signaling effects. This study clarified the cognitive aging mechanism of signaling effects in which signaling supports changes in the strategy utilization during organizational processes at encoding and this mediation promotes memory for procedural sentences, though disuse of the strategy utilization due to aging restrains their memory for procedural sentences.

Comparative clinical evaluation of transcutaneous electrical nerve stimulator over conventional local anesthesia in children seeking dental procedures: A clinical study

Directory of Open Access Journals (Sweden)

M Varadharaja

2014-01-01

Full Text Available Aim: The aim of this study to evaluate the effectiveness of pain control by employing transcutaneous electrical nerve stimulator (TENS over conventional injectable local anesthesia for children requiring restorative procedures under rubber dam. Materials and Methods: The study design considered was the split mouth design, in experiment (right side, dental procedures under rubber dam was performed under TENS and in control (left side, dental procedures under rubber dam was performed under conventional injectable local anesthetic (LA. The level of comfort and discomfort experienced during TENS and conventional LA was determined using visual analog scale (VAS and heart rate. Result: Increase in mean heart rate associated with TENS (0.78% was significantly less compared to increase in heart rate with administration of conventional local anesthesia (11.78%. In VAS, the mean values for pain indicate that minimum pain was felt with TENS, which was closely followed by LA. Conclusion: TENS can offer many safer and psychological advantages and is a valuable alternative to conventional LA for children.

Residual stress effects in LMFBR fracture assessment procedures

International Nuclear Information System (INIS)

Hooton, D.G.

1984-01-01

Two post-yield fracture mechanics methods, which have been developed into fully detailed failure assessment procedures for ferritic structures, have been reviewed from the point of view of the manner in which as-welded residual stress effects are incorporated, and comparisons then made with finite element and theoretical models of centre-cracked plates containing residual/thermal stresses in the form of crack-driving force curves. Applying the procedures to austenitic structures, comparisons are made in terms of failure assessment curves and it is recommended that the preferred method for the prediction of critical crack sizes in LMFBR austenitic structures containing as-welded residual stresses is the CEGB-R6 procedure based on a flow stress defined at 3% strain in the parent plate. When the prediction of failure loads in such structures is required, it is suggested that the CEGB-R6 procedure be used with residual/thermal stresses factored to give a maximum total stress of flow stress magnitude

The minimal ice water caloric test compared with established vestibular caloric test procedures.

Science.gov (United States)

Schmäl, Frank; Lübben, Björn; Weiberg, Kerstin; Stoll, Wolfgang

2005-01-01

Caloric testing of the vestibular labyrinth is usually performed by classical caloric test procedures (CCTP) using water warmed to 30 degrees C and 44 degrees C. Ice water irrigation (4 degrees C) is usually not performed, although it might be useful as a bedside test. To verify the validity of the Minimal Ice Water Caloric Test (MIWCT), comparative video-oculographic investigations were performed in 22 healthy subjects using ice water (0.5 ml, 1.0 ml, 2 ml), CCTP, and cold air (27 degrees C). Frequency, amplitude, slow phase velocity (SPV), the onset, and the duration of nystagmus were documented. After addition of three ice cubes, the temperature of conventional tap water (16 degrees C) fell within 13 min to 4 degrees C. In pessimum position the subjects demonstrated no nystagmus response. Compared to CCTP, MIWCT was associated with a significantly later onset of nystagmus and a significant prolongation of the nystagmus reaction. In contrast to air stimulation (27 degrees C), a significant Spearman's correlation was noted between MIWCT (1 and 2 ml) and established CCTP in respect of essential nystagmus parameters (frequency, amplitude and SPV). Furthermore, MIWCT (0.5 and 1 ml) showed a higher sensitivity and specificity with regard to the detection of canal paresis based on Jongkees' formula compared to stimulation with air 27 degrees C. Thus, MIWCT appears to be a suitable procedure for bedside investigation of vestibular function outside the vestibular laboratory, e.g. in a hospital ward, where bedridden patients with vertigo occasionally require vestibular testing.

Effectiveness of sublingual nitroglycerin before puncture compared with conventional intra-arterial nitroglycerin in transradial procedures: a randomized trial

Energy Technology Data Exchange (ETDEWEB)

Turan, Burak, E-mail: drburakturan@gmail.com; Daşlı, Tolga; Erkol, Ayhan; Erden, İsmail

2015-10-15

Aim: Sublingual (SL) nitroglycerin administered before radial artery puncture can improve cannulation success and decrease the incidence of radial artery spasm (RAS) compared with intra-arterial (IA) nitroglycerin in transradial procedures. Methods: Patients undergoing diagnostic transradial angiography were randomized to IA (200 mcg) or SL (400 mcg) nitroglycerin. Primary endpoints were puncture time and puncture attempts. Secondary endpoint was the incidence of RAS. Results: Total of 101 participants (mean age 60 ± 11 years, 53% male) were randomized (51 in IA and 50 in SL groups). Puncture time (50 [36–75] vs 50 [35–90] sec), puncture attempts (1.18 ± 0.48 vs 1.20 ± 0.49), multiple punctures (13.7 vs 16.0%) and RAS (19.6 vs 24.0%) were not statistically different between IA vs SL groups respectively. A composite endpoint of all adverse events related to transradial angiography (multiple punctures, RAS, access site crossover, hypotension/bradycardia associated with nitroglycerin and radial artery occlusion) was very similar in IA vs SL groups (39 vs 40%, respectively). However puncture time was significantly longer with SL nitroglycerin in patients < 1.65 m height (47 [36–66] vs 63 [41–110] sec, p = 0.042). Multiple punctures seemed higher with SL nitroglycerin in patients with diabetes (0 vs 30%, p = 0.028) or in patients < 1.65 m height (7.4 vs 25%, p = 0.085). Likewise, RAS with SL nitroglycerin seemed more frequent in smokers compared to IA nitroglycerin (0 vs 27%, p = 0.089). Conclusions: SL nitroglycerin was not different from IA nitroglycerin in terms of efficiency and safety in overall study population. However it may be inferior to IA nitroglycerin in certain subgroups (shorter individuals, diabetics and smokers). - Highlights: • Improvement in radial artery puncture time and success with subcutaneous nitrate was reported. • Giving nitrate sublingually may have vasodilation along entire length of radial artery and may prevent RAS

Procedural justice effects on self-esteem under certainty versus uncertainty emotions

OpenAIRE

Cremer, David; Hiel, Alain

2008-01-01

textabstractBuilding upon the idea that procedural justice effects are more pronounced when uncertainty is high, we proposed that recall of an uncertainty-eliciting emotion (fear) will render people more responsive to variations in procedural justice than will recall of a certainty-eliciting emotion (disgust). Results from Study 1, (n = 79 undergraduate students) confirmed that a fair procedure (voice condition) enhanced self-esteem relative to an unfair procedure (no voice condition) to a gr...

Compensation for Real Properties Acquired for Roads in Different Procedures - Comparative Analysis

Directory of Open Access Journals (Sweden)

Barańska Anna

2017-12-01

Full Text Available Real properties acquired for the so-called public purpose, such as road investments, generate a one-off financial indemnity in the form of compensation paid to the expropriated owner. Due to the different possible modes of expropriation (pursuant to the Real Estate Management Act or the Special Road Act, the amount of the compensation due may be determined in different ways, which entails a variety of results. The article compares the compensation levels determined in two possible procedures: basing on the predominant use of the adjacent areas or on data from the transactions of real properties intended for public roads.

Conscious sedation for patients undergoing enteroclysis: Comparing the safety and patient-reported effectiveness of two protocols

International Nuclear Information System (INIS)

Maglinte, Dean D.T.; Applegate, Kimberly E.; Rajesh, Arumugam; Jennings, S. Gregory; Ford, Jason M.; Savabi, Mojgan Sarah; Lappas, John C.

2009-01-01

Objective: To compare the safety and patient-reported effectiveness of two regimens for conscious sedation during enteroclysis. Materials and methods: We surveyed two groups of outpatients and retrospectively reviewed procedure records for conscious sedation and complications. Patients were divided into Group One (received sedative/amnesic diazepam), and Group Two, (received amnesic/sedative, midazolam and analgesic fentanyl). Results: All enteroclyses were successfully completed; there were no hospital admissions due to complications. In Group One (n = 106), mean dose of diazepam was 12.7 mg. 25% had oxygen desaturation (n = 25), and post-procedure vomiting without aspiration (n = 1). 56% of outpatients completed phone surveys, and 68% recalled procedural discomfort. In Group Two (n = 45), mean doses were 3.9 mg midazolam and 108 mcg fentanyl. 31% had desaturation (n = 13), and post-procedure vomiting without aspiration (n = 1). 87% had only a vague recall of the procedure or of any discomfort. Conclusion: A combination of amnesic and fentanyl prevented the recall of discomfort of nasoenteric intubation and infusion in most patients who had enteroclysis compared to diazepam. Most of the patients would undergo the procedure again, if needed.

Conscious sedation for patients undergoing enteroclysis: Comparing the safety and patient-reported effectiveness of two protocols

Energy Technology Data Exchange (ETDEWEB)

Maglinte, Dean D.T. [Department of Radiology, Indiana University Medical Center, 550 N, University Boulevard, University Hospital Room 0279, Indianapolis, IN 46202-5253 (United States)], E-mail: dmaglint@iupui.edu; Applegate, Kimberly E.; Rajesh, Arumugam; Jennings, S. Gregory; Ford, Jason M. [Department of Radiology, Indiana University Medical Center, 550 N, University Boulevard, University Hospital Room 0279, Indianapolis, IN 46202-5253 (United States); Savabi, Mojgan Sarah [Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, 550 N, University Boulevard, Indianapolis, IN 46202-5253 (United States); Lappas, John C. [Department of Radiology, Indiana University Medical Center, 550 N, University Boulevard, University Hospital Room 0279, Indianapolis, IN 46202-5253 (United States)

2009-06-15

Objective: To compare the safety and patient-reported effectiveness of two regimens for conscious sedation during enteroclysis. Materials and methods: We surveyed two groups of outpatients and retrospectively reviewed procedure records for conscious sedation and complications. Patients were divided into Group One (received sedative/amnesic diazepam), and Group Two, (received amnesic/sedative, midazolam and analgesic fentanyl). Results: All enteroclyses were successfully completed; there were no hospital admissions due to complications. In Group One (n = 106), mean dose of diazepam was 12.7 mg. 25% had oxygen desaturation (n = 25), and post-procedure vomiting without aspiration (n = 1). 56% of outpatients completed phone surveys, and 68% recalled procedural discomfort. In Group Two (n = 45), mean doses were 3.9 mg midazolam and 108 mcg fentanyl. 31% had desaturation (n = 13), and post-procedure vomiting without aspiration (n = 1). 87% had only a vague recall of the procedure or of any discomfort. Conclusion: A combination of amnesic and fentanyl prevented the recall of discomfort of nasoenteric intubation and infusion in most patients who had enteroclysis compared to diazepam. Most of the patients would undergo the procedure again, if needed.

Is Office-Based Surgery Safe? Comparing Outcomes of 183,914 Aesthetic Surgical Procedures Across Different Types of Accredited Facilities.

Science.gov (United States)

Gupta, Varun; Parikh, Rikesh; Nguyen, Lyly; Afshari, Ashkan; Shack, R Bruce; Grotting, James C; Higdon, K Kye

2017-02-01

There has been a dramatic rise in office-based surgery. However, due to wide variations in regulatory standards, the safety of office-based aesthetic surgery has been questioned. This study compares complication rates of cosmetic surgery performed at office-based surgical suites (OBSS) to ambulatory surgery centers (ASCs) and hospitals. A prospective cohort of patients undergoing cosmetic surgery between 2008 and 2013 were identified from the CosmetAssure database (Birmingham, AL). Patients were grouped by type of accredited facility where the surgery was performed: OBSS, ASC, or hospital. The primary outcome was the incidence of major complication(s) requiring emergency room visit, hospital admission, or reoperation within 30 days postoperatively. Potential risk factors including age, gender, body mass index (BMI), smoking, diabetes, type of procedure, and combined procedures were reviewed. Of the 129,007 patients (183,914 procedures) in the dataset, the majority underwent the procedure at ASCs (57.4%), followed by hospitals (26.7%) and OBSS (15.9%). Patients operated in OBSS were less likely to undergo combined procedures (30.3%) compared to ASCs (31.8%) and hospitals (35.3%, P procedures. Plastic surgeons should continue to triage their patients carefully based on other significant comorbidities that were not measured in this present study. LEVEL OF EVIDENCE 3. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

Comparative evaluation of the US Environmental Protection Agency's and the Oak Ridge Institute for Science and Education's environmental survey and site assessment program field sampling procedures

International Nuclear Information System (INIS)

Vitkus, T.J.; Bright, T.L.; Roberts, S.A.

1997-10-01

At the request of the U.S. Nuclear Regulatory Commission's (NRC's) Headquarters Office, the Environmental Survey and Site Assessment Program (ESSAP) of the Oak Ridge Institute for Science and Education (ORISE) compared the documented procedures that the U.S. Environmental Protection Agency (EPA) and ESSAP use for collecting environmental samples. The project objectives were to review both organizations' procedures applicable to collecting various sample matrices, compare the procedures for similarities and differences, and then to evaluate the reason for any identified procedural differences and their potential impact on ESSAP's sample data quality. The procedures reviewed included those for sampling surface and subsurface soil, surface and groundwater, vegetation, air, and removable surface contamination. ESSAP obtained copies of relevant EPA documents and reviewed and prepared a tabulated summary of each applicable procedure. The methods for collecting and handling each type of sample were evaluated for differences, and where these were identified, the significance and effect of the differences on analytical quality were determined. The results of the comparison showed that, overall, the procedures and methods that EPA and ESSAP use for sample collection are very similar. The number of minor differences noted were the result of restrictions or procedures necessary to ensure sample integrity and prevent the introduction of interfering compounds when samples are to be analyzed for chemical parameters. For most radio nuclide analyses, these additional procedures are not necessary. Another item noted was EPA's inclusion of steps that reduce the potential for sample cross-contamination by preparing (dressing) a location prior to collecting a sample or removing a portion of a sample prior to containerization

The Effect of Preintervention Preparation on Pain and Anxiety Related to Peripheral Cannulation Procedures in Children.

Science.gov (United States)

Tunç-Tuna, Pinar; Açikgoz, Ayfer

2015-12-01

This study was performed to determine the effect of several preintervention preparation practices on pain and anxiety related to the peripheral cannulation procedure in children ages 9-12 years. The study included 60 Turkish children (28 female, 32 male, randomly selected by lot), 30 of whom were included in the intervention group and 30 of whom were included in the control group. The children's demographic data were collected by a data collection form prepared by the researcher. The children in the intervention group read the training manual before peripheral cannulation, and the procedure was demonstrated on a teddy bear. Their level of pain was assessed using the Wong-Baker Faces Rating Scale, and their level of anxiety was determined by the Spielberger State-Trait Anxiety Inventory for Children, before and during the procedure in both groups. Results showed that while anxiety and pain scores increased during the actual procedure compared to the preparatory procedure in the control group (anxiety t = -4.957, pain Z(a) = -4.048), anxiety and pain scores decreased during the actual procedure in the intervention group compared to the preparatory procedure (anxiety t = 7.896, pain t = 6.196). When the pain and anxiety scores were examined, it was found that both anxiety and pain scores in the intervention group were significantly lower than in the control group. In conclusion, children in this study experienced pain and situational anxiety during peripheral cannulation, and this pain can be reduced by preparing the child in advance of the procedure. It is suggested that children should be informed about and able to practice the procedure on a toy or model before peripheral cannulation. Preparation of the children to painful procedures in accordance with their cognitive development can reduce anxiety and pain. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Comparative study on cleanup procedures for the determination of organophosphorus pesticides in vegetables

International Nuclear Information System (INIS)

Alvin, Chai Lian Kuet; Lau, Seng

2008-01-01

A study was carried out to compare the cleanup procedures for the determination of organophosphorus pesticides in vegetables. Eleven organophosphorus pesticides were extracted with acetone and methylene chloride. Extracts were cleanup by solid-phase extraction (SPE) mixed-mode column using quaternary amine and aminopropyl (SAX/ NH 2 ) or octadecyl (C 18 ) sorbents. The pesticides were determined by gas chromatography with flame photometric detector. The recovery results obtained from the SPE SAX/ NH 2 and C 18 cleanups in carrot, cucumber and green mustard samples were in the range of 71.0 % to 115 %. Lower recoveries were obtained for polar pesticides, methamidophos and dimethoate. These results were compared to the method currently used in the laboratory which does not include any cleanup. (author)

Do single-use medical devices containing biopolymers reduce the environmental impacts of surgical procedures compared with their plastic equivalents?

Science.gov (United States)

Unger, Scott R; Hottle, Troy A; Hobbs, Shakira R; Thiel, Cassandra L; Campion, Nicole; Bilec, Melissa M; Landis, Amy E

2017-01-01

Background While petroleum-based plastics are extensively used in health care, recent developments in biopolymer manufacturing have created new opportunities for increased integration of biopolymers into medical products, devices and services. This study compared the environmental impacts of single-use disposable devices with increased biopolymer content versus typically manufactured devices in hysterectomy. Methods A comparative life cycle assessment of single-use disposable medical products containing plastic(s) versus the same single-use medical devices with biopolymers substituted for plastic(s) at Magee-Women's Hospital (Magee) in Pittsburgh, PA and the products used in four types of hysterectomies that contained plastics potentially suitable for biopolymer substitution. Magee is a 360-bed teaching hospital, which performs approximately 1400 hysterectomies annually. Results There are life cycle environmental impact tradeoffs when substituting biopolymers for petroplastics in procedures such as hysterectomies. The substitution of biopolymers for petroleum-based plastics increased smog-related impacts by approximately 900% for laparoscopic and robotic hysterectomies, and increased ozone depletion-related impacts by approximately 125% for laparoscopic and robotic hysterectomies. Conversely, biopolymers reduced life cycle human health impacts, acidification and cumulative energy demand for the four hysterectomy procedures. The integration of biopolymers into medical products is correlated with reductions in carcinogenic impacts, non-carcinogenic impacts and respiratory effects. However, the significant agricultural inputs associated with manufacturing biopolymers exacerbate environmental impacts of products and devices made using biopolymers. Conclusions The integration of biopolymers into medical products is correlated with reductions in carcinogenic impacts, non-carcinogenic impacts and respiratory effects; however, the significant agricultural inputs associated

Tooth-bleaching procedures and their controversial effects: A literature review

Science.gov (United States)

Alqahtani, Mohammed Q.

2014-01-01

Aim This review article will help clinicians improve their understanding of the history of bleaching procedures, bleaching types, components, mechanisms, and their effects on soft tissue, tooth structures, resin composite, and bonding. Methods The controversial issues about bleaching procedures and their effects are reviewed. Additionally, the consequences of pre- and post-bleaching on the bonding potential of composite resin restorations to tooth structure are discussed. Conclusion The overall goal of the paper is to help reduce risks for patients. PMID:25408594

When simulated environments make the difference : the effectiveness of different types of training of car service procedures

NARCIS (Netherlands)

Borsci, Simone; Lawson, Glyn; Salanitri, Davide; Jha, Bhavna

2016-01-01

An empirical analysis was performed to compare the effectiveness of different approaches to training a set of procedural skills to a sample of novice trainees. Sixty-five participants were randomly assigned to one of the following three training groups: (1) learning-by-doing in a 3D desktop virtual

Collective effective dose in Europe from x-ray and nuclear medicine procedures

International Nuclear Information System (INIS)

Bly, R.; Jaervinen, H.; Jahnen, A.; Olerud, H.; Vassileva, J.; Vogiatzi, S.

2015-01-01

Population doses from radiodiagnostic (X-ray and nuclear medicine) procedures in Europe were estimated based on data collected from 36 European countries. For X-ray procedures in EU and EFTA countries (except Liechtenstein) the collective effective dose is 547 500 man Sv, resulting in a mean effective dose of 1.06 mSv per caput. For all European countries included in the survey the collective effective dose is 605 000 man Sv, resulting in a mean effective dose of 1.05 mSv per caput. For nuclear medicine procedures in EU countries and EFTA (except Liechtenstein) countries the collective effective dose is 30 700 man Sv, resulting in a mean effective dose of 0.06 mSv per caput. For all European countries included in the survey the collective effective dose is 31 100 man Sv, resulting in a mean effective dose of 0.05 mSv per caput. (authors)

Effectiveness of internet-based affect induction procedures: A systematic review and meta-analysis.

Science.gov (United States)

Ferrer, Rebecca A; Grenen, Emily G; Taber, Jennifer M

2015-12-01

Procedures used to induce affect in a laboratory are effective and well-validated. Given recent methodological and technological advances in Internet research, it is important to determine whether affect can be effectively induced using Internet methodology. We conducted a meta-analysis and systematic review of prior research that has used Internet-based affect induction procedures, and examined potential moderators of the effectiveness of affect induction procedures. Twenty-six studies were included in final analyses, with 89 independent effect sizes. Affect induction procedures effectively induced general positive affect, general negative affect, fear, disgust, anger, sadness, and guilt, but did not significantly induce happiness. Contamination of other nontarget affect did not appear to be a major concern. Video inductions resulted in greater effect sizes. Overall, results indicate that affect can be effectively induced in Internet studies, suggesting an important venue for the acceleration of affective science. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Essure hysteroscopic sterilization versus interval laparoscopic bilateral tubal ligation: a comparative effectiveness review.

Science.gov (United States)

Ouzounelli, Myrsini; Reaven, Nancy L

2015-01-01

A comparative effectiveness analysis was performed to examine the risks and benefits of laparoscopic bilateral tubal ligation compared with hysteroscopic sterilization using the Essure Permanent Birth Control System (Bayer HealthCare AG, Whippany, NJ). Existing evidence shows that both LBTL and Essure are safe and effective methods of female sterilization. Both have high rates of efficacy and low rates of complications although when complications do occur, those related to the Essure procedure are more likely to be minor in nature. The analysis was limited by the restricted number of studies involving head-to-head comparisons of the 2 approaches. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

Trends and the determination of effective doses for standard X-ray procedures

International Nuclear Information System (INIS)

Johnson, H.M.; Neduzak, C.; Gallet, J.; Sandeman, J.

2001-01-01

Trends in the entrance skin exposures (air kerma) for standard x-ray imaging procedures are reported for the Province of Manitoba, Canada. Average annual data per procedure using standard phantoms and standard ion chambers have been recorded since 1981. For example, chest air kerma (backscatter included) has decreased from 0.14 to 0.09 mGy. Confounding factors may negate the gains unless facility quality control programs are maintained. The data were obtained for a quality assurance and regulatory compliance program. Quoting such data for risk evaluation purposes lacks rigor hence a compartment model for organ apportioning, using organ absorbed doses and weighting factors, has been applied to determine effective dose per procedure. The effective doses for the standard procedures are presented, including the value of 0.027 mSv (1999) calculated for the effective dose in PA chest imaging. (author)

Measurement of patient radiation doses in certain urography procedures

International Nuclear Information System (INIS)

Sulieman, A.; Barakat, H.; Zailae, A.; Abuderman, A.; Theodorou, K.

2015-01-01

Patients are exposed to significant radiation doses during diagnostic and interventional urological procedures. This study aimed to measure patient entrance surface air kerma (ESAK) and to estimate the effective dose during intravenous urography (IVU), extracorporeal shock-wave lithotripsy (ESWL), and ascending urethrogram (ASU) procedures. ESAK was measured in patients using calibrated thermo luminance dosimeters, GR200A). Effective doses (E) were calculated using the National Radiological Protection Board (NRPB) software. A total of 179 procedures were investigated. 27.9 % of the patients underwent IVU procedures, 27.9 % underwent ESWL procedures and 44.2 % underwent ASU procedures. The mean ESAK was 2.1, 4.18 and 4.9 mGy for IVU, ESWL, and ASU procedures, respectively. Differences in patient ESAK for the same procedure were observed. The mean ESAK values were comparable with those in previous studies. (authors)

Procedural justice effects on self-esteem under certainty versus uncertainty emotions

NARCIS (Netherlands)

D. de Cremer (David); A. van Hiel (Alain)

2008-01-01

textabstractBuilding upon the idea that procedural justice effects are more pronounced when uncertainty is high, we proposed that recall of an uncertainty-eliciting emotion (fear) will render people more responsive to variations in procedural justice than will recall of a certainty-eliciting emotion

The Effect of an Orthopaedic Surgical Procedure in the National Basketball Association.

Science.gov (United States)

Minhas, Shobhit V; Kester, Benjamin S; Larkin, Kevin E; Hsu, Wellington K

2016-04-01

Professional basketball players have a high incidence of injuries requiring surgical intervention. However, no studies in the current literature have compared postoperative performance outcomes among common injuries to determine high- and low-risk procedures to these athletes' careers. To compare return-to-play (RTP) rates and performance-based outcomes after different orthopaedic procedures in National Basketball Association (NBA) players and to determine which surgeries are associated with the worst postoperative change in performance. Cohort study; Level of evidence, 3. Athletes in the NBA undergoing anterior cruciate ligament reconstruction, Achilles tendon repair, lumbar discectomy, microfracture, meniscus surgery, hand/wrist or foot fracture fixation, and shoulder stabilization were identified through team injury reports and archives on public record. The RTP rate, games played per season, and player efficiency rating (PER) were determined before and after surgery. Statistical analysis was used to compare the change between pre- and postsurgical performance among the different injuries. A total of 348 players were included. The RTP rates were highest in patients with hand/wrist fractures (98.1%; mean age, 27.0 years) and lowest for those with Achilles tears (70.8%; mean age, 28.4 years) (P = .005). Age ≥30 years (odds ratio [OR], 3.85; 95% CI, 1.24-11.91) and body mass index ≥27 kg/m(2) (OR, 3.46; 95% CI, 1.05-11.40) were predictors of not returning to play. Players undergoing Achilles tendon repair and arthroscopic knee surgery had a significantly greater decline in postoperative performance outcomes at the 1- and 3-year time points and had shorter career lengths compared with the other procedures. NBA players undergoing Achilles tendon rupture repair or arthroscopic knee surgery had significantly worse performance postoperatively compared with other orthopaedic procedures. © 2016 The Author(s).

Comparative study of deterioration procedure in chemical-leavened steamed bread dough under frozen storage and freeze/thaw condition.

Science.gov (United States)

Wang, Pei; Yang, Runqiang; Gu, Zhenxin; Xu, Xueming; Jin, Zhengyu

2017-08-15

Successive freeze/thaw (FT) cycle was a widely used empirical approach to shorten the experimental period since it could accelerate frozen dough deterioration compared with frozen storage (FS). In order to compare the effect of FS and FT cycle on deterioration procedure of chemical-leavened steamed bread dough, kinetic studies of bread quality indices were performed and the relationships between bread quality and dough components were further established. Results showed that degradation of steamed bread loaf volume and firmness followed first-order kinetics during FS and zero-order kinetics during FT, respectively. Glutenin macropolymers (GMP) depolymerization and dough weight loss occurred steadily throughout FS and FT. Significant enhancement of damaged starch and crystallinity were observed at the later FS period and FT cycle. Multiple regression study led to the conclusion that dough weight loss contributed the most to the reduced bread loaf volume under FS whereas GMP depolymerization dominated under FT condition. Copyright © 2017 Elsevier Ltd. All rights reserved.

Nutritional effects of the serial transverse enteroplasty procedure in experimental short bowel syndrome

DEFF Research Database (Denmark)

Kaji, Tatsuru; Tanaka, Hiroaki; Wallace, Laurie E

2009-01-01

The serial transverse enteroplasty (STEP) procedure appears beneficial clinically, but the mechanism(s) underlying these effects remains unclear. The present study evaluated the nutritional, hormonal, and morphologic effects of the STEP procedure in a rodent model of short bowel syndrome....

Software for the estimation of organ equivalent and effective doses from diagnostic radiology procedures

International Nuclear Information System (INIS)

Osei, Ernest K; Barnett, Rob

2009-01-01

Diagnostic radiological imaging such as conventional radiography, fluoroscopy and computed tomography (CT) examinations will continue to provide tremendous benefits in modern healthcare. The benefit derived by the patient should far outweigh the risk associated with a properly conducted imaging examination. Nonetheless, it is very important to be able to quantify the risk associated with any radiological examination of patients, and effective dose has been considered a useful indicator of patient exposure. Quantification of the risks associated with radiological imaging is very important as such information will be helpful to physicians and their patients for comparing risks from various imaging examinations and for making informed decisions whenever there is a need for any radiological imaging. The determination of equivalent and effective doses in diagnostic radiology is of interest as a basis for estimates of risk from medical exposures. In this paper we describe a simple computer program OrgDose, which calculates the doses to 27 organs in the body and then calculates the organ equivalent and effective doses and the risk from various procedures in the radiology department including conventional radiography, fluoroscopy and computed tomography examinations. The program will be a useful tool for the medical and paramedical personnel who are involved with assessing organ and effective doses and risks from diagnostic radiology procedures.

Comparing Effective Treatments for Attention-Maintained and Escape- Maintained Behaviors in Children with Behavior Disorders: Brief Review and Analysis

OpenAIRE

Lauren Worcester; T. F. McLaughlin

2013-01-01

This literature review compares treatment for attention-maintainedversus escape maintained aberrant behavior in children with behavior disorders. Specifically, studies utilizing time out procedures, differential reinforcement procedures, noncontingent reinforcement, and functional communication training are discussed. It was found that these are effective treatments for attention-maintained behaviors; while escape extinction, positive and negative reinforcement, functional communication trai...

The learning effect of intraoperative video-enhanced surgical procedure training.

Science.gov (United States)

van Det, M J; Meijerink, W J H J; Hoff, C; Middel, L J; Koopal, S A; Pierie, J P E N

2011-07-01

The transition from basic skills training in a skills lab to procedure training in the operating theater using the traditional master-apprentice model (MAM) lacks uniformity and efficiency. When the supervising surgeon performs parts of a procedure, training opportunities are lost. To minimize this intervention by the supervisor and maximize the actual operating time for the trainee, we created a new training method called INtraoperative Video-Enhanced Surgical Training (INVEST). Ten surgical residents were trained in laparoscopic cholecystectomy either by the MAM or with INVEST. Each trainee performed six cholecystectomies that were objectively evaluated on an Objective Structured Assessment of Technical Skills (OSATS) global rating scale. Absolute and relative improvements during the training curriculum were compared between the groups. A questionnaire evaluated the trainee's opinion on this new training method. Skill improvement on the OSATS global rating scale was significantly greater for the trainees in the INVEST curriculum compared to the MAM, with mean absolute improvement 32.6 versus 14.0 points and mean relative improvement 59.1 versus 34.6% (P=0.02). INVEST significantly enhances technical and procedural skill development during the early learning curve for laparoscopic cholecystectomy. Trainees were positive about the content and the idea of the curriculum.

Different effects of bariatric surgical procedures on dyslipidemia: a registry-based analysis.

Science.gov (United States)

Spivak, Hadar; Sakran, Nasser; Dicker, Dror; Rubin, Moshe; Raz, Itamar; Shohat, Tamy; Blumenfeld, Orit

2017-07-01

The scale and variables linked to bariatric surgery's effect on dyslipidemia have not been conclusive. To compare the effect of Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and adjustable gastric banding (LAGB) on dyslipidemia SETTING: National bariatric surgery registry. Plasma lipids and associated variables were compared at baseline and 1 year (12±4 mo) after surgery for registry patients with dyslipidemia enrolled from June 2013 to August 2014. The greatest mean total-cholesterol (TC) reduction was observed post-RYGB, 226.7±26.4 to 181.3±30.9 mg/dL (19.9%, n = 208), followed by post-SG, 227.9±24.4 to 206.7±34.2 mg/dL (8.9%, n = 1515; Pdyslipidemia, independent of weight loss. Overall, the RYGB achieved the biggest reduction in plasma lipids (TC and LDL), although SG did affect HDL. Our results could aid in the decision-making process regarding the most appropriate procedure for patients with dyslipidemia. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Comparative studies of imaging procedures: What is the contribution of CT?

International Nuclear Information System (INIS)

Witte, G.; Buecheler, E.

1990-01-01

Within the field of diagnostic imaging, CT and MR are competing procedures, each of which has particular advantages in specific diagnostic situations. Knowledge of these advantages is helpful in deciding upon a diagnostic procedure. We evaluate the indications for CT according to area of examination. (orig.) [de

Oral versus intravenous premedication for small bowel biopsy in children: effect on procedure and fluoroscopy times.

Science.gov (United States)

Stenhammar, L; Wärngård, O; Lewander, P; Nordvall, M

1993-01-01

Oral alimemazine and cisapride, or diazepam and cisapride, or iv midazolam and metoclopramide were given as premedication for small bowel biopsy to three groups of children from a total population of 185 individuals. The biopsy procedures were performed under intermittent fluoroscopy and times for both were recorded. The median biopsy procedure time was significantly shorter in children given iv midazolam and metoclopramide (6 min) compared to those given oral premedication (10 min) (p < 0.001). The median fluoroscopy time was very short in all groups, ranging between 3 and 6 s. It is concluded that iv premedication is superior to oral premedication for small bowel biopsy in children because more effective sedation is obtained.

The value-based medicine comparative effectiveness and cost-effectiveness of penetrating keratoplasty for keratoconus.

Science.gov (United States)

Roe, Richard H; Lass, Jonathan H; Brown, Gary C; Brown, Melissa M

2008-10-01

comparatively effective and cost-effective procedure when compared with other interventions across different medical specialties.

Cost-effectiveness analysis of clinic-based chloral hydrate sedation versus general anaesthesia for paediatric ophthalmological procedures.

Science.gov (United States)

Burnett, Heather F; Lambley, Rosemary; West, Stephanie K; Ungar, Wendy J; Mireskandari, Kamiar

2015-11-01

The inability of some children to tolerate detailed eye examinations often necessitates general anaesthesia (GA). The objective was to assess the incremental cost effectiveness of paediatric eye examinations carried out in an outpatient sedation unit compared with GA. An episode of care cost-effectiveness analysis was conducted from a societal perspective. Model inputs were based on a retrospective cross-over cohort of Canadian children aged Costs ($CAN), adverse events and number of successful procedures were modelled in a decision analysis with one-way and probabilistic sensitivity analysis. The mean cost per patient was $406 (95% CI $401 to $411) for EUS and $1135 (95% CI $1125 to $1145) for EUA. The mean number of successful procedures per patient was 1.39 (95% CI 1.34 to 1.42) for EUS and 2.06 (95% CI 2.02 to 2.11) for EUA. EUA was $729 more costly on average than EUS (95% CI $719 to $738) but resulted in an additional 0.68 successful procedures per child. The result was robust to varying the cost assumptions. Cross-over designs offer a powerful way to assess costs and effectiveness of two interventions because patients serve as their own control. This study demonstrated significant savings when ophthalmological exams were carried out in a hospital outpatient clinic, although with slightly fewer procedures completed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Nitrous oxide provides safe and effective analgesia for minor paediatric procedures - a systematic review

DEFF Research Database (Denmark)

Pedersen, Rie S; Bayat, Allan; Steen, Nick Phaff

2013-01-01

Pain and distress during minor hospital-related procedures is a familiar problem in many children. Inadequate relief of children's procedural pain and distress not only affects the experience of the children and their parents, but also adversely impacts procedural success. We aimed to review the ...... the safety and efficacy of nitrous oxide during brief, but painful paediatric procedures and to compare nitrous oxide with some of the commonly used pharmacological and non-pharmacological treatments for relieving anxiety and mild to moderate pain in Denmark....

Do Ethical Judgments Depend on the Type of Response Scale? Comparing Acceptability versus Unacceptability Judgments in the Case of Life-Ending Procedures

Directory of Open Access Journals (Sweden)

Etienne Mullet

2010-01-01

Full Text Available Using Functional Measurement (Anderson, 2008, Frileux, Lelièvre, Muñoz Sastre, Mullet, and Sorum (2003 examined the joint impact of several key factors on lay people's judgments of the acceptability of physicians' interventions to end patients' lives. The level of acceptability was high, and the information integration rule that best described the participants' judgments was Acceptability = Patient's Request + Patient's Age + Residual Suffering + Incurability. Critics suggested, however, that acceptability was high because the ethical problem was framed in terms of acceptability (Murphy, 2007. Presenting participants with acceptability scales may have caused the life-ending procedure to be represented in participants' mind as basically "acceptable". By contrast, presenting participants with unacceptability scales might cause the procedure to be represented as basically "unacceptable". In the present study, therefore, we directly compared lay people's judgments of the acceptability of life-ending procedures under two opposite conditions - an acceptability condition, and an unacceptability condition. The life-ending procedure did not appear as more acceptable to participants responding in terms of acceptability than to those responding in terms of unacceptability. In addition, the impacts of the factors describing the end-of-life situations were not affected by the type of judgment scale that was used. Functional Measurement seems to be resistant to goal-framing effects; the findings that have been observed using acceptability scales can be considered as robust.

A COMPARATIVE STUDY OF PEDIATRIC CARDIAC CATHETERIZATION PROCEDURE UNDER GENERAL ANESTHESIA WITH OR WITHOUT FEMORAL NERVE BLOCK

Directory of Open Access Journals (Sweden)

Jigisha

2016-02-01

Full Text Available OBJECTIVE Anesthetic management for interventional cardiac procedures/cardiac catheterization in pediatric patients is challenging. Cardiac anomalies vary from simple to complex congenital cardiac anomalies, shunts may be present at multiple levels and patients may be profoundly cyanotic, may be with ventricular dysfunction. They usually require sedation and analgesia to maintain steady stable state. In adults, such type of procedures can be well managed with local anesthesia. METHODS Fifty patients were included in the study. They were randomly divided into two groups- Group A (n=25 patients received femoral N. block along with IV sedation and analgesia while group B (n=25 patients received only IV sedation and analgesia. Both groups were compared for hemodynamics, pain score and requirement of IV anesthetic agents and any complications if come up. RESULTS Group A patients required IV ketamine 3.24mg/kg (±0.31SD as compared to 5.58mg/kg (±1.6SD in group B, which suggests significantly reduced requirement of IV anesthetic agents in group where femoral nerve block has been given. Hemodynamic parameters remained stable and comparable (no statistically significant variation Pain score was less in group A patients than group B. CONCLUSION It has been observed that Group A patients required less dosages of IV anesthetic agents, with stable hemodynamics and less pain score and sedation score as compared to group B patients.

Unexpected effects of computer presented procedures

International Nuclear Information System (INIS)

Blackman, H.S.; Nelson, W.R.

1988-01-01

Results from experiments conducted at the Idaho National Engineering Laboratory have been presented regarding the computer presentation of procedural information. The results come from the experimental evaluation of an expert system which presented procedural instructions to be performed by a nuclear power plant operator. Lessons learned and implications from the study are discussed as well as design issues that should be considered to avoid some of the pitfalls in computer presented or selected procedures

A Comparative Analysis of the Procedure Employed in Item ...

African Journals Online (AJOL)

Zimbabwe Journal of Educational Research ... and psychological scales designed to measure constructs in education and social sciences were purposively selected for the study based on accessibility and availability of validation information. The instruments used for the study were scaling procedures used in 27 published ...

A robust procedure for comparing multiple means under heteroscedasticity in unbalanced designs.

Directory of Open Access Journals (Sweden)

Esther Herberich

2010-03-01

Full Text Available Investigating differences between means of more than two groups or experimental conditions is a routine research question addressed in biology. In order to assess differences statistically, multiple comparison procedures are applied. The most prominent procedures of this type, the Dunnett and Tukey-Kramer test, control the probability of reporting at least one false positive result when the data are normally distributed and when the sample sizes and variances do not differ between groups. All three assumptions are non-realistic in biological research and any violation leads to an increased number of reported false positive results. Based on a general statistical framework for simultaneous inference and robust covariance estimators we propose a new statistical multiple comparison procedure for assessing multiple means. In contrast to the Dunnett or Tukey-Kramer tests, no assumptions regarding the distribution, sample sizes or variance homogeneity are necessary. The performance of the new procedure is assessed by means of its familywise error rate and power under different distributions. The practical merits are demonstrated by a reanalysis of fatty acid phenotypes of the bacterium Bacillus simplex from the "Evolution Canyons" I and II in Israel. The simulation results show that even under severely varying variances, the procedure controls the number of false positive findings very well. Thus, the here presented procedure works well under biologically realistic scenarios of unbalanced group sizes, non-normality and heteroscedasticity.

Unexpected effects of computer presented procedures

International Nuclear Information System (INIS)

Blackman, H.S.; Nelson, W.R.

1988-01-01

Results from experiments conducted at the Idaho National Engineering Laboratory will be presented regarding the computer presentation of procedural information. The results come from the experimental evaluation of an expert system which presented procedural instructions to be performed by a nuclear power plant operator. Lessons learned and implications from the study will be discussed as well as design issues that should be considered to avoid some of the pitfalls in computer presented or selected procedures. 1 ref., 1 fig

75 FR 54594 - Effectiveness of Licensing Procedures for Agricultural Commodities to Cuba

Science.gov (United States)

2010-09-08

...] Effectiveness of Licensing Procedures for Agricultural Commodities to Cuba AGENCY: Bureau of Industry and... Administration Regulations for the export of agricultural commodities to Cuba. BIS will include a description of...), to Cuba. Requirements and procedures associated with such authorization are set forth in section 740...

Comparing adaptive procedures for estimating the psychometric function for an auditory gap detection task.

Science.gov (United States)

Shen, Yi

2013-05-01

A subject's sensitivity to a stimulus variation can be studied by estimating the psychometric function. Generally speaking, three parameters of the psychometric function are of interest: the performance threshold, the slope of the function, and the rate at which attention lapses occur. In the present study, three psychophysical procedures were used to estimate the three-parameter psychometric function for an auditory gap detection task. These were an up-down staircase (up-down) procedure, an entropy-based Bayesian (entropy) procedure, and an updated maximum-likelihood (UML) procedure. Data collected from four young, normal-hearing listeners showed that while all three procedures provided similar estimates of the threshold parameter, the up-down procedure performed slightly better in estimating the slope and lapse rate for 200 trials of data collection. When the lapse rate was increased by mixing in random responses for the three adaptive procedures, the larger lapse rate was especially detrimental to the efficiency of the up-down procedure, and the UML procedure provided better estimates of the threshold and slope than did the other two procedures.

Etiology of Readmissions Following Orthopaedic Procedures and Medical Admissions. A Comparative Analysis.

Science.gov (United States)

Maslow, Jed; Hutzler, Lorraine; Slover, James; Bosco, Joseph

2015-12-01

The Federal Government, the largest payer of health care, considers readmission within 30 days of discharge an indicator of quality of care. Many studies have focused on causes for and strategies to reduce readmissions following medical admissions. However, few studies have focused on the differences between them. We believe that the causes for readmission following orthopaedic surgery are markedly different than those following medical admissions, and therefore, the strategies developed to reduce medical readmissions will not be as effective in reducing readmissions after elective orthopaedic surgery. All unplanned 30-day readmissions following an index hospitalization for an elective orthopaedic procedure (primary and revision total joint arthroplasty and spine procedure) or for one of the three publicly reported medical conditions (AMI, HF, and pneumonia, which accounted for 11% of readmissions) were identified at our institution from 2010 through 2012. A total of 268 patients and 390 medical patients were identified as having an unplanned 30-day readmission. We reviewed a prospectively collected data base to determine the reason for readmission in each encounter. A total of 233 (86.9%) orthopaedic patients were readmitted for surgical complications, most commonly for a wound infection (56.0%) or wound complication (11.6%). Following an index admission of HF or AMI, the primary reason for readmission was a disease of the circulatory system (55.9% and 57.4%, respectively). Following an index admission for pneumonia, the primary reason for readmission was a disease of the respiratory system (34.5%). The causes of readmissions following orthopaedic surgery and medical admissions are different. Patients undergoing orthopaedic procedures are readmitted for surgical complications, frequently unrelated to aftercare, and medicine patients are readmitted for reasons related to the index diagnosis. Interventions designed to reduce orthopaedic readmissions must focus on

77 FR 55183 - Effectiveness of Licensing Procedures for Agricultural Commodities to Cuba

Science.gov (United States)

2012-09-07

...] Effectiveness of Licensing Procedures for Agricultural Commodities to Cuba AGENCY: Bureau of Industry and... Administration Regulations for the export of agricultural commodities to Cuba. BIS will include a description of...), to Cuba. Requirements and procedures associated with such authorization are set forth in Sec. 740.18...

Increasing spelling achievement: an analysis of treatment procedures utilizing an alternating treatments design.

OpenAIRE

Ollendick, T H; Matson, J L; Esveldt-Dawson, K; Shapiro, E S

1980-01-01

Two studies which examine the effectiveness of spelling remediation procedures are reported. In both studies, an alternating treatment design was employed. In the first study, positive practice overcorrection plus positive reinforcement was compared to positive practice alone and a no-remediation control condition. In the second study, positive practice plus positive reinforcement was compared to a traditional corrective procedure plus positive reinforcement and a traditional procedure when u...

Bilateral effects of hospital patient-safety procedures on nurses' job satisfaction.

Science.gov (United States)

Inoue, T; Karima, R; Harada, K

2017-09-01

The aim of this study was to examine how hospital patient-safety procedures affect the job satisfaction of hospital nurses. Additionally, we investigated the association between perceived autonomy and hospital patient-safety procedures and job satisfaction. Recently, measures for patient safety have been recognized as an essential requirement in hospitals. Hospital patient-safety procedures may enhance the job satisfaction of nurses by improving the quality of their work. However, such procedures may also decrease their job satisfaction by imposing excessive stress on nurses because they cannot make mistakes. The participants included 537 nurses at 10 private hospitals in Japan (The surveys were collected from March to July 2012). Factors related to hospital patient-safety procedures were demonstrated using factor analysis, and the associations between these factors and nurses' self-perceived autonomy and job satisfaction were examined using structural equation modelling. Five factors regarding hospital patient-safety procedures were extracted. Additionally, structural equation modelling revealed statistically significant associations between these factors and the nurses' self-perceived autonomy and job satisfaction. The findings showed that nurses' perceived autonomy of the workplace enhanced their job satisfaction and that their perceptions of hospital patient-safety procedures promoted their job satisfaction. However, some styles of chief nurses' leadership regarding patient safety restrict nurses' independent and autonomous decision-making and actions, resulting in a lowering of job satisfaction. This study demonstrated that hospital patient-safety procedures have ambiguous effects on nurses' job satisfaction. In particular, chief nurses' leadership relating to patient safety can have a positive or negative effect on nurses' job satisfaction. The findings indicated that hospital managers should demonstrate positive attitudes to improve patient safety for

Diagnosing alcoholism in high-risk drinking drivers: comparing different diagnostic procedures with estimated prevalence of hazardous alcohol use

NARCIS (Netherlands)

Korzec, A.; Bär, M.; Koeter, M. W.; de Kieviet, W.

2001-01-01

In several European countries, drivers under influence (DUI), suspected of an alcohol use disorder (AUD, 'alcoholism') are referred for diagnostic examination. The accuracy of diagnostic procedures used in diagnosing AUD in the DUI population is unknown. The aim of this study was to compare three

The Comparing Options for Management: Patient-centered Results for Uterine Fibroids (COMPARE-UF) Registry: Rationale and Design.

Science.gov (United States)

Stewart, Elizabeth A; Lytle, Barbara L; Thomas, Laine; Wegienka, Ganesa R; Jacoby, Vanessa; Diamond, Michael P; Nicholson, Wanda K; Anchan, Raymond M; Venable, Sateria; Wallace, Kedra; Marsh, Erica E; Maxwell, George L; Borah, Bijan J; Catherino, William H; Myers, Evan R

2018-05-08

To design and establish a uterine fibroid (UF) registry based in the United States (US) to provide comparative effectiveness data regarding UF treatment. We report here the design and initial recruitment for the Comparing Options for Management: Patient-centered Results for Uterine Fibroids (COMPARE-UF) registry (Clinicaltrials.gov, NCT02260752), funded by the Agency for Healthcare Research and Quality (AHRQ) in collaboration with the-Patient-Centered Outcomes Research Institute (PCORI). COMPARE-UF is designed to help answer critical questions about treatment options for women with symptomatic UF. Women undergoing a procedure for UF (hysterectomy, myomectomy [abdominal, hysteroscopic, vaginal and laparoscopic/robotic], endometrial ablation, radiofrequency fibroid ablation, uterine artery embolization, magnetic resonance guided focused ultrasound or progestin-releasing intrauterine device insertion) at one of the COMPARE-UF sites are invited to participate in a prospective registry with three years follow-up for post-procedural outcomes. Enrolled participants provide annual follow-up through an online portal or through traditional phone contact. A central data abstraction center provides information obtained from imaging, operative or procedural notes and pathology reports. Women with uterine fibroids and other stakeholders are a key part of the COMPARE-UF registry and participate at all points from study design to dissemination of results. We built a network of nine clinical sites across the US with expertise in the care of women with UF to capture geographic, racial, ethnic and procedural diversity. Of the initial 2031 women enrolled in COMPARE-UF, 42% are self-identified as Black or African-American and 40% are age 40 years or younger with 16% of participants under age 35. Women undergoing myomectomy comprise the largest treatment group at 46% of all procedures with laparoscopic or robotic myomectomy comprising the largest subset of myomectomies at 19% of all

The effects of divided attention at study and reporting procedure on regulation and monitoring for episodic recall.

Science.gov (United States)

Sauer, James; Hope, Lorraine

2016-09-01

Eyewitnesses regulate the level of detail (grain size) reported to balance competing demands for informativeness and accuracy. However, research to date has predominantly examined metacognitive monitoring for semantic memory tasks, and used relatively artificial phased reporting procedures. Further, although the established role of confidence in this regulation process may affect the confidence-accuracy relation for volunteered responses in predictable ways, previous investigations of the confidence-accuracy relation for eyewitness recall have largely overlooked the regulation of response granularity. Using a non-phased paradigm, Experiment 1 compared reporting and monitoring following optimal and sub-optimal (divided attention) encoding conditions. Participants showed evidence of sacrificing accuracy for informativeness, even when memory quality was relatively weak. Participants in the divided (cf. full) attention condition showed reduced accuracy for fine- but not coarse-grained responses. However, indices of discrimination and confidence diagnosticity showed no effect of divided attention. Experiment 2 compared the effects of divided attention at encoding on reporting and monitoring using both non-phased and 2-phase procedures. Divided attention effects were consistent with Experiment 1. However, compared to those in the non-phased condition, participants in the 2-phase condition displayed a more conservative control strategy, and confidence ratings were less diagnostic of accuracy. When memory quality was reduced, although attempts to balance informativeness and accuracy increased the chance of fine-grained response errors, confidence provided an index of the likely accuracy of volunteered fine-grained responses for both condition. Copyright © 2016 Elsevier B.V. All rights reserved.

The Effect of Microneedle Thickness on Pain During Minimally Invasive Facial Procedures: A Clinical Study.

Science.gov (United States)

Sezgin, Billur; Ozel, Bora; Bulam, Hakan; Guney, Kirdar; Tuncer, Serhan; Cenetoglu, Seyhan

2014-07-01

Minimally invasive procedures are becoming increasingly popular because they require minimal downtime and are effective for achieving a more youthful appearance. The choice of needle for minimally invasive procedures can be a major factor in the patient's comfort level, which in turn affects the physician's comfort level. In this comparative study, the authors assessed levels of pain and bruising after participants were injected with 30-gauge or 33-gauge (G) microneedles, which are commonly used for minimally invasive injection procedures. Twenty healthy volunteers were recruited for this prospective study. Eight injection points (4 on each side of the face) were determined for each patient. All participants received injections of saline with both microneedles in a randomized, blinded fashion. Levels of pain and bruising were assessed and analyzed for significance. The highest level of pain was in the malar region, and the lowest level was in the glabella. Although all pain scores were lower for the 33-G microneedle, the difference was significant only for the forehead. Because most minimally invasive procedures require multiple injections during the same sitting, the overall procedure was evaluated as well. Assessment of the multiple-injection process demonstrated a significant difference in pain level, favoring the 33-G needle. Although the difference in bruising was not statistically significant between the 2 needles, the degree of bruising was lower with the 33-G needle. For procedures that involve multiple injections to the face (such as mesotherapy and injection of botulinum toxin A), thinner needles result in less pain, making the overall experience more comfortable for the patient and the physician. 3. © 2014 The American Society for Aesthetic Plastic Surgery, Inc.

Short communication. Effect of soybean meal heat procedures on growth performance of broiler chickens

Energy Technology Data Exchange (ETDEWEB)

Tousi-Mojarradi, M.; Seidavi, A.; Dadashbeiki, M.; Roca-Fernandez, A. I.

2014-06-01

The aim of this research was to study the effect of soybean meal (SBM) heat procedures on growth performance of broiler chickens. A trial was carried out using 200 male Ross 308 strain chickens during 3 feeding periods (starter, grower and finisher, 42 days). The experiment was based on a completely randomized design with 5 treatments giving 4 replications of 10 broilers per treatment. Treatments consisted on: T1 (control, un-processed SBM), T2 (autoclaved SBM: 121 degree centigrade, 20 min), T3 (autoclaved SBM: 121 degree centigrade, 30 min), T4 (roasted SBM: 120 degree centigrade, 20 min) and T5 (microwaved SBM: 46 degree centigrade, 540 watt, 7 min). Growth performance of animals was examined by determining body weight (BW), body weight grain (BWG), feed intake (FI) and feed conversion rate (FCR). Higher BW (p<0.05) and BWG (p<0.05) and lower FCR (p<0.05) were found in broiler chickens fed heat processed SBM diets compared to those fed a raw SBM diet, probably due to higher nutrient availability. However, no differences were found among heat SBM procedures (autoclaving, roasting and microwaving) on growth performance of animals for the starter, grower and finisher periods. From the results of this experiment, it is concluded that further research needs to be developed to establish the effect of temperature-time heat procedures on nutritive value of SBM in terms of levels of anti-nutritional factors (trypsin inhibitor activity and phytic acid) and amino acids profile and its influence on growth performance of broilers. (Author)

Estimating effective dose to pediatric patients undergoing interventional radiology procedures using anthropomorphic phantoms and MOSFET dosimeters.

Science.gov (United States)

Miksys, Nelson; Gordon, Christopher L; Thomas, Karen; Connolly, Bairbre L

2010-05-01

The purpose of this study was to estimate the effective doses received by pediatric patients during interventional radiology procedures and to present those doses in "look-up tables" standardized according to minute of fluoroscopy and frame of digital subtraction angiography (DSA). Organ doses were measured with metal oxide semiconductor field effect transistor (MOSFET) dosimeters inserted within three anthropomorphic phantoms, representing children at ages 1, 5, and 10 years, at locations corresponding to radiosensitive organs. The phantoms were exposed to mock interventional radiology procedures of the head, chest, and abdomen using posteroanterior and lateral geometries, varying magnification, and fluoroscopy or DSA exposures. Effective doses were calculated from organ doses recorded by the MOSFET dosimeters and are presented in look-up tables according to the different age groups. The largest effective dose burden for fluoroscopy was recorded for posteroanterior and lateral abdominal procedures (0.2-1.1 mSv/min of fluoroscopy), whereas procedures of the head resulted in the lowest effective doses (0.02-0.08 mSv/min of fluoroscopy). DSA exposures of the abdomen imparted higher doses (0.02-0.07 mSv/DSA frame) than did those involving the head and chest. Patient doses during interventional procedures vary significantly depending on the type of procedure. User-friendly look-up tables may provide a helpful tool for health care providers in estimating effective doses for an individual procedure.

Trends in examination frequency and collective effective doses from computed tomography (CT) procedures in Sudan

International Nuclear Information System (INIS)

Yousif, S. B. I.

2011-01-01

This study was carried out to estimate the examination frequency and collective dose to population from CT procedures in Sudan. To calculate the annual collective dose from CT examinations a survey was done at 10 hospitals providing data of examinations frequency per day. The data of effective dose have been obtained from pervious study on effective dose per CT examination in Sudan. Then the annual examination frequency and annual collective effective dose had been calculated and discussed providing that the annual collective effective dose from CT examinations is (1482 man.Sv). The highest percentage examination frequency was for head examination (40%). The highest percentage contribution to the total collective dose from CT examinations was for abdomen examinations (32%). The calculated annual examination frequency and annual collective effective dose had been compared with the results of literature and international studies to evaluate the estimated values. The calculated annual collective dose from CT examinations is much lower comparing with the results presented in the literature. The study offers an insight on the examination frequency and the percentage of the risk from different standard radiographic examination within the country. (Author)

Safety and efficacy of rivaroxaban compared with warfarin in patients undergoing peripheral arterial procedures.

Science.gov (United States)

Talukdar, Anjan; Wang, S Keisin; Czosnowski, Lauren; Mokraoui, Nassim; Gupta, Alok; Fajardo, Andres; Dalsing, Michael; Motaganahalli, Raghu

2017-10-01

Rivaroxaban is a United States Food and Drug Administration-approved oral anticoagulant for venous thromboembolic disease; however, there is no information regarding the safety and its efficacy to support its use in patients after open or endovascular arterial interventions. We report the safety and efficacy of rivaroxaban vs warfarin in patients undergoing peripheral arterial interventions. This single-institution retrospective study analyzed all sequential patients from December 2012 to August 2014 (21 months) who were prescribed rivaroxaban or warfarin after a peripheral arterial procedure. Our study population was then compared using American College of Chest Physicians guidelines with patients then stratified as low, medium, or high risk for bleeding complications. Statistical analyses were performed using the Student t-test and χ 2 test to compare demographics, readmissions because of bleeding, and the need for secondary interventions. Logistic regression models were used for analysis of variables associated with bleeding complications and secondary interventions. The Fisher exact test was used for power analysis. There were 44 patients in the rivaroxaban group and 50 patients in the warfarin group. Differences between demographics and risk factors for bleeding between groups or reintervention rate were not statistically significant (P = .297). However, subgroup evaluation of the safety profile suggests that patients who were aged ≤65 years and on warfarin had an overall higher incidence of major bleeding (P = .020). Patients who were aged >65 years, undergoing open operation, had a significant risk for reintervention (P = .047) when they received rivaroxaban. Real-world experience using rivaroxaban and warfarin in patients after peripheral arterial procedures suggests a comparable safety and efficacy profile. Subgroup analysis of those requiring an open operation demonstrated a decreased bleeding risk when rivaroxaban was used (in those aged <65�

Are minimally invasive procedures harder to acquire than conventional surgical procedures?

Science.gov (United States)

Hiemstra, Ellen; Kolkman, Wendela; le Cessie, Saskia; Jansen, Frank Willem

2011-01-01

It is frequently suggested that minimally invasive surgery (MIS) is harder to acquire than conventional surgery. To test this hypothesis, residents' learning curves of both surgical skills are compared. Residents had to be assessed using a general global rating scale of the OSATS (Objective Structured Assessment of Technical Skills) for every procedure they performed as primary surgeon during a 3-month clinical rotation in gynecological surgery. Nine postgraduate-year-4 residents collected a total of 319 OSATS during the 2 years and 3 months investigation period. These assessments concerned 129 MIS (laparoscopic and hysteroscopic) and 190 conventional (open abdominal and vaginal) procedures. Learning curves (in this study defined as OSATS score plotted against procedure-specific caseload) for MIS and conventional surgery were compared using a linear mixed model. The MIS curve revealed to be steeper than the conventional curve (1.77 vs. 0.75 OSATS points per assessed procedure; 95% CI 1.19-2.35 vs. 0.15-1.35, p < 0.01). Basic MIS procedures do not seem harder to acquire during residency than conventional surgical procedures. This may have resulted from the incorporation of structured MIS training programs in residency. Hopefully, this will lead to a more successful implementation of the advanced MIS procedures. Copyright © 2010 S. Karger AG, Basel.

Configural and component processing in simultaneous and sequential lineup procedures.

Science.gov (United States)

Flowe, Heather D; Smith, Harriet M J; Karoğlu, Nilda; Onwuegbusi, Tochukwu O; Rai, Lovedeep

2016-01-01

Configural processing supports accurate face recognition, yet it has never been examined within the context of criminal identification lineups. We tested, using the inversion paradigm, the role of configural processing in lineups. Recent research has found that face discrimination accuracy in lineups is better in a simultaneous compared to a sequential lineup procedure. Therefore, we compared configural processing in simultaneous and sequential lineups to examine whether there are differences. We had participants view a crime video, and then they attempted to identify the perpetrator from a simultaneous or sequential lineup. The test faces were presented either upright or inverted, as previous research has shown that inverting test faces disrupts configural processing. The size of the inversion effect for faces was the same across lineup procedures, indicating that configural processing underlies face recognition in both procedures. Discrimination accuracy was comparable across lineup procedures in both the upright and inversion condition. Theoretical implications of the results are discussed.

Effect of Sucrose Analgesia, for Repeated Painful Procedures, on Short-term Neurobehavioral Outcome of Preterm Neonates: A Randomized Controlled Trial.

Science.gov (United States)

Banga, Shreshtha; Datta, Vikram; Rehan, Harmeet Singh; Bhakhri, Bhanu Kiran

2016-04-01

Safety of oral sucrose, commonly used procedural analgesic in neonates, is questioned. To evaluate the effect of sucrose analgesia, for repeated painful procedures, on short-term neurobehavioral outcome of preterm neonates. Stable preterm neonates were randomized to receive either sucrose or distilled water orally, for every potentially painful procedure during the first 7 days after enrollment. Neurodevelopmental status at 40 weeks postconceptional age (PCA) measured using the domains of Neurobehavioral Assessment of Preterm Infants scale. A total of 93 newborns were analyzed. The baseline characteristics of the groups were comparable. No statistically significant difference was observed in the assessment at 40 weeks PCA, among the groups. Use of sucrose analgesia, for repeated painful procedures on newborns, does not lead to any significant difference in the short-term neurobehavioral outcome. © The Author [2015]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Effects of measurement procedure and equipment on average room acoustic measurements

DEFF Research Database (Denmark)

Gade, Anders Christian; Bradley, J S; Siebein, G W

1993-01-01

This paper reports the results of a measurement tour of nine U.S. concert halls. Three measurements teams, from the University of Florida, the National Research Council of Canada, and the Technical University of Denmark, made parallel sets of measurements using their own equipment and procedures........ [Work partially supported by the Concert Hall Research Group.]......This paper reports the results of a measurement tour of nine U.S. concert halls. Three measurements teams, from the University of Florida, the National Research Council of Canada, and the Technical University of Denmark, made parallel sets of measurements using their own equipment and procedures....... In some of the halls measurements were repeated using the procedures of the other teams to make it possible to separate the effects of different equipment and different procedures. The paper will present position-averaged results from the three teams and will discuss reasons for the differences observed...

Comparison of local anesthetic effects of lidocaine versus tramadol and effect of child anxiety on pain level in circumcision procedure.

Science.gov (United States)

Polat, Fazli; Tuncel, Altug; Balci, Melih; Aslan, Yilmaz; Sacan, Ozlem; Kisa, Cebrail; Kayali, Mustafa; Atan, Ali

2013-10-01

To compare the local anesthetic effects of tramadol hydrochloride with those of lidocaine in circumcision procedures. We also investigated the effect of child anxiety on pain level. A total of 70 children were included in this study. The children were randomized into 3 groups. Group 1 (n = 26) received lidocaine hydrochloride + epinephrine and they underwent circumcision using Ali's clamp(®). Group 2 (n = 35) received lidocaine hydrochloride + epinephrine and group 3 (n = 12) 5% tramadol. The last two groups underwent conventional circumcision. The mean anxiety score was 22.6. We did not find significant differences in terms of anxiety score among the groups (p = 0.761). When the pain scores of the groups during injection were compared, it was found that there were no significant differences. However, the pain score of the third group was significantly high when it was compared with the first and second group 2 and 10 min after injection. In the correlation analysis, we found a positive correlation between children's anxiety scores and the pain degree during injection (r = 0.373, p = 0.001). Tramadol may not provide effective local anesthesia in male circumcision. The child's anxiety before the circumcision seems to have a negative effect on pain level. Copyright © 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Observational studies in systematic [corrected] reviews of comparative effectiveness: AHRQ and the Effective Health Care Program.

Science.gov (United States)

Norris, Susan L; Atkins, David; Bruening, Wendy; Fox, Steven; Johnson, Eric; Kane, Robert; Morton, Sally C; Oremus, Mark; Ospina, Maria; Randhawa, Gurvaneet; Schoelles, Karen; Shekelle, Paul; Viswanathan, Meera

2011-11-01

Systematic reviewers disagree about the ability of observational studies to answer questions about the benefits or intended effects of pharmacotherapeutic, device, or procedural interventions. This study provides a framework for decision making on the inclusion of observational studies to assess benefits and intended effects in comparative effectiveness reviews (CERs). The conceptual model and recommendations were developed using a consensus process by members of the methods workgroup of the Effective Health Care Program of the Agency for Healthcare Research and Quality. In considering whether to use observational studies in CERs for addressing beneficial effects, reviewers should answer two questions: (1) Are there gaps in the evidence from randomized controlled trials (RCTs)? (2) Will observational studies provide valid and useful information? The latter question involves the following: (a) refocusing the study questions on gaps in the evidence from RCTs, (b) assessing the risk of bias of the body of evidence of observational studies, and (c) assessing whether available observational studies address the gap review questions. Because it is unusual to find sufficient evidence from RCTs to answer all key questions concerning benefit or the balance of benefits and harms, comparative effectiveness reviewers should routinely assess the appropriateness of inclusion of observational studies for questions of benefit. Furthermore, reviewers should explicitly state the rationale for inclusion or exclusion of observational studies when conducting CERs. Copyright © 2011 Elsevier Inc. All rights reserved.

High procedural fairness heightens the effect of outcome favorability on self-evaluations : An attributional analysis

NARCIS (Netherlands)

Brockner, J.; Heuer, L.; Magner, N.; Folger, R.; Umphress, E.; Bos, K. van den; Vermunt, Riël; Magner, M.; Siegel, P.

2003-01-01

Previous research has shown that outcome favorability and procedural fairness often interact to influence employees work attitudes and behaviors. Moreover, the form of the interaction effect depends upon the dependent variable. Relative to when procedural fairness is low, high procedural fairness:

A comparative study of trabeculectomy and the new clear-cornea filtering procedure, intrastromal diathermal keratostomy (IDK)

DEFF Research Database (Denmark)

Bach-Holm, Daniella; Storr-Paulsen, Allan; Norregaard, Jens Christian

2012-01-01

Hg in the IDK group. The number of medications pre- and postoperatively in the trabeculectomy group was 3.1 and 0.5 versus 3.2 and 1.3 in the IDK group. Forty-four (59%) of the eyes in the trabeculectomy group met the complete success criteria compared with 5 (20%) in the IDK group (p......Purpose: For the first time to compare the 1-year success rates of trabeculectomy and the new clear-cornea filtering procedure, intrastromal diathermal keratostomy (IDK). Methods: Prospective clinical observational study including 99 consecutively operated eyes (69 patients) with well......-established primary open-angle glaucoma referred for filtering operation. We compared the change in intraocular pressure (IOP), number of anti-glaucomatous medication, complications and reoperations after 1 year. Seventy-four eyes were operated with trabeculectomy, and 25 with IDK. Complete success was defined as IOP...

Calculation methods' comparative analysis of monorail hoist crane local bending effects

Directory of Open Access Journals (Sweden)

Cvijović Goran M.

2016-01-01

Full Text Available The results of numerical and experimental researches of local bending problems, carried on classic and medium-wide I profiles, were a basis for the adoption of the current standards (EN 15011: 2014 which regulates the action of the local stress caused by the effect of cart wheels. Regarding the fact that IPB (HE-B wide flange profiles are largely used for production of the main carriers of monorail transport systems, this paper presents the results of the action of the local stress caused by the effect of cart wheels on the HE-A flange profile, using the methods and procedures of relevant researchers, the procedures prescribed by the standard EN 15011 as well as the results of calculations using finite element method. It has been revealed, based on comparative analysis of the results, that in the transition zone low flange / rib longitudinal local stress on the lower contour flange, determined using the above mentioned standards have tightening characteristic, while all other methods, including finite element method, give the pressing nature of the considered voltage. In addition, all of these procedures, except for the finite element method, adopt the assumption that absolute value of voltage, caused by local bending on upper and lower contour of the loaded flange, are the same, and there is no physical justification. Bearing in mind the fact that stress identification, caused by the flange local bending, is an extremely important phase proving the strength of monorail beams, we may conclude that the application of standard EN 15011 does not provide reliable results when it comes to wide flange profiles.

A comparative study of some aspects of radiation protection and dosimetry procedures. Pt. 1 and 2

International Nuclear Information System (INIS)

Drexler, G.; Goeksu, H.Y.; Johns, T.F.

1987-10-01

A study has been made of the procedures used in the Member States of the European Communities for dealing with certain practical and administrative aspects of radiation protection of occupationally exposed persons, and especially of the methods and procedures used in personnel dosimetry. It was found that the different states have adopted quite different methods for dealing with some of these problems, the method chosen seeming to depend on the size of the country and the extent and timing of its involvement with nuclear power developments; but although the different countries have adopted different methods of control, as far as we can judge they have all been reasonably effective in achieving adequate control of occupational exposures. Nevertheless, there are still issues that each country could probably learn and perhaps improve its own procedure by making a more careful study of the way in which other countries deal with these problems. Therefore the study was extended to cover the USA and Japan in order to facilitate such comparisons and improvements. (orig.)

Traditional couching is not an effective alternative procedure for cataract surgery in Mali.

Science.gov (United States)

Schémann, J F; Bakayoko, S; Coulibaly, S

2000-12-01

In Mali, more cataract patients receive sight-restoring surgery using a traditional "couching" procedure (the lens inside the vitreous body) than by modern cataract surgery. In order to evaluate the relative effectiveness and other outcomes of the traditional procedure compared to the modern surgical intervention, we conducted a population-based survey in a rural district of Mali in 1996. A total of 99,800 persons from 160 villages were eligible to be included in the sample. All individuals operated for cataract by a modern procedure were checked for visual acuity and questioned regarding their clinical history, the cost of the surgery and their satisfaction with the surgery immediately following the operation and presently. Each patient was paired with one person operated by a traditional cataract surgical procedure. From a total population of 99,800 we found 85 individuals (0.085%) who had been operated by intracapsular extraction (ICCE) without lens implantation and we paired these with 82 individuals operated by the traditional method and by a local healer. In both groups, males were predominant (74.4% in the modern group and 61.3% in the traditional) and the median age was 65 and 68 years, respectively. Men with a higher social status (defined as administrative or religious authority) were slightly more common among those operated by ICCE (18.9%) than among those operated by the traditional healer (4.4%). Nearly half (47.6%) of the patients operated by couching did not know that a modern alternative existed. The mean cost to the patient of the two procedures was similar; with traditional couching costing on average US$ 42.10 and modern surgery (including transport and drugs) costing US$ 52.40. The traditional healer was often paid partially in kind and the price paid varied according to the patient's ability to pay. The clinical results differed greatly between the two methods. After aphakic correction of eyes operated by ICCE, 5.3% had good vision (33/18), 76

Acute Procedural Pain in Children

DEFF Research Database (Denmark)

Kristensen, Helle Nygård; Lundbye-Christensen, Søren; Haslund-Thomsen, Helle

2018-01-01

INTRODUCTION: Hospitalized children often describe needle-related procedures as the worst pain possible and such procedures may be emotionally traumatic. The use of hospital clowns related to painful medical procedures in children may offer pain relief, but this has not been systematically...... evaluated. The objective of this study was to assess the effect of a therapeutic clown in comparison to standard care on the experience of pain for children receiving venipuncture. METHODS: A sample of 116 children aged 4-15 years consecutively admitted to the hospital was allocated to either......: Without the clown present, the mean pain score (2.7±2.8) was not significantly different between the two age groups. Children aged 7-15 years had lower pain scores when the clown was present compared to the control group (P=0.025). Children aged 4-6 years had higher pain scores with the clown present...

Effectiveness of tramadol/paracetamol compared with etoricoxib as ...

African Journals Online (AJOL)

Choy Y. Choy

Day care surgery is cost-effective and forms 70% of hospital- based surgical ... more major procedures, e.g. laparoscopic cholecystectomy and ... Nonpharmacological methods of pain control, e.g. ..... Open unilateral inguinal hernia repair. 8. 7.

INFLUENCE OF ADDITIONAL VIBRATION IMPACT ON THE EFFECTIVENESS OF ELECTRICAL STIMULATION PROCEDURE

Directory of Open Access Journals (Sweden)

M. G. Kiselev

2017-01-01

Full Text Available An experimental instrument complex which includes hardware for performing complex procedures using electrical shock massager frictional action was performed. The aim of the study was to influence the additional vibration effect on the efficiency of the procedure of electrostimulation.In order to increase the efficiency of the procedure electrostimulation authors proposed to carry it out with using of massager shock-friction action. The changes of muscular indicator on different stimulation treatments was shown after a series of seven treatments .Results of the processing of the experimental data and its subsequent analysis found that the use of the vibration exposure is accompanied by increase of load parameters in untrained volunteers. The increase in contact area due to decrease in the distance between the nozzle and the axis of rotation of the tumbler body surface, increases the electrical efficiency of the procedure.On the basis of a generalized analysis of data reflecting the effect of inappropriate electrical stimulation, it was established that, in order to achieve the best results, oscillatory systems providing shock-friction mode of its interaction with the skin surface, in particular a shock-frictional massager, were used.

Skin-to-skin care for procedural pain in neonates.

Science.gov (United States)

Johnston, Celeste; Campbell-Yeo, Marsha; Fernandes, Ananda; Inglis, Darlene; Streiner, David; Zee, Rebekah

2014-01-23

Skin-to-skin care (SSC), otherwise known as Kangaroo Care (KC) due to its similarity with marsupial behaviour of ventral maternal-infant contact, is one non-pharmacological intervention for pain control in infants. The primary objectives were to determine the effect of SSC alone on pain from medical or nursing procedures in neonates undergoing painful procedures compared to no intervention, sucrose or other analgesics, or additions to simple SSC such as rocking; and the effects of the amount of SSC (duration in minutes) and the method of administration (who provided the SSC, positioning of caregiver and neonate pair).The secondary objectives were to determine the incidence of untoward effects of SSC and to compare the SSC effect in different postmenstrual age subgroups of infants. The standard methods of the Cochrane Neonatal Collaborative Review Group were used. Databases searched in August 2011: Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library); Evidence-Based Medicine Reviews; MEDLINE (1950 onwards); PubMed (1975 onwards); EMBASE (1974 onwards); CINAHL (1982 onwards); Web of Science (1980 onwards); LILACS database (1982 onwards); SCIELO database (1982 onwards); PsycInfo (1980 onwards); AMED (1985 onwards); Dissertation-Abstracts International (1980 onwards). Searches were conducted throughout September 2012. Studies with randomisation or quasi-randomisation, double or single-blinded, involving term infants (> 37 completed weeks postmenstrual age (PMA)) to a maximum of 44 weeks PMA and preterm infants (lance as the painful procedure, one study combined venepuncture and heel stick (n = 50), two used intramuscular injection, and one used 'vaccination' (n = 80). The studies that were included were generally strong and free from bias.Eleven studies (n = 1363) compared SSC alone to a no-treatment control. Although 11 studies measured heart rate during painful procedures, data from only four studies (n = 121) could be combined to give a

The effect of vasodilatory medications on radial artery spasm in patients undergoing transradial coronary artery procedures: a systematic review.

Science.gov (United States)

Curtis, Elizabeth; Fernandez, Ritin; Lee, Astin

2017-07-01

standardized data extraction tool from RevMan5 (Copenhagen: The Nordic Cochrane Centre, Cochrane). Quantitative data, where possible, was pooled in statistical meta-analysis using RevMan5. All results were subject to double data entry. Effect sizes expressed as risk ratio (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals were calculated for analysis. Nine trials involving 3614 patients were included in the final review. Pooled data involving 992 patients on the effect of calcium channel blockers demonstrated a statistically significant reduction in the incidence of vasospasm in patients who received verapamil 5 mg compared to those who received a placebo (OR 0.33; 95%CI 0.19, 0.58). Similarly patients who received verapamil 2.5 mg or 1.25 mg had significantly fewer incidences of vasospasm when compared to those who received a placebo. Nitroglycerine 100mcg was demonstrated to be associated with a statistically significant reduction in the incidence of vasospasm. The evidence demonstrates a benefit in the use of vasodilatory medications for the reduction of vasospasm in patients having radial coronary procedures. Further large-scale multi-center trials are needed to determine the preferred medication.

Effectiveness of HVAC duct cleaning procedures in improving indoor air quality.

Science.gov (United States)

Ahmad, I; Tansel, B; Mitrani, J D

2001-12-01

Indoor air quality has become one of the most serious environmental concerns as an average person spends about 22 hr indoors on a daily basis. The study reported in this article, was conducted to determine the effectiveness of three commercial HVAC (Heating Ventilation Air Conditioning) duct cleaning processes in reducing the level of airborne particulate matter and viable bioaerosols. The three HVAC sanitation processes were: (1) Contact method (use of conventional vacuum cleaning of interior duct surfaces); (2) Air sweep method (use of compressed air to dislodging dirt and debris); (3) Rotary brush method (insertion of a rotary brush into the ductwork to agitate and dislodge the debris). Effectiveness of these sanitation processes was evaluated in terms of airborne particulate and viable bioaerosol concentrations in residential homes. Eight identical homes were selected in the same neighborhood. Two homes were cleaned using each procedure and two were used as controls. It was found that both particle count readings and bioaerosol concentrations were higher when cleaning was being performed than before or after cleaning, which suggests that dirt, debris and other pollutants may become airborne as a result of disturbances caused by the cleaning processes. Particle count readings at 0.3 micron size were found to have increased due to cigarette smoking. Particle counts at 1.0 micron size were reduced due to HVAC duct cleaning. Post-level bioaerosol concentrations, taken two days after cleaning, were found to be lower than the pre-level concentrations suggesting that the cleaning procedures were effective to some extent. Homes cleaned with the Air Sweep procedure showed the highest degree of reduction in bioaerosol concentration among the three procedures investigated.

[Effects of different types and concentration of oral sweet solution on reducing neonatal pain during heel lance procedures].

Science.gov (United States)

Leng, Hong-yao; Zheng, Xian-lan; Yan, Li; Zhang, Xian-hong; He, Hua-yun; Xiang, Ming

2013-09-01

To compare the effect of different types and concentrations of sweet solutions on neonatal pain during heel lance procedure. Totally 560 full term neonates (male 295, female 265) were randomized into 7 groups:placebo group (plain water), 10% glucose, 25% glucose, 50% glucose, 12% sucrose, 24% sucrose and 30% sucrose groups.In each group, 2 ml corresponding oral solutions were administered through a syringe by dripping into the neonate's mouth 2 minute before heel lance. The procedure process was recorded by videos, from which to collect heart rate, oxygen saturation and pain score 1 min before puncture, 3, 5 and 10 min after puncture. The average heart rate increase 3, 5 and 10 min after procedure in the 25% and 50% glucose groups, 12% and 24% and 30% sucrose groups was significantly lower than those in the placebo group (P lance (both P lance, but the best concentration of sucrose for pain relief needs further study.

[The transrectus sheath preperitoneal procedure: a safe, effective and cheap surgical approach to inguinal hernia?].

Science.gov (United States)

Prins, M W Wiesje; Voropai, D A Dasha; van Laarhoven, C J H M Kees; Akkersdijk, Willem L

2013-01-01

The main complication of surgery for inguinal hernia is chronic postoperative pain. This is often reported following the Lichtenstein procedure. A new, open surgical technique for the repair of inguinal hernia has been developed. This procedure is called the transrectus sheath preperitoneal procedure (TREPP). At TREPP a lightweight mesh with a ring made of memory metal is introduced into the preperitoneal space through the transrectus sheath. The first results of this operative technique are very promising: short operation time, short learning curve and not many patients with chronic postoperative pain. In a randomised, multi-centre study which will start mid-2013 (ISRCTN18591339), the TREPP procedure is compared with the transinguinal preperitoneal procedure. The primary outcome measure of this study is chronic postoperative pain.

Components of Hospital Perioperative Infrastructure Can Overcome the Weekend Effect in Urgent General Surgery Procedures.

Science.gov (United States)

Kothari, Anai N; Zapf, Matthew A C; Blackwell, Robert H; Markossian, Talar; Chang, Victor; Mi, Zhiyong; Gupta, Gopal N; Kuo, Paul C

2015-10-01

We hypothesized that perioperative hospital resources could overcome the "weekend effect" (WE) in patients undergoing emergent/urgent surgeries. The WE is the observation that surgeon-independent patient outcomes are worse on the weekend compared with weekdays. The WE is often explained by differences in staffing and resources resulting in variation in care between the week and weekend. Emergent/urgent surgeries were identified using the Healthcare Cost and Utilization Project State Inpatient Database (Florida) from 2007 to 2011 and linked to the American Hospital Association (AHA) Annual Survey Database to determine hospital level characteristics. Extended median length of stay (LOS) on the weekend compared with the weekdays (after controlling for hospital, year, and procedure type) was selected as a surrogate for WE. Included were 126,666 patients at 166 hospitals. A total of 17 hospitals overcame the WE during the study period. Logistic regression, controlling for patient characteristics, identified full adoption of electronic medical records (OR 4.74), home health program (OR 2.37), pain management program [odds ratio (OR) 1.48)], increased registered nurse-to-bed ratio (OR 1.44), and inpatient physical rehabilitation (OR 1.03) as resources that were predictors for overcoming the WE. The prevalence of these factors in hospitals exhibiting the WE for all 5 years of the study period were compared with those hospitals that overcame the WE (P surgery procedures. Improved hospital perioperative infrastructure represents an important target for overcoming disparities in surgical care.

Long-term clinical outcomes with the retropubic tension-free vaginal tape (TVT) procedure compared to Burch colposuspension for correcting stress urinary incontinence (SUI).

Science.gov (United States)

Holdø, Bjørn; Verelst, Margareta; Svenningsen, Rune; Milsom, Ian; Skjeldestad, Finn Egil

2017-11-01

The retropubic tension-free vaginal tape (TVT) procedure replaced Burch colposuspension as the primary surgical method for stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) in women in our department in 1998. In this study we compared the short-term and long-term clinical outcomes of these surgical procedures. Using a case series design, we compared the last 5 years of the Burch procedure (n = 127, 1994-1999) with the first 5 years of the retropubic TVT procedure (n = 180, 1998-2002). Information from the medical records was transferred to a case report form comprising data on perioperative and long-term complications as well as recurrence of UI, defined as bothersome UI or UI in need of repeat surgery. Other endpoints were rates of perioperative and late complications and the rates of prolapse surgery after primary surgery. The data were analyzed with the chi-squared and t tests and survival analysis using SPSS. The cumulative recurrence rate of SUI in women with preoperative SUI was significantly higher after the Burch procedure, but no difference was observed in women with MUI. There were no significant differences in rates of perioperative and late complications. At 12 years there was a significant increase in rates of repeat surgery for incontinence and prolapse in women after the Burch procedure. The long-term efficacy of TVT surgery was superior to that of Burch colposuspension in women with SUI. In addition, the rate of late prolapse surgery was significantly higher after the Burch procedure.

Quality of harvested autologous platelets compared with stored donor platelets for use after cardiopulmonary bypass procedures.

Science.gov (United States)

Crowther, M; Ford, I; Jeffrey, R R; Urbaniak, S J; Greaves, M

2000-10-01

Platelet dysfunction has a major contribution in bleeding after cardiopulmonary bypass (CPB) and transfusion of platelets is frequently used to secure haemostasis. Allogeneic platelets prepared for transfusion are functionally impaired. Autologous platelets harvested preoperatively require a shorter storage time before transfusion and their use also avoids the risks associated with transfusion of allogeneic blood products. For the first time, we have compared the functional quality of autologous platelets with allogeneic platelets prepared by two methods, immediately before infusion. Platelet activation was assessed by P-selectin expression and fibrinogen binding using flow cytometry. We also monitored the effects of CPB surgery and re-infusion of autologous platelets on platelet function. Autologous platelet-rich plasma (PRP) contained a significantly lower (P platelets compared with allogeneic platelet preparations, and also contained a significantly higher (P platelets. Allogeneic platelets prepared by donor apheresis were more activated and less responsive than those produced by centrifugation of whole blood. In patients' blood, the percentage of platelets expressing P-selectin or binding fibrinogen increased significantly after CPB (P platelets responsive to in vitro agonists was decreased (P platelet activation during the procedure. The percentage of activated platelets decreased (statistically not significant) after re-infusion of autologous PRP. P-selectin expression had returned to pre-CPB levels 24 h post-operatively. Autologous platelet preparations display minimal activation, but remain responsive. Conservation of platelet function may contribute to the potential clinical benefits of autologous transfusion in cardiopulmonary bypass.

Measuring variability of procedure progression in proceduralized scenarios

International Nuclear Information System (INIS)

Kim, Yochan; Park, Jinkyun; Jung, Wondea

2012-01-01

Highlights: ► The VPP measure was developed to quantify how differently operators follow the procedures. ► Sources that cause variability of ways to follow a given procedure were identified. ► The VPP values for the scenarios are positively related to the scenario performance time. ► The VPP measure is meaningful for explaining characteristics of several PSFs. -- Abstract: Various performance shaping factors (PSFs) have been presented to explain the contributors to unsafe acts in a human failure event or predict a human error probability of new human performance. However, because most of these parameters of an HRA depend on the subjective knowledge and experience of HRA analyzers, the results of an HRA insufficiently provide unbiased standards to explain human performance variations or compare collected data with other data from different analyzers. To secure the validity of the HRA results, we propose a quantitative measure, which represents the variability of procedure progression (VPP) in proceduralized scenarios. A VPP measure shows how differently the operators follow the steps of the procedures. This paper introduces the sources of the VPP measure and relevance to PSFs. The assessment method of the VPP measure is also proposed, and the application examples are shown with a comparison of the performance time. Although more empirical studies should be conducted to reveal the relationship between the VPP measure and other PSFs, it is believed that the VPP measure provides evidence to quantitatively evaluate human performance variations and to cross-culturally compare the collected data.

The effect of the modified puestow procedure on diabetes in patients with tropical chronic pancreatitis--a prospective study.

Science.gov (United States)

Sidhu, S S; Nundy, S; Tandon, R K

2001-01-01

Surgical decompression of the pancreatic duct in patients with chronic pancreatitis relieves pain in 80-90% of subjects, but its effect on exocrine and endocrine pancreatic function is not clear. We sought to further examine such effects. We performed the modified Puestow procedure (lateral pancreaticojejunostomy) in 53 patients with chronic tropical pancreatitis. Pain evaluation was done subjectively and objectively, and the fasting and postprandial blood glucose, insulin requirements, and 72-h fecal fat levels were estimated before and at 3 months and 5 yr after operation. We compared 46 operated patients who completed 5 yr of follow-up with 40 patients who did not undergo operation. Forty-one patients (89%) had complete pain relief. The mean fasting (209 mg/dl) and postprandial (320 mg/dl) blood glucose and insulin requirements (40 U/day) decreased postoperatively (fasting, 162 mg/dl; postprandial blood glucose, 254mg/dl; insulin requirement, 18.2 U/day; p Puestow procedure not only have relief from pain but also improvement of diabetes.

Comparative clinical study of the effect of LLLT in the immediate and late treatments of hypoesthesia due to surgical procedures

Science.gov (United States)

Ladalardo, Thereza C.; Brugnera, Aldo, Jr.; Pinheiro, Antonio L. B.; Castanho Garrini, Ana E.; Bologna, Elisangela D.; Takamoto, Marcia; Siqueira, Jose T.; Dias, Pedro; Campos, Roberto A. d. C.

2002-06-01

We evaluated the effect of LLLT in 68 patients who presented hypoesthesia due to odontological surgery procedures: dental implant surgeries (N=51); extraction of impacted lower third molars (N=10); endodontics in lower first molars (N=7). Lesions treated within 30 days after the nerve injury had occurred were part of the immediate group, and lesions with more than 30 days from the occurrence of the injury were part of the late group. Treatments were carried out with an infrared diode laser of 40 mW-830nm, continuous wave emission, spot size 3 mm2, and a total dosage of 18 joules per session in a contact mode of application, 20 sessions altogether. The efficacy of laser therapy in peripheral nerve regeneration is also related to the degree of the peripheral nerve lesion, and not only to the lesion duration. LLLT resulted in neurosensory functional improvement in both immediate and late treatments of hypoesthesia.

Facilitating comparative effectiveness research in cancer genomics: evaluating stakeholder perceptions of the engagement process.

Science.gov (United States)

Deverka, Patricia A; Lavallee, Danielle C; Desai, Priyanka J; Armstrong, Joanne; Gorman, Mark; Hole-Curry, Leah; O'Leary, James; Ruffner, B W; Watkins, John; Veenstra, David L; Baker, Laurence H; Unger, Joseph M; Ramsey, Scott D

2012-07-01

The Center for Comparative Effectiveness Research in Cancer Genomics completed a 2-year stakeholder-guided process for the prioritization of genomic tests for comparative effectiveness research studies. We sought to evaluate the effectiveness of engagement procedures in achieving project goals and to identify opportunities for future improvements. The evaluation included an online questionnaire, one-on-one telephone interviews and facilitated discussion. Responses to the online questionnaire were tabulated for descriptive purposes, while transcripts from key informant interviews were analyzed using a directed content analysis approach. A total of 11 out of 13 stakeholders completed both the online questionnaire and interview process, while nine participated in the facilitated discussion. Eighty-nine percent of questionnaire items received overall ratings of agree or strongly agree; 11% of responses were rated as neutral with the exception of a single rating of disagreement with an item regarding the clarity of how stakeholder input was incorporated into project decisions. Recommendations for future improvement included developing standard recruitment practices, role descriptions and processes for improved communication with clinical and comparative effectiveness research investigators. Evaluation of the stakeholder engagement process provided constructive feedback for future improvements and should be routinely conducted to ensure maximal effectiveness of stakeholder involvement.

9 CFR 147.14 - Procedures to determine status and effectiveness of sanitation monitored program.

Science.gov (United States)

2010-01-01

... status and effectiveness of sanitation monitored program. The following monitoring procedures 10 may be applied at the discretion of the Official State Agency: 10 Laboratory procedures for monitoring operations... egg conalbumin; and (ii) Tetrathionate selective enrichment broths, competitor-controlling plating...

25 CFR 291.13 - When do Class III gaming procedures for an Indian tribe become effective?

Science.gov (United States)

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false When do Class III gaming procedures for an Indian tribe... ECONOMIC ENTERPRISES CLASS III GAMING PROCEDURES § 291.13 When do Class III gaming procedures for an Indian tribe become effective? Upon approval of Class III gaming procedures for the Indian tribe under either...

A comparative examination of sample treatment procedures for ICAP-AES analysis of biological tissue

Science.gov (United States)

De Boer, J. L. M.; Maessen, F. J. M. J.

The objective of this study was to contribute to the evaluation of existing sample preparation procedures for ICAP-AES analysis of biological material. Performance characteristics were established of current digestion procedures comprising extraction, solubilization, pressure digestion, and wet and dry ashing methods. Apart from accuracy and precision, a number of criteria of special interest for the analytical practice was applied. As a test sample served SRM bovine liver. In this material six elements were simultaneously determined. Results showed that every procedure has its defects and advantages. Hence, unambiguous recommendation of standard digestion procedures can be made only when taking into account the specific analytical problem.

Assessment of different concentrations of ketofol in procedural operations

International Nuclear Information System (INIS)

Daabiss, Mohamed; Elsherbiny, Medhat; Al Otaibi, Rashed

2009-01-01

Propofol is an intravenous anesthetic that is often used as an adjuvant during monitored anesthesia care, the addition of ketamine to propofol may counteract the cardiorespiratory depression seen with propofol used alone. Ketofol (ketamine/propofol combination) was used for procedural sedation and analgesia. However, evaluation of the effectiveness of different concentrations of Ketofol in procedural operation regarding changes in haemodynamics, emergence phenomena, recovery time, the doses, and adverse effects was not yet studied, so this randomized, double blinded study was designed to compare the quality of analgesia and side effects of intravenous different concentrations of ketofol. One hundred children of both sex undergoing procedural operation, e.g. esophgoscopy, rectoscopy, bone marrow aspiration and liver biopsy participated in this. Patients received an infusion of a solution containing either combination of propofol: ketamine (1:1) (Group I) or propofol: ketamine (4:1) (Group II). Subsequent infusion rates to a predetermined sedation level using Ramsay Sedation Scale. Heart rate, noninvasive arterial blood pressure (NIBP), oxygen saturation (SpO2), end tidal carbon dioxide (Etco 2 ) and incidence of any side effects were recorded. There were no significant hemodynamic changes in both groups after induction. However, there was an increase in postoperative nausea, psychomimetic side effects, and delay in discharge times in group I compared to group II. The adjunctive use of smaller dose of ketamine in ketofol combination minimizes the psychomimetic side effects and shortens the time of hospital discharge. (author)

[Multimodal distraction to relieve pain in children undergoing acute medical procedures].

Science.gov (United States)

Miller, Kate; Rodger, Sylvia; Bucolo, Sam; Wang, Xue-Qing; Kimble, Roy M

2009-10-01

Non-pharmacological approaches to pain management have been used by therapists for decades to reduce the anxiety and pain experienced by children during burn care procedures. With a greater understanding of pain and the principles behind what causes a child to be distracted, combined with access to state of the art technology, we have developed an easy to use, hand held multimodal distraction device (MMD). MMD is an interactive device that prepares the child for a procedure and uses developmentally appropriate distraction stories and games during the procedures to alleviate anxiety and pain. This paper summarizes the results of three randomized control trials. The trials aimed to understand the effectiveness of MMD as a distraction and preparation tool in reducing anxiety and pain in children undergoing burns and non-burns medical procedures compared to pure pharmacological approaches Standard Distraction (SD) and off the shelf video games (VG). Three separate prospective randomized control trials involving 182 children having 354 dressing changes were conducted in the burns and orthopedic departments at Royal Children's Hospital, Brisbane, Australia, to address the above aims. Pain and anxiety scores were completed for the child, caregiver and nursing staff according to the Modified Faces, Legs, Activity, Cry and Consolability Scale, Faces Pain Scale-Revised, Visual Analogue Scale and Wong-Baker Faces Pain Rating Scale. Procedural length was recorded. MMD as a preparation and distraction tool were shown to have a significant impact on child, parent and nursing staff reported anxiety and pain during procedures compared to standard care and video games (P positive effect on clinical time and was shown to sustain its impact on pain and time with further dressing changes. MMD is more effective in reducing the pain and anxiety experienced by children in acute medical procedures as compared with SD and VG. MMD is continuing to be trialed and is continuing to show

Sentinel node biopsy (SNB) in malignant melanoma as same day procedure vs delayed procedure

DEFF Research Database (Denmark)

Rødgaard, Jes Christian; Kramer, Stine; Stolle, Lars B

2013-01-01

The aim of this study was to compare a delayed sentinel node biopsy (dSNB) procedure with a same-day procedure (sSNB) in malignant melanoma. In March 2012, Aarhus University Hospital went from the dSNB to the sSNB procedure defined by lymphoscintigraphy (LS) and sentinel node biopsy (SNB) perform......, essential to keep the morbidity and economic costs low, while keeping the quality of the procedure high....

Comparative analysis of diagnostic accuracy of different brain biopsy procedures.

Science.gov (United States)

Jain, Deepali; Sharma, Mehar Chand; Sarkar, Chitra; Gupta, Deepak; Singh, Manmohan; Mahapatra, A K

2006-12-01

Image-guided procedures such as computed tomography (CT) guided, neuronavigator-guided and ultrasound-guided methods can assist neurosurgeons in localizing the intraparenchymal lesion of the brain. However, despite improvements in the imaging techniques, an accurate diagnosis of intrinsic lesion requires tissue sampling and histological verification. The present study was carried out to examine the reliability of the diagnoses made on tumor sample obtained via different stereotactic and ultrasound-guided brain biopsy procedures. A retrospective analysis was conducted of all brain biopsies (frame-based and frameless stereotactic and ultrasound-guided) performed in a single tertiary care neurosciences center between 1995 and 2005. The overall diagnostic accuracy achieved on histopathology and correlation with type of biopsy technique was evaluated. A total of 130 cases were included, which consisted of 82 males and 48 females. Age ranged from 4 to 75 years (mean age 39.5 years). Twenty per cent (27 patients) were in the pediatric age group, while 12% (16 patients) were >or= 60-years of age. A definitive histological diagnosis was established in 109 cases (diagnostic yield 80.2%), which encompassed 101 neoplastic and eight nonneoplastic lesions. Frame-based, frameless stereotactic and ultrasound-guided biopsies were done in 95, 15 and 20 patients respectively. Although the numbers of cases were small there was trend for better yield with frameless image-guided stereotactic biopsy and maximum diagnostic yield was obtained i.e, 87% (13/15) in comparison to conventional frame-based CT-guided stereotactic biopsy and ultrasound-guided biopsy. Overall, a trend of higher diagnostic yield was seen in cases with frameless image-guided stereotactic biopsy. Thus, this small series confirms that frameless neuronavigator-guided stereotactic procedures represent the lesion sufficiently in order to make histopathologic diagnosis.

Human factoring administrative procedures

International Nuclear Information System (INIS)

Grider, D.A.; Sturdivant, M.H.

1991-01-01

In nonnuclear business, administrative procedures bring to mind such mundane topics as filing correspondence and scheduling vacation time. In the nuclear industry, on the other hand, administrative procedures play a vital role in assuring the safe operation of a facility. For some time now, industry focus has been on improving technical procedures. Significant efforts are under way to produce technical procedure requires that a validated technical, regulatory, and administrative basis be developed and that the technical process be established for each procedure. Producing usable technical procedures requires that procedure presentation be engineered to the same human factors principles used in control room design. The vital safety role of administrative procedures requires that they be just as sound, just a rigorously formulated, and documented as technical procedures. Procedure programs at the Tennessee Valley Authority and at Boston Edison's Pilgrim Station demonstrate that human factors engineering techniques can be applied effectively to technical procedures. With a few modifications, those same techniques can be used to produce more effective administrative procedures. Efforts are under way at the US Department of Energy Nuclear Weapons Complex and at some utilities (Boston Edison, for instance) to apply human factors engineering to administrative procedures: The techniques being adapted include the following

Short communication Effects of drying procedures on chemical ...

African Journals Online (AJOL)

jancik.filip

2016-12-31

Dec 31, 2016 ... Another drying procedure included pre-treatment by heating in a ... freeze-drying method and that this procedure is useful for forage analyses and evaluation. ... oven drying (OD) and innovative drying procedures (pre-treatments .... This was probably caused by losses of compounds such as ammonia and.

Is the Whipple procedure harmful for long-term outcome in treatment of chronic pancreatitis? 15-years follow-up comparing the outcome after pylorus-preserving pancreatoduodenectomy and Frey procedure in chronic pancreatitis.

Science.gov (United States)

Bachmann, Kai; Tomkoetter, Lena; Kutup, Asad; Erbes, Johannes; Vashist, Yogesh; Mann, Oliver; Bockhorn, Maximilian; Izbicki, Jakob R

2013-11-01

The aim of this study was to report on 15-year long-term results of a randomized controlled trial comparing extended drainage procedure (Frey) and classical resectional procedure [pylorus-preserving pancreatoduodenectomy (PD)] in patients with chronic pancreatitis. Chronic pancreatitis is a common inflammatory disease with a prevalence of 10 to 30 cases per 100,000 inhabitants. It is characterized by the progressive conversion of pancreatic parenchyma to fibrous tissue. Different surgical procedures are used in treatment of persistent pain. Sixty-four patients suffering from chronic pancreatitis with inflammatory mass in the pancreatic head were randomly assigned in 2 treatment groups (PD, n = 32) and (Frey, n = 32). The perioperative course of the randomized controlled trial and the 7 years follow-up have been previously published. All participating patients were contacted with a standardized, validated questionnaire (EORTC QLQ C30) to evaluate the long-term survival, quality-of-life pain, and exocrine and endocrine function. In the 15-year long-term follow-up, the pain control was good and comparable between both groups, but the quality of life was better after Frey procedure in regard of the physical status [PD: 100 (0-100) vs PD: 60 (0-100) (P = 0.011)]. No significant differences in terms of the Pain Score were detected between both groups [PD: 7 (0-100) vs Frey 4 (0-100) P = 0.258]. Seven patients after Frey OP and 6 patients after PD were free of pain. Analyzing the postoperative overall survival, a higher long-term mortality was found after PD (53%) than that found after Frey procedure (30%) resulting in a longer mean survival (14.5 ± 0.8 vs 11.3 ± 0.8 years; P = 0.037). No correlation between endocrine or exocrine pancreatic function and pain was found, whereas continuous alcohol consumption was associated with poorer outcome regarding quality of life (P treatment of chronic pancreatitis.

Randomized, Split-Face/Décolleté Comparative Trial of Procedure Enhancement System for Fractional non-Ablative Laser Resurfacing Treatment.

Science.gov (United States)

Robinson, Deanne Mraz; Frulla, Ashton P

2017-07-01

INTRODUCTION: A topical proprietary procedural enhancement system (PES) containing a combination of active ingredients including a tripeptide and hexapeptide (TriHex Technology™, Alastin Procedure Enhancement Invasive System, ALASTIN Skincare™, Inc., Carlsbad, CA) has been used successfully to aid in healing and improve symptomatology following resurfacing procedures. METHODS: PES (Gentle Cleanser, Regenerating Skin Nectar with TriHex Technology™, Ultra Nourishing Moisturizer with TriHex Technology™, Soothe + Protect Recovery Balm, Broad Spectrum 30+ Sunscreen) was compared to a basic regimen (Aquaphor™, Cerave™ cleanser, Vanicream™, Alastin Broad Spectrum 30+ Sunscreen) in a split face/ décolleté trial following fractional non-ablative thulium-doped resurfacing treatment to the face or décolleté. The skin was pre-conditioned and treated during and after the procedure using the two regimens. RESULTS: A blinded investigator rated the PES statistically superior to the basic regimen on healing post-laser treatment on day 4 based on lentigines, texture, and Global Skin Quality. Subjects also reported 'better looking and feeling' skin on the PES side. CONCLUSION: PES appears to improve healing post-non ablative thulium-doped resurfacing treatment to the face/décolleté in comparison with standard of care. J Drugs Dermatol. 2017;16(7):707-710..

Long-term follow-up of a randomized clinical trial comparing Beger with pylorus-preserving Whipple procedure for chronic pancreatitis.

Science.gov (United States)

Müller, M W; Friess, H; Martin, D J; Hinz, U; Dahmen, R; Büchler, M W

2008-03-01

Duodenum-preserving pancreatic head resection according to Beger and the pylorus-preserving Whipple (ppWhipple) procedure were compared in patients with chronic pancreatitis (CP) in a randomized clinical trial. Perioperative data and short-term outcome have been reported previously. The present study evaluated long-term follow-up. Forty patients were enrolled originally, 20 in each group. Long-term follow-up included mortality, morbidity, pain status, occupational rehabilitation, quality of life (QoL), and endocrine and exocrine function at median follow-up of 7 and 14 years. One patient who had a ppWhipple procedure was lost to follow-up. There were five late deaths in each group. No differences were noted in pain status and exocrine pancreatic function. Loss of appetite was significantly worse in the ppWhipple group at 14 years' follow-up, but there were no other differences in QoL parameters examined. After 14 years, diabetes mellitus was present in seven of 15 patients who had the Beger procedure and 11 of 14 patients after ppWhipple resection (P = 0.128). After long-term follow-up of up to 14 years early advantages of the Beger procedure were no longer present. 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Minimally invasive surgical procedures for the treatment of lumbar disc herniation

Directory of Open Access Journals (Sweden)

Raspe, Heiner

2005-11-01

Full Text Available Introduction: In up to 30% of patients undergoing lumbar disc surgery for herniated or protruded discs outcomes are judged unfavourable. Over the last decades this problem has stimulated the development of a number of minimally-invasive operative procedures. The aim is to relieve pressure from compromised nerve roots by mechanically removing, dissolving or evaporating disc material while leaving bony structures and surrounding tissues as intact as possible. In Germany, there is hardly any utilisation data for these new procedures – data files from the statutory health insurances demonstrate that about 5% of all lumbar disc surgeries are performed using minimally-invasive techniques. Their real proportion is thought to be much higher because many procedures are offered by private hospitals and surgeries and are paid by private health insurers or patients themselves. So far no comprehensive assessment comparing efficacy, safety, effectiveness and cost-effectiveness of minimally-invasive lumbar disc surgery to standard procedures (microdiscectomy, open discectomy which could serve as a basis for coverage decisions, has been published in Germany. Objective: Against this background the aim of the following assessment is: * Based on published scientific literature assess safety, efficacy and effectiveness of minimally-invasive lumbar disc surgery compared to standard procedures. * To identify and critically appraise studies comparing costs and cost-effectiveness of minimally-invasive procedures to that of standard procedures. * If necessary identify research and evaluation needs and point out regulative needs within the German health care system. The assessment focusses on procedures that are used in elective lumbar disc surgery as alternative treatment options to microdiscectomy or open discectomy. Chemonucleolysis, percutaneous manual discectomy, automated percutaneous lumbar discectomy, laserdiscectomy and endoscopic procedures accessing the disc

Comparison of VFA titration procedures used for monitoring the biogas process.

Science.gov (United States)

Lützhøft, Hans-Christian Holten; Boe, Kanokwan; Fang, Cheng; Angelidaki, Irini

2014-05-01

Titrimetric determination of volatile fatty acids (VFAs) contents is a common way to monitor a biogas process. However, digested manure from co-digestion biogas plants has a complex matrix with high concentrations of interfering components, resulting in varying results when using different titration procedures. Currently, no standardized procedure is used and it is therefore difficult to compare the performance among plants. The aim of this study was to evaluate four titration procedures (for determination of VFA-levels of digested manure samples) and compare results with gas chromatographic (GC) analysis. Two of the procedures are commonly used in biogas plants and two are discussed in literature. The results showed that the optimal titration results were obtained when 40 mL of four times diluted digested manure was gently stirred (200 rpm). Results from samples with different VFA concentrations (1-11 g/L) showed linear correlation between titration results and GC measurements. However, determination of VFA by titration generally overestimated the VFA contents compared with GC measurements when samples had low VFA concentrations, i.e. around 1 g/L. The accuracy of titration increased when samples had high VFA concentrations, i.e. around 5 g/L. It was further found that the studied ionisable interfering components had lowest effect on titration when the sample had high VFA concentration. In contrast, bicarbonate, phosphate and lactate had significant effect on titration accuracy at low VFA concentration. An extended 5-point titration procedure with pH correction was best to handle interferences from bicarbonate, phosphate and lactate at low VFA concentrations. Contrary, the simplest titration procedure with only two pH end-points showed the highest accuracy among all titration procedures at high VFA concentrations. All in all, if the composition of the digested manure sample is not known, the procedure with only two pH end-points should be the procedure of

Automatic segmentation of rotational x-ray images for anatomic intra-procedural surface generation in atrial fibrillation ablation procedures.

Science.gov (United States)

Manzke, Robert; Meyer, Carsten; Ecabert, Olivier; Peters, Jochen; Noordhoek, Niels J; Thiagalingam, Aravinda; Reddy, Vivek Y; Chan, Raymond C; Weese, Jürgen

2010-02-01

Since the introduction of 3-D rotational X-ray imaging, protocols for 3-D rotational coronary artery imaging have become widely available in routine clinical practice. Intra-procedural cardiac imaging in a computed tomography (CT)-like fashion has been particularly compelling due to the reduction of clinical overhead and ability to characterize anatomy at the time of intervention. We previously introduced a clinically feasible approach for imaging the left atrium and pulmonary veins (LAPVs) with short contrast bolus injections and scan times of approximately 4 -10 s. The resulting data have sufficient image quality for intra-procedural use during electro-anatomic mapping (EAM) and interventional guidance in atrial fibrillation (AF) ablation procedures. In this paper, we present a novel technique to intra-procedural surface generation which integrates fully-automated segmentation of the LAPVs for guidance in AF ablation interventions. Contrast-enhanced rotational X-ray angiography (3-D RA) acquisitions in combination with filtered-back-projection-based reconstruction allows for volumetric interrogation of LAPV anatomy in near-real-time. An automatic model-based segmentation algorithm allows for fast and accurate LAPV mesh generation despite the challenges posed by image quality; relative to pre-procedural cardiac CT/MR, 3-D RA images suffer from more artifacts and reduced signal-to-noise. We validate our integrated method by comparing 1) automatic and manual segmentations of intra-procedural 3-D RA data, 2) automatic segmentations of intra-procedural 3-D RA and pre-procedural CT/MR data, and 3) intra-procedural EAM point cloud data with automatic segmentations of 3-D RA and CT/MR data. Our validation results for automatically segmented intra-procedural 3-D RA data show average segmentation errors of 1) approximately 1.3 mm compared with manual 3-D RA segmentations 2) approximately 2.3 mm compared with automatic segmentation of pre-procedural CT/MR data and 3

A procedure for effective Dancoff factor calculation

International Nuclear Information System (INIS)

Milosevic, M.

2001-01-01

In this paper, a procedure for Dancoff factors calculation based on equivalence principle and its application in the SCALE-4.3 code system is described. This procedure is founded on principle of conservation of neutron absorption for resolved resonance range in a heterogeneous medium and an equivalent medium consisted of an infinite array of two-region pin cells, where the presence of other fuel rods is taken into account through a Dancoff factor. The neutron absorption in both media is obtained using a fine-group elastic slowing-down calculation. This procedure is implemented in a design oriented lattice physics code, which is applicable for any geometry where the method of collision probability is possible to apply to get a flux solution. Proposed procedure was benchmarked for recent exercise that represents a system with a fuel double heterogeneity, i.e., fuel in solid form (pellets) surrounded by fissile material in solution, and for a 5x5 irregular pressurised water reactor assembly, which requires different Dancoff factors. (author)

Endoscopic versus stereotactic procedure for pineal tumour biopsies: Comparative review of the literature and learning from a 25-year experience.

Science.gov (United States)

Balossier, A; Blond, S; Touzet, G; Lefranc, M; de Saint-Denis, T; Maurage, C-A; Reyns, N

2015-01-01

Pineal tumours account for 1% to 4% of brain tumours in adults and for around 10% in children. Except in a few cases where germ cell markers are elevated, accurate histological samples are mandatory to initiate the treatment. Open surgery still has a high morbidity and is often needless. Biopsies can either be obtained by endoscopic or stereotactic procedures. Following an extensive review of the literature (PubMed 1970-2013; keywords pineal tumour, biopsy; English and French), 33 studies were analysed and relevant data compared regarding the type of procedure, diagnosis rate, cerebrospinal fluid diversion type and rate, perioperative mortality, morbidity. Endoscopic and stereotactic biopsies showed a diagnosis rate of 81.1% (20%-100%) and 93.7% (82%-100%), respectively. Endoscopic biopsies involved 21.0% of minor and 2.0% of major complications whereas stereotactic biopsies involved 6.4% of minor and 1.6% of major complications. The most frequently reported complication was haemorrhage for both endoscopic and stereotactic procedures, accounting for 4.8% and 4.3%, respectively. Mortality rate was low for both endoscopic and stereotactic procedures, equal to 0.4% and 1.3%, respectively. Local experience of stereotactic biopsies was also reported and corroborated the previous data. The difference between both procedures is not statistically significant (p>0.05) across large series (≥20patients). Nevertheless, tissue diagnosis appears less accurate with endoscopic procedures than with stereotactic procedures (81.1% versus 93.7%, weighted mean across all series). In our opinion, the neuroendoscopic approach is the best tool for managing hydrocephalus, whereas stereotactic biopsies remain the best way to obtain a tissue diagnosis with accuracy and low morbidity. Copyright © 2014. Published by Elsevier Masson SAS.

Double dosimetry procedures for the determination of occupational effective dose in interventional radiology

International Nuclear Information System (INIS)

Jaervinen, H.; Buls, N.; Clerinx, P.; Miljanic, S.; Ranogajec-Komor, M.; Nikodemova, D.; D'Errico, F.

2008-01-01

Full text: In interventional radiology, for an accurate determination of occupational effective dose, measurements with two dosemeters ('double dosimetry', DD) have been recommended, one dosemeter located above and one under the protective apron. In this paper, based on an extensive literature search, the most recent algorithms developed for the determination of effective dose from the dosimeter readings have been compared for a few practical interventional procedures. Recommendations on the practices and algorithms are given on the basis of the results. For the comparison of algorithms, dosemeter readings and the effective dose were obtained both experimentally and by calculation. Further, data from published Monte Carlo calculations have been applied. The literature review has indicated that very few regulations for DD exist and the DD practices have not been harmonized. There is no firm consensus on the most suitable calculation algorithms. Single dosemeter (SD) measurements are still mostly used for the calculation of effective dose. Most DD and SD algorithms overestimate effective dose significantly, sometimes by over ten times. However, SD algorithms can significantly underestimate effective dose in certain interventional radiology conditions. Due to the possibility of underestimating effective dose, DD is generally recommended. The results suggest that there might not be a single DD algorithm which would be optimum for all interventional radiology procedures. However, the selection of a precise DD algorithm for each individual condition is not practical and compromises must be made. For accurate personnel dosimetry, the accuracy of the algorithm selected should be tested for typical local interventional radiology condition. Personnel dosemeters should be used in the recommended positions. The dosemeter above the apron should be on a collar and its reading also used to assess the risk of lens injuries. The dosemeter under the apron can be on the chest or

Skin-to-skin care for procedural pain in neonates.

Science.gov (United States)

Johnston, Celeste; Campbell-Yeo, Marsha; Disher, Timothy; Benoit, Britney; Fernandes, Ananda; Streiner, David; Inglis, Darlene; Zee, Rebekah

2017-02-16

Skin-to-skin care (SSC), often referred to as 'kangaroo care' (KC) due to its similarity with marsupial behaviour of ventral maternal-infant contact, is one non-pharmacological intervention for pain control in infants. The primary objectives were to determine the effect of SSC alone on pain from medical or nursing procedures in neonates compared to no intervention, sucrose or other analgesics, or additions to simple SSC such as rocking; and to determine the effects of the amount of SSC (duration in minutes), method of administration (e.g. who provided the SSC) of SSC in reducing pain from medical or nursing procedures in neonatesThe secondary objectives were to determine the safety of SSC care for relieving procedural pain in infants; and to compare the SSC effect in different postmenstrual age subgroups of infants. For this update, we used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 1); MEDLINE via PubMed (1966 to 25 February 2016); Embase (1980 to 25 February 2016); and CINAHL (1982 to 25 February 2016). We also searched clinical trials' databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials. Studies with randomisation or quasi-randomisation, double- or single-blinded, involving term infants (≥ 37 completed weeks' postmenstrual age (PMA) to a maximum of 44 weeks' PMA and preterm infants (care, and duration of SSC. Twenty-five studies (n = 2001 infants) were included. Nineteen studies (n = 1065) used heel lance as the painful procedure, one study combined venepuncture and heel stick (n = 50), three used intramuscular injection (n = 776), one used 'vaccination' (n = 60), and one used tape removal (n = 50). The studies were generally strong and had low or uncertain risk of bias. Blinding of the intervention was not possible, making them subject to high risk, depending on the

Vitrification of human ovarian tissue: effect of different solutions and procedures.

Science.gov (United States)

Amorim, Christiani Andrade; David, Anu; Van Langendonckt, Anne; Dolmans, Marie-Madeleine; Donnez, Jacques

2011-03-01

To test the effect of different vitrification solutions and procedures on the morphology of human preantral follicles. Pilot study. Gynecology research unit in a university hospital. Ovarian biopsies were obtained from nine women aged 22-35 years. Ovarian tissue fragments were subjected to [1] different vitrification solutions to test their toxicity or [2] different vitrification methods using plastic straws, medium droplets, or solid-surface vitrification before in vitro culture. Number of morphologically normal follicles after toxicity testing or vitrification with the different treatments determined by histologic analysis. In the toxicity tests, only VS3 showed similar results to fresh tissue before and after in vitro culture (fresh controls 1 and 2). In addition, this was the only solution able to completely vitrify. In all vitrification procedures, the percentage of normal follicles was lower than in controls. However, of the three protocols, the droplet method yielded a significantly higher proportion of normal follicles. Our experiments showed VS3 to have no deleterious effect on follicular morphology and to be able to completely vitrify, although vitrification procedures were found to affect human follicles. Nevertheless, the droplet method resulted in a higher percentage of morphologically normal follicles. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Brachytherapy for prostate cancer: Comparative characteristics of procedures

Directory of Open Access Journals (Sweden)

S. V. Kanaev

2015-01-01

Full Text Available The introduction of interstitial radiation sources is the «youngest» of the radical method of treatment of patients with prostate cancer (PC. The high level of efficiency comparable to prostatectomy at a significantly lower rate of complications causes rapid growth of clinical use of brachytherapy (BT. Depending on the radiation source and the mode of administration into the prostate gland are two types BT – high-dose rate (temporary (HDR-BT and low-dose rate (permanent (LDR-BT brachytherapy. At the heart of these two methods are based on a single principle of direct effect of the quantum gamma radiation on the area of interest. However, the differences between the characteristics of isotopes used and technical aspects of the techniques cause the difference in performance and complication rates for expression HDR-BT and LDR-BT.

Effect of Preoperative Low Maximal Flow Rate on Postoperative Voiding Trials after the Midurethral Sling Procedure in Women with Stress Urinary Incontinence.

Science.gov (United States)

Chae, Ji Y; Bae, Jae H; Lee, Jeong G; Park, Hong S; Moon, Du G; Oh, Mi M

2017-06-02

To evaluate the effects of preoperative low maximal flow rate (Qmax) on voiding trials after the midurethral sling (MUS) procedure in women with stress urinary incontinence (SUI). One hundred and sixty-eight women who underwent MUS procedure were enrolled. Preoperative free uroflowmetry was performed and patients were divided by Qmax. Low Qmax was defined as a Qmax under 15 mL/sec with voided volume at least 150 mL. Surgical results, failure of voiding trial, and postoperative uroflowmetry parameters were compared between the groups. Failure of voiding trial was defined by a PVR more than 100 mL on postoperative uroflowmetry. At the discharge day, there were 42 cases showing failure of voiding trial and 33 cases requiring CIC, but only one patient showed failure of voiding trial at 12 months postoperatively. Overall, 48 patients had preoperative low Qmax. Low Qmax group showed lower Qmax in all of postoperative uroflowmetry, but there were no significant differences in the rate of postoperative voiding trial failure or CIC. The low Qmax group was then divided into two groups according to the preoperative detrusor pressure at Qmax over and under 20 cmH 2 O in pressure flow study. Comparing the two groups, no significant differences were observed in the cure rate, voiding trial failure or CIC. Our results suggest that women with preoperative low Qmax experienced no definite unfavorable voiding problem from the MUS procedure compared to those with normal voiding function. MUS procedure may be regarded as a safe and successful procedure in SUI women with low Qmax. © 2017 John Wiley & Sons Australia, Ltd.

Procedures for analyzing the effectiveness of siren systems for alerting the public

International Nuclear Information System (INIS)

Keast, D.N.; Towers, D.A.; Anderson, G.S.; Kenoyer, J.L.; Desrosiers, A.E.

1982-09-01

NUREG-0654, Revision 1 (Criteria for Preparation and Evaluation of Radiological Emergency Response Plans and Preparedness in Support of Nuclear Power Plants), Appendix 3, discusses requirements of the licensees to implement a prompt notification system within the 10-mile emergency planning zone (EPZ) surrounding a nuclear facility. Sirens are being installed for use as part of or as the entire notification system by many licensees. This report describes a procedure for predicting siren system effectiveness under defined conditions within the EPZ's. The procedure requires a good topographical map and knowledge of the meteorology, demographics, and human activity patterns within the EPZ. The procedure is intended to be applied to systems of sirens and to obtain average results for a large number (30 or more) of listener locations

Comparison of pancuronium and vecuronium for fetal neuromuscular blockade during invasive procedures.

Science.gov (United States)

Watson, W J; Atchison, S R; Harlass, F E

1996-01-01

Neuromuscular blocking agents, used to arrest fetal motion for invasive intrauterine procedures, may cause temporary fetal heart rate changes. After 21 invasive procedures using either pancuronium bromide or vecuronium bromide, post-procedure fetal heart rate tracings were retrospectively compared. Pancuronium was associated with an increased fetal heart rate and decreased beat-to-beat variability for 2.5 hours after its use, whereas vecuronium caused no fetal heart rate changes. Vecuronium bromide offers advantages over pancuronium, because the decreased effect on the fetal heart allows better assessment of fetal well-being immediately following invasive intrauterine procedures.

Office-based procedures for diagnosis and treatment of esophageal pathology.

Science.gov (United States)

Wellenstein, David J; Schutte, Henrieke W; Marres, Henri A M; Honings, Jimmie; Belafsky, Peter C; Postma, Gregory N; Takes, Robert P; van den Broek, Guido B

2017-09-01

Diagnostic and therapeutic office-based procedures under topical anesthesia are emerging in the daily practice of laryngologists and head and neck surgeons. Since the introduction of the transnasal esophagoscope, office-based procedures for the esophagus are increasingly performed. We conducted a systematic review of literature on office-based procedures under topical anesthesia for the esophagus. Transnasal esophagoscopy is an extensively investigated office-based procedure. This procedure shows better patient tolerability and equivalent accuracy compared to conventional transoral esophagoscopy, as well as time and cost savings. Secondary tracheoesophageal puncture, esophageal dilatation, esophageal sphincter injection, and foreign body removal are less investigated, but show promising results. With the introduction of the transnasal esophagoscope, an increasing number of diagnostic and therapeutic office-based procedures for the esophagus are possible, with multiple advantages. Further investigation must prove the clinical feasibility and effectiveness of the therapeutic office-based procedures. © 2017 Wiley Periodicals, Inc.

A procedure for estimating the dose modifying effect of chemotherapy on radiation response

International Nuclear Information System (INIS)

Hao, Y.; Keane, T.

1994-01-01

A procedure based on a logistic regression model was used to estimate the dose-modifying effect of chemotherapy on the response of normal tissues to radiation. The DEF in the proposed procedure is expressed as a function of logistic regression coefficients, response levels and values of covariates in the model. The proposed procedure is advantageous as it allows consideration of both the response levels and the values of covariates in calculating the DEF. A plot of the DEF against the response or a covariate describes how the DEF varies with the response levels or the covariate values. Confidence intervals of the DEF were obtained based on the normal approximation of the distribution of the estimated DEF and on a non-parametric Bootstrap method. An example is given to illustrate the proposed procedure. (Author)

A Comparison of Error-Correction Procedures on Skill Acquisition during Discrete-Trial Instruction

Science.gov (United States)

Carroll, Regina A.; Joachim, Brad T.; St. Peter, Claire C.; Robinson, Nicole

2015-01-01

Previous research supports the use of a variety of error-correction procedures to facilitate skill acquisition during discrete-trial instruction. We used an adapted alternating treatments design to compare the effects of 4 commonly used error-correction procedures on skill acquisition for 2 children with attention deficit hyperactivity disorder…

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

Science.gov (United States)

Hamidi, Nurullah; Ozturk, Erdem

2017-05-01

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

Curative effects of two new endometrial ablation procedures using radiofrequency thermocoagulation for the treatment of severe abnormal uterine bleeding.

Science.gov (United States)

Yin, Geping; Li, Juan; Zhu, Tongyu; Chen, Ming

2013-07-01

Severe Abnormal Uterine Bleeding (SAUB) is a common gynecological disorder. The clinical characteristics include disordered menstrual cycle and massive bleeding that can cause anemia or secondary infection. Current treatment mainly relies on drug therapy or surgical removal of the uterus, each having its significant disadvantages. How to preserve the uterus, reduce the pain from surgery, and achieve better treatment effects have been well known but remaining as unresolved issues. This study aims at evaluating two types of radiofrequency (RF) thermocoagulation procedures for the treatment of SAUB: the RF-A procedure group included 25 SAUB patients ≥45 years of age treated for amenorrhea; the RF-B procedure group included 51 patients at bleeding. Post-treatment ratings of menstrual satisfaction and pre-/post-treatment menstrual scores-pictorial blood loss assessment chart (PBAC)-and hemoglobin levels were collected; and the mean length of follow-up was 72 months. Also, 38 SAUB patients treated with standard drug regimens served as a control group. The results of the study showed that following RF treatment, the average long-term patient menstrual satisfaction was greater than 92 %. In both the RF groups, PBAC scores and hemoglobin levels were significantly improved from baseline (p < .05). Compared with the control group, PBAC scores and hemoglobin levels were also significantly better for the RF groups at 6-24-month post-operation. Patients experienced no hysterectomy in association with the RF procedures. In conclusion, this pilot study suggests that the novel RF procedures are both safe and effective in treating patients with SAUB. Further investigation is necessary to evaluate their application in broader clinical indication.

The effect of economic downturn on the volume of surgical procedures: A systematic review.

Science.gov (United States)

Fujihara, Nasa; Lark, Meghan E; Fujihara, Yuki; Chung, Kevin C

2017-08-01

Economic downturn can have a wide range of effects on medicine at both individual and national levels. We aim to describe these effects in relation to surgical volume to guide future planning for physician specialization, patient expectations in the face of economic crises, or estimating healthcare expenditure. We hypothesized that because of high out-of-pocket costs, cosmetic procedure volumes would be most affected by economic decline. A systematic review was conducted using MEDLINE, Embase, and ABI/INFORMS. The main search terms were "economic recession" and "surgical procedures, operative". Studies were included if surgical volumes were measured and economic indicators were used as predictors of economic conditions. Twelve studies were included, and the most common subject was cosmetic (n = 5), followed by orthopedic (n = 2) and cardiac surgeries (n = 2). The majority of studies found that in periods of economic downturn, surgical volume decreased. Among the eight studies using Pearson's correlation analysis, there were no significant differences between cosmetic procedures and other elective procedures, indicating that cosmetic procedures may display trends similar to those of non-cosmetic elective procedures in periods of economic downturn. Surgical volume generally decreased when economic indicators declined, observed for both elective and non-elective surgery fields. However, a few specific procedure volumes such as vasectomy and caesarean section for male babies increased during the economic downturn. Knowledge of these trends can be useful for future surgical planning and distribution of healthcare resources. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

A study on the systematic framework to develop effective diagnosis procedures of nuclear power plants

International Nuclear Information System (INIS)

Park, Jinkyun; Jung, Wondea

2004-01-01

In complex systems such as the nuclear and chemical industry, the importance of a diagnosis procedure has been well recognized, since identifying the nature of an on-going event should be preceded to determine successful countermeasures or remedial actions. Unfortunately, a systematic framework that can suggest a unified and consistent process for constructing useful diagnosis procedures seems to be scant. In this paper, the systematic framework that can provide a sound way in constructing a diagnosis procedure is suggested based on two kinds of technical bases, such as the decision-making strategies of human and the test sequencing technique. To demonstrate the appropriateness of suggested framework, the diagnosis procedure of the reference nuclear power plant is reformed based on it. Subjective ratings are conducted to compare reformed procedure with the original one, and results support that operators' performance in an event diagnosis could be improved. Thus, although well designed experiments are needed to draw a reliable conclusion, it is expected that suggested framework could be applied to provide a consistent process in constructing useful diagnosis procedures

Effect of porous silicon on the performances of silicon solar cells during the porous silicon-based gettering procedure

Energy Technology Data Exchange (ETDEWEB)

Nouri, H.; Bessais, B. [Laboratoire de Nanomateriaux et des Systemes pour l' Energie, Centre de Recherches et des Technologies de l' Energie, Technopole de Borj-Cedria, BP 95, 2050 Hammam-Lif (Tunisia); Bouaicha, M. [Laboratoire de Photovoltaique, des Semi-conducteurs et des Nanostructures, Centre de Recherches et des Technologies de l' Energie, Technopole de Borj-Cedria, BP 95, 2050 Hammam-Lif (Tunisia)

2009-10-15

In this work we analyse the effect of porous silicon on the performances of multicrystalline silicon (mc-Si) solar cells during the porous silicon-based gettering procedure. This procedure consists of forming PS layers on both front and back sides of the mc-Si wafers followed by an annealing in an infrared furnace under a controlled atmosphere at different temperatures. Three sets of samples (A, B and C) have been prepared; for samples A and B, the PS films were removed before and after annealing, respectively. In order to optimize the annealing temperature, we measure the defect density at a selected grain boundary (GB) using the dark current-voltage (I-V) characteristics across the GB itself. The annealing temperature was optimized to 1000 C. The effect of these treatments on the performances of mc-Si solar cells was studied by means of the current-voltage characteristic (at AM 1.5) and the internal quantum efficiency (IQE). The results obtained for cell A and cell B were compared to those obtained on a reference cell (C). (author)

Short-term effect of TVT-SECUR procedure on quality of life and sexual function in women with stress urinary incontinence.

Science.gov (United States)

Tang, Xiang; Zhu, Lan; Zhong, Wen; Li, Bin; Lang, Jinghe

2013-01-01

To investigate whether patient quality of life and sexual function are improved after the tension-free vaginal tape SECUR (TVT-S) procedure (H-type). Prospective study (Canadian Task Force classification II-3). Single-center hospital. Thirty-three women with stress urinary incontinence (SUI) (high urethral mobility) and no concomitant pelvic floor prolapse underwent TVT-S between October 2009 and October 2011. TVT-S procedure. Before and after surgery(6 and 12 months), all patients completed the Chinese version of the Incontinence Quality of Life Questionnaire (I-QOL). In addition, 28 sexually active patients who underwent the TVT-S procedure completed the short-form Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12) before and after surgery (6 and 12 months). We used a paired t test to compare I-QOL scores before and after surgery. The Wilcoxon signed-rank test was used to compare the preoperative and postoperative PISQ scores. The objective cure rate was 78% (26 of 33 patients) at 12 months after surgery. The objective improvement rate was 12.1% (4 of 33 patients). The subjective satisfaction rate was 90%. Three operations (9.1%) were considered failures. Two patients underwent a TVT procedure after TVT-S because of recurrence. No patients reported severe pain; the mean (SD) visual analog scale pain score was 1.8 (1.2) after surgery. Only 1 patient (3%) was found to have sling erosion at 12 months postoperatively. The I-QOL score was 28.3 (14.2) before surgery and increased to 69.5 (18.9) at 12 months after the TVT-S procedure. The I-QOL score improved significantly after surgery (p .05). Although the objective cure rate was not high, the TVT-S procedure is a minimally invasive, safe, and effective surgical procedure for treatment of SUI (high urethral mobility) and can improve the quality of life and sexual function in women with SUI. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

Comparative evaluation of stress levels before, during, and after periodontal surgical procedures with and without nitrous oxide-oxygen inhalation sedation

Directory of Open Access Journals (Sweden)

Gurkirat Sandhu

2017-01-01

Full Text Available Context: Periodontal surgical procedures produce varying degree of stress in all patients. Nitrous oxide-oxygen inhalation sedation is very effective for adult patients with mild-to-moderate anxiety due to dental procedures and needle phobia. Aim: The present study was designed to perform periodontal surgical procedures under nitrous oxide-oxygen inhalation sedation and assess whether this technique actually reduces stress physiologically, in comparison to local anesthesia alone (LA during lengthy periodontal surgical procedures. Settings and Design: This was a randomized, split-mouth, cross-over study. Materials and Methods: A total of 16 patients were selected for this randomized, split-mouth, cross-over study. One surgical session (SS was performed under local anesthesia aided by nitrous oxide-oxygen inhalation sedation, and the other SS was performed on the contralateral quadrant under LA. For each session, blood samples to measure and evaluate serum cortisol levels were obtained, and vital parameters including blood pressure, heart rate, respiratory rate, and arterial blood oxygen saturation were monitored before, during, and after periodontal surgical procedures. Statistical Analysis Used: Paired t-test and repeated measure ANOVA. Results: The findings of the present study revealed a statistically significant decrease in serum cortisol levels, blood pressure and pulse rate and a statistically significant increase in respiratory rate and arterial blood oxygen saturation during periodontal surgical procedures under nitrous oxide inhalation sedation. Conclusion: Nitrous oxide-oxygen inhalation sedation for periodontal surgical procedures is capable of reducing stress physiologically, in comparison to LA during lengthy periodontal surgical procedures.

Continuous Descent Approach (CDA) compared to regular descent procedures : Less annoying?

NARCIS (Netherlands)

White, K.; Arntzen, M.; Bronkhorst, A.; Meeter, M.

2014-01-01

Annoyance reactions to different types of landing procedures were addressed in a controlled laboratory setting using a Virtual Community Noise Simulator (VCNS) with a head mounted display.Participants, standing on a virtual countryside road, experienced four types of descentflyovers by an A330

Policies and procedures in the workplace: how health care organizations compare.

Science.gov (United States)

Loo, R

1993-01-01

Many organizations are implementing programs and services to manage the human and economic costs of stress. A mail survey was conducted of 500 randomly selected Canadian organizations having at least 500 employees. The survey tapped four major areas: organizational policies and procedures for managing stress; programs and services offered; perceived benefits and constraints for the organization; and projected future directions in this area. Analyses of returns from 210 organizations-43 health and 167 non-health-revealed various findings. For example, over half of health care organizations have policies and procedures as opposed to less than half of non-health care organizations. Also, health care organizations place greater emphasis on smoking cessation, weight control programs and on stress management training. Although some Canadian organizations are addressing stress, much more could and should be done, especially by organizations that do not yet recognize the impact of stress on employees and their work performance.

Comparative analysis of diagnostic accuracy of different brain biopsy procedures

OpenAIRE

Jain Deepali; Sharma Mehar; Sarkar Chitra; Gupta Deepak; Singh Manmohan; Mahapatra A

2006-01-01

Background: Image-guided procedures such as computed tomography (CT) guided, neuronavigator-guided and ultrasound-guided methods can assist neurosurgeons in localizing the intraparenchymal lesion of the brain. However, despite improvements in the imaging techniques, an accurate diagnosis of intrinsic lesion requires tissue sampling and histological verification. Aims: The present study was carried out to examine the reliability of the diagnoses made on tumor sample obtained via different s...

Creating Tic Suppression: Comparing the Effects of Verbal Instruction to Differential Reinforcement

Science.gov (United States)

Woods, Douglas W.; Himle, Michael B.

2004-01-01

The purpose of this study was to compare two methods designed to produce tic reduction in 4 children with Tourette's syndrome. Specifically, a verbal instruction not to engage in tics was compared to a verbal instruction plus differential reinforcement of zero-rate behavior (DRO). Results showed that the DRO-enhanced procedure yielded greater…

Dissociation of Procedural and Working Memory in Pigeons (Columba livia

Directory of Open Access Journals (Sweden)

Walter T. Herbranson

2016-07-01

Full Text Available A new method was developed to concurrently investigate procedural memory and working memory in pigeons. Pigeons performed a sequence of keypecks across 3 response keys in a serial response task, with periodic choice probes for the location of a recently produced response. Procedural memory was operationally defined as decreasing response times to predictable cues in the sequence. Working memory was reflected by accurate responses to the choice probes. Changing the sequence of required keypecks to a random sequence interfered with procedural memory in the form of slowed response times, but did not prevent pigeons from effectively using working memory to remember specific cue locations. Conversely, changing exposure duration of to a cue location influenced working memory but had no effect on procedural memory. Double dissociations such as this have supported the multiple systems approach to the study of memory in cognitive psychology and neuroscience, and they encourage a similar approach in comparative psychology.

Procedure for statistical analysis of one-parameter discrepant experimental data

International Nuclear Information System (INIS)

Badikov, Sergey A.; Chechev, Valery P.

2012-01-01

A new, Mandel–Paule-type procedure for statistical processing of one-parameter discrepant experimental data is described. The procedure enables one to estimate a contribution of unrecognized experimental errors into the total experimental uncertainty as well as to include it in analysis. A definition of discrepant experimental data for an arbitrary number of measurements is introduced as an accompanying result. In the case of negligible unrecognized experimental errors, the procedure simply reduces to the calculation of the weighted average and its internal uncertainty. The procedure was applied to the statistical analysis of half-life experimental data; Mean half-lives for 20 actinides were calculated and results were compared to the ENSDF and DDEP evaluations. On the whole, the calculated half-lives are consistent with the ENSDF and DDEP evaluations. However, the uncertainties calculated in this work essentially exceed the ENSDF and DDEP evaluations for discrepant experimental data. This effect can be explained by adequately taking into account unrecognized experimental errors. - Highlights: ► A new statistical procedure for processing one-parametric discrepant experimental data has been presented. ► Procedure estimates a contribution of unrecognized errors in the total experimental uncertainty. ► Procedure was applied for processing half-life discrepant experimental data. ► Results of the calculations are compared to the ENSDF and DDEP evaluations.

Effective and efficient learning in the operating theater with intraoperative video-enhanced surgical procedure training

OpenAIRE

van Det, M.J.; Meijerink, W.J.; Hoff, C.; Middel, B.; Pierie, J.P.

2013-01-01

INtraoperative Video Enhanced Surgical procedure Training (INVEST) is a new training method designed to improve the transition from basic skills training in a skills lab to procedural training in the operating theater. Traditionally, the master-apprentice model (MAM) is used for procedural training in the operating theater, but this model lacks uniformity and efficiency at the beginning of the learning curve. This study was designed to investigate the effectiveness and efficiency of INVEST co...

The effect of trainee involvement on procedure and list times: A statistical analysis with discussion of current issues affecting orthopaedic training in UK.

Science.gov (United States)

Wilson, T; Sahu, A; Johnson, D S; Turner, P G

2010-02-01

Training surgeons adds time to the duration of procedures and operation lists. This is not accounted for in the finance received to perform the operation by the hospital in the Payment by Results (PbR) system. To find out: 1. The effect on the duration of a procedure and the number of procedures performed on the list when a trainee is involved. 2. The percentage of orthopaedic cases with trainee involvement. 3. The effect of European working time directive (EWTD) on the trainee involvement in cases from theatre data in 2008 versus logbook data from 2004 - 2008. Data was taken from two different sources. Firstly, the Operating Room Information System (ORMIS) and patient operation notes. The second source was a consultant's logbook comprising 227 primary total knee replacements performed between 2004 and 2008. The data produced trends suggesting trainees took longer to perform procedures than consultants. In orthopaedic operations, 92% of cases had trainees present and of these 17% of cases were performed by trainees in 2008. Before the implementation of the EWTD, trainees performed more procedures when compared with current logbook data (38% versus 17% cases). Time taken by a trainee to perform the procedure under direct consultant supervision was significantly higher in comparison to procedures performed by a consultant alone (P = < 0.0001). Analysing the ORMIS and logbook data gave similar conclusions. Hospitals should be given financial recognition for training. In this debate, we should remain focused on the provision of quality training for the next generation of surgeons.

Comparative Cost-Effectiveness Analysis of Three Different Automated Medication Systems Implemented in a Danish Hospital Setting.

Science.gov (United States)

Risør, Bettina Wulff; Lisby, Marianne; Sørensen, Jan

2018-02-01

Automated medication systems have been found to reduce errors in the medication process, but little is known about the cost-effectiveness of such systems. The objective of this study was to perform a model-based indirect cost-effectiveness comparison of three different, real-world automated medication systems compared with current standard practice. The considered automated medication systems were a patient-specific automated medication system (psAMS), a non-patient-specific automated medication system (npsAMS), and a complex automated medication system (cAMS). The economic evaluation used original effect and cost data from prospective, controlled, before-and-after studies of medication systems implemented at a Danish hematological ward and an acute medical unit. Effectiveness was described as the proportion of clinical and procedural error opportunities that were associated with one or more errors. An error was defined as a deviation from the electronic prescription, from standard hospital policy, or from written procedures. The cost assessment was based on 6-month standardization of observed cost data. The model-based comparative cost-effectiveness analyses were conducted with system-specific assumptions of the effect size and costs in scenarios with consumptions of 15,000, 30,000, and 45,000 doses per 6-month period. With 30,000 doses the cost-effectiveness model showed that the cost-effectiveness ratio expressed as the cost per avoided clinical error was €24 for the psAMS, €26 for the npsAMS, and €386 for the cAMS. Comparison of the cost-effectiveness of the three systems in relation to different valuations of an avoided error showed that the psAMS was the most cost-effective system regardless of error type or valuation. The model-based indirect comparison against the conventional practice showed that psAMS and npsAMS were more cost-effective than the cAMS alternative, and that psAMS was more cost-effective than npsAMS.

Measuring automatic retrieval: a comparison of implicit memory, process dissociation, and speeded response procedures.

Science.gov (United States)

Horton, Keith D; Wilson, Daryl E; Vonk, Jennifer; Kirby, Sarah L; Nielsen, Tina

2005-07-01

Using the stem completion task, we compared estimates of automatic retrieval from an implicit memory task, the process dissociation procedure, and the speeded response procedure. Two standard manipulations were employed. In Experiment 1, a depth of processing effect was found on automatic retrieval using the speeded response procedure although this effect was substantially reduced in Experiment 2 when lexical processing was required of all words. In Experiment 3, the speeded response procedure showed an advantage of full versus divided attention at study on automatic retrieval. An implicit condition showed parallel effects in each study, suggesting that implicit stem completion may normally provide a good estimate of automatic retrieval. Also, we replicated earlier findings from the process dissociation procedure, but estimates of automatic retrieval from this procedure were consistently lower than those from the speeded response procedure, except when conscious retrieval was relatively low. We discuss several factors that may contribute to the conflicting outcomes, including the evidence for theoretical assumptions and criterial task differences between implicit and explicit tests.

Realistic Vascular Replicator for TAVR Procedures.

Science.gov (United States)

Rotman, Oren M; Kovarovic, Brandon; Sadasivan, Chander; Gruberg, Luis; Lieber, Baruch B; Bluestein, Danny

2018-04-13

Transcatheter aortic valve replacement (TAVR) is an over-the-wire procedure for treatment of severe aortic stenosis (AS). TAVR valves are conventionally tested using simplified left heart simulators (LHS). While those provide baseline performance reliably, their aortic root geometries are far from the anatomical in situ configuration, often overestimating the valves' performance. We report on a novel benchtop patient-specific arterial replicator designed for testing TAVR and training interventional cardiologists in the procedure. The Replicator is an accurate model of the human upper body vasculature for training physicians in percutaneous interventions. It comprises of fully-automated Windkessel mechanism to recreate physiological flow conditions. Calcified aortic valve models were fabricated and incorporated into the Replicator, then tested for performing TAVR procedure by an experienced cardiologist using the Inovare valve. EOA, pressures, and angiograms were monitored pre- and post-TAVR. A St. Jude mechanical valve was tested as a reference that is less affected by the AS anatomy. Results in the Replicator of both valves were compared to the performance in a commercial ISO-compliant LHS. The AS anatomy in the Replicator resulted in a significant decrease of the TAVR valve performance relative to the simplified LHS, with EOA and transvalvular pressures comparable to clinical data. Minor change was seen in the mechanical valve performance. The Replicator showed to be an effective platform for TAVR testing. Unlike a simplified geometric anatomy LHS, it conservatively provides clinically-relevant outcomes and complement it. The Replicator can be most valuable for testing new valves under challenging patient anatomies, physicians training, and procedural planning.

Comparison of the effect of paper and computerized procedures on operator error rate and speed of performance

International Nuclear Information System (INIS)

Converse, S.A.; Perez, P.B.; Meyer, S.; Crabtree, W.

1994-01-01

The Computerized Procedures Manual (COPMA-II) is an advanced procedure manual that can be used to select and execute procedures, to monitor the state of plant parameters, and to help operators track their progress through plant procedures. COPMA-II was evaluated in a study that compared the speed and accuracy of operators' performance when they performed with COPMA-II and traditional paper procedures. Sixteen licensed reactor operators worked in teams of two to operate the Scales Pressurized Water Reactor Facility at North Carolina State University. Each team performed one change of power with each type of procedure to simulate performance under normal operating conditions. Teams then performed one accident scenario with COPMA-II and one with paper procedures. Error rates, performance times, and subjective estimates of workload were collected, and were evaluated for each combination of procedure type and scenario type. For the change of power task, accuracy and response time were not different for COPMA-II and paper procedures. Operators did initiate responses to both accident scenarios fastest with paper procedures. However, procedure type did not moderate response completion time for either accident scenario. For accuracy, performance with paper procedures resulted in twice as many errors as did performance with COPMA-II. Subjective measures of mental workload for the accident scenarios were not affected by procedure type

Comparative cost-effectiveness of fine needle aspiration biopsy versus image-guided biopsy, and open surgical biopsy in the evaluation of breast cancer in the era of Affordable Care Act: a changing landscape.

Science.gov (United States)

Masood, Shahla; Rosa, Marilin; Kraemer, Dale F; Smotherman, Carmen; Mohammadi, Amir

2015-08-01

Proven as a time challenged and cost-effective sampling procedure, the use of FNAB has still remained controversial among the scientific community. Currently, other minimally invasive sampling procedures such as ultrasound guided fine needle aspiration biopsy (US-FNAB) and image guided core needle biopsy (IG-CNB) have become the preferred sampling procedures for evaluation of breast lesions. However, changes in the medical economy and the current growing emphasis on cost containment in the era of the Affordable Care Act make it necessary to stimulate a renewed interest in the use of FNAB as the initial diagnostic sampling procedure. This study was designed to define the changing trend in the practice of tissue sampling during the last several years, and to assess the comparative effectiveness and appropriateness of the procedure of choice for breast cancer diagnosis. After Institutional Review Board (IRB) approval, the computer database of the Pathology Department, University of Florida, College of Medicine-Jacksonville at UF Health was retrospectively searched to identify all breast biopsy pathology reports issued during the period of January 2004 to December 2011. The inclusion criteria were all women that underwent any of the following biopsy types: FNAB, US-FNAB, IG-CNB, and surgical biopsy (SB). Diagnostic procedures were identified using current procedural terminology (CPT) codes recorded on claims from the UF Health Jacksonville patient accounting application files. The data obtained was used to determine which technique has the best cost-effectiveness in the diagnosis of breast cancer. The outcome variable for this project was a positive breast cancer diagnosis resulting from these methodologies. The predictor variable was the biopsy type used for sampling. The rate of cancer detection for each procedure was also determined. Among the four groups of procedures compared, the lower cost was attributed to FNAB, followed by US-FNAB, and SB. IG-CNB was the most

Estimation of effective dose during hysterosalpingography procedures; Estimación de dosis efectiva durante los procedimientos hysterosalpingography

Energy Technology Data Exchange (ETDEWEB)

Alzimamil, K.; Babikir, E.; Alkhorayef, M. [King Saud University, College of Applied Medical Sciences, Radiological Sciences Department, P. O. Box 10219, Riyadh 11433, (Saudi Arabia); Sulieman, A. [Salman bin Abdulaziz University, College of Applied Medical Sciences, Radiology and Medical Imaging Department, P. O. Box 422, Alkharj (Saudi Arabia); Alsafi, K. [King Abdulaziz University, Faculty of Medicine, Radiology Department, Jeddah 22254 (Saudi Arabia); Omer, H., E-mail: kalzimami@ksu.edu.sa [Dammam University, Faculty of Medicine, Dammam Khobar Coastal Rd, Khobar 31982 (Saudi Arabia)

2014-08-15

Hysterosalpingography (HSG) is the most frequently used diagnostic tool to evaluate the endometrial cavity and fallopian tube by using conventional x-ray or fluoroscopy. Determination of the patient radiation doses values from x-ray examinations provides useful guidance on where best to concentrate efforts on patient dose reduction in order to optimize the protection of the patients. The aims of this study were to measure the patients entrance surface air kerma doses (ESA K), effective doses and to compare practices between different hospitals in Sudan. ESA K were measured for patient using calibrated thermo luminance dosimeters (TLDs, Gr-200A). Effective doses were estimated using National Radiological Protection Board (NRPB) software. This study was conducted in five radiological departments: Two Teaching Hospitals (A and D), two private hospitals (B and C) and one University Hospital (E). The mean ESD was 20.1 mGy, 28.9 mGy, 13.6 mGy, 58.65 mGy, 35.7, 22.4 and 19.6 mGy for hospitals A,B,C,D, and E), respectively. The mean effective dose was 2.4 mSv, 3.5 mSv, 1.6 mSv, 7.1 mSv and 4.3 mSv in the same order. The study showed wide variations in the ESDs with three of the hospitals having values above the internationally reported values. Number of x-ray images, fluoroscopy time, operator skills x-ray machine type and clinical complexity of the procedures were shown to be major contributors to the variations reported. Results demonstrated the need for standardization of technique throughout the hospital. The results also suggest that there is a need to optimize the procedures. Local DRLs were proposed for the entire procedures. (author)

The Effects of Learning Procedure, Tempo, and Performance Condition on Transfer of Rhythm Skills in Instrumental Music.

Science.gov (United States)

Pierce, Michael A.

1992-01-01

Describes study of effects of learning procedures and performance tempo on ability of 64 middle school students to perform previously learned rhythmic passages. Reviews the four learning procedures used for each rhythmic passage. Finds no evidence attributed to learning procedure but significant adverse differences if the tempo was changed from…

Comparison of hand hygiene procedures for removing Bacillus cereus spores.

Science.gov (United States)

Sasahara, Teppei; Hayashi, Shunji; Hosoda, Kouichi; Morisawa, Yuji; Hirai, Yoshikazu

2014-01-01

Bacillus cereus is a spore-forming bacterium. B. cereus occasionally causes nosocomial infections, in which hand contamination with the spores plays an important role. Therefore, hand hygiene is the most important practice for controlling nosocomial B. cereus infections. This study aimed to determine the appropriate hand hygiene procedure for removing B. cereus spores. Thirty volunteers' hands were experimentally contaminated with B. cereus spores, after which they performed 6 different hand hygiene procedures. We compared the efficacy of the procedures in removing the spores from hands. The alcohol-based hand-rubbing procedures scarcely removed them. The soap washing procedures reduced the number of spores by more than 2 log10. Extending the washing time increased the spore-removing efficacy of the washing procedures. There was no significant difference in efficacy between the use of plain soap and antiseptic soap. Handwashing with soap is appropriate for removing B. cereus spores from hands. Alcohol-based hand-rubbing is not effective.

Experience with using unfolding procedures in ATLAS

CERN Document Server

Biondi, Silvia; The ATLAS collaboration

2016-01-01

In ATLAS, several unfolding methods are used to correct experimental measurements for detector effects, like acceptance and resolution. These methods use as input the raw experimental distributions, as well as Monte Carlo simulation for the description of the detector effects. The systematic uncertainties associated to the various unfolding methods are evaluated. The statistical and systematic uncertainties affecting the raw measurements and/or the simulation are propagated through the unfolding procedure. The resulting corrected measurements with their uncertainties can be directly compared with the corresponding theoretical predictions.

Distraction arthroplasty compared to other cartilage preservation procedures in patients with post-traumatic arthritis: a systematic review.

Science.gov (United States)

Rivera, Jessica C; Beachler, Jason A

2018-01-23

Post-traumatic arthritis (PTA) is characterized by the deterioration of articular cartilage temporally associated with an articular injury. With a paucity of literature comparing joint preservation techniques, we performed a systematic review of the literature intending to describe and summarize the results of ankle distraction arthroplasty as it compares with studies on tibio-talar microfracture, allograft, and autograft for ankle joint preservation in the post-traumatic population under 50 years of age. Research databases were searched and abstracts screened for relevance on our topic of interest. Abstracts meeting screening criteria with high interobserver reliability underwent full-manuscript review and coding for pertinent citation, study level, treatment, and outcome variables. Outcome variables for patient-reported pain scales, validated outcome measurement tools, radiographic progression, reoperation/re-treatment rates, and complication rates were recorded. Out of 105 unique citations, 10 publications were included. The distraction arthroplasty studies had 36 out of 181 patients requiring reoperation for complications (19.9%), while other joint-preserving procedures studies had 40 out of 177 patients requiring reoperations for complications (22.6%). Clinical outcome scores at mean follow-up time ranging from 2 to 10 years between studies were similar. Reported results for a variety of cartilage preservation procedures, including distraction arthroplasty, are satisfactory and reoperation rates for complication are similar. Limitations in available data and underlying study quality affect synthesis of the results therein. While distraction arthroplasty is an option for cartilage preservation in patients with PTA of the ankle, the technique is highly specialized which may affect the external validity. III.

Reduced infant response to a routine care procedure after sucrose analgesia.

Science.gov (United States)

Taddio, Anna; Shah, Vibhuti; Katz, Joel

2009-03-01

Sucrose has analgesic and calming effects in newborns. To date, it is not known whether the beneficial effects extend to caregiving procedures that are performed after painful procedures. Our objective was to determine the effect of sucrose analgesia for procedural pain on infant pain responses during a subsequent caregiving procedure. We conducted a double-blind, randomized, controlled trial. Healthy neonates within 2 strata (normal infants and infants of diabetic mothers) were randomly assigned to a sucrose or placebo water group before all needle procedures after birth. Pain response during a diaper change performed after venipuncture for the newborn screening test was determined by using a validated multidimensional measure, the Premature Infant Pain Profile. The study was conducted between September 15, 2003, and July 27, 2004. Altogether, 412 parents were approached; 263 consented. Twenty-three infants were not assigned, leaving 240 for participation (n = 120 per group), with an equal number in each infant strata. Of those, 186 (78%) completed the study. There were no significant differences in birth characteristics between groups. During diaper change, sucrose-treated infants had lower pain scores than placebo-treated infants. The relative risk of having pain, defined as a Premature Infant Pain Profile score of >/=6, was 0.64 with sucrose compared with placebo. This study demonstrates that when used to manage pain, sucrose reduces the pain response to a subsequent routine caregiving procedure. Therefore, the benefits of sucrose analgesia extend beyond the painful event to other aversive and potentially painful procedures.

Ghanaian nurses' knowledge of invasive procedural pain and its effect on children, parents and nurses.

Science.gov (United States)

Anim-Boamah, Oboshie; Aziato, Lydia; Adabayeri, Victoria May

2017-09-11

To explore Ghanaian nurses' knowledge of invasive procedural pain in children who are in hospital and to identify the effect of unrelieved pain on children, parents and nurses. An exploratory, descriptive and qualitative design was adopted. A purposive sampling technique was used and individual face-to-face, semi-structured interviews were conducted with 16 registered nurses from four children's units at a hospital in the Eastern Region of Ghana. Thematic and content analyses were performed. Four themes emerged: types of invasive procedure; pain expression; pain assessment; and effects of unrelieved pain. Participants had adequate knowledge of painful invasive procedures, however, they were not aware of the range of available validated pain assessment tools, using observations and body language instead to assess pain. Ghanaian nurses require education on the use of validated rating scales to assess procedural pain in children. The inclusion of pain assessment and management in pre-registration curricula could improve knowledge. ©2012 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Inside-out: comparing internally generated and externally generated basic emotions.

Science.gov (United States)

Salas, Christian E; Radovic, Darinka; Turnbull, Oliver H

2012-06-01

A considerable number of mood induction (MI) procedures have been developed to elicit emotion in normal and clinical populations. Although external procedures (e.g., film clips, pictures) are widely used, a number of experiments elicit emotion by using self-generated procedures (e.g., recalling an emotional personal episode). However, no study has directly compared the effectiveness of two types of internal versus external MI across multiple discrete emotions. In the present experiment, 40 undergraduate students watched film clips (external procedure) and recalled personal events (internal procedure) inducing 4 basic emotions (fear, anger, joy, sadness) and later completed a self-report questionnaire. Remarkably, both internal and external procedures elicited target emotions selectively, compared with nontarget emotions. When contrasting the intensity of target emotions, both techniques showed no significant differences, with the exception of Joy, which was more intensely elicited by the internal procedure. Importantly, when considering the overall level of intensity, it was always greater in the internal procedure, for each stimulus. A more detailed investigation of the data suggest that recalling personal events (a type of internal procedure) generates more negative and mixed blends of emotions, which might account for the overall higher intensity of the internal mood induction.

An improved ashing procedure for biologic sample

Energy Technology Data Exchange (ETDEWEB)

Zongmei, Wu [Zhejiang Province Enviromental Radiation Monitoring Centre (China)

1992-07-01

The classical ashing procedure in muffle was modified for biologic samples. In the modified procedure the door of muffle was open in the duration of ashing process, the ashing was accelerated and the ashing product quality was comparable to that the classical procedure. The modified procedure is suitable for ashing biologic samples in large batches.

An improved ashing procedure for biologic sample

International Nuclear Information System (INIS)

Wu Zongmei

1992-01-01

The classical ashing procedure in muffle was modified for biologic samples. In the modified procedure the door of muffle was open in the duration of ashing process, the ashing was accelerated and the ashing product quality was comparable to that the classical procedure. The modified procedure is suitable for ashing biologic samples in large batches

Procedural training in virtual reality: A comparison of technology types

International Nuclear Information System (INIS)

Sebok, A.; Nystad, E.

2006-01-01

This paper describes a study investigating questions of learning effectiveness in different VR technology types. Four VR display technology types were compared in terms of their ability to support procedural learning. The VR systems included two desktop displays (mono-scopic and stereoscopic view), a large screen stereoscopic display, and a mono-scopic head-mounted display. Twenty-four participants completed procedural training scenarios on these different display types. Training effectiveness was assessed in terms of objective task performance. Following the training session, participants performed the procedure they had just learned using the same VR display type they used for training. Time to complete the procedure and errors were recorded. Retention and transfer of training were evaluated in a talk-through session 24 hours after the training. In addition, subjective questionnaire data were gathered to investigate perceived workload, Sense of Presence, simulator sickness, perceived usability, and ease of navigation. While no difference was found for the short-term learning, the study results indicate that retention and transfer of training were better supported by the large screen stereoscopic condition. (authors)

Learning Declarative and Procedural Knowledge via Video Lectures: Cognitive Load and Learning Effectiveness

Science.gov (United States)

Hong, Jianzhong; Pi, Zhongling; Yang, Jiumin

2018-01-01

Video lectures are being widely used in online and blended learning classes worldwide, and their learning effectiveness is becoming a focus of many educators and researchers. This study examined the cognitive load and learning effectiveness of video lectures in terms of the type of knowledge being taught (declarative or procedural) and instructor…

A fast, easy circumcision procedure combining a CO2 laser and cyanoacrylate adhesive: a non-randomized comparative trial

Directory of Open Access Journals (Sweden)

Tahsin Gorgulu

2016-02-01

Full Text Available ABSTRACT Background Circumcision is performed as a routine operation in many countries, more commonly for religious and cultural reasons than for indicated conditions, such as phimosis and balanitis. There are many techniques available, and recently electrocautery and both Nd:YAG and CO2 lasers, instead of blades, have been used for skin and mucosal incisions. However, the infection risk in circumcisions performed using a CO2 laser was 10% higher. There are also reports of sutureless procedures using cyanoacrylate, but these have higher risks of hematoma and hemorrhage. We combined a CO2 laser and cyanoacrylate to shorten the operation time and to decrease bleeding complications. Materials and Methods : Circumcisions were performed under general anesthesia with CO2 laser and cyanoacrylate combination in 75 6–9-year-old boys between May 2013 and August 2014 only for religious reasons. As a control, we compared them retrospectively with 75 age-matched patients who were circumcised using the conventional guillotine method in our clinic. Results No hematomas, bleeding, or wound infections were observed. One wound dehiscence (1.33% occurred during the early postoperative period and healed without any additional procedures. The median operating time was 7 (range 6–9 minutes. The conventional guillotine group comprised one hematoma (1.3%, two wound dehiscences (2.6%, and two hemorrhages (2.6%, and the median operating time was 22 (range 20–26 minutes. The difference in surgical time was significant (p<0.001, with no significant difference in the rate of complications between the two groups. Conclusion The combined CO2 laser and cyanoacrylate procedure not only decreased the operating time markedly, but also eliminated the disadvantages associated with each individual procedure alone.

Evaluation of sedation for standing clinical procedures in horses using detomidine combined with buprenorphine.

Science.gov (United States)

Taylor, Polly; Coumbe, Karen; Henson, Frances; Scott, David; Taylor, Alan

2014-01-01

To examine the effect of including buprenorphine with detomidine for sedation of horses undergoing clinical procedures. Partially blinded, randomised, prospective clinical field trial. Eighty four client-owned horses scheduled for minor surgery or diagnostic investigation under standing sedation. The effects of buprenorphine (5 μg kg(-1) ) (Group B, n = 46) or placebo (5% glucose solution) (Group C, n = 38) in combination with detomidine (10 μg kg(-1) ) were compared in standing horses undergoing minor clinical procedures. The primary outcome measure was successful completion of the procedure. The degree of sedation and ataxia were scored using simple descriptive scales. Heart and respiratory rates were recorded at 15-30 minute intervals. Parametric data from each group were compared using anova or t-test and non parametric data using the Mann-Whitney U test. The procedure was carried out successfully in 91% of Group B and 63% of Group C (p detomidine, increased after buprenorphine but not glucose administration, was more profound in group B and lasted longer (60 versus 30 minutes) p detomidine 10 and 20 μg kg(-1) with minor side effects similar to other alpha2 agonist/opioid combinations. Detomidine-buprenorphine sedation is suitable for standing procedures in horses. © 2013 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.

Comparative effectiveness of one-stage versus two-stage basilic vein transposition arteriovenous fistulas.

Science.gov (United States)

Ghaffarian, Amir A; Griffin, Claire L; Kraiss, Larry W; Sarfati, Mark R; Brooke, Benjamin S

2018-02-01

Basilic vein transposition (BVT) fistulas may be performed as either a one-stage or two-stage operation, although there is debate as to which technique is superior. This study was designed to evaluate the comparative clinical efficacy and cost-effectiveness of one-stage vs two-stage BVT. We identified all patients at a single large academic hospital who had undergone creation of either a one-stage or two-stage BVT between January 2007 and January 2015. Data evaluated included patient demographics, comorbidities, medication use, reasons for abandonment, and interventions performed to maintain patency. Costs were derived from the literature, and effectiveness was expressed in quality-adjusted life-years (QALYs). We analyzed primary and secondary functional patency outcomes as well as survival during follow-up between one-stage and two-stage BVT procedures using multivariate Cox proportional hazards models and Kaplan-Meier analysis with log-rank tests. The incremental cost-effectiveness ratio was used to determine cost savings. We identified 131 patients in whom 57 (44%) one-stage BVT and 74 (56%) two-stage BVT fistulas were created among 8 different vascular surgeons during the study period that each performed both procedures. There was no significant difference in the mean age, male gender, white race, diabetes, coronary disease, or medication profile among patients undergoing one- vs two-stage BVT. After fistula transposition, the median follow-up time was 8.3 months (interquartile range, 3-21 months). Primary patency rates of one-stage BVT were 56% at 12-month follow-up, whereas primary patency rates of two-stage BVT were 72% at 12-month follow-up. Patients undergoing two-stage BVT also had significantly higher rates of secondary functional patency at 12 months (57% for one-stage BVT vs 80% for two-stage BVT) and 24 months (44% for one-stage BVT vs 73% for two-stage BVT) of follow-up (P < .001 using log-rank test). However, there was no significant difference

Experience with using unfolding procedures in ATLAS

CERN Document Server

AUTHOR|(INSPIRE)INSPIRE-00407321; The ATLAS collaboration

2016-01-01

In the ATLAS experiment, several unfolding methods are used to correct experimental measurements for detector effects, like acceptance and resolution. These methods use as input the raw experimental distributions, as well as Monte Carlo simulation for the description of the detector effects. The systematic uncertainties associated to the various unfolding methods are evaluated. The statistical and systematic uncertainties affecting the raw measurements and/or the simulation are propagated through the unfolding procedure. The resulting corrected measurements with their uncertainties can be directly compared with the corresponding theoretical predictions.

Two-stage dental implants inserted in a one-stage procedure : a prospective comparative clinical study

NARCIS (Netherlands)

Heijdenrijk, Kees

2002-01-01

The results of this study indicate that dental implants designed for a submerged implantation procedure can be used in a single-stage procedure and may be as predictable as one-stage implants. Although one-stage implant systems and two-stage.

Comparative Effect of Contrast Media Type on the Incidence of Contrast-Induced Nephropathy: A Systematic Review and Meta-analysis.

Science.gov (United States)

Eng, John; Wilson, Renee F; Subramaniam, Rathan M; Zhang, Allen; Suarez-Cuervo, Catalina; Turban, Sharon; Choi, Michael J; Sherrod, Cheryl; Hutfless, Susan; Iyoha, Emmanuel E; Bass, Eric B

2016-03-15

Iodine contrast media are essential components of many imaging procedures. An important potential side effect is contrast-induced nephropathy (CIN). To compare CIN risk for contrast media within and between osmolality classes in patients receiving diagnostic or therapeutic imaging procedures. PubMed, EMBASE, Cochrane Library, Clinical Trials.gov, and Scopus through June 2015. Randomized, controlled trials that reported CIN-related outcomes in patients receiving low-osmolar contrast media (LOCM) or iso-osmolar contrast media for imaging. Independent study selection and quality assessment by 2 reviewers and dual extraction of study characteristics and results. None of the 5 studies that compared types of LOCM reported a statistically significant or clinically important difference among study groups, but the strength of evidence was low. Twenty-five randomized, controlled trials found a slight reduction in CIN risk with the iso-osmolar contrast media agent iodixanol compared with a diverse group of LOCM that just reached statistical significance in a meta-analysis (pooled relative risk, 0.80 [95% CI, 0.65 to 0.99]; P = 0.045). This comparison's strength of evidence was moderate. In a meta regression of randomized, controlled trials of iodixanol, no relationship was found between route of administration and comparative CIN risk. Few studies compared LOCM. Procedural details about contrast administration were not uniformly reported. Few studies specified clinical indications or severity of baseline renal impairment. No differences were found in CIN risk among types of LOCM. Iodixanol had a slightly lower risk for CIN than LOCM, but the lower risk did not exceed a criterion for clinical importance. Agency for Healthcare Research and Quality.

Effect of Various Finishing Procedures on the Reflectivity (Shine) of Tooth Enamel - An In-vitro Study.

Science.gov (United States)

Patil, Harshal Ashok; Chitko, Shrikant Shrinivas; Kerudi, Veerendra Virupaxappa; Maheshwari, Amit Ratanlal; Patil, Neeraj Suresh; Tekale, Pawankumar Dnyandeo; Gore, Ketan Ashorao; Zope, Amit Ashok

2016-08-01

Reflectivity of an object is a good parameter for surface finish. As the patient evaluates finishing as a function of gloss/reflectivity/shine an attempt is made here to evaluate changes in surface finish with custom made reflectometer. The aim of the present study was to study the effect of various procedures during orthodontic treatment on the shine of enamel, using a custom made reflectometer. Sixty one extracted premolars were collected and each tooth was mounted on acrylic block. Reflectivity of the teeth was measured as compared to standard before any procedure. One tooth was kept as standard throughout the study. Sixty teeth were acid etched. Reflectivity was measured on custom made reflectometer and readings recorded. Same procedure was repeated after debonding. Then 60 samples were divided into three groups: Group 1 - Tungsten Carbide, Group 2 - Astropol, Group 3- Sof-Lex disc depending upon the finishing method after debonding and reflectivity was measured. The mean percentage of reflectivity after acid etching was 31.4%, debonding 45.5%, Tungsten carbide bur finishing (Group 1) was 58.3%, Astropol (Group 2) 72.8%, and Sof-Lex disc (Group 3) 84.4% as that to the standard. There was statistically very highly significant (p Group 2> Group 1. The primary goal was to restore the enamel to its original state after orthodontic treatment. The methods tested in this study could not restore the original enamel reflectivity.

How Does This Make You Feel? A Comparison of Four Affect Induction Procedures

Directory of Open Access Journals (Sweden)

Xuan eZhang

2014-07-01

Full Text Available Affect is a fundamental aspect of the human mind. An increasing number of experiments attempt to examine the influence of affect on other psychological phenomena. To accomplish this research, it is necessary to experimentally modify participants’ affective states. In the present experiment, we compared the effectiveness of four commonly used affect induction procedures. Participants were randomly assigned to either a pleasant or an unpleasant affect induction group, and then underwent four different affect induction procedures: (1 recall of an affectively salient event accompanied by affectively congruent music, (2 script-driven guided imagery, (3 viewing images while listening to affectively congruent music, and (4 posing affective facial actions, body postures, and vocal expressions. All four affect induction methods were successful in inducing both pleasant and unpleasant affective states. The combined image/music and recall/music procedures were most effective in enhancing pleasant affect, whereas the combined image/music procedure was most effective in enhancing unpleasant affect. Implications for the scientific study of affect are discussed.

Procedures for the selection of stopping power ratios for electron beams: Comparison of IAEA TRS procedures and of DIN procedures with Monte Carlo results

International Nuclear Information System (INIS)

Roos, M.; Christ, G.

2000-01-01

In the International Code of Practice IAEA TRS-381 the stopping power ratios water/air are selected according to the half-value depth and the depth of measurement. In the German Standard DIN 6800-2 a different procedure is recommended, which, in addition, takes the practical electron range into account; the stopping power data for monoenergetic beams from IAEA TRS-381 are used. Both procedures are compared with recent Monte Carlo calculations carried out for various beams of clinical accelerators. It is found that the DIN procedure shows a slightly better agreement. In addition, the stopping power ratios in IAEA TRS-381 are compared with those in DIN 6800-2 for the reference conditions of the beams from the PTB linac; the maximum deviation is not larger than 0.6%. (author)

Patient doses from fluoroscopically guided cardiac procedures in pediatrics

International Nuclear Information System (INIS)

Martinez, L C; Vano, E; Gutierrez, F; Rodriguez, C; Gilarranz, R; Manzanas, M J

2007-01-01

Infants and children are a higher risk population for radiation cancer induction compared to adults. Although some values on pediatric patient doses for cardiac procedures have been reported, data to determine reference levels are scarce, especially when compared to those available for adults in diagnostic and therapeutic procedures. The aim of this study is to make a new contribution to the scarce published data in pediatric cardiac procedures and help in the determination of future dose reference levels. This paper presents a set of patient dose values, in terms of air kerma area product (KAP) and entrance surface air kerma (ESAK), measured in a pediatric cardiac catheterization laboratory equipped with a biplane x-ray system with dynamic flat panel detectors. Cardiologists were properly trained in radiation protection. The study includes 137 patients aged between 10 days and 16 years who underwent diagnostic catheterizations or therapeutic procedures. Demographic data and technical details of the procedures were also gathered. The x-ray system was submitted to a quality control programme, including the calibration of the transmission ionization chamber. The age distribution of the patients was 47 for 2 respectively for the four age bands. These KAP values increase by a factor of 8 when moving through the four age bands. The probability of a fatal cancer per fluoroscopically guided cardiac procedure is about 0.07%. Median values of ESAK for the four age bands were 46, 50, 56 and 163 mGy, which lie far below the threshold for deterministic effects on the skin. These dose values are lower than those published in previous papers

CT-guided cervical nerve root injections: comparing the immediate post-injection anesthetic-related effects of the transforaminal injection with a new indirect technique

International Nuclear Information System (INIS)

Sutter, Reto; Pfirrmann, Christian W.A.; Peterson, Cynthia K.; Zanetti, Marco; Hodler, Juerg

2011-01-01

To describe an ''indirect'' cervical nerve root injection technique with a dorsal approach that should carry less inherent risk than the ''direct'' cervical transforaminal injection approach, and to compare the immediate post-injection results of the two procedures. The indirect and direct cervical nerve root injection procedures are described in detail. Fifty-three consecutive patients receiving the indirect nerve root injections during 2009-2010 were age- and gender-matched to 53 patients who underwent direct transforaminal nerve root injections performed in 2006. Pain level data were collected immediately before and 20-30 min after each procedure. The percentages of pain change in the two groups were compared using the unpaired Student's t test. Fifty-two men (mean age 49) and 54 women (mean age 55) were included. The mean percentage of pain reduction for patients receiving indirect nerve root injections was 38.4% and for those undergoing the direct nerve root injections approach it was 43.2%. This was not significantly different (P = 0.455). No immediate or late adverse effects were reported after either injection procedure. The indirect cervical nerve root injection procedure is a potentially safer alternative to direct cervical transforaminal nerve root injections. The short-term pain reduction is similar using the two injection methods. (orig.)

Procedural sedation analgesia

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Sheta Saad

2010-01-01

Full Text Available The number of noninvasive and minimally invasive procedures performed outside of the operating room has grown exponentially over the last several decades. Sedation, analgesia, or both may be needed for many of these interventional or diagnostic procedures. Individualized care is important when determining if a patient requires procedural sedation analgesia (PSA. The patient might need an anti-anxiety drug, pain medicine, immobilization, simple reassurance, or a combination of these interventions. The goals of PSA in four different multidisciplinary practices namely; emergency, dentistry, radiology and gastrointestinal endoscopy are discussed in this review article. Some procedures are painful, others painless. Therefore, goals of PSA vary widely. Sedation management can range from minimal sedation, to the extent of minimal anesthesia. Procedural sedation in emergency department (ED usually requires combinations of multiple agents to reach desired effects of analgesia plus anxiolysis. However, in dental practice, moderate sedation analgesia (known to the dentists as conscious sedation is usually what is required. It is usually most effective with the combined use of local anesthesia. The mainstay of success for painless imaging is absolute immobility. Immobility can be achieved by deep sedation or minimal anesthesia. On the other hand, moderate sedation, deep sedation, minimal anesthesia and conventional general anesthesia can be all utilized for management of gastrointestinal endoscopy.

Comparison of procedures for reducing cross-contamination during steam distillations in nitrogen-15 tracer research

International Nuclear Information System (INIS)

Mulvaney, R.L.

1986-01-01

A study was conducted to compare the effectiveness of various procedures for reduction of cross-contamination errors when unenriched samples of (NH 4 ) 2 SO 4 containing 0.5 mg of N were steam-distilled in a glass distillation apparatus following samples enriched with 50 atom % 15 N. Twelve procedures were compared in this study, including most of those previously proposed in the literature. None of the procedures completely eliminated cross-contamination; however, some were considerably more effective than others. The results suggest that, when a glass distillation apparatus is used in 15 N-tracer research, the best way to reduce cross-contamination error is to distill two aliquots of each sample whenever possible, discarding the first distillate and retaining the second for isotope-ratio analysis. When this is not possible, it is recommended that 1 mL of 1M formic acid be distilled for 1 min and 25 mL of 16.4 M (95%) ethanol be distilled for 3 min between samples. This procedure can be made more effective by increasing the amount of formic acid used and extending distillation beyond 1 min

Are Self-study Procedural Teaching Methods Effective? A Pilot Study of a Family Medicine Residency Program.

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Deffenbacher, Brandy; Langner, Shannon; Khodaee, Morteza

2017-11-01

A family medicine residency is a unique training environment where residents are exposed to care in multiple settings, across all ages. Procedures are an integral part of family medicine practice. Family medicine residency (FMR) programs are tasked with the job of teaching these skills at a level of intensity and frequency that allows a resident to achieve competency of such skills. In an environment that is limited by work hour restrictions, self-study teaching methods are one way to ensure all residents receive the fundamental knowledge of how to perform procedures. We developed and evaluated the efficacy of a self-study procedure teaching method and procedure evaluation checklist. A self-study procedure teaching intervention was created, consisting of instructional articles and videos on three procedures. To assess the efficacy of the intervention, and the competency of the residents, pre- and postintervention procedure performance sessions were completed. These sessions were reviewed and scored using a standardized procedure performance checklist. All 24 residents participated in the study. Overall, the resident procedure knowledge increased on two of the three procedures studied, and ability to perform procedure according to expert-validated checklist improved significantly on all procedures. A self-study intervention is a simple but effective way to increase and improve procedure training in a way that fits the complex scheduling needs of a residency training program. In addition, this study demonstrates that the procedure performance checklists are a simple and reliable way to increase assessment of resident procedure performance skills in a residency setting.

Estimation of absorbed dose and its biological effects in subjects undergoing neuro interventional radiological procedures

International Nuclear Information System (INIS)

Basheerudeen, Safa Abdul Syed; Subramanian, Vinodhini; Venkatachalam, Perumal; Joseph, Santosh; Selvam, Paneer; Jose, M.T.; Annalakshmi, O.

2016-01-01

Radiological imaging has many applications due to its non-invasiveness, rapid diagnosis of life threatening diseases, and shorter hospital stay which benefit patients of all age groups. However, these procedures are complicated and time consuming, which use repeated imaging views and radiation, thereby increasing patient dose, and collective effective dose to the background at low doses. The effects of high dose radiation are well established. However, the effects of low dose exposure remain to be determined. Therefore, investigating the effect on medically exposed individuals is an alternative source to understand the low dose effects of radiation. The ESD (Entrance Surface Dose) was recorded using Lithium borate based TL dosimeters to measure the doses received by the head, neck and shoulder of the study subjects (n = 70) who underwent procedures like cerebral angiography, coiling, stenting and embolization

Effectiveness of thermal annular procedures in treating discogenic low back pain.

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Helm Ii, Standiford; Deer, Timothy R; Manchikanti, Laxmaiah; Datta, Sukdeb; Chopra, Pradeep; Singh, Vijay; Hirsch, Joshua A

2012-01-01

Persistent low back pain refractory to conservative treatment is a common problem that leads to widespread impairment, resulting in significant costs to society. The intervertebral disc is a major source of persistent low back pain. Technologies developed to treat this problem, including various surgical instrumentation and fusion techniques, have not reliably provided satisfactory results in terms of either pain relief or increased function. Thermal annular procedures (TAPs) were first developed in the late 1990s in an attempt to treat discogenic pain. The hope was that they would provide greater value than fusion in terms of efficacy, morbidity, and cost. Three technologies have been developed to apply heat to the annulus: intradiscal electrothermal therapy (IDET), discTRODE, and biacuplasty. Since nerve ingrowth and tissue regeneration in the annulus is felt to be the source of pain in discogenic low back pain, when describing the 3 above techniques we use the term "thermal annular procedures" rather than "thermal intradiscal procedures." We have specifically excluded studies treating the nucleus. TAPs have been the subject of significant controversy. Multiple reviews have been conducted resulting in varying conclusions. A systematic review of TAPs for the treatment of discogenic low back pain. To evaluate the effectiveness of TAPs in treating discogenic low back pain and to assess complications associated with those procedures. The available literature on TAPs in treating discogenic low back pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria for interventional techniques for randomized trials, and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force. Data sources included relevant literature

The Effects of Procedural Knowledge Transparency on Adoption in Corporate Social Networks

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Jensen, Bjoern J. M.

2017-01-01

This dissertation investigated how a certain type of organizational knowledge sharing, procedural knowledge transparency, affected innovation adoption rates of members of a corporate social network within a large Scandinavian organization, in its two years of activity. It also explored the mediation of these effects by different types of…

A comparison of vowel normalization procedures for language variation research

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Adank, Patti; Smits, Roel; van Hout, Roeland

2004-11-01

An evaluation of vowel normalization procedures for the purpose of studying language variation is presented. The procedures were compared on how effectively they (a) preserve phonemic information, (b) preserve information about the talker's regional background (or sociolinguistic information), and (c) minimize anatomical/physiological variation in acoustic representations of vowels. Recordings were made for 80 female talkers and 80 male talkers of Dutch. These talkers were stratified according to their gender and regional background. The normalization procedures were applied to measurements of the fundamental frequency and the first three formant frequencies for a large set of vowel tokens. The normalization procedures were evaluated through statistical pattern analysis. The results show that normalization procedures that use information across multiple vowels (``vowel-extrinsic'' information) to normalize a single vowel token performed better than those that include only information contained in the vowel token itself (``vowel-intrinsic'' information). Furthermore, the results show that normalization procedures that operate on individual formants performed better than those that use information across multiple formants (e.g., ``formant-extrinsic'' F2-F1). .

Effect of a water-maze procedure on the redox mechanisms in brain parts of aged rats

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Natalia Andreevna Krivova

2015-03-01

Full Text Available The Morris water maze (MWM is a tool for assessment of age-related cognitive deficits. In our work, MWM was used for appraisal of cognitive deficits in 11-month-old rats and investigation of the effect exerted by training in the Morris water maze on the redox mechanisms in rat brain parts. Young adult (3-month-old and aged (11-month-old male rats were trained in the water maze. Intact animals of the corresponding age were used as the reference groups. The level of pro- and antioxidant capacity in brain tissue homogenates was assessed using the chemiluminescence method.Cognitive deficits were found in 11-month-old rats: at the first day of training they showed only 30% of successful MWM trials. However, at the last training day the percentage of successful trials was equal for young adult and aged animals. This indicates that cognitive deficits in aged rats can be reversed by MWM training. Therewith, the MWM spatial learning procedure itself produces changes in different processes of redox homeostasis in 11-month-old and 3-month-old rats as compared to intact animals. Young adult rats showed a decrease in prooxidant capacity in all brain parts, while 11-month-old rats demonstrated an increase in antioxidant capacity in the olfactory bulb, pons + medulla oblongata and frontal lobe cortex. Hence, the MWM procedure activates the mechanisms that restrict the oxidative stress in brain parts. The obtained results may be an argument for further development of the animal training procedures aimed to activate the mechanisms responsible for age-related cognitive deficits. This may be useful not only for the development of training procedures applicable to human patients with age-related cognitive impairments, but also for their rehabilitation.

A study on the systematic framework to develop an effective diagnosis procedure of the nuclear power plants

International Nuclear Information System (INIS)

Park, Jin Kyun; Jung, Won Dea; Kim, Jae Whan; Ha, Jae Joo

2003-11-01

In complex systems, the importance of the diagnosis procedures has been well recognized, since identifying the nature of the on-going event should be preceded to determine successful countermeasures or remedial actions. Unfortunately, a systematic framework that can suggest a unified and consistent process for constructing useful diagnosis procedures seems to be scant. In this paper, the systematic framework that can provide a sound way in constructing a diagnosis procedure is suggested based on two kinds of technical bases, such as the decision-making strategies of human and the test sequencing technique. In addition, to demonstrate the appropriateness of the suggested framework, the diagnosis procedure of the reference nuclear power plant is reformed based on it. Various kinds of activities have been conducted to compare the reformed diagnosis procedure with the original one, and the results indicate that the operators' performance in the event diagnosis can be improved, when they used the reformed procedure. Thus, it is expected that the suggested framework can be applied to give a consistent process in constructing a useful diagnosis procedure that can play an important role in enhancing safety of the nuclear power plants

Effects of polishing procedures on color stability of composite resins

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Ahmet Umut Güler

2009-04-01

Full Text Available The purpose of this study was to investigate the effect of different polishing methods on color stability of posterior, universal and nanohybrid composite resin restorative materials upon exposure to a staining agent. Twenty-five specimens were prepared for each of 5 different composite resins (Filtek Z250, Filtek P60, Quadrant LC, Grandio and Filtek Supreme. Specimens were divided into 5 groups and different polishing procedures, including polishing discs (Pd, polishing discs then diamond polishing paste (PdP, polishing discs then a liquid polishing system (Biscover (PdB, and combinations of these (PdPB were used. Unpolished specimens served as the control (C. The specimens were stored for 48 h in a coffee solution. The color of all specimens was measured before and after exposure with a colorimeter, and total color change (DE* were calculated. The data were analyzed with a two-way ANOVA and the means were compared by Tukey HSD test (a=0.05. The lowest color difference was observed in the groups PdP and C, while the highest color difference was observed in PdPB, and PdB. When comparing the five different restorative materials, no significant difference was observed between FiltekP60 and FiltekZ250, and these materials demonstrated significantly less color change than Quadrant LC and the nanohybrid materials (Grandio, Filtek Supreme. The posterior (Filtek P60 and universal (Filtek Z250 composite resin restorative materials, which do not contain tetraethyleneglycol dimethacrylate (TEGDMA, were found to be less stainable than the nanohybrid (Grandio, Filtek Supreme and universal (Quadrant LC composite resins, which contain TEGDMA. The use of diamond polishing paste after polishing with polishing discs significantly decreased staining when compared to the groups that used polishing discs alone, for all restorative materials tested. The highest color change values were obtained for the specimens that were polished with the Biscover liquid polish

[Robot assisted Frykman-Goldberg procedure. Case report].

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Zubieta-O'Farrill, Gregorio; Ramírez-Ramírez, Moisés; Villanueva-Sáenz, Eduardo

2017-12-01

Rectal prolapse is defined as the protrusion of the rectal wall through the anal canal; with a prevalence of less than 0.5%. The most frequent symptoms include pain, incomplete defecation sensation with blood and mucus, fecal incontinence and/or constipation. The surgical approach can be perineal or abdominal with the tendency for minimal invasion. Robot-assisted procedures are a novel option that offer technique advantages over open or laparoscopic approaches. 67 year-old female, who presented with rectal prolapse, posterior to an episode of constipation, that required manual reduction, associated with transanal hemorrhage during defecation and occasional fecal incontinence. A RMI defecography was performed that reported complete rectal and uterine prolapse, and cystocele. A robotic assisted Frykman-Goldberg procedure wass performed. There are more than 100 surgical procedures for rectal prolapse treatment. We report the first robot assisted procedure in Mexico. Robotic assisted surgery has the same safety rate as laparoscopic surgery, with the advantages of better instrument mobility, no human hand tremor, better vision, and access to complicated and narrow areas. Robotic surgery as the surgical treatment is a feasible, safe and effective option, there is no difference in recurrence and function compared with laparoscopy. It facilitates the technique, improves nerve preservation and bleeding. Further clinical, prospective and randomized studies to compare the different minimal invasive approaches, their functional and long term results for this pathology are needed. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

The Moderating Effect of Procedural Justice on the Effectiveness of the Balanced Scorecard in Improving Managerial Performance through Organizational Commitment

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Supriyadi Supriyadi

2010-09-01

Full Text Available This study extends prior studies on the effectiveness of theBalanced Scorecard (BSC to improve managerial performancedone by Lau and Mosser (2008 and Lau and Sholihin (2005.Specifically, the study empirically tests the moderating effects ofprocedural justice on the relationship between the financial andnonfinancial dimensions of BSC and managerial performance. Italso tests the impact of organizational commitment on performance.Based on survey data from 76 respondents, the results indicate thatperceived procedural justice in the use financial and nonfinancialdimensions of the BSC is associated with managers’ organizationalcommitment. It further finds that organizational commitment ispositively related to performance. The study extends the literatureby providing empirical evidence about the moderating effect ofprocedural justice on the relationship between the financial andnonfinancial dimensions of BSC and organizational commitment. Keywords: balanced scorecard; organizational commitment; financial measures;managerial performance; moderating effect; nonfinancial measures;procedural justice

The prevalence of mental health problems among users of NHS stop smoking services: effects of implementing a routine screening procedure

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Ratschen Elena

2011-08-01

Full Text Available Abstract Background Tobacco dependence among people with mental health problems is an issue that deserves attention both from a clinical and from a public health perspective. Research suggests that Stop Smoking Services often fail to ask clients about underlying mental health problems and thus fail to put in place the treatment adaptations and liaison procedures often required to meet the needs of clients with a mental health condition who want to stop smoking. This study assesses the recording of mental health problems in a large NHS stop smoking service in England and examines the effect of implementing a short screening procedure on recording mental health conditions. Methods Treatment records from the Stop Smoking Service covering a period of 13 months were audited. The prevalence of reported mental health problems in the six month period before the implementation of the mental health screening procedure was compared with that of the six month period following implementation. The screening procedure was only implemented in the support services directly provided by the Stop Smoking Service. Comparisons were also made with third-party sections of the service where no such screening procedure was introduced. Results The prevalence of reported mental health problems among a total of n = 4999 clients rose from less than 1% before implementation of the screening procedure to nearly 12% in the period following implementation, with the change being statistically significant. No significant rise was observed over the same period in the sections of the service where no screening procedure was implemented. Conclusions The absence of standard procedures to record mental health problems among service users in many stop smoking services is currently likely to prevent the detection of co morbidity. Implementing a simple screening procedure appears suitable to increase the routine recording of mental health problems in a stop smoking service, which is an

Effects of different preparation procedures during tooth whitening on enamel bonding.

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Wilson, Dustin; Xu, Changqi; Hong, Liang; Wang, Yong

2009-04-01

The objective of this study was to assess effects of some clinically related preparation procedures during tooth whitening on enamel bonding properties. Sixty-two extracted human teeth were cleaned and divided into four groups. Forty-two of the teeth were left with their natural surface intact while 20 teeth were polished to form a flat surface. Half of the tooth served as the experimental side and received one of the two whitening products: Opalescence (10% carbamide peroxide) and Crest Whitestrips (6.5% hydrogen peroxide), for 2 weeks. Post-bleaching intervals included: 1 day, 1 week, and 2 weeks. On these days, tooth (10 mm x 1.5 mm x 1.5 mm) sections were evaluated using Raman spectroscopy, scanning electron microscopy and tensile bond strength tests. T-test, ANOVA test, and mixed model regression analysis were used to assess the differences. No significant difference existed between natural surface and polished surface teeth for all groups at both Day One and Week Two (P > 0.05). On Day One, both treated groups had significant lower bond strength than the control group (P = 0.002). After 2 weeks, no significant difference existed between any group (P = 0.381). SEM indicated that resin-enamel interfaces in bleached enamel exhibited more defects in granular formations when compared to the control. Raman results indicated a lower degree of polymerization (DP) of adhesive at the interface for treated teeth surfaces. In summary, pre-bleaching surface treatments such as polish or non-polish, had no effect on bond strength. Bleaching significantly decreased bond strength initially, but after 2 weeks, bleaching had no significant effect on bond strength. Storage time had significant effect on Opalescence treated enamel, but not on control and Whitestrip treated enamel. The decrease of bond strength may be related to interfacial defects and low DP due to oxygen release after bleaching.

Aesthetic procedures in office practice.

Science.gov (United States)

Small, Rebecca

2009-12-01

Since the approval of botulinum toxin, dermal fillers, and lasers for cosmetic use, minimally invasive aesthetic procedures have rapidly become the treatments of choice for age-related facial changes. In the past 10 years, aesthetic procedures have increased nearly five-fold. Of the 10.2 million aesthetic treatments performed in 2008, 83 percent were minimally invasive procedures. Botulinum toxin and dermal filler injections, laser hair reduction, chemical peels, laser skin resurfacing, microdermabrasion, and intense pulsed light photorejuvenation were the most commonly performed procedures in 2008. These procedures are effective and associated with minimal discomfort, and they have a low incidence of adverse effects and short recovery times. High patient and physician satisfaction have contributed to their growing popularity and availability in the primary care setting. As patient demand for aesthetic treatments increases, family physicians should be familiar with common minimally invasive aesthetic procedures when advising patients or incorporating aesthetic care into office practice.

Determination of Pesticides Residues in Cucumbers Grown in Greenhouse and the Effect of Some Procedures on Their Residues.

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Leili, Mostafa; Pirmoghani, Amin; Samadi, Mohammad Taghi; Shokoohi, Reza; Roshanaei, Ghodratollah; Poormohammadi, Ali

2016-11-01

The objective of this study was to determine the residual concentrations of ethion and imidacloprid in cucumbers grown in greenhouse. The effect of some simple processing procedures on both ethion and imidacloprid residues were also studied. Ten active greenhouses that produce cucumber were randomly selected. Ethion and imidacloprid as the most widely used pesticides were measured in cucumber samples of studied greenhouses. Moreover, the effect of storing, washing, and peeling as simple processing procedures on both ethion and imidacloprid residues were investigated. One hour after pesticide application; the maximum residue levels (MRLs) of ethion and imidacloprid were higher than that of Codex standard level. One day after pesticide application, the levels of pesticides were decreased about 35 and 31% for ethion and imidacloprid, respectively, which still were higher than the MRL. Washing procedure led to about 51 and 42.5% loss in ethion and imidacloprid residues, respectively. Peeling procedure also led to highest loss of 93.4 and 63.7% in ethion and imidacloprid residues, respectively. The recovery for both target analytes was in the range between 88 and 102%. The residue values in collected samples one hour after pesticides application were higher than standard value. The storing, washing, and peeling procedures lead to the decrease of pesticide residues in greenhouse cucumbers. Among them, the peeling procedure has the greatest impact on residual reduction. Therefore, these procedures can be used as simple and effective processing techniques for reducing and removing pesticides from greenhouse products before their consumption.

Test Operations Procedure (TOP) 1-1-062 Environmental Effects Data Collection

Science.gov (United States)

2008-09-12

this procedure. 11. ESTIMATION DESCRIPTION The prime example of an empirically based model is the Universal Soil Loss Equation ( USLE ) developed...impacts to human health and welfare and to the natural environment. The type of data collected might include noise levels, soil erosion, and...uptake relevant to flora/fauna and the soil erosion effects of proposed testing. c. Plan to identify any modifications/alternatives implemented

A randomized controlled trial to compare fentanyl-propofol and ketamine-propofol combination for procedural sedation and analgesia in laparoscopic tubal ligation

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Ranju Singh

2013-01-01

Full Text Available Background: Procedural sedation and analgesia is widely being used for female laparoscopic sterilization using combinations of different drugs at varying doses. This study compared the combination of fentanyl and propofol, and ketamine and propofol in patients undergoing outpatient laparoscopic tubal ligation, with respect to their hemodynamic effects, postoperative recovery characteristics, duration of hospital stay, adverse effects, and patient comfort and acceptability. Settings and Design: Randomized, double blind. Methods: Patients were assigned to receive premixed injection of either fentanyl 1.5 μg/kg + propofol 2 mg/kg (Group PF, n0=50 or ketamine 0.5 mg/kg + propofol 2 mg/kg (Group PK, n=50. Hemodynamic data, peripheral oxygen saturation, and respiratory rate were recorded perioperatively. Recovery time, time to discharge, and comfort score were noted. Statistical Analysis: Chi-square (χ2 test was used for categorical data. Student′s t-test was used for quantitative variables for comparison between the two groups. For intragroup comparison, paired t-test was used. SPSS 14.0 was used for analysis. Results: Although the heart rate was comparable, blood pressures were consistently higher in group PK. Postoperative nausea and vomiting and delay in voiding were more frequent in group PK ( P<0.05. The time to reach Aldrete score ≥8 was significantly longer in group PK (11.14±3.29 min in group PF vs. 17.3±6.32 min in group PK, P<0.01. The time to discharge was significantly longer in group PK (105.8±13.07 min in group PF vs.138.18±13.20 min in group PK, P<0.01. Patient comfort and acceptability was better in group PF, P<0.01. Conclusion: As compared to ketamine-propofol, fentanyl-propofol combination is associated with faster recovery, earlier discharge, and better patient acceptability.

Patient doses in interventional cardiology procedures

International Nuclear Information System (INIS)

Domienik, J.; Papierz, S.; Jankowski, J.; Peruga, J.Z.

2008-01-01

In most countries of European Union legislation requires the determination of the total skin dose to patient resulting from interventional procedures to assess the risk of deterministic effect. To this end, various dose indicators like dose area product (DAP), cumulative dose (CD) and entrance dose at the patient plane (EFD) are used in clinical practice. The study aims at relating those dose indicators with doses ascribe to the most irradiated areas of the patient skin usually expressed in terms of local maximal skin dose (MSD). For the study the local MSD and related to their areas are investigated and compared for coronary angiography CA and intervention (PCI). Two methods implying radiographic films Kodak EDR2 and matrixes of thermoluminescent dosimeters (TLDs) are applied for direct measurements of dose distribution for selected procedures. Both methods are compared. Additionally, for patient dosimetry the following data: MSD, CD, EFD, fluoroscopy time (FT), number of acquired images, total DAP, fluoro-DAP and record-DAP were collected for randomly selected procedure. The statistical quantities like: median, 3 rd quartile, mean and standard deviation for all dosimetric parameters are determined. Preliminary study showed that the values of data collected for coronary procedures are in the ranges 0,7 - 27,3 min for fluoroscopy time, 50 - 350 Gy cm 2 for total DAP, 300 - 2000 mGy for CD, 140 - 2000 mGy for EFD and 100 - 1500 mGy for local maximal skin dose. For interventions the ranges are, accordingly 3,0 - 43,6 min , 25 - 450 Gy cm 2 , 270 - 6600 mGy, 80 - 2600 mGy and 80 - 1500 mGy. As a result of the study the correlations between dose indicators and local MSD are analyzed. The concentration of dose on irradiated films are going to be investigated in some detail as well. (author)

Patient radiation doses from neuroradiology procedures

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Garcia-Roman, M J; Abreu-Luis, J; Hernandez-Armas, J [Servicio de Fisica Medica, Hospital Universitario de Canarias, La Laguna, Tenerife (Spain); Prada-Martinez, E [Servicio de Radiodiagnostico, Hospital Universitario de Canarias, La Laguna, Tenerife (Spain)

2001-03-01

Following the presentation of radiation-induced deterministic effects by some patients undergoing neuroradiological procedures during successive sessions, such as temporary epilation, in the 'Hospital Universitario de Canarias', measurements were made of dose to patients. The maximum dose-area product measured by ionization chamber during these procedures was 39617 cGy.cm{sup 2} in a diagnostic of aneurysm and the maximum dose to the skin measured by thermoluminescent dosemeters (TLDs) was 462.53 mGy. This can justify certain deterministic effects but it is unlikely that the patients will suffer serious effects from this skin dose. Also, measurements were made of effective dose about two usual procedures, embolisation of tumour und embolisation of aneurysm. These procedures were reproduced with an anthropomorphic phantom Rando and doses were measured with TLDs. Effective doses obtained were 3.79 mSv and 4.11 mSv, respectively. The effective dose valued by the program EFFDOSE was less than values measured with TLDs. (author)

Patient radiation doses from neuroradiology procedures

International Nuclear Information System (INIS)

Garcia-Roman, M.J.; Abreu-Luis, J.; Hernandez-Armas, J.; Prada-Martinez, E.

2001-01-01

Following the presentation of radiation-induced deterministic effects by some patients undergoing neuroradiological procedures during successive sessions, such as temporary epilation, in the 'Hospital Universitario de Canarias', measurements were made of dose to patients. The maximum dose-area product measured by ionization chamber during these procedures was 39617 cGy.cm 2 in a diagnostic of aneurysm and the maximum dose to the skin measured by thermoluminescent dosemeters (TLDs) was 462.53 mGy. This can justify certain deterministic effects but it is unlikely that the patients will suffer serious effects from this skin dose. Also, measurements were made of effective dose about two usual procedures, embolisation of tumour und embolisation of aneurysm. These procedures were reproduced with an anthropomorphic phantom Rando and doses were measured with TLDs. Effective doses obtained were 3.79 mSv and 4.11 mSv, respectively. The effective dose valued by the program EFFDOSE was less than values measured with TLDs. (author)

The Effect of the Extinction Procedure in Function-Based Intervention

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Janney, Donna M.; Umbreit, John; Ferro, Jolenea B.; Liaupsin, Carl J.; Lane, Kathleen L.

2013-01-01

In this study, we examined the contribution of the extinction procedure in function-based interventions implemented in the general education classrooms of three at-risk elementary-aged students. Function-based interventions included antecedent adjustments, reinforcement procedures, and function-matched extinction procedures. Using a combined ABC…

Can a Drill Guide Improve the Coracoid Graft Placement During the Latarjet Procedure? A Prospective Comparative Study With the Freehand Technique.

Science.gov (United States)

Barth, Johannes; Boutsiadis, Achilleas; Neyton, Lionel; Lafosse, Laurent; Walch, Gilles

2017-10-01

One of the factors that can affect the success of the Latarjet procedure is accurate coracoid graft (CG) placement. The use of a guide can improve placement of the CG and screw positioning in the sagittal and axial planes as compared with the classic open ("freehand") technique. Cohort study; Level of evidence, 2. A total of 49 patients who underwent a Latarjet procedure for the treatment of recurrent anterior shoulder instability were prospectively included; the procedure was performed with the freehand technique in 22 patients (group 1) and with use of a parallel drill guide during screw placement in 27 patients (group 2). All patients underwent a postoperative computed tomography scan with the same established protocol. The scans were used to evaluate and compare the position of the CG in the sagittal and axial planes, the direction of the screws (α angle), and overall contact of the graft with the anterior surface of the glenoid after the 2 surgical techniques. The CG was placed >60% below the native glenoid equator in 23 patients (85.2%) in group 2, compared with 14 patients (63.6%) in group 1 ( P = .004). In the axial plane, the position of the CG in group 2 patients was more accurate (85.2% and 88.9% flush) at the inferior and middle quartiles of the glenoid surface ( P = .012 and .009), respectively. Moreover, with the freehand technique (group 1), the graft was in a more lateral position in the inferior and middle quartiles ( P = .012 and .009, respectively). No differences were found between groups 1 and 2 regarding the mean α angle of the superior (9° ± 4.14° vs 11° ± 6.3°, P = .232) and inferior (9.5° ± 6° vs 10° ± 7.5°, P = .629) screws. However, the mean contact angle (angle between the posterior coracoid and the anterior glenoid surface) with the freehand technique (3.8° ± 6.8°) was better than that of the guide (8.55° ± 8°) ( P = .05). Compared with the classic freehand operative technique, the parallel drill guide can ensure

Payment Procedures for Electronic Government Services

OpenAIRE

Pousttchi, Key; Wiedemann, Dietmar Georg

2005-01-01

In this paper, we analyse payment procedures for their suitability for electronic government. We provide an overview of the payment procedures currently available on the market, compare the situation in electronic government with the situation in electronic commerce and analyze what we can transfer. Based on functional requirements we propose a scheme that allows public agencies to examine the appropriateness of any given payment procedure for electronic government.

Nuclear Waste Fund cash management procedures

International Nuclear Information System (INIS)

1988-04-01

The Nuclear Waste Policy Act if 1982 (NWPA) provided for the Office of Radioactive Waste Management (OCRWM) to adopt financial and accounting methods comparable to those used by private industry, including borrowing and investing authority. This document describes the procedures OCRWM follows to meet its borrowing and investing authority under the NWPA. These procedures are a supplement to, and are, therefore, not intended to supersede, existing Departmental policies and procedures

Anticonflict effect of alpidem as compared with the benzodiazepine alprazolam in rats.

Science.gov (United States)

Hascoët, M; Bourin, M

1997-02-01

A comparative study between two drugs acting on the GABAA receptor, alprazolam and alpidem was undertaken, using simple tests such as measurement of spontaneous locomotor activity, four plates test and rotarod in mice. Additional conflict test was further performed using a new conflict paradigm where the opportunity existed for rats to choose during punished periods between immediate, punished reinforcement and delayed non-punished reinforcement. The benzodiazepine alprazolam, demonstrated, as expected, strong anxiolytic effects in mice and increased punished response in rats at non sedative doses (0.5, 1 mg/kg). High doses of alprazolam decreased spontaneous locomotor activity and induced myorelaxant effects in mice. Alpidem, an imidazopyridine derivative, induced motor impairment in mice and only very weak anxiolytic effects in the four plates test in mice (4 mg/kg) and in punished procedure in rats (32 mg/kg). As alprazolam is a full agonist for the GABAA receptor complex and alpidem is a partial agonist acting with specificity on omega 1 GABAA receptor subtypes, the results are discussed. Activity on omega 1 receptor subtypes is perhaps not sufficient in order to obtain a true anti-conflict effect and compounds such as alpidem only relieve some of the symptoms of anxiety disorders.

Effective dose and dose to crystalline lens during angiographic procedures

International Nuclear Information System (INIS)

Pages, J.

1998-01-01

The highest radiation doses levels received by radiologists are observed during interventional procedures. Doses to forehead and neck received by a radiologist executing angiographic examinations at the department of radiology at the academic hospital (AZ-VUB) have been measured for a group of 34 examinations. The doses to crystalline lens and the effective doses for a period of one year have been estimated. For the crystalline lens the maximum dose approaches the ICRP limit, that indicates the necessity for the radiologist to use leaded glasses. (N.C.)

Effectiveness and efficiency of CT-colonography compared to conventional colonoscopy for the early detection and diagnosis of colorectal cancer

Directory of Open Access Journals (Sweden)

Hiebinger, Cora

2009-02-01

to this calculation, the CTC-screening is cost-effective compared to the option ‘no screening’; however, conventional coloscopy-screening is generally more cost-effective.DiscussionIf modern CTC-devices are used with adequate technical settings, software, appropriate patient preparation and training of the operator, better results regarding sensitivity can be expected. Basically, the fact that no therapeutic measures (polypectomy can be taken during CTC compared to conventional coloscopy needs to be considered. Unanswered medical questions pertain to the interval of examinations for screening (considering the radiation exposure, the approach to small polyps and the significance of flat and depressed lesions. Regarding its cost-effectiveness, conventional coloscopy-screening results in greater health benefits and lower costs than CTC-screening in most model calculations. These results cannot be applied to Germany directly. An important ethical aspect is the consideration of patient preferences regarding the procedures. Legal aspects concern the stipulation and maintenance of quality standards. Conclusions: At this time, a clear endorsement of CTC as an alternative procedure for diagnosis and screening to the current gold standard conventional coloscopy cannot be given. On the basis of the available literature this holds true for both the medical as well as the economic assessment. However, despite the numerous studies and analyses on this topic, this assessment is afflicted with uncertainties. Due to the rapid development of CTC, short term revisions of these research questions are needed.

Sequence-specific procedural learning deficits in children with specific language impairment.

Science.gov (United States)

Hsu, Hsinjen Julie; Bishop, Dorothy V M

2014-05-01

This study tested the procedural deficit hypothesis of specific language impairment (SLI) by comparing children's performance in two motor procedural learning tasks and an implicit verbal sequence learning task. Participants were 7- to 11-year-old children with SLI (n = 48), typically developing age-matched children (n = 20) and younger typically developing children matched for receptive grammar (n = 28). In a serial reaction time task, the children with SLI performed at the same level as the grammar-matched children, but poorer than age-matched controls in learning motor sequences. When tested with a motor procedural learning task that did not involve learning sequential relationships between discrete elements (i.e. pursuit rotor), the children with SLI performed comparably with age-matched children and better than younger grammar-matched controls. In addition, poor implicit learning of word sequences in a verbal memory task (the Hebb effect) was found in the children with SLI. Together, these findings suggest that SLI might be characterized by deficits in learning sequence-specific information, rather than generally weak procedural learning. © 2014 The Authors. Developmental Science Published by John Wiley & Sons Ltd.

An integrated computer-based procedure for teamwork in digital nuclear power plants.

Science.gov (United States)

Gao, Qin; Yu, Wenzhu; Jiang, Xiang; Song, Fei; Pan, Jiajie; Li, Zhizhong

2015-01-01

Computer-based procedures (CBPs) are expected to improve operator performance in nuclear power plants (NPPs), but they may reduce the openness of interaction between team members and harm teamwork consequently. To support teamwork in the main control room of an NPP, this study proposed a team-level integrated CBP that presents team members' operation status and execution histories to one another. Through a laboratory experiment, we compared the new integrated design and the existing individual CBP design. Sixty participants, randomly divided into twenty teams of three people each, were assigned to the two conditions to perform simulated emergency operating procedures. The results showed that compared with the existing CBP design, the integrated CBP reduced the effort of team communication and improved team transparency. The results suggest that this novel design is effective to optim team process, but its impact on the behavioural outcomes may be moderated by more factors, such as task duration. The study proposed and evaluated a team-level integrated computer-based procedure, which present team members' operation status and execution history to one another. The experimental results show that compared with the traditional procedure design, the integrated design reduces the effort of team communication and improves team transparency.

Bifurcation Culprit Lesions in ST-segment Elevation Myocardial Infarction: Procedural Success and 5-year Outcome Compared With Nonbifurcation Lesions.

Science.gov (United States)

Salinas, Pablo; Mejía-Rentería, Hernán; Herrera-Nogueira, Raúl; Jiménez-Quevedo, Pilar; Nombela-Franco, Luis; Núñez-Gil, Iván Javier; Gonzalo, Nieves; Del Trigo, María; Pérez-Vizcayno, María José; Quirós, Alicia; Escaned, Javier; Macaya, Carlos; Fernández-Ortiz, Antonio

2017-08-09

We assessed short- and long-term outcomes of primary angioplasty in ST-segment elevation myocardial infarction by comparing bifurcation culprit lesions (BCL) with non-BCL. Observational study with a propensity score matched control group. Among 2746 consecutive ST-segment elevation myocardial infarction patients, we found 274 (10%) patients with BCL. The primary outcome was a composite endpoint including all-cause death, myocardial infarction, coronary artery bypass grafting or target vessel revascularization, assessed at 30-days and 5-years. Baseline characteristics showed no differences after propensity matching (1:1). In the BCL group, the most frequent strategy was provisional stenting of the main branch (84%). Compared with the non-BCL group, the procedures were technically more complex in the BCL group in terms of need for balloon dilatation (71% BCL vs 59% non-BCL; P = .003), longer procedural time (70 ± 29minutes BCL vs 62.8 ± 28.9minutes non-BCL; P = .004) and contrast use (256.2 ± 87.9mL BCL vs 221.1 ± 82.3mL non-BCL; P < .001). Main branch angiographic success was similar (93.4% BCL vs 93.8% non-BCL; P = .86). Thirty-day all-cause mortality was similar between groups: 4.7% BCL vs 5.1% non-BCL; P = .84. At the 5-year follow-up, there were no differences in all-cause death (12% BCL vs 13% non-BCL; P = .95) or the combined event (22% BCL vs 21% non-BCL; P = .43). Primary angioplasty of a BCL was technically more complex; however, main branch angiographic success was similar, and there were no differences in long-term prognosis compared with non-BCL patients. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Planning and consultation procedures for low-level radioactive waste disposal: a comparative analysis of overseas experience

International Nuclear Information System (INIS)

Kemp, R.

1989-03-01

The results are presented of a study the purpose of which was to learn from experience in countries other than the UK, of planning and public consultation procedures associated with the establishment of low-level radioactive waste (LLW) disposal sites. Information on LLW developments in the United States, Canada, France, Holland, Switzerland, Sweden, and West Germany was sought. Particular regard was given to the efficacy of public consultation and negotiation procedures; the key aspects bearing on the public acceptability of LLW proposals; and the form and effect of any compensation mechanisms in operation. The main findings include: (i) Public acceptability of radioactive waste proposals depends upon a combination of basic understanding, trust, consultation and negotiation. (ii) There is no overall correct approach. (iii) The greatest success overseas appears to be linked to some combination of the following elements: authority and clarity in the exposition of radioactive waste management policy; the early involvement of local authority organisations in site selection; careful attention to the potential contribution of authoritative independent advisory groups; the development and nurturing of local liaison committees to establish good communications at the local level; careful consideration of means of devolving some power to local authority level for safety reassurance; and the development of an incremental, openly negotiated approach to compensation. (author)

Using mixed methods effectively in prevention science: designs, procedures, and examples.

Science.gov (United States)

Zhang, Wanqing; Watanabe-Galloway, Shinobu

2014-10-01

There is growing interest in using a combination of quantitative and qualitative methods to generate evidence about the effectiveness of health prevention, services, and intervention programs. With the emerging importance of mixed methods research across the social and health sciences, there has been an increased recognition of the value of using mixed methods for addressing research questions in different disciplines. We illustrate the mixed methods approach in prevention research, showing design procedures used in several published research articles. In this paper, we focused on two commonly used mixed methods designs: concurrent and sequential mixed methods designs. We discuss the types of mixed methods designs, the reasons for, and advantages of using a particular type of design, and the procedures of qualitative and quantitative data collection and integration. The studies reviewed in this paper show that the essence of qualitative research is to explore complex dynamic phenomena in prevention science, and the advantage of using mixed methods is that quantitative data can yield generalizable results and qualitative data can provide extensive insights. However, the emphasis of methodological rigor in a mixed methods application also requires considerable expertise in both qualitative and quantitative methods. Besides the necessary skills and effective interdisciplinary collaboration, this combined approach also requires an open-mindedness and reflection from the involved researchers.

Semi-empirical procedures for correcting detector size effect on clinical MV x-ray beam profiles

International Nuclear Information System (INIS)

Sahoo, Narayan; Kazi, Abdul M.; Hoffman, Mark

2008-01-01

The measured radiation beam profiles need to be corrected for the detector size effect to derive the real profiles. This paper describes two new semi-empirical procedures to determine the real profiles of high-energy x-ray beams by removing the detector size effect from the measured profiles. Measured profiles are corrected by shifting the position of each measurement point by a specific amount determined from available theoretical and experimental knowledge in the literature. The authors developed two procedures to determine the amount of shift. In the first procedure, which employs the published analytical deconvolution procedure of other investigators, the shift is determined from the comparison of the analytical fit of the measured profile and the corresponding analytical real profile derived from the deconvolution of the fitted measured profile and the Gaussian detector response function. In the second procedure, the amount of shift at any measurement point is considered to be proportional to the value of an analytical function related to the second derivative of the real profile at that point. The constant of proportionality and a parameter in the function are obtained from the values of the shifts at the 90%, 80%, 20%, and 10% dose levels, which are experimentally known from the published results of other investigators to be approximately equal to half of the radius of the detector. These procedures were tested by correcting the profiles of 6 and 18 MV x-ray beams measured by three different ionization chambers and a stereotactic field diode detector with 2.75, 2, 1, and 0.3 mm radii of their respective active cylindrical volumes. The corrected profiles measured by different detectors are found to be in close agreement. The detector size corrected penumbra widths also agree with the expected values based on the results of an earlier investigation. Thus, the authors concluded that the proposed procedures are accurate and can be used to derive the real

Radiation dose during angiographic procedures

International Nuclear Information System (INIS)

Lavoie, Ch.; Rasuli, P.

2001-01-01

The use of angiographic procedures is becoming more prevalent as new techniques and equipment are developed. There have been concerns in the scientific community about the level of radiation doses received by patients, and indirectly by staff, during some of these radiological procedures. The purpose of this study was to assess the level of radiation dose from angiographic procedures to patient at the Ottawa Hospital, General Campus. Radiation dose measurements, using Thermo-Luminescent Dosimeters (TLDs), were performed on more than 100 patients on various procedures. The results show that while the patient dose from the great majority of angiographic procedures is less than 2 Gy, a significant number of procedures, especially interventional procedures may have doses greater than 2 Gy and may lead to deterministic effects. (author)

Randomized Comparative Study of the U- and H-Type Approaches of the TVT-Secur Procedure for the Treatment of Female Stress Urinary Incontinence: One-Year Follow-Up

Science.gov (United States)

Kim, Jung Jun; Lee, Young-Suk

2010-01-01

Purpose We compared outcomes of the U- and H-type approaches of the tension-free vaginal tape (TVT)-Secur procedure for the treatment of female stress urinary incontinence (SUI). Materials and Methods From March 2007 to July 2008, 115 women with SUI underwent TVT-Secur by a single surgeon. Patients were randomly assigned to either the U- or the H-type approach. After 12 months, postoperative changes in the Sandvik questionnaire, incontinence quality of life questionnaire (I-QoL), Bristol female lower urinary tract symptoms-scored form (BFLUTS-SF), and postoperative patient satisfaction were evaluated. Cure was regarded as no leakage on the Sandvik questionnaire. Complications were also evaluated. Results Of 115 women, 53 were treated with the U approach, and 62 women were treated with the H approach. At 12 months, 88.7% of those treated with the U approach and 87.1% of those treated with the H approach were cured (p=0.796). The I-QoL and filling, incontinence, sexual function, and QoL sum (BFLUTS-SF) scores were improved with both approaches, and there were no significant differences in the degree of improvement between approaches. Approximately 83.7% and 82.9% of the women treated with the U and H approaches, respectively, were satisfied with the outcome (p=0.858). There were 3 cases of intra-operative vaginal wall perforation in the H-type group. Immediate postoperative retention was observed in 2 women in the U-type group and 1 woman in the H-type group. One woman in the U-type group underwent tape releasing and cutting procedures for persistent large post-void residuals. Conclusions The U- and the H-type approaches of the TVT-Secur procedure provided comparable effectiveness for the treatment of female SUI. PMID:20428427

Technical and surgical aspects of the sphenopalatine ganglion (SPG) microstimulator insertion procedure

DEFF Research Database (Denmark)

Assaf, A T; Hillerup, S; Rostgaard, J

2016-01-01

into the pterygopalatine fossa (PPF) is presented herein. Technical aspects include detailed descriptions of the preoperative planning using computed tomography or cone beam computed tomography scans for presurgical digital microstimulator insertion into the patient-specific anatomy and intraoperative verification......), and removal (n=5). This SPG microstimulator insertion procedure has sequelae comparable to other oral cavity procedures including tooth extractions, sinus surgery, and dental implant placement. Twenty-five of 29 subjects (86%) completing a self-assessment questionnaire indicated that the surgical effects were...

Muscle lesion comparing of imaging procedures (sonography and MRT) -experimental and clinical study

International Nuclear Information System (INIS)

Mellerowicz, H.; Lubasch, A.; Dulce, M.; Wagner, S.; Paul, B.

1993-01-01

Muscle injuries in sports are more common now. Diagnosis and follow up of muscle injuries is nowadays achieved by sonography and MRT. In order to assess the two imagine procedures, a direct test for comparison of sonography and MRT was performed in an experimental study: A standardised disconnection of m. triceps surae in rats was either sutured and glued or not treated. Clinical studies were performed in 26 patients suffering from muscle trauma. Sonography was proved to be a reliable procedure especially in follow up control until full weight bearing and should be used first. Negative or doubtfull findings require further investigation by MRT. Especially contrast medium (Gd-DTPA) assisted examinations enables a long term follow up and may even show small (muscle strain) and deep lying injuries. (orig.) [de

Assessment of Patients Radiation Dose During Interventional Radiological Procedure in PPUKM

International Nuclear Information System (INIS)

Mohd Khalid Matori; Husaini Salleh; Muhammad Jamal Muhammad Isa

2014-01-01

Interventional Radiology (IR) is a relatively new subspecialty of radiology. It is subspecialty where minimally invasive procedures are performed under radiological guidance using X-ray. This procedure can deliver high radiation doses compared with other radiological method due to long screening time. Because of these it is important to determine radiation doses received by patients undergoing IR procedures. It is to ensure that the dose is within the range deemed to be saved. A total of 128 patients undergoing IR procedures in PPUKM between 2012 and 2013 were study retrospectively. Dose area product (DAP) meter were used to measure the integral dose for the whole procedures. Mean kerma-area products for abdomen, head, pelvis, and thorax were 243.1, 107.3, 39.05 and 45.7 Gycm 2 , respectively. This study may provide the useful information which can be use to establish baseline patient dose data for dose optimizing study and carried out a recommendation on effective method of patient dose reduction during IR procedures. A more detail results of this study are presented in this paper. (author)

FFTF fuel pin design procedure verification for transient operation

International Nuclear Information System (INIS)

Baars, R.E.

1975-05-01

The FFTF design procedures for evaluating fuel pin transient performance are briefly reviewed, and data where available are compared with design procedure predictions. Specifically, burst conditions derived from Fuel Cladding Transient Tester (FCTT) tests and from ANL loss-of-flow tests are compared with burst pressures computed using the design procedure upon which the cladding integrity limit was based. Failure times are predicted using the design procedure for evaluation of rapid reactivity insertion accidents, for five unterminated TREAT experiments in which well characterized fuel failures were deliberately incurred. (U.S.)

22 CFR 92.37 - Authentication procedure.

Science.gov (United States)

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Authentication procedure. 92.37 Section 92.37... Notarial Acts § 92.37 Authentication procedure. (a) The consular officer must compare the foreign official...) Where the State law requires the consular officer's certificate of authentication to show that the...

A vertical-energy-thresholding procedure for data reduction with multiple complex curves.

Science.gov (United States)

Jung, Uk; Jeong, Myong K; Lu, Jye-Chyi

2006-10-01

Due to the development of sensing and computer technology, measurements of many process variables are available in current manufacturing processes. It is very challenging, however, to process a large amount of information in a limited time in order to make decisions about the health of the processes and products. This paper develops a "preprocessing" procedure for multiple sets of complicated functional data in order to reduce the data size for supporting timely decision analyses. The data type studied has been used for fault detection, root-cause analysis, and quality improvement in such engineering applications as automobile and semiconductor manufacturing and nanomachining processes. The proposed vertical-energy-thresholding (VET) procedure balances the reconstruction error against data-reduction efficiency so that it is effective in capturing key patterns in the multiple data signals. The selected wavelet coefficients are treated as the "reduced-size" data in subsequent analyses for decision making. This enhances the ability of the existing statistical and machine-learning procedures to handle high-dimensional functional data. A few real-life examples demonstrate the effectiveness of our proposed procedure compared to several ad hoc techniques extended from single-curve-based data modeling and denoising procedures.

Adopting wedge hepatic venography with CO2 during transjugular intrahepatic portosystemic shunt procedures

International Nuclear Information System (INIS)

Zhang Linpeng; Chen Songtao; Shi Xiulan

2012-01-01

Objective: To renovate angiography in identifying portal vein anatomy during transjugular intrahepatic portosystemic shunt (TIPS) procedures, saving the time of TIPS procedures, decreasing the risk of the complications of the post-procedure. Methods: The difference between the Wedge hepatic venography with Carbon Dioxide in 6 cases and Inferior Mesenteric artery angiography in 7 cases during TIPS procedures were compared in the identification of portal vein anatomy. The quality of images, their effects on the procedures, the complications and the recovery post-procedure were evaluated. Results: Using CO 2 , the portal veins were opacified in all 6 cases. TIPS procedures succeeded in all cases except 1 case because of poor coagulation function. Using Inferior Mesenteric artery angiography, the portal veins were opacified in all 7 cases. TIPS procedure succeeded in all cases except 1 case because of chronic portal occlusion. Puncture-site hematoma occurred in 1 case after TIPS procedure. Conclusion: Wedge hepatic venography with Carbon Dioxide is superior, safer and more convenient than Inferior Mesenteric Artery angiography in identifying portal vein anatomy during TIPS. (authors)

Comparability Effects of Mandatory IFRS Adoption

OpenAIRE

Stefano Cascino; Joachim Gassen

2012-01-01

The mandatory adoption of IFRS by many countries worldwide fuels the expectation that financial accounting information might become more comparable across countries. This expectation is opposed to an alternative view that stresses the importance of incentives in shaping accounting information. We provide early evidence on this debate by investigating the effects of mandatory IFRS adoption on the comparability of financial accounting information around the world. Using two comparability proxie...

Procedure to decouple reflectance and down-shifting effects in luminescent down-shifting enhanced photovoltaics.

Science.gov (United States)

Gabr, Ahmed M; Walker, Alexandre W; Wilkins, Matthew M; Kleiman, Rafael; Hinzer, Karin

2017-06-12

The down-shifting (DS) process is a purely optical approach used to improve the short-wavelength response of a solar cell by shifting high-energy photons to the visible range, which can be more efficiently absorbed by the solar cell. In addition to the DS effect, coupling a DS layer to the top surface of a solar cell results in a change in surface reflectance. The two effects are intermixed and therefore, usually reported as a single effect. Here we propose a procedure to decouple the two effects. Analytical equations are derived to decouple the two effects, that consider the experimentally measured quantum efficiency of the solar cell with and without the DS layer, in addition to transfer matrix simulations of the parasitic absorption in the device structure. In this work, an overall degradation of 0.46 mA/cm 2 is observed when adding a DS layer composed of silicon nanocrystals embedded in a quartz matrix to a silicon solar cell of 11% baseline efficiency. To fully understand the contribution from each effect, the surface reflectance and DS effects are decoupled and quantified using the described procedure. We observe an enhancement of 0.27 mA/cm 2 in short-circuit current density due to the DS effect, while the surface reflectance effect leads to a degradation of 0.73 mA/cm 2 in short-circuit current density.

The effect of in vitro procedures on cyclic AMP accumulation in human leucocytes

DEFF Research Database (Denmark)

Johansen, Torben; Friis, U G; Rasmussen, A K

1994-01-01

The aim of this study was to investigate the effect of various methodological procedures or protocols on cyclic AMP formation in human leucocytes. The data showed that: (1) ATP content and lactate production was unaffected by hypotonic lysis during leucocyte isolation; (2) there was a linear rela...

Effect of mobile laminar airflow units on airborne bacterial contamination during neurosurgical procedures.

Science.gov (United States)

von Vogelsang, A-C; Förander, P; Arvidsson, M; Löwenhielm, P

2018-03-24

Surgical site infections (SSIs) after neurosurgery are potentially life-threatening and entail great costs. SSIs may occur from airborne bacteria in the operating room, and ultraclean air is desired during infection-prone cleaning procedures. Door openings and the number of persons present in the operating room affect the air quality. Mobile laminar airflow (MLAF) units, with horizontal laminar airflow, have previously been shown to reduce airborne bacterial contamination. To assess the effect of MLAF units on airborne bacterial contamination during neurosurgical procedures. In a quasi-experimental design, bacteria-carrying particles (colony-forming units: cfu) during neurosurgical procedures were measured with active air-sampling in operating rooms with conventional turbulent ventilation, and with additional MLAF units. The MLAF units were shifted between operating rooms monthly. Colony-forming unit count and bacterial species detection were conducted after incubation. Data was collected for a period of 18 months. A total of 233 samples were collected during 45 neurosurgical procedures. The use of MLAF units significantly reduced the numbers of cfu in the surgical site area (P neurosurgery to ultraclean air levels. MLAF units are valuable when the main operating room ventilation system is unable to produce ultraclean air in infection-prone clean neurosurgery. Copyright © 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Effects of off-specification procedures on the mechanical properties of half-bead weld repairs

International Nuclear Information System (INIS)

Hobson, D.O.; Nanstad, R.K.

1983-07-01

We examined the effects of off-specification procedures on the mechanical properties of half-bead weld repairs. The name half-bead is derived from the specification that half the thickness of the initial weld layer be ground off before the second layer is deposited. In this study the heat-affected zones of a weldment made with both all and none of the first layer removed were tested for toughness, hardness, and microstructural differences, and the results were compared with the properties of a protypical half-bead repair made under ASME Boiler and Pressure Vessel Code, Sect. XI, guidelines. The results of this limited study showed no apparent justification for the requirement to grind off half the first layer in this type of weld repair. The graded electrode sizes used to make the welds probably had more to do with the weld properties than did the range of first-layer thicknesses used in this study

Surgeon-patient communication during awake procedures.

Science.gov (United States)

Smith, Claire S; Guyton, Kristina; Pariser, Joseph J; Siegler, Mark; Schindler, Nancy; Langerman, Alexander

2017-06-01

Surgeons are increasingly performing procedures on awake patients. Communication during such procedures is complex and underexplored in the literature. Surgeons were recruited from the faculty of 2 hospitals to participate in an interview regarding their approaches to communication during awake procedures. Three researchers used the constant comparative method to transcribe, code, and review interviews until saturation was reached. Twenty-three surgeons described the advantages and disadvantages of awake procedures, their communication with the awake patient, their interactions with staff and with trainees, the environment of awake procedures, and how communication in this context is taught and learned. Surgeons recognized communication during awake procedures as important and reported varied strategies for ensuring patient comfort in this context. However, they also acknowledged challenges with multiparty communication during awake procedures, especially in balancing commitments to teaching with their duty to comfort the patient. Copyright © 2016 Elsevier Inc. All rights reserved.

Patient doses from fluoroscopically guided cardiac procedures in pediatrics

Science.gov (United States)

Martinez, L. C.; Vano, E.; Gutierrez, F.; Rodriguez, C.; Gilarranz, R.; Manzanas, M. J.

2007-08-01

Infants and children are a higher risk population for radiation cancer induction compared to adults. Although some values on pediatric patient doses for cardiac procedures have been reported, data to determine reference levels are scarce, especially when compared to those available for adults in diagnostic and therapeutic procedures. The aim of this study is to make a new contribution to the scarce published data in pediatric cardiac procedures and help in the determination of future dose reference levels. This paper presents a set of patient dose values, in terms of air kerma area product (KAP) and entrance surface air kerma (ESAK), measured in a pediatric cardiac catheterization laboratory equipped with a biplane x-ray system with dynamic flat panel detectors. Cardiologists were properly trained in radiation protection. The study includes 137 patients aged between 10 days and 16 years who underwent diagnostic catheterizations or therapeutic procedures. Demographic data and technical details of the procedures were also gathered. The x-ray system was submitted to a quality control programme, including the calibration of the transmission ionization chamber. The age distribution of the patients was 47 for <1 year; 52 for 1-<5 years; 25 for 5-<10 years and 13 for 10-<16 years. Median values of KAP were 1.9, 2.9, 4.5 and 15.4 Gy cm2 respectively for the four age bands. These KAP values increase by a factor of 8 when moving through the four age bands. The probability of a fatal cancer per fluoroscopically guided cardiac procedure is about 0.07%. Median values of ESAK for the four age bands were 46, 50, 56 and 163 mGy, which lie far below the threshold for deterministic effects on the skin. These dose values are lower than those published in previous papers.

Reducing Seclusion Timeout and Restraint Procedures with At-Risk Youth

Science.gov (United States)

Ryan, Joseph B.; Peterson, Reece; Tetreault, George; Hagen, Emily Vander

2007-01-01

The purpose of this pilot study was to review the effects of professional staff training in crisis management and de-escalation techniques on the use of seclusion timeout and restraint procedures with at-risk students in a K-12 special day school. An exploratory pre-post study was conducted over a two-year period, comparing the use of these…

Comparative effects of enteric-coated pancreatin microsphere therapy after conventional and pylorus-preserving pancreatoduodenectomy

NARCIS (Netherlands)

Bruno, M. J.; Borm, J. J.; Hoek, F. J.; Delzenne, B.; Hofmann, A. F.; de Goeij, J. J.; van Royen, E. A.; van Gulik, T. M.; de Wit, L. T.; Gouma, D. J.; van Leeuwen, D. J.; Tytgat, G. N.

1997-01-01

BACKGROUND: A comparative study was performed between patients with exocrine pancreatic insufficiency after conventional pancreatoduodenectomy (Whipple's procedure) and pylorus-preserving pancreatoduodenectomy (PPPD). In these patients the pharmacodynamics of 2-mm enteric-coated pancreatin

Monte Carlo based estimation of organ and effective doses to patients undergoing hysterosalpingography and retrograde urethrography fluoroscopy procedures

Science.gov (United States)

Ngaile, J. E.; Msaki, P. K.; Kazema, R. R.

2018-04-01

Contrast investigations of hysterosalpingography (HSG) and retrograde urethrography (RUG) fluoroscopy procedures remain the dominant diagnostic tools for the investigation of infertility in females and urethral strictures in males, respectively, owing to the scarcity and high cost of services of alternative diagnostic technologies. In light of the radiological risks associated with contrast based investigations of the genitourinary tract systems, there is a need to assess the magnitude of radiation burden imparted to patients undergoing HSG and RUG fluoroscopy procedures in Tanzania. The air kerma area product (KAP), fluoroscopy time, number of images, organ dose and effective dose to patients undergoing HSG and RUG procedures were obtained from four hospitals. The KAP was measured using a flat transmission ionization chamber, while the organ and effective doses were estimated using the knowledge of the patient characteristics, patient related exposure parameters, geometry of examination, KAP and Monte Carlo calculations (PCXMC). The median values of KAP for the HSG and RUG were 2.2 Gy cm2 and 3.3 Gy cm2, respectively. The median organ doses in the present study for the ovaries, urinary bladder and uterus for the HSG procedures, were 1.0 mGy, 4.0 mGy and 1.6 mGy, respectively, while for urinary bladder and testes of the RUG were 3.4 mGy and 5.9 mGy, respectively. The median values of effective doses for the HSG and RUG procedures were 0.65 mSv and 0.59 mSv, respectively. The median values of effective dose per hospital for the HSG and RUG procedures had a range of 1.6-2.8 mSv and 1.9-5.6 mSv, respectively, while the overall differences between individual effective doses across the four hospitals varied by factors of up to 22.0 and 46.7, respectively for the HSG and RUG procedures. The proposed diagnostic reference levels (DRLs) for the HSG and RUG were for KAP 2.8 Gy cm2 and 3.9 Gy cm2, for fluoroscopy time 0.8 min and 0.9 min, and for number of images 5 and 4

Exposure from diagnostic nuclear medicine procedures

International Nuclear Information System (INIS)

Iacob, O.; Diaconescu, C.; Isac, R.

2002-01-01

According to our last national study on population exposures from natural and artificial sources of ionizing radiation, 16% of overall annual collective effective dose represent the contribution of diagnostic medical exposures. Of this value, 92% is due to diagnostic X-ray examinations and only 8% arise from diagnostic nuclear medicine procedures. This small contribution to collective dose is mainly the result of their lower frequency compared to that of the X-ray examinations, doses delivered to patients being, on average, ten times higher. The purpose of this review was to reassess the population exposure from in vivo diagnostic nuclear medicine procedures and to evaluate the temporal trends of diagnostic usage of radiopharmaceuticals in Romania. The current survey is the third one conducted in the last decade. As in the previous ones (1990 and 1995), the contribution of the Radiation Hygiene Laboratories Network of the Ministry of Health and Family in collecting data from nuclear medicine departments in hospitals was very important

New image-processing and noise-reduction software reduces radiation dose during complex endovascular procedures.

Science.gov (United States)

Kirkwood, Melissa L; Guild, Jeffrey B; Arbique, Gary M; Tsai, Shirling; Modrall, J Gregory; Anderson, Jon A; Rectenwald, John; Timaran, Carlos

2016-11-01

A new proprietary image-processing system known as AlluraClarity, developed by Philips Healthcare (Best, The Netherlands) for radiation-based interventional procedures, claims to lower radiation dose while preserving image quality using noise-reduction algorithms. This study determined whether the surgeon and patient radiation dose during complex endovascular procedures (CEPs) is decreased after the implementation of this new operating system. Radiation dose to operators, procedure type, reference air kerma, kerma area product, and patient body mass index were recorded during CEPs on two Philips Allura FD 20 fluoroscopy systems with and without Clarity. Operator dose during CEPs was measured using optically stimulable, luminescent nanoDot (Landauer Inc, Glenwood, Ill) detectors placed outside the lead apron at the left upper chest position. nanoDots were read using a microStar ii (Landauer Inc) medical dosimetry system. For the CEPs in the Clarity group, the radiation dose to surgeons was also measured by the DoseAware (Philips Healthcare) personal dosimetry system. Side-by-side measurements of DoseAware and nanoDots allowed for cross-calibration between systems. Operator effective dose was determined using a modified Niklason algorithm. To control for patient size and case complexity, the average fluoroscopy dose rate and the dose per radiographic frame were adjusted for body mass index differences and then compared between the groups with and without Clarity by procedure. Additional factors, for example, physician practice patterns, that may have affected operator dose were inferred by comparing the ratio of the operator dose to procedural kerma area product with and without Clarity. A one-sided Wilcoxon rank sum test was used to compare groups for radiation doses, reference air kermas, and operating practices for each procedure type. The analysis included 234 CEPs; 95 performed without Clarity and 139 with Clarity. Practice patterns of operators during

Effectiveness of current disinfection procedures against biofilm on contaminated GI endoscopes.

Science.gov (United States)

Neves, Marcelo S; da Silva, Marlei Gomes; Ventura, Grasiella M; Côrtes, Patrícia Barbur; Duarte, Rafael Silva; de Souza, Heitor S

2016-05-01

Attention to patient safety has increased recently due to outbreaks of nosocomial infections associated with GI endoscopy. The aim of this study was to evaluate current cleaning and disinfection procedures of endoscope channels with high bioburden and biofilm analysis, including the use of resistant mycobacteria associated with postsurgical infections in Brazil. Twenty-seven original endoscope channels were contaminated with organic soil containing 10(8) colony-forming units/mL of Pseudomonas aeruginosa, Staphylococcus aureus, or Mycobacterium abscessus subsp bolletii. Biofilms with the same microorganisms were developed on the inner surface of channels with the initial inoculum of 10(5) colony-forming units/mL. Channels were reprocessed following current protocol, and samples from cleaning and disinfection steps were analyzed by bioluminescence for adenosine triphosphate, cultures for viable microorganisms, and confocal microscopy. After contamination, adenosine triphosphate levels increased dramatically, and high bacterial growth was observed in all cultures. After cleaning, adenosine triphosphate levels decreased to values comparable to precontamination levels, and bacterial growth was demonstrated in 5 of 27 catheters, 2 with P aeruginosa and 3 with M abscessus. With regard to induced biofilm, a remarkable reduction occurred after cleaning, but significant microbial growth inhibition occurred only after disinfection. Nevertheless, viable microorganisms within the biofilm were still detected by confocal microscopy, more so with glutaraldehyde than with peracetic acid or O-phataladehyde. After the complete disinfection procedure, viable microorganisms could still be detected within the biofilm on endoscope channels. Prevention of biofilm development within endoscope channels should be a priority in disinfection procedures, particularly for ERCP and EUS. Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights

Comparison of transition-matrix sampling procedures

DEFF Research Database (Denmark)

Yevick, D.; Reimer, M.; Tromborg, Bjarne

2009-01-01

We compare the accuracy of the multicanonical procedure with that of transition-matrix models of static and dynamic communication system properties incorporating different acceptance rules. We find that for appropriate ranges of the underlying numerical parameters, algorithmically simple yet high...... accurate procedures can be employed in place of the standard multicanonical sampling algorithm....

What drives the comparability effect of mandatory IFRS adoption?

OpenAIRE

Stefano Cascino; Joachim Gassen

2015-01-01

We investigate the effects of mandatory IFRS adoption on the comparability of financial accounting information. Using two comparability proxies based on De Franco et al. [2011] and a comparability proxy based on the degree of information transfer, our results suggest that the overall comparability effect of mandatory IFRS adoption is marginal. We hypothesize that firm-level heterogeneity in IFRS compliance explains the limited comparability effect. To test this conjecture, we first hand-colle...

A 12 years audit of upper gastrointestinal endoscopic procedures

International Nuclear Information System (INIS)

Khurram, M.; Khaar, H.B.; Hasan, Z.; Umar, M.; Javed, S.; Asghar, T.; Minhas, Z.; Akbar, A.; Atta, N.; Nassar, F.; Sultana, Q.; Pervaiz, A.; Masoom, A.

2003-01-01

Objective: Evaluation of upper gastrointestinal (GI) endoscopy in terms of indications, diagnostic efficacy, and diseases diagnosed. Results: Of the 8481 patients, 4935 (58.2%) were female and 3546 (41.8%) male. Mean patient age was 40.5 years. Dyspepsia (42.6%), upper GI bleed (32.8%), and evaluation of chronic liver disease (10.2%) were common indications of the procedure. An endoscopic diagnosis was possible in 82.6% patients. Varices, gastritis, duodenitis, and combined lesions were common endoscopic diagnosis. Gastritis and duodenitis were most frequent causes of upper GI bleed. We noted more gastric ulcers compared to duodenal ulcers. Females had significantly more normal endoscopies, p-value = 0.02. Conclusion: Upper GI endoscopy is an effective procedure. Dyspepsia evaluation is commonest indication for upper GI endoscopy in our patients. Etiology of upper GI bleed, and incidence of duodenal ulcer compared to gastric ulcer in our patients are different than described in literature. Females have significantly more normal endoscopies. (author)

Experimental design technique applied to the validation of an instrumental Neutron Activation Analysis procedure

International Nuclear Information System (INIS)

Santos, Uanda Paula de M. dos; Moreira, Edson Gonçalves

2017-01-01

In this study optimization of procedures and standardization of Instrumental Neutron Activation Analysis (INAA) method were carried out for the determination of the elements bromine, chlorine, magnesium, manganese, potassium, sodium and vanadium in biological matrix materials using short irradiations at a pneumatic system. 2 k experimental designs were applied for evaluation of the individual contribution of selected variables of the analytical procedure in the final mass fraction result. The chosen experimental designs were the 2 3 and the 2 4 , depending on the radionuclide half life. Different certified reference materials and multi-element comparators were analyzed considering the following variables: sample decay time, irradiation time, counting time and sample distance to detector. Comparator concentration, sample mass and irradiation time were maintained constant in this procedure. By means of the statistical analysis and theoretical and experimental considerations, it was determined the optimized experimental conditions for the analytical methods that will be adopted for the validation procedure of INAA methods in the Neutron Activation Analysis Laboratory (LAN) of the Research Reactor Center (CRPq) at the Nuclear and Energy Research Institute (IPEN /CNEN-SP). Optimized conditions were estimated based on the results of z-score tests, main effect, interaction effects and better irradiation conditions. (author)

Experimental design technique applied to the validation of an instrumental Neutron Activation Analysis procedure

Energy Technology Data Exchange (ETDEWEB)

Santos, Uanda Paula de M. dos; Moreira, Edson Gonçalves, E-mail: uandapaula@gmail.com, E-mail: emoreira@ipen.br [Instituto de Pesquisas Energéticas e Nucleares (IPEN/CNEN-SP), São Paulo, SP (Brazil)

2017-07-01

In this study optimization of procedures and standardization of Instrumental Neutron Activation Analysis (INAA) method were carried out for the determination of the elements bromine, chlorine, magnesium, manganese, potassium, sodium and vanadium in biological matrix materials using short irradiations at a pneumatic system. 2{sup k} experimental designs were applied for evaluation of the individual contribution of selected variables of the analytical procedure in the final mass fraction result. The chosen experimental designs were the 2{sup 3} and the 2{sup 4}, depending on the radionuclide half life. Different certified reference materials and multi-element comparators were analyzed considering the following variables: sample decay time, irradiation time, counting time and sample distance to detector. Comparator concentration, sample mass and irradiation time were maintained constant in this procedure. By means of the statistical analysis and theoretical and experimental considerations, it was determined the optimized experimental conditions for the analytical methods that will be adopted for the validation procedure of INAA methods in the Neutron Activation Analysis Laboratory (LAN) of the Research Reactor Center (CRPq) at the Nuclear and Energy Research Institute (IPEN /CNEN-SP). Optimized conditions were estimated based on the results of z-score tests, main effect, interaction effects and better irradiation conditions. (author)

PC based temporary shielding administrative procedure (TSAP)

International Nuclear Information System (INIS)

Olsen, D.E.; Pederson, G.E.; Hamby, P.N.

1995-01-01

A completely new Administrative Procedure for temporary shielding was developed for use at Commonwealth Edison's six nuclear stations. This procedure promotes the use of shielding, and addresses industry requirements for the use and control of temporary shielding. The importance of an effective procedure has increased since more temporary shielding is being used as ALARA goals become more ambitious. To help implement the administrative procedure, a personal computer software program was written to incorporate the procedural requirements. This software incorporates the useability of a Windows graphical user interface with extensive help and database features. This combination of a comprehensive administrative procedure and user friendly software promotes the effective use and management of temporary shielding while ensuring that industry requirements are met

PC based temporary shielding administrative procedure (TSAP)

Energy Technology Data Exchange (ETDEWEB)

Olsen, D.E.; Pederson, G.E. [Sargent & Lundy, Chicago, IL (United States); Hamby, P.N. [Commonwealth Edison Co., Downers Grove, IL (United States)

1995-03-01

A completely new Administrative Procedure for temporary shielding was developed for use at Commonwealth Edison`s six nuclear stations. This procedure promotes the use of shielding, and addresses industry requirements for the use and control of temporary shielding. The importance of an effective procedure has increased since more temporary shielding is being used as ALARA goals become more ambitious. To help implement the administrative procedure, a personal computer software program was written to incorporate the procedural requirements. This software incorporates the useability of a Windows graphical user interface with extensive help and database features. This combination of a comprehensive administrative procedure and user friendly software promotes the effective use and management of temporary shielding while ensuring that industry requirements are met.

Comparative assessment of immunization procedures for development of anti proinsulin antisera for radioimmunoassay

International Nuclear Information System (INIS)

Nascimento, M. do; Borghi, V.C.; Bellini, M.H.; Mesquita, C.H.; Wajchenberg, B.L.

1992-08-01

Two schedules of immunization were employed for developing anti proinsulin antisera for radioimmunoassay. Biosynthetic human proinsulin-h P I (Elli Lilly. US), was injected subcutaneously in guinea pigs in multiple sites. In the first schedule were used 50 u g of h P I and the booster injections were administered 4 weeks after the primary immunization and then at 3-week intervals. In the second schedule was used 250 u g of h P I and boosters were done 7, 9 and 18 weeks later. As the antisera were not sufficiently specific for h P I they were purified and assessed for kinetic of precipitation and avidity. Both immunization schedules gave comparable responses. The antisera generated by the use of 50 u g of h P I presented higher cross-reactivity with insulin while the reactivity with c p eptide was of the same order in both antiserum groups. The avidity was very variable in the two groups and the three most sensitive antisera required 24 h at 4 o C for achieving maximum binding with the 125 I-h P I. However, only one antiserum (from the first group) was suitable for the radioimmunoassay. This study emphasizes the difficulties of making valid comparisons between different immunization procedures, especially in the cases when highest avidity is required. (author)

JUDICIAL PROTECTION EFFECTIVENESS AND THE FUNDAMENTAL RIGHT TO PROOF IN THE NEW BRAZILIAN CIVIL PROCEDURE RULES

Directory of Open Access Journals (Sweden)

Luis Alberto Reichelt

2017-05-01

Full Text Available The present study aims to reflect about the effectiveness of the fundamental right of proof considering the Civil Procedure Rules, taking as a measure the ideas of truth discovery through the process and of the rational persuasion. In this sense, it is examined the testimonial evidence with the introduction of the possibility of cross-examination and also the expert witness in the context of the procedural negotiation.

Cost-Effectiveness Analysis of Stereotactic Body Radiation Therapy Compared With Radiofrequency Ablation for Inoperable Colorectal Liver Metastases

Energy Technology Data Exchange (ETDEWEB)

Kim, Hayeon, E-mail: kimh2@upmc.edu [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Gill, Beant; Beriwal, Sushil; Huq, M. Saiful [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Roberts, Mark S. [Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania (United States); Smith, Kenneth J. [Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (United States)

2016-07-15

Purpose: To conduct a cost-effectiveness analysis to determine whether stereotactic body radiation therapy (SBRT) is a cost-effective therapy compared with radiofrequency ablation (RFA) for patients with unresectable colorectal cancer (CRC) liver metastases. Methods and Materials: A cost-effectiveness analysis was conducted using a Markov model and 1-month cycle over a lifetime horizon. Transition probabilities, quality of life utilities, and costs associated with SBRT and RFA were captured in the model on the basis of a comprehensive literature review and Medicare reimbursements in 2014. Strategies were compared using the incremental cost-effectiveness ratio, with effectiveness measured in quality-adjusted life years (QALYs). To account for model uncertainty, 1-way and probabilistic sensitivity analyses were performed. Strategies were evaluated with a willingness-to-pay threshold of $100,000 per QALY gained. Results: In base case analysis, treatment costs for 3 fractions of SBRT and 1 RFA procedure were $13,000 and $4397, respectively. Median survival was assumed the same for both strategies (25 months). The SBRT costs $8202 more than RFA while gaining 0.05 QALYs, resulting in an incremental cost-effectiveness ratio of $164,660 per QALY gained. In 1-way sensitivity analyses, results were most sensitive to variation of median survival from both treatments. Stereotactic body radiation therapy was economically reasonable if better survival was presumed (>1 month gain) or if used for large tumors (>4 cm). Conclusions: If equal survival is assumed, SBRT is not cost-effective compared with RFA for inoperable colorectal liver metastases. However, if better local control leads to small survival gains with SBRT, this strategy becomes cost-effective. Ideally, these results should be confirmed with prospective comparative data.

Cost-Effectiveness Analysis of Stereotactic Body Radiation Therapy Compared With Radiofrequency Ablation for Inoperable Colorectal Liver Metastases

International Nuclear Information System (INIS)

Kim, Hayeon; Gill, Beant; Beriwal, Sushil; Huq, M. Saiful; Roberts, Mark S.; Smith, Kenneth J.

2016-01-01

Purpose: To conduct a cost-effectiveness analysis to determine whether stereotactic body radiation therapy (SBRT) is a cost-effective therapy compared with radiofrequency ablation (RFA) for patients with unresectable colorectal cancer (CRC) liver metastases. Methods and Materials: A cost-effectiveness analysis was conducted using a Markov model and 1-month cycle over a lifetime horizon. Transition probabilities, quality of life utilities, and costs associated with SBRT and RFA were captured in the model on the basis of a comprehensive literature review and Medicare reimbursements in 2014. Strategies were compared using the incremental cost-effectiveness ratio, with effectiveness measured in quality-adjusted life years (QALYs). To account for model uncertainty, 1-way and probabilistic sensitivity analyses were performed. Strategies were evaluated with a willingness-to-pay threshold of $100,000 per QALY gained. Results: In base case analysis, treatment costs for 3 fractions of SBRT and 1 RFA procedure were $13,000 and $4397, respectively. Median survival was assumed the same for both strategies (25 months). The SBRT costs $8202 more than RFA while gaining 0.05 QALYs, resulting in an incremental cost-effectiveness ratio of $164,660 per QALY gained. In 1-way sensitivity analyses, results were most sensitive to variation of median survival from both treatments. Stereotactic body radiation therapy was economically reasonable if better survival was presumed (>1 month gain) or if used for large tumors (>4 cm). Conclusions: If equal survival is assumed, SBRT is not cost-effective compared with RFA for inoperable colorectal liver metastases. However, if better local control leads to small survival gains with SBRT, this strategy becomes cost-effective. Ideally, these results should be confirmed with prospective comparative data.

Comparative enhancing effects of electret with chemical enhancers on transdermal delivery of meloxicam in vitro

International Nuclear Information System (INIS)

Cui, L L; Hou, X M; Li, G D; Jiang, J; Liang, Y Y; Xin, X

2008-01-01

Electret offers enhancing effect in transdermal drug delivery for altering of the arrangement of lipid molecules in the stratum corneum, forming many transient permeable apertures and enhancing the transdermal drug delivery. In this paper, meloxicam patch formulations were developed to make the comparative study of transdermal drug delivery between electret and chemical enhancers. Patches were made into control, electret, chemical enhancer and electret with chemical enhancer ones, according to the preparation procedure. The electret combined with chemical enhancer patch was designed to probe the incorporation between electret and chemical enhancer in transdermal drug delivery. The meloxicam release from the patch was found to increase in order of blank, chemical enhancer, electret and electret with chemical enhancer patch, in general.

Activity based costing of diagnostic procedures at a nuclear medicine center of a tertiary care hospital.

Science.gov (United States)

Hada, Mahesh Singh; Chakravarty, Abhijit; Mukherjee, Partha

2014-10-01

Escalating health care expenses pose a new challenge to the health care environment of becoming more cost-effective. There is an urgent need for more accurate data on the costs of health care procedures. Demographic changes, changing morbidity profile, and the rising impact of noncommunicable diseases are emphasizing the role of nuclear medicine (NM) in the future health care environment. However, the impact of emerging disease load and stagnant resource availability needs to be balanced by a strategic drive towards optimal utilization of available healthcare resources. The aim was to ascertain the cost of diagnostic procedures conducted at the NM Department of a tertiary health care facility by employing activity based costing (ABC) method. A descriptive cross-sectional study was carried out over a period of 1 year. ABC methodology was utilized for ascertaining unit cost of different diagnostic procedures and such costs were compared with prevalent market rates for estimating cost effectiveness of the department being studied. The cost per unit procedure for various procedures varied from Rs. 869 (USD 14.48) for a thyroid scan to Rs. 11230 (USD 187.16) for a meta-iodo-benzyl-guanidine (MIBG) scan, the most cost-effective investigations being the stress thallium, technetium-99 m myocardial perfusion imaging (MPI) and MIBG scan. The costs obtained from this study were observed to be competitive when compared to prevalent market rates. ABC methodology provides precise costing inputs and should be used for all future costing studies in NM Departments.

Activity based costing of diagnostic procedures at a nuclear medicine center of a tertiary care hospital

International Nuclear Information System (INIS)

Hada, Mahesh Singh; Chakravarty, Abhijit; Mukherjee, Partha

2014-01-01

Escalating health care expenses pose a new challenge to the health care environment of becoming more cost-effective. There is an urgent need for more accurate data on the costs of health care procedures. Demographic changes, changing morbidity profile, and the rising impact of noncommunicable diseases are emphasizing the role of nuclear medicine (NM) in the future health care environment. However, the impact of emerging disease load and stagnant resource availability needs to be balanced by a strategic drive towards optimal utilization of available healthcare resources. The aim was to ascertain the cost of diagnostic procedures conducted at the NM Department of a tertiary health care facility by employing activity based costing (ABC) method. A descriptive cross-sectional study was carried out over a period of 1 year. ABC methodology was utilized for ascertaining unit cost of different diagnostic procedures and such costs were compared with prevalent market rates for estimating cost effectiveness of the department being studied. The cost per unit procedure for various procedures varied from Rs. 869 (USD 14.48) for a thyroid scan to Rs. 11230 (USD 187.16) for a meta-iodo-benzyl-guanidine (MIBG) scan, the most cost-effective investigations being the stress thallium, technetium-99 m myocardial perfusion imaging (MPI) and MIBG scan. The costs obtained from this study were observed to be competitive when compared to prevalent market rates. ABC methodology provides precise costing inputs and should be used for all future costing studies in NM Departments

Results of a national survey on nuclear medicine procedures

International Nuclear Information System (INIS)

Curti, A.R.; Gatica, N.A.; Melis, H.J.

1998-01-01

Full text: In 1997, the Nuclear Regulatory Authority of Argentina carried out a compilation of data on radiopharmaceuticals administered to patients in nuclear medicine procedures. Its aim was to get information on the radiopharmaceuticals that are used in different procedures and the activity administered to the patient, to assess the radiation exposure of the population and to contribute to a global survey of medical radiation usage and exposures conducted by the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR), by sending information of the country. The data compiled were analysed, and for the most frequent procedures, the mean activity administered, the standard deviation, the distribution of the number of procedures for different age groups, sex and radiopharmaceuticals were assessed. The radiation exposure for children and adults was estimated. For the main diagnostic examinations, the results of the survey were compared with specific values published in the Basic Safety Standards of the International Atomic Energy Agency (Safety Series No. 115, 1996). As a conclusion, it may be point out the importance of continuing with the compilation of this kind of information in order to identify emerging trends on the use of nuclear medicine procedures in Argentina and the activity of radiopharmaceuticals administered to the patients. (author) [es

Procedure for prolapse and hemorrhoids vs traditional surgery for outlet obstructive constipation.

Science.gov (United States)

Lu, Ming; Yang, Bo; Liu, Yang; Liu, Qing; Wen, Hao

2015-07-14

To compare the clinical efficacies of two surgical procedures for hemorrhoid rectal prolapse with outlet obstruction-induced constipation. One hundred eight inpatients who underwent surgery for outlet obstructive constipation caused by internal rectal prolapse and circumferential hemorrhoids at the First Affiliated Hospital of Xinjiang Medical University from June 2012 to June 2013 were prospectively included in the study. The patients with rectal prolapse hemorrhoids with outlet obstruction-induced constipation were randomly divided into two groups to undergo either a procedure for prolapse and hemorrhoids (PPH) (n = 54) or conventional surgery (n = 54; control group). Short-term (operative time, postoperative hospital stay, postoperative urinary retention, postoperative perianal edema, and postoperative pain) and long-term (postoperative anal stenosis, postoperative sensory anal incontinence, postoperative recurrence, and postoperative difficulty in defecation) clinical effects were compared between the two groups. The short- and long-term efficacies of the two procedures were determined. In terms of short-term clinical effects, operative time and postoperative hospital stay were significantly shorter in the PPH group than in the control group (24.36 ± 5.16 min vs 44.27 ± 6.57 min, 2.1 ± 1.4 d vs 3.6 ± 2.3 d, both P hemorrhoids.

Instructional strategy effects on the retention and transfer of procedures of different difficulty level

NARCIS (Netherlands)

Jelsma, Otto; Pieters, Julius Marie

1989-01-01

In the present study, the effects of two instructional strategies on the retention and transfer of procedures of different difficulty level were investigated. Difficulty level was manipulated by providing a different number of cues during training. The instructional strategies differed with respect

The comparative effectiveness of persuasion, commitment and leader block strategies in motivating sorting.

Science.gov (United States)

Mickaël, Dupré

2014-04-01

Household waste management has become essential in industrialized countries. For the recycling programs to be a success, all citizens must comply with the developed residential procedures. Governmental bodies are thus dependent on as many people as possible adhering to the sorting systems they develop. Since the 1970s oil crisis, governments have called upon social psychologists to help develop effective communication strategies. These studies have been based on persuasion and behavioral commitment (Kiesler, 1971). Less common are studies based on developing participative communication (Horsley, 1977), a form of communication that relies on individuals to pass on information. After going through the main communication perspectives as they relate to the sorting of household waste, a comparative field study will be presented on the effectiveness of persuasive, committing and participative communication. Participative communication relied on users to pass along information to their neighbors. The results show that the participants who spread information in this way, along with those who made a commitment, changed their behavior to a greater degree than the other participants. Copyright © 2014 Elsevier Ltd. All rights reserved.

Patients exposure from fluoroscopic guided pacemaker implantation procedures

International Nuclear Information System (INIS)

Alkhorayef, M.; Babikir, E.; Sulieman, A.; Daar, E.; Alnaaimi, M.; Alduaij, M.; Bradley, D.

2016-10-01

A pacemaker, which is used for heart re synchronization with electrical impulses, is used to manage many clinical conditions. Recently, the frequency of the pacemaker implantation procedures increased 50% worldwide. During this procedure, patients and staff can be exposed to excessive radiation exposure. Wide range of doses was reported in previous studies, suggesting that optimization of this procedure is not fulfilled yet. This study aims to evaluate the patient and staff radiation doses during cardiac pacemaker procedure and quantify the patient effective dose. A total of 145 procedures were performed for five pacemakers procedures (VVI, VVIR, VVD, VVDR and DDDR) two hospitals were evaluated. Patients doses were measured using the kerma-area product meter. Effective doses were estimated using software based on Monte Carlo simulation from National Radiological Protection Board. The effective dose values were used to estimate the cancer risk from pacemaker procedure. Patients demographic data, exposure parameters for both fluoroscopy and radiography were quantified. The mean patients doses (Gy. cm 2 ) for VVI, VVIR, VVD, VVDR and DDDR was 1.52±0.13 (1.43-1.61), 3.28±2.34 (0.29-8.73), 3.04±1.67 (1.57-4.86), 6.04±2.326 and 19.2±3.6 (5.43-30.2), respectively, per procedure. The overall patients effective dose is 1.1 mSv per procedure. (Author)

Patients exposure from fluoroscopic guided pacemaker implantation procedures

Energy Technology Data Exchange (ETDEWEB)

Alkhorayef, M.; Babikir, E. [King Saud University, College of Applied Sciences, Radiological Sciences Department, P. O. Box 10219, Riyadh 11433 (Saudi Arabia); Sulieman, A. [Prince Sattam bin Abdulaziz University, College of Applied Medical Sciences, Radiology and Medical Imaging Department, P. O. Box 422, Alkharj 11942 (Saudi Arabia); Daar, E. [University of Jordan, Faculty of Science, Department of Physics, Amman 11942 (Jordan); Alnaaimi, M.; Alduaij, M. [Kuwait Cancer Control Centre, Department of Nuclear Medicine, Shwiekh (Kuwait); Bradley, D., E-mail: malkhorayef@ksu.edu.sa [University of Surrey, Centre for Nuclear and Radiation Physics, Guildford, Surrey, GU2 7XH (United Kingdom)

2016-10-15

A pacemaker, which is used for heart re synchronization with electrical impulses, is used to manage many clinical conditions. Recently, the frequency of the pacemaker implantation procedures increased 50% worldwide. During this procedure, patients and staff can be exposed to excessive radiation exposure. Wide range of doses was reported in previous studies, suggesting that optimization of this procedure is not fulfilled yet. This study aims to evaluate the patient and staff radiation doses during cardiac pacemaker procedure and quantify the patient effective dose. A total of 145 procedures were performed for five pacemakers procedures (VVI, VVIR, VVD, VVDR and DDDR) two hospitals were evaluated. Patients doses were measured using the kerma-area product meter. Effective doses were estimated using software based on Monte Carlo simulation from National Radiological Protection Board. The effective dose values were used to estimate the cancer risk from pacemaker procedure. Patients demographic data, exposure parameters for both fluoroscopy and radiography were quantified. The mean patients doses (Gy. cm{sup 2}) for VVI, VVIR, VVD, VVDR and DDDR was 1.52±0.13 (1.43-1.61), 3.28±2.34 (0.29-8.73), 3.04±1.67 (1.57-4.86), 6.04±2.326 and 19.2±3.6 (5.43-30.2), respectively, per procedure. The overall patients effective dose is 1.1 mSv per procedure. (Author)

The protective effects of acute cardiovascular exercise on the interference of procedural memory.

Science.gov (United States)

Jo, J S; Chen, J; Riechman, S; Roig, M; Wright, D L

2018-04-10

Numerous studies have reported a positive impact of acute exercise for procedural skill memory. Previous work has revealed this effect, but these findings are confounded by a potential contribution of a night of sleep to the reported exercise-mediated reduction in interference. Thus, it remains unclear if exposure to a brief bout of exercise can provide protection to a newly acquired motor memory. The primary objective of the present study was to examine if a single bout of moderate-intensity cardiovascular exercise after practice of a novel motor sequence reduces the susceptibility to retroactive interference. To address this shortcoming, 17 individuals in a control condition practiced a novel motor sequence that was followed by test after a 6-h wake-filled interval. A separate group of 17 individuals experienced practice with an interfering motor sequence 45 min after practice with the original sequence and were then administered test trials 6 h later. One additional group of 12 participants was exposed to an acute bout of exercise immediately after practice with the original motor sequence but prior to practice with the interfering motor sequence and the subsequent test. In comparison with the control condition, increased response times were revealed during the 6-h test for the individuals that were exposed to interference. The introduction of an acute bout of exercise between the practice of the two motor sequences produced a reduction in interference from practice with the second task at the time of test, however, this effect was not statistically significant. These data reinforce the hypothesis that while there may be a contribution from exercise to post-practice consolidation of procedural skills which is independent of sleep, sleep may interact with exercise to strengthen the effects of the latter on procedural memory.

Effective Work Procedure design Using Discomfort and Effort Factor in Brick stacking operation-A case study

Science.gov (United States)

Rout, Biswaranjan; Dash, R. R.; Dhupal, D.

2018-02-01

In this work a typical planning of movement of limbs and torso of the worker to be well design to reduce fatigue and energy of the worker. A simulation model is generated to suit the procedure and comply with the constraints in the workspace. It requires verifying the capability of human postures and movements in different working conditions for the evaluation of effectiveness of the new design. In this article a simple human performance measure is introduce that enable the mathematical model for evaluation of a cost function. The basic scheme is to evaluate the performance in the form of several cost factors using AI techniques. Here two main cost factors taken in to consideration are discomfort factor and effort factor in limb movements. Discomfort factor measures the level of discomfort from the most neutral position of a given limb to the position of the corresponding limb after movement and effort factor is a measure of the displacement of the corresponding limbs from the original position. The basic aim is to optimize the movement of the limbs with the above mentioned cost functions. The effectiveness of the procedure is tested with an example of working procedure of workers used for stacking of fly ash bricks in a local fly ash bricks manufacturing unit. The objective is to find out the optimised movement of the limbs to reduce discomfort level and effort required of workers. The effectiveness of the procedure in this case study illustrated with the obtained results.

Comparative efficiency of final endodontic cleansing procedures in removing a radioactive albumin from root canal systems

International Nuclear Information System (INIS)

Cecic, P.A.; Peters, D.D.; Grower, M.F.

1984-01-01

Fifty-six teeth were initially instrumented, with the use of seven irrigants or irrigant combinations, and filled with radioactive albumin. The study then showed the relative ability of three final endodontic procedures (copious reirrigation with saline solution, drying with paper points, and reassuring patency of the canal with the final instrument) to remove the albumin. Even after copious irrigation, each additional procedure removed statistically significant amounts of albumin. Alternating an organic solvent and an inorganic solvent did appear to leave the canal system in the optimal condition for final cleansing procedures. The study then correlated the relative efficiency of irrigation alone versus instrumentation plus irrigation in removing the remaining albumin from the canal systems. Reinstrumentation plus copious irrigation removed significantly more albumin than copious irrigation alone

Averaging models: parameters estimation with the R-Average procedure

Directory of Open Access Journals (Sweden)

S. Noventa

2010-01-01

Full Text Available The Functional Measurement approach, proposed within the theoretical framework of Information Integration Theory (Anderson, 1981, 1982, can be a useful multi-attribute analysis tool. Compared to the majority of statistical models, the averaging model can account for interaction effects without adding complexity. The R-Average method (Vidotto & Vicentini, 2007 can be used to estimate the parameters of these models. By the use of multiple information criteria in the model selection procedure, R-Average allows for the identification of the best subset of parameters that account for the data. After a review of the general method, we present an implementation of the procedure in the framework of R-project, followed by some experiments using a Monte Carlo method.

The effect of lubricating oils on bearing fatigue-life using the Evonik RohMax pitting test procedure

Energy Technology Data Exchange (ETDEWEB)

Bartels, Thorsten [Evonik RohMax Additives GmbH, Darmstadt (Germany)

2009-07-01

A major requirement for modern driveline lubricants is the need to reduce churning losses and friction in order to deliver continual improvements in fuel efficiency. In trying to achieve this oil formulators target lower and lower viscosities, testing the limits of what is acceptable Churning loss reductions are being made by reducing the viscosity of the lubricating oil. Reduced oil viscosities can lead to reduced oil film thicknesses, especially at high operating temperatures. Thinner oil films can lead to an increase in friction, and a decrease in the fatigue-life capacity in lubricated contacts of bearings and gears in several driveline applications. Extensive fluid testing is required. Current test procedures are subject to extremely high variability, and large numbers of experiments are required to develop high confidence in the test conclusions. This publication introduces a new fatigue-life test method, which in our hands provides a clear improvement in test time, cost, and reproducibility. The test's results enable an estimation of the effect of lubricating oils on bearing fatigue-life. This is done by comparing the results to those obtained with reference oils which have also been tested in the standardized bearing tests for lubricating oils. The effects of operating parameters on test accuracy and repeatability have been studied. The parameters studied are oil temperature, contact pressure, speed and the test specimen batch. In addition to the measurement of bearing fatigue-life, the new test may also be used to study gear fatigue-life. We have used this test to investigate the lubrication oils' influence on fatigue-life in bearings and in gears. In order to extend the comparisons to gear performance the reference fluids were evaluated in standard industry test procedures used for determining gear performance, in particular the FZG test rig, thus establishing an extra insight in the fluids' performance by comparing gear test performance

EU and OECD benchmarking and peer review compared

NARCIS (Netherlands)

Groenendijk, Nico

2009-01-01

Benchmarking and peer review are essential elements of the so-called EU open method of coordination (OMC) which has been contested in the literature for lack of effectiveness. In this paper we compare benchmarking and peer review procedures as used by the EU with those used by the OECD. Different

Additional radiation dose to population due to X-ray diagnostic procedures

International Nuclear Information System (INIS)

Chougule, A.

2006-01-01

entrance skin dose (mGy) received by the patient during the radiological procedure will be presented in the paper. From the population of the region, the frequency of radiological procedures/person/year is estimated and in the present study it worked out to be 10,500-procedures/ year/100,000 population. From the data collected, estimation of additional contribution of radiation dose to population due to X ray diagnostic procedures was done. In present st udy it was found that the contribution of radiation dose due to radiological procedure to population is 0.22 mSv/year/person. The UNSCEAR (2000) reported the 1.2 mSv as mean effective dose per capita due to medical X ray examinations in developed countries where frequency of x ray procedure is much higher as compared to India. The results in detail are discussed in this communication. (author)

Effect finishing and polishing procedures on the surface roughness of IPS Empress 2 ceramic.

Science.gov (United States)

Boaventura, Juliana Maria Capelozza; Nishida, Rodrigo; Elossais, André Afif; Lima, Darlon Martins; Reis, José Mauricio Santos Nunes; Campos, Edson Alves; de Andrade, Marcelo Ferrarezi

2013-01-01

To evaluate the surface roughness of IPS Empress 2 ceramic when treated with different finishing/polishing protocols. Sixteen specimens of IPS Empress 2 ceramic were made from wax patterns obtained using a stainless steel split mold. The specimens were glazed (Stage 0-S0, control) and divided into two groups. The specimens in Group 1 (G1) were finished/polished with a KG Sorensen diamond point (S1), followed by KG Sorensen siliconized points (S2) and final polishing with diamond polish paste (S3). In Group 2 (G2), the specimens were finished/polished using a Shofu diamond point (S1), as well as Shofu siliconized points (S2) and final polishing was performed using Porcelize paste (S3). After glazing (S0) and following each polishing procedure (S1, S2 or S3), the surface roughness was measured using TALYSURF Series 2. The average surface roughness results were analyzed using ANOVA followed by Tukey post-hoc tests (α = 0.01) RESULTS: All of the polishing procedures yielded higher surface roughness values when compared to the control group (S0). S3 yielded lower surface roughness values when compared to S1 and S2. The proposed treatments negatively affected the surface roughness of the glazed IPS Empress 2 ceramic.

Comparative Evaluation of Effects of Laser Modalities on Shear Bond Strengths of Veneering Porcelains to Laser Sintered Substructures: An In Vitro Study.

Science.gov (United States)

Gorler, Oguzhan; Saygin, Aysegul Goze

2017-06-01

Laser modalities and direct metal laser sintering (DMLS) have a potential to enhance micromechanical bonding between dental super- and infrastructures. However, the effect of different manufacturing methods on the metal-ceramic bond strength needs further evaluation. We investigated the effect of surface treatment with Er:YAG, Nd:YAG, and Ho:YAG lasers on the shear bond strength (SBS) of high-fusion dental porcelains (Vita and G-Ceram) to infrastructures prepared with DMLS in vitro settings. Study specimens (n = 128) were randomly divided into study subsets (n = 8), considering treatment types applied on the surface of infrastructures, including sandblasting and selected laser modalities; infrastructure types as direct laser sintered (DLS) and Ni-Cr based; and superstructure porcelains as Vita and G-Ceram. The SBS test was performed to assess the effectiveness of surface modifications that were also examined with a stereo microscope. Considering laser procedure types, the highest SBS values were obtained by Er:YAG laser, followed by, with a decreasing efficiency, Ho:YAG laser and sandblasting procedures, and Nd:YAG laser procedure (p laser decreases the bonding of Vita and G-Ceram in all the infrastructures compared with sandblasting. Considering porcelains, the highest SBS values were obtained by Vita (p laser procedures caused surface irregularities as revealed by the stereo microscopic examination. In current experimental settings, Er:YAG laser applied to DLS infrastructure veneered with Vita porcelain increases bonding strength more distinctly, and Nd:YAG laser applied to Ni-Cr-based infrastructure veneered with G-Ceram porcelain alters bonding strength unfavorably.

Evaluation of abalone β-glucuronidase substitution in current urine hydrolysis procedures.

Science.gov (United States)

Malik-Wolf, Brittany; Vorce, Shawn; Holler, Justin; Bosy, Thomas

2014-04-01

This study examined the potential of abalone β-glucuronidase as a viable and cost effective alternative to current hydrolysis procedures using acid, Helix pomatia β-glucuronidase and Escherichia coli β-glucuronidase. Abalone β-glucuronidase successfully hydrolyzed oxazepam-glucuronide and lorazepam-glucuronide within 5% of the spiked control concentration. Benzodiazepines present in authentic urine specimens were within 20% of the concentrations obtained with the current hydrolysis procedure using H. pomatia β-glucuronidase. JWH 018 N-(5-hydroxypentyl) β-d-glucuronide was hydrolyzed within 10% of the control concentration. Authentic urine specimens showed improved glucuronide cleavage using abalone β-glucuronidase with up to an 85% increase of drug concentration, compared with the results obtained using E. coli β-glucuronidase. The JWH 018 and JWH 073 carboxylic acid metabolites also showed increased drug concentrations of up to 24%. Abalone β-glucuronidase was able to completely hydrolyze a morphine-3-glucuronide control, but only 82% of total morphine was hydrolyzed in authentic urine specimens compared with acid hydrolysis results. Hydrolysis of codeine and hydromorphone varied between specimens, suggesting that abalone β-glucuronidase may not be as efficient in hydrolyzing the glucuronide linkages in opioid compounds compared with acid hydrolysis. Abalone β-glucuronidase demonstrates effectiveness as a low cost option for enzyme hydrolysis of benzodiazepines and synthetic cannabinoids.

Radiation exposure of nuclear medicine procedures in Germany

International Nuclear Information System (INIS)

Hacker, M.

2005-01-01

Nuclear Medicine procedures offer the possibility to detect abnormalities on the basis of physiological and metabolic changes and to treat a growing number of diseases in human beings. However, the use of radiopharmaceuticals for nuclear medicine examinations causes a significant component of the total radiation exposure of populations. In Germany it is an essential task of the Federal Office for Radiation Protection to determinate and assess radiation exposure of the population due to nuclear medicine diagnostics and therapy. An important input for this task is the frequency of nuclear-medical examinations with application of ionising radiation and the radiation exposure of patients related to the various procedures. Additional implementation of age- and gender-specific data today allows more exact risk stratification in focusing on different subgroups of patients. Moreover, the collective effective dose as well as the per caput effective dose of the German population may be estimated and compared with earlier collected data or foreign countries. These data reveal where the indication should be questioned particularly critically and if the dose for the various examinations can be reduced and, thus, contribute to the definition of diagnostic reference levels for nuclear medicine procedures in Germany with the aim of both a sufficient image quality and a minimum of radiation exposure. Exceeding the high- as well as the low-values requires documentation and explanation. (orig.)

Estimation of staff lens doses during interventional procedures. Comparing cardiology, neuroradiology and interventional radiology

International Nuclear Information System (INIS)

Vano, E.; Sanchez, R.M.; Fernandez, J.M.

2015-01-01

The purpose of this article is to estimate lens doses using over apron active personal dosemeters in interventional catheterisation laboratories (cardiology IC, neuroradiology IN and radiology IR) and to investigate correlations between occupational lens doses and patient doses. Active electronic personal dosemeters placed over the lead apron were used on a sample of 204 IC procedures, 274 IN and 220 IR (all performed at the same university hospital). Patient dose values (kerma area product) were also recorded to evaluate correlations with occupational doses. Operators used the ceiling-suspended screen in most cases. The median and third quartile values of equivalent dose Hp(10) per procedure measured over the apron for IC, IN and IR resulted, respectively, in 21/67, 19/44 and 24/54 μSv. Patient dose values (median/third quartile) were 75/128, 83/176 and 61/159 Gy cm 2 , respectively. The median ratios for dosemeters worn over the apron by operators ( protected by the ceiling-suspended screen) and patient doses were 0.36; 0.21 and 0.46 μSv Gy -1 cm -2 , respectively. With the conservative approach used (lens doses estimated from the over apron chest dosemeter) we came to the conclusion that more than 800 procedures y -1 and per operator were necessary to reach the new lens dose limit for the three interventional specialties. (authors)

A comparative study on assessment procedures and metric properties of two scoring systems of the Coma Recovery Scale-Revised items: standard and modified scores.

Science.gov (United States)

Sattin, Davide; Lovaglio, Piergiorgio; Brenna, Greta; Covelli, Venusia; Rossi Sebastiano, Davide; Duran, Dunja; Minati, Ludovico; Giovannetti, Ambra Mara; Rosazza, Cristina; Bersano, Anna; Nigri, Anna; Ferraro, Stefania; Leonardi, Matilde

2017-09-01

The study compared the metric characteristics (discriminant capacity and factorial structure) of two different methods for scoring the items of the Coma Recovery Scale-Revised and it analysed scale scores collected using the standard assessment procedure and a new proposed method. Cross sectional design/methodological study. Inpatient, neurological unit. A total of 153 patients with disorders of consciousness were consecutively enrolled between 2011 and 2013. All patients were assessed with the Coma Recovery Scale-Revised using standard (rater 1) and inverted (rater 2) procedures. Coma Recovery Scale-Revised score, number of cognitive and reflex behaviours and diagnosis. Regarding patient assessment, rater 1 using standard and rater 2 using inverted procedures obtained the same best scores for each subscale of the Coma Recovery Scale-Revised for all patients, so no clinical (and statistical) difference was found between the two procedures. In 11 patients (7.7%), rater 2 noted that some Coma Recovery Scale-Revised codified behavioural responses were not found during assessment, although higher response categories were present. A total of 51 (36%) patients presented the same Coma Recovery Scale-Revised scores of 7 or 8 using a standard score, whereas no overlap was found using the modified score. Unidimensionality was confirmed for both score systems. The Coma Recovery Scale Modified Score showed a higher discriminant capacity than the standard score and a monofactorial structure was also supported. The inverted assessment procedure could be a useful evaluation method for the assessment of patients with disorder of consciousness diagnosis.

Is the frozen elephant trunk procedure superior to the conventional elephant trunk procedure for completion of the second stage?

Science.gov (United States)

Rustum, Saad; Beckmann, Erik; Wilhelmi, Mathias; Krueger, Heike; Kaufeld, Tim; Umminger, Julia; Haverich, Axel; Martens, Andreas; Shrestha, Malakh

2017-10-01

Our goal was to compare the results and outcomes of second-stage completion in patients who had previously undergone the elephant trunk (ET) or the frozen elephant trunk (FET) procedure for the treatment of complex aortic arch and descending aortic disease. Between August 2001 and December 2014, 53 patients [mean age 61 ± 13 years, 64% (n = 34) male] underwent a second-stage completion procedure. Of these patients, 32% (n = 17) had a previous ET procedure and 68% (n = 36) a previous FET procedure as a first-stage procedure. The median times to the second-stage procedure were 7 (0-78) months in the ET group and 8 (0-66) months in the FET group. The second-stage procedure included thoracic endovascular aortic repair in 53% (n = 28) of patients and open surgical repair in 47% (n = 25). More endovascular interventions were performed in FET patients (61%, n = 22) than in the ET group (35%, n = 6, P = 0.117). The in-hospital mortality rate was significantly lower in the FET (8%, n = 3) group compared with the ET group (29%, n = 5, P = 0.045). The median follow-up time after the second-stage operation for the entire cohort was 4.6 (0.4-10.4) years. The 5-year survival rate was 76% in the ET patients versus 89% in the FET patients (log-rank: P = 0.11). We observed a significantly lower in-hospital mortality rate in the FET group compared to the ET group. This result might be explained by the higher rate of endovascular completion in the FET group. We assume that the FET procedure offers the benefit of a more ideal landing zone, thus facilitating endovascular completion. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Evaluation of patients skin dose undergoing interventional cardiology procedure using radiochromic films

International Nuclear Information System (INIS)

Silva, Mauro W. Oliveira da; Canevaro, Lucia V.; Rodrigues, Barbara B. Dias

2011-01-01

In interventional cardiology (IC), coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) procedures are the most frequent ones. Since the 1990s, the number of IC procedures has increased rapidly. It is also known that these procedures are associated with high radiation doses due to long fluoroscopy time (FT) and large number of cine-frames (CF) acquired to document the procedure. Mapping skin doses in IC is useful to find the probability of skin injuries, to detect areas of overlapping field, and to get a permanent record of the most exposed areas of skin. The purpose of this study was to estimate the maximum skin dose (MSD) in patients undergoing CA and PTCA, and to compare these values with the reference levels proposed in the literature. Patients' dose measurements were carried out on a sample of 38 patients at the hemodynamic department, in four local hospitals in Rio de Janeiro, Brazil, using Gafchromic XR-RV2 films. In PTCA procedures, the median and third quartile values of MSD were estimated at 2.5 and 5.3 Gy, respectively. For the CA procedures, the median and third quartile values of MSD were estimated at 0.5 and 0.7 Gy, respectively. In this paper, we used the Pearson's correlation coefficient (r), and we found a fairly strong correlation between FT and MSD (r=0.8334, p<0.0001), for CA procedures. The 1 Gy threshold for deterministic effects was exceeded in nine patients. The use of Gafchromic XR-RV2 films was shown to be an effective method to measure MSD and the dose distribution map. The method is effective to identify the distribution of radiation fields, thus allowing the follow-up of the patient to investigate the appearance of skin injuries. (author)

Smoking Habit in Severe Obese after bariatric procedures.

Science.gov (United States)

Maniscalco, Mauro; Carratù, Pierluigi; Faraone, Stanislao; Cerbone, Maria Rosaria; Cristiano, Stefano; Zedda, Anna; Resta, Onofrio

2015-01-01

Bariatric procedures provide an effective means of short term weight loss and sustained weight control for the morbidly obese. The effect of bariatric procedures on smoking habit in obese subjects is not well known. Therefore, we examined the short term effect of bariatric surgery on smoking habit of severe obese patients up to 12 months from the intervention. Smoking habit was assessed in a cohort of 78 morbid smoking obese patients followed at our clinic for bariatric procedures. They underwent non surgical intra-gastric balloon (IB) or surgical procedures such as lap-band laparoscopic surgery (LAGB) or sleeve gastrectomy/gastric by-pass (SPG). Subjects were administered a written questionnaire about their smoking habit before and 3, 6 and 12 months after the procedures. No differences were found among the three groups at 6 and 12 months after the procedures (IB 21 %, LAGB 6 %, SPG 5 %; and IB 14 %, LAGB 3 %, SPG 5 %). Only after 3 months, the rate of quitting of the IB group was higher than LAGB and SPG groups (36 %, 6 % and 5 %, respectively; p = 0.02). Bariatric procedures have no effects on smoking habit of moderate-to-heavy smoker severe obese patients. The use of other traditional smoking cessation methods in patients undergone to bariatric procedures should be implemented.

Radiation exposure of paediatric patients during micturating cysto-urethrography procedures

International Nuclear Information System (INIS)

Sulieman, A.; Babikir, E.; Alkhorayef, M.; Alrihaima, N.; Bradley, D.; Theodorou, K.

2015-10-01

The objectives of this work are to measure the entrance surface air kerma (ESA K) and the effective doses for pediatric patients undergoing MCU. The study was carried out in five hospitals in Khartoum. The ESA K was determined by using calibrated thermoluminescent dosimeters (TLD- Gr 200 A) for 167 pediatric patients. Patients' populations were categorized into three groups in accordance with their ages (0-5 year (group 1), 6-10 years (group 2) and 11-15 years (group 3)). The mean ESA K± sd and range (mGy) resulting from MCU procedure has been estimated to be 2.2±0.5 (0.8-9.2), 2.48±0.6 (0.9-8.1) and 3.90±0.6 (1.1-10.3) for first, second and third age groups, respectively. The mean effective dose was between 0.03 to 0.4 mSv per procedure for all pediatric population. The number of films ranged between 2.0 to 11.0 per procedure. The radiation dose to the patients is comparable with previous studies in all hospitals. Pediatric patients were exposed to avoidable radiation dose because no gonad shields were used. (Author)

Radiation exposure of paediatric patients during micturating cysto-urethrography procedures

Energy Technology Data Exchange (ETDEWEB)

Sulieman, A. [Prince Sattam Abdulaziz University, College of Applied Medical Sciences, Radiology and Medical Imaging Department, P. O. Box 422, Alkharj 11942 (Saudi Arabia); Babikir, E.; Alkhorayef, M. [King Saud University, College of Applied Sciences, Radiological Sciences Department, P. O. Box 10219, Riyadh 11433 (Saudi Arabia); Alrihaima, N. [Sudan Atomic Energy Commission, P. O. Box 55, Khartoum (Sudan); Bradley, D. [University of Surrey, Centre for Nuclear and Radiation Physics, Department of Physics, Surrey GU2 7XH Guildford (United Kingdom); Theodorou, K., E-mail: Abdelmoneim_a@yahoo.com [University Hospital of Larissa, Medical Physics Department, P. O. Box 1425, Larissa 41110 (Greece)

2015-10-15

The objectives of this work are to measure the entrance surface air kerma (ESA K) and the effective doses for pediatric patients undergoing MCU. The study was carried out in five hospitals in Khartoum. The ESA K was determined by using calibrated thermoluminescent dosimeters (TLD- Gr 200 A) for 167 pediatric patients. Patients' populations were categorized into three groups in accordance with their ages (0-5 year (group 1), 6-10 years (group 2) and 11-15 years (group 3)). The mean ESA K± sd and range (mGy) resulting from MCU procedure has been estimated to be 2.2±0.5 (0.8-9.2), 2.48±0.6 (0.9-8.1) and 3.90±0.6 (1.1-10.3) for first, second and third age groups, respectively. The mean effective dose was between 0.03 to 0.4 mSv per procedure for all pediatric population. The number of films ranged between 2.0 to 11.0 per procedure. The radiation dose to the patients is comparable with previous studies in all hospitals. Pediatric patients were exposed to avoidable radiation dose because no gonad shields were used. (Author)

Enhancing photogrammetric 3d city models with procedural modeling techniques for urban planning support

International Nuclear Information System (INIS)

Schubiger-Banz, S; Arisona, S M; Zhong, C

2014-01-01

This paper presents a workflow to increase the level of detail of reality-based 3D urban models. It combines the established workflows from photogrammetry and procedural modeling in order to exploit distinct advantages of both approaches. The combination has advantages over purely automatic acquisition in terms of visual quality, accuracy and model semantics. Compared to manual modeling, procedural techniques can be much more time effective while maintaining the qualitative properties of the modeled environment. In addition, our method includes processes for procedurally adding additional features such as road and rail networks. The resulting models meet the increasing needs in urban environments for planning, inventory, and analysis

Three-dimensional head-mounted gaming task procedure maximizes effects of vestibular rehabilitation in unilateral vestibular hypofunction: a randomized controlled pilot trial.

Science.gov (United States)

Micarelli, Alessandro; Viziano, Andrea; Augimeri, Ivan; Micarelli, Domenico; Alessandrini, Marco

2017-12-01

Considering the emerging advantages related to virtual reality implementation in clinical rehabilitation, the aim of the present study was to discover possible (i) improvements achievable in unilateral vestibular hypofunction patients using a self-assessed head-mounted device (HMD)-based gaming procedure when combined with a classical vestibular rehabilitation protocol (HMD group) as compared with a group undergoing only vestibular rehabilitation and (ii) HMD procedure-related side effects. Therefore, 24 vestibular rehabilitation and 23-matched HMD unilateral vestibular hypofunction individuals simultaneously underwent a 4-week rehabilitation protocol. Both otoneurological measures (vestibulo-ocular reflex gain and postural arrangement by studying both posturography parameters and spectral values of body oscillation) and performance and self-report measures (Italian Dizziness Handicap Inventory; Activities-specific Balance Confidence scale; Zung Instrument for Anxiety Disorders, Dynamic Gait Index; and Simulator Sickness Questionnaire) were analyzed by means of a between-group/within-subject analysis of variance model. A significant post-treatment between-effect was found, and the HMD group demonstrated an overall improvement in vestibulo-ocular reflex gain on the lesional side, in posturography parameters, in low-frequency spectral domain, as well as in Italian Dizziness Handicap Inventory and Activities-specific Balance Confidence scale scores. Meanwhile, Simulator Sickness Questionnaire scores demonstrated a significant reduction in symptoms related to experimental home-based gaming tasks during the HMD procedure. Our findings revealed the possible advantages of HMD implementation in vestibular rehabilitation, suggesting it as an innovative, self-assessed, low-cost, and compliant tool useful in maximizing vestibular rehabilitation outcomes.

The effectiveness of familiar auditory stimulus on hospitalized neonates' physiologic responses to procedural pain.

Science.gov (United States)

Azarmnejad, Elham; Sarhangi, Forogh; Javadi, Mahrooz; Rejeh, Nahid; Amirsalari, Susan; Tadrisi, Seyed Davood

2017-06-01

Hospitalized neonates usually undergo different painful procedures. This study sought to test the effects of a familiar auditory stimulus on the physiologic responses to pain of venipuncture among neonates in intensive care unit. The study design is quasi-experimental. The randomized clinical trial study was done on 60 full-term neonates admitted to the neonatal intensive care unit between March 20 to June 20, 2014. The neonates were conveniently selected and randomly allocated to the control and the experimental groups. Recorded maternal voice was played for the neonates in the experimental group from 10 minutes before to 10 minutes after venipuncture while the neonates in the control group received no sound therapy intervention. The participants' physiologic parameters were assessed 10 minutes before, during, and after venipuncture. At baseline, the study groups did not differ significantly regarding the intended physiologic parameters (P > .05). During venipuncture, maternal voice was effective in reducing the neonates' heart rate, respiratory rate, and diastolic blood pressure (P familiar sounds to effectively manage neonates' physiologic responses to procedural pain of venipuncture. © 2017 John Wiley & Sons Australia, Ltd.

Fact retrieval and memory consolidation for a movement sequence: bidirectional effects of 'unrelated' cognitive tasks on procedural memory.

Directory of Open Access Journals (Sweden)

Rachel Tibi

Full Text Available The generation of long-term memory for motor skills can be modulated by subsequent motor experiences that interfere with the consolidation process. Recent studies suggest that even a non-motor task may adversely affect some aspects of motor sequence memory. Here we show that motor sequence memory can be either enhanced or reduced, by different cognitive tasks. Participants were trained in performing finger movement sequences. Fully explicit instructions about the target sequence were given before practice. The buildup of procedural knowledge was tested at three time-points: immediately before training (T1, after practice (T2, and 24 hours later (T3. Each participant performed the task on two separate occasions; training on a different movement sequence on each occasion. In one condition, interference, participants performed a non-motor task immediately after T2. Half the participants solved simple math problems and half performed a simple semantic judgment task. In the baseline condition there was no additional task. All participants improved significantly between T1 and T2 (within-session gains. In addition, in the baseline condition, performance significantly improved between T2 and T3 (delayed 'off-line' gains. Solving math problems significantly enhanced these delayed gains in motor performance, whereas performing semantic decisions significantly reduced delayed gains compared to baseline. Thus, procedural motor memory consolidation can be either enhanced or inhibited by subsequent cognitive experiences. These effects do not require explicit or implicit new learning. The retrieval of unrelated, non-motor, well established knowledge can modulate procedural memory.

SU-G-IeP3-05: Effects of Image Receptor Technology and Dose Reduction Software On Radiation Dose Estimates for Fluoroscopically-Guided Interventional (FGI) Procedures

Energy Technology Data Exchange (ETDEWEB)

Merritt, Z; Dave, J; Eschelman, D; Gonsalves, C [Thomas Jefferson University, Philadelphia, PA (United States)

2016-06-15

Purpose: To investigate the effects of image receptor technology and dose reduction software on radiation dose estimates for most frequently performed fluoroscopically-guided interventional (FGI) procedures at a tertiary health care center. Methods: IRB approval was obtained for retrospective analysis of FGI procedures performed in the interventional radiology suites between January-2011 and December-2015. This included procedures performed using image-intensifier (II) based systems which were subsequently replaced, flat-panel-detector (FPD) based systems which were later upgraded with ClarityIQ dose reduction software (Philips Healthcare) and relatively new FPD system already equipped with ClarityIQ. Post procedure, technologists entered system-reported cumulative air kerma (CAK) and kerma-area product (KAP; only KAP for II based systems) in RIS; these values were analyzed. Data pre-processing included correcting typographical errors and cross-verifying CAK and KAP. The most frequent high and low dose FGI procedures were identified and corresponding CAK and KAP values were compared. Results: Out of 27,251 procedures within this time period, most frequent high and low dose procedures were chemo/immuno-embolization (n=1967) and abscess drainage (n=1821). Mean KAP for embolization and abscess drainage procedures were 260,657, 310,304 and 94,908 mGycm{sup 2}, and 14,497, 15,040 and 6307 mGycm{sup 2} using II-, FPD- and FPD with ClarityIQ- based systems, respectively. Statistically significant differences were observed in KAP values for embolization procedures with respect to different systems but for abscess drainage procedures significant differences were only noted between systems with FPD and FPD with ClarityIQ (p<0.05). Mean CAK reduced significantly from 823 to 308 mGy and from 43 to 21 mGy for embolization and abscess drainage procedures, respectively, in transitioning to FPD systems with ClarityIQ (p<0.05). Conclusion: While transitioning from II- to FPD- based

Economic Assessment and Budgetary Impact of a Telemedicine Procedure and Spirometry Quality Control in the Primary Care Setting.

Science.gov (United States)

Marina, Nuria; Bayón, Juan Carlos; López de Santa María, Elena; Gutiérrez, Asunción; Inchausti, Marta; Bustamante, Victor; Gáldiz, Juan B

2016-01-01

To evaluate the economic impact of a telemedicine procedure designed to improve the quality of lung function testing (LFT) in primary care in a public healthcare system, compared with the standard method. The economic impact of 9,039 LFTs performed in 51 health centers (2010-2013) using telespirometry (TS) compared to standard spirometry (SS) was studied. TS costs more per unit than SS (€47.80 vs. €39.70) (2013), but the quality of the TS procedure is superior (84% good quality, compared to 61% using the standard procedure). Total cost of TS was €431,974 (compared with €358,306€ for SS), generating an economic impact of €73,668 (2013). The increase in cost for good quality LFT performed using TS was €34,030 (2010) and €144,295 (2013), while the costs of poor quality tests fell by €15,525 (2010) and 70,627€ (2013). The cost-effectiveness analysis concludes that TS is 23% more expensive and 46% more effective. Healthcare costs consequently fall as the number of LFTs performed by TS rises. Avoiding poor quality, invalid LFTs generates savings that compensate for the increased costs of performing LFTs with TS, making it a cost-effective method. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

Ulnar artery: The Ulysses ultimate resort for coronary procedures

Directory of Open Access Journals (Sweden)

George Hahalis, MD, PhD

2016-07-01

Full Text Available Despite the increasing worldwide adoption of the transradial access site, the ulnar artery (UA only very infrequently serves as a primary option for coronary procedures. In contrast to the uncertainty surrounding previous reports regarding the feasibility and safety, recent data from larger registries and randomized trials provide more conclusive evidence that the transulnar route may be safely selected as an alternative arterial access approach. However, a default transulnar strategy appears time-consuming and is associated with higher crossover rates compared with the radial artery (RA. Once arterial access is obtained, the likelihood of a successful coronary procedure is high and similar between the two forearm arteries. The UA has similar flow-mediating vasodilating properties with and seems at least as vulnerable as the RA with regard to incident occlusion, with UA occlusion (UAO rates being probably higher than previously anticipated. A learning curve effect may not be apparent for crossover rates among experienced radialists, but increasing experience is associated with reduction in the fluoroscopy time, contrast volume and frequency of large hematoma formation. The UA may represents an important alternative access site for coronary procedures, and experienced radial operators should obtain additional skills to perform the transulnar approach. Nevertheless, in view of this method's lower feasibility compared to the RA, an initial ulnar access strategy should be reserved for carefully selected patients to ensure satisfactory cannulation rates.

Survey of effective doses to patients undergoing contrast-based X-ray fluoroscopy procedures in Tanzania

International Nuclear Information System (INIS)

Ngaile, J.E.; Msaki, P.K.; Kazema, R.R.

2017-01-01

The aim of this study was to assess the radiation burden imparted to patients from contrast-based X-ray fluoroscopy procedures in Tanzania. The effective doses (EDs) to patients from five contrast-based fluoroscopy procedures were obtained from four hospitals. The ED was estimated using the knowledge of the patient characteristics, patient-related exposure parameters, measurements of air kerma area product and PCXCM software. The median EDs for the barium swallow (BS), barium meal (BM), barium enema (BE), hysterosalpingography (HSG) and retrograde urethrography (RUG) were 0.50, 1.43, 2.83, 0.65 and 0.59 mSv, respectively. The median ED per hospital for the BS and BM procedures varied by factors of up to 9.9 and 4.2, respectively, while for the BE, HSG and RUG varied by factors of up to 2.3, 2.4 and 4.3, respectively. The overall differences between individual EDs across the four hospitals varied by factors of up to 53, 58.9 and 11.4 for the BS, BM and BE, respectively, while for the HSG and RUG differed by factors of up to 22 and 46.7, respectively. The mean EDs in this study were mostly lower than reported values from Spain, the UK, Ghana and Greece, while slightly higher than those reported from India. The observed wide variations of procedural protocols and patient doses within and across the hospitals; and the observed high patient doses in this study relative to those from the literature call for the need to standardize procedural protocols and optimize contrast-based fluoroscopy procedures. (authors)

Estimation of staff lens doses during interventional procedures. Comparing cardiology, neuroradiology and interventional radiology.

Science.gov (United States)

Vano, E; Sanchez, R M; Fernandez, J M

2015-07-01

The purpose of this article is to estimate lens doses using over apron active personal dosemeters in interventional catheterisation laboratories (cardiology IC, neuroradiology IN and radiology IR) and to investigate correlations between occupational lens doses and patient doses. Active electronic personal dosemeters placed over the lead apron were used on a sample of 204 IC procedures, 274 IN and 220 IR (all performed at the same university hospital). Patient dose values (kerma area product) were also recorded to evaluate correlations with occupational doses. Operators used the ceiling-suspended screen in most cases. The median and third quartile values of equivalent dose Hp(10) per procedure measured over the apron for IC, IN and IR resulted, respectively, in 21/67, 19/44 and 24/54 µSv. Patient dose values (median/third quartile) were 75/128, 83/176 and 61/159 Gy cm(2), respectively. The median ratios for dosemeters worn over the apron by operators (protected by the ceiling-suspended screen) and patient doses were 0.36; 0.21 and 0.46 µSv Gy(-1) cm(-2), respectively. With the conservative approach used (lens doses estimated from the over apron chest dosemeter) we came to the conclusion that more than 800 procedures y(-1) and per operator were necessary to reach the new lens dose limit for the three interventional specialties. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Laparoscopy Instructional Videos : The Effect of Preoperative Compared With Intraoperative Use on Learning Curves

NARCIS (Netherlands)

Broekema, Theo H.; Talsma, Aaldert K.; Wevers, Kevin P.; Pierie, Jean-Pierre E. N.

OBJECTIVE: Previous studies have shown that the use of intraoperative instructional videos has a positive effect on learning laparoscopic procedures. This study investigated the effect of the timing of the instructional videos on learning curves in laparoscopic skills training. DESIGN: After

Health economic aspects of vertebral augmentation procedures.

Science.gov (United States)

Borgström, F; Beall, D P; Berven, S; Boonen, S; Christie, S; Kallmes, D F; Kanis, J A; Olafsson, G; Singer, A J; Åkesson, K

2015-04-01

We reviewed all peer-reviewed papers analysing the cost-effectiveness of vertebroplasty and balloon kyphoplasty for osteoporotic vertebral compression fractures. In general, the procedures appear to be cost effective but are very dependent upon model input details. Better data, rather than new models, are needed to answer outstanding questions. Vertebral augmentation procedures (VAPs), including vertebroplasty (VP) and balloon kyphoplasty (BKP), seek to stabilise fractured vertebral bodies and reduce pain. The aim of this paper is to review current literature on the cost-effectiveness of VAPs as well as to discuss the challenges for economic evaluation in this research area. A systematic literature search was conducted to identify existing published studies on the cost-effectiveness of VAPs in patients with osteoporosis. Only peer-reviewed published articles that fulfilled the criteria of being regarded as full economic evaluations including both morbidity and mortality in the outcome measure in the form of quality-adjusted life years (QALYs) were included. The search identified 949 studies, of which four (0.4 %) were identified as relevant with one study added later. The reviewed studies differed widely in terms of study design, modelling framework and data used, yielding different results and conclusions regarding the cost-effectiveness of VAPs. Three out of five studies indicated in the base case results that VAPs were cost effective compared to non-surgical management (NSM). The five main factors that drove the variations in the cost-effectiveness between the studies were time horizon, quality of life effect of treatment, offset time of the treatment effect, reduced number of bed days associated with VAPs and mortality benefit with treatment. The cost-effectiveness of VAPs is uncertain. In answering the remaining questions, new cost-effectiveness analysis will yield limited benefit. Rather, studies that can reduce the uncertainty in the underlying data

Complementary clinical effects of topical tightening treatment in conjunction with a radiofrequency procedure.

Science.gov (United States)

Goldberg, David J; Yatskayer, Margarita; Raab, Susana; Chen, Nannan; Krol, Yevgeniy; Oresajo, Christian

2014-10-01

Abstract Background: Skin laxity and cellulite on the buttocks and thighs are two common cosmetic concerns. Skin tightening with radiofrequency (RF) devices has become increasingly popular. The purpose of this study is to evaluate the efficacy and safety of a topical skin laxity tightening agent when used in combination with an RF device. A double-blinded, randomized clinical trial enrolled twenty females with mild-to-moderate skin laxity on the posterior thighs/buttocks. Each subject underwent two monthly treatments with an RF source (Alma Accent) to both legs. Subjects were then randomized to apply a topical agent (Skinceuticals Body Tightening Concentrate) twice daily to only one designated thigh/buttock throughout the eight-week duration of the study. All subjects were evaluated for improvement in lifting, skin tone, radiance, firmness/tightness, skin texture, and overall appearance based on photographic evaluation by blinded investigators at 12 weeks following the final RF treatment. A statistically significant improvement was found in the overall appearance on both sides treated with the RF device when compared to baseline. However, the area treated with the topical agent showed a statistically significantly greater degree of improvement than the side where no topical agent was applied. No adverse effects were reported. The use of a novel skin tightening agent used after RF procedures is both safe and effective for treatment of skin laxity on the buttocks and thighs. Combined therapy leads to a better result.

The impact of a medical procedure service on patient safety, procedure quality and resident training opportunities.

Science.gov (United States)

Tukey, Melissa H; Wiener, Renda Soylemez

2014-03-01

At some academic hospitals, medical procedure services are being developed to provide supervision for residents performing bedside procedures in hopes of improving patient safety and resident education. There is limited knowledge of the impact of such services on procedural complication rates and resident procedural training opportunities. To determine the impact of a medical procedure service (MPS) on patient safety and resident procedural training opportunities. Retrospective cohort analysis comparing characteristics and outcomes of procedures performed by the MPS versus the primary medical service. Consecutive adults admitted to internal medicine services at a large academic hospital who underwent a bedside medical procedure (central venous catheterization, thoracentesis, paracentesis, lumbar puncture) between 1 July 2010 and 31 December 2011. The primary outcome was a composite rate of major complications. Secondary outcomes included resident participation in bedside procedures and use of "best practice" safety process measures. We evaluated 1,707 bedside procedures (548 by the MPS, 1,159 by the primary services). There were no differences in the composite rate of major complications (1.6 % vs. 1.9 %, p = 0.71) or resident participation in bedside procedures (57.0 % vs. 54.3 %, p = 0.31) between the MPS and the primary services. Procedures performed by the MPS were more likely to be successfully completed (95.8 % vs. 92.8 %, p = 0.02) and to use best practice safety process measures, including use of ultrasound guidance when appropriate (96.8 % vs. 90.0 %, p = 0.0004), avoidance of femoral venous catheterization (89.5 vs. 82.7 %, p = 0.02) and involvement of attending physicians (99.3 % vs. 57.0 %, p < 0.0001). Although use of a MPS did not significantly affect the rate of major complications or resident opportunities for training in bedside procedures, it was associated with increased use of best practice safety process measures.

The Effect and Implications of a "Self-Correcting" Assessment Procedure

Science.gov (United States)

Francis, Alisha L.; Barnett, Jerrold

2012-01-01

We investigated Montepare's (2005, 2007) self-correcting procedure for multiple-choice exams. Findings related to memory suggest this procedure should lead to improved retention by encouraging students to distribute the time spent reviewing the material. Results from a general psychology class (n = 98) indicate that the benefits are not as…

[Mood induction procedures: a critical review].

Science.gov (United States)

Gilet, A-L

2008-06-01

ée. Université de Nantes, Nantes] or combined inductions [Gilet AL. Etude des effets des humeurs positives et négatives sur l'organisation des connaissances en mémoire sémantique. Thèse de doctorat non publiée, Université de Nantes, Nantes, J Ment Imagery 19 (1995) 133-150]. In music or film clip inductions, subjects are asked to listen or view some mood-suggestive pieces of material determined by the experimenter according to standardized music or film sets [J Ment Imagery 19 (1995) 133-150, Cogn Emotion 7 (1993) 171-193] and selected to elicit target moods. According to many authors, these two mood induction procedures seem to be among the most effective manners to induce moods [Br J Psychol 85 (1994) 55-78, Eur J Soc Psychol 26 (1996) 557-580] in an individual or in a group setting [Jallais C. Effets des humeurs positives et négatives sur les structures de connaissances de type script. Thèse de doctorat non publiée. Université de Nantes, Nantes]. As it is believed that multiple inductions contribute additively to a mood [Am Psychol 36 (1981) 129-148], researchers proposed to combine two or more techniques at the same time. Thus, the Velten Mood Induction Procedure has been successively associated with the hypnosis mood induction procedure [J Pers Soc Psychol 42 (1982) 927-934], the music mood induction procedure [Behav Res Ther 21 (1983) 233-239, J Exp Soc Psychol 26 (1990) 465-480] or the imagination mood induction procedure [Br J Clin Psychol 21 (1982) 111-117]. Successful combinations of inductions usually use a first induction that occupies foreground attention and a second one that contributes to congruent background atmosphere. One of the most successful combined mood induction procedures has been developed by Mayer, Allen and Beauregard [J Ment Imagery 19 (1995) 133-150]. This technique associates guided imagery with music and is supposed to increase effectiveness of the induction. In the second part of this paper the aim is to present the usefulness of

The Effects of Self-Monitoring on the Procedural Integrity of a Behavioral Intervention for Young Children with Developmental Disabilities

Science.gov (United States)

Plavnick, Joshua B.; Ferreri, Summer J.; Maupin, Angela N.

2010-01-01

The effects of self-monitoring on procedural integrity of token economy implementation by 3 staff in a special education classroom were evaluated. The subsequent changes in academic readiness behaviors of 2 students with low-incidence disabilities were measured. Multiple baselines across staff and students showed that procedural integrity…

Justice orientation as a moderator of the framing effect on procedural justice perception.

Science.gov (United States)

Sasaki, Hiroyuki; Hayashi, Yoichiro

2014-01-01

Justice orientation is a justice-relevant personality trait, which is referred to as the tendency to attend to fairness issues and to internalize justice as a moral virtue. This study examined the moderating role of justice orientation in the relationship between justice perception and response to a decision problem. The authors manipulated procedural justice and the outcome valence of the decision frame within a vignette, and measured justice orientation of 174 Japanese participants. As hypothesized, the results indicated an interaction between procedural justice and framing manipulation, which was moderated by individual differences in justice orientation. In negative framing, justice effects were larger for individuals with high rather than low justice orientation. The results are explained from a social justice perspective, and the contributions and limitations of this study are also discussed with respect to our sample and framing manipulation.

Comparative antinociceptive and sedative effects of epidural romifidine and detomidine in buffalo (Bubalus bubalis).

Science.gov (United States)

Marzok, M A; El-Khodery, S A

2017-07-01

In this study, comparative antinociceptive and sedative effects of epidural administration of romifidine and detomidine in buffalo were evaluated. Eighteen healthy adult buffalo, allocated randomly in three groups (two experimental and one control; n=6) received either 50 μg/kg of romifidine or detomidine diluted in sterile saline (0.9 per cent) to a final volume of 20 ml, or an equivalent volume of sterile saline epidurally. Antinociception, sedation and ataxia parameters were recorded immediately after drug administration. Epidural romifidine and detomidine produced mild to deep sedation and complete antinociception of the perineum, inguinal area and flank, and extended distally to the coronary band of the hindlimbs and cranially to the chest area. Times to onset of antinociception and sedation were significantly shorter with romifidine than with detomidine. The antinociceptive and sedative effects were significantly longer with romifidine than with detomidine. Romifidine or detomidine could be used to provide a reliable, long-lasting and cost-effective method for achieving epidural anaesthesia for standing surgical procedures in buffalo. Romifidine induces a longer antinociceptive effect and a more rapid onset than detomidine. Consequently, epidural romifidine may offer better therapeutic benefits in the management of acute postoperative pain. British Veterinary Association.

Bridging meta-analysis and the comparative method: a test of seed size effect on germination after frugivores' gut passage.

Science.gov (United States)

Verdú, Miguel; Traveset, Anna

2004-02-01

Most studies using meta-analysis try to establish relationships between traits across taxa from interspecific databases and, thus, the phylogenetic relatedness among these taxa should be taken into account to avoid pseudoreplication derived from common ancestry. This paper illustrates, with a representative example of the relationship between seed size and the effect of frugivore's gut on seed germination, that meta-analytic procedures can also be phylogenetically corrected by means of the comparative method. The conclusions obtained in the meta-analytical and phylogenetical approaches are very different. The meta-analysis revealed that the positive effects that gut passage had on seed germination increased with seed size in the case of gut passage through birds whereas decreased in the case of gut passage through non-flying mammals. However, once the phylogenetic relatedness among plant species was taken into account, the effects of gut passage on seed germination did not depend on seed size and were similar between birds and non-flying mammals. Some methodological considerations are given to improve the bridge between the meta-analysis and the comparative method.

Pediatric abdominal non-Hodgkin's lymphoma: diagnosis through surgical and non-surgical procedures.

Science.gov (United States)

Aguiar, Arthur Almeida; Lima, Luciana Cavalvanti; Araújo, Cláudia Corrêa de; Gallindo, Rodrigo Melo

2017-12-29

To describe the success rate and the complications after procedures to diagnose abdominal non-Hodgkin's lymphoma in children and adolescents. A retrospective cross-sectional study was conducted with a population consisting of children and adolescents with abdominal non-Hodgkin's lymphoma diagnosed between September 1994 and December 2012. The sample comprised of 100 patients who underwent 113 diagnostic procedures, including urgent surgery (n=21), elective surgery (n=36), and non-surgical diagnosis (n=56). The most frequent procedures were laparotomy (46.9%) and ultrasound-guided core biopsy (25.6%). The rate of diagnostic success was 95.2% for urgent surgeries; 100% for elective surgeries and 82.1% for non-surgical procedures (p<0.05). The rates of complication during the three diagnosis procedures considered were significant (p<0.001; 95.2% of the urgent surgeries, 83.8% of the elective surgeries, and 10.7% of the non-surgical procedures). The length of time before resuming a full diet and starting chemotherapy was significantly reduced for patients who underwent non-surgical procedures when compared with the other procedures (p<0.001). Non-surgical procedures for the diagnosis of pediatric abdominal non-Hodgkin's lymphoma are an effective option with low morbidity rate, allowing an earlier resumption of a full diet and chemotherapy initiation. Furthermore, non-surgical procedures should also be considered for obtaining tumor samples from patients with extensive disease. Copyright © 2017. Published by Elsevier Editora Ltda.

Usability Testing for Developing Effective Interactive Multimedia Software: Concepts, Dimensions, and Procedures

Directory of Open Access Journals (Sweden)

Sung Heum Lee

1999-04-01

Full Text Available Usability testing is a dynamic process that can be used throughout the process of developing interactive multimedia software. The purpose of usability testing is to find problems and make recommendations to improve the utility of a product during its design and development. For developing effective interactive multimedia software, dimensions of usability testing were classified into the general categories of: learnability; performance effectiveness; flexibility; error tolerance and system integrity; and user satisfaction. In the process of usability testing, evaluation experts consider the nature of users and tasks, tradeoffs supported by the iterative design paradigm, and real world constraints to effectively evaluate and improve interactive multimedia software. Different methods address different purposes and involve a combination of user and usability testing, however, usability practitioners follow the seven general procedures of usability testing for effective multimedia development. As the knowledge about usability testing grows, evaluation experts will be able to choose more effective and efficient methods and techniques that are appropriate to their goals.

Development of a 3-dimensional flow analysis procedure for axial pump impellers

International Nuclear Information System (INIS)

Kim, Min Hwan; Kim, Jong In; Park, Jin Seok; Huh, Houng Huh; Chang, Moon Hee

1999-06-01

A fluid dynamic analysis procedure was developed using the three-dimensional solid model of an axial pump impeller which was theoretically designed using I-DEAS CAD/CAM/CAE software. The CFD software FLUENT was used in the flow field analysis. The steady-state flow regime in the MCP impeller and diffuser was simulated using the developed procedure. The results of calculation were analyzed to confirm whether the design requirements were properly implemented in the impeller model. The validity of the developed procedure was demonstrated by comparing the calculation results with the experimental data available. The pump performance at the design point could be effectively predicted using the developed procedure. The computed velocity distributions have shown a good agreement with the experimental data except for the regions near the wall. The computed head, however, was over-predicted than the experiment. The design period and cost required for the development of an axial pump impeller can be significantly reduced by applying the proposed methodology. (author). 7 refs., 2 tabs

Longitudinal trends with improvement in quality of life after TVT, TVT O and Burch colposuspension procedures.

Science.gov (United States)

Drahoradova, Petra; Martan, Alois; Svabik, Kamil; Zvara, Karel; Otava, Martin; Masata, Jaromir

2011-02-01

Comparison of the quality of life (QoL) trends after TVT, TVT O and Burch colposuspension (BCS) procedures and comparison of long-term subjective and objective outcomes. The study included 215 women who underwent a TVT, TVT O or BCS procedure. We monitored QoL after each procedure and the effect of complications on the QoL as assessed by the IQOL questionnaire over a 3-year period. The study was completed by 74.5% of women after TVT, 74.5% after TVT O, and 65.2% after BCS procedure. In the long-term, the QoL improved from 46.9 to 88.7 and remained stable after BCS; after TVT and TVT O, it declined, but only after TVT O was the decline statistically significant compared to BCS. The IQOL for women with post-operative complications has a clear descending tendency. The effect of the complications is highly significant (pTVT O, but not with TVT or BCS. Anti-incontinence operations significantly improve quality of life for women with MI, but compared to the SI group, the quality of life is worse when measured at a longer time interval after the operation. Anti-incontinence operations significantly improve quality of life, and the difference in preoperative status in the long-term follow-up is demonstrable.

Differences in utilization of dental procedures by children enrolled in Wisconsin Medicaid and Delta Dental insurance plans.

Science.gov (United States)

Bhagavatula, Pradeep; Xiang, Qun; Szabo, Aniko; Eichmiller, Fredrick; Okunseri, Christopher

2017-12-01

Few studies have directly compared dental procedures provided in public and private insurance plans for enrollees living in dental health professional shortage areas (DHPSAs). We examined the rates for the different types of dental procedures received by 0-18-year-old children living in DHPSAs and non-DHPSAs who were enrolled in Medicaid and those enrolled under Delta Dental of Wisconsin (DDW) for years 2002 to 2008. Medicaid and DDW dental claims data for 2002 to 2008 was analyzed. Enrollees were divided into DDW-DHPSA and non-DHPSA and Medicaid-DHPSA and non-DHPSA groups. Descriptive and multivariable analyses using over-dispersed Poisson regression were performed to examine the effect of living in DHPSAs and insurance type in relation to the number of procedures received. Approximately 49 and 65 percent of children living in non-DHPSAs that were enrolled in Medicaid and DDW received at least one preventive dental procedure annually, respectively. Children in DDW non-DHPSA group had 1.79 times as many preventive, 0.27 times fewer complex restorative and 0.51 times fewer endodontic procedures respectively, compared to those in Medicaid non-DHPSA group. Children enrolled in DDW-DHPSA group had 1.53 times as many preventive and 0.25 times fewer complex restorative procedures, compared to children in Medicaid-DHPSA group. DDW enrollees had significantly higher utilization rates for preventive procedures than children in Medicaid. There were significant differences across Medicaid and DDW between non-DHPSA and DHPSA for most dental procedures received by enrollees. © 2016 American Association of Public Health Dentistry.

Effect of static and dynamic muscle stretching as part of warm up procedures on knee joint proprioception and strength.

Science.gov (United States)

Walsh, Gregory S

2017-10-01

The importance of warm up procedures prior to athletic performance is well established. A common component of such procedures is muscle stretching. There is conflicting evidence regarding the effect of static stretching (SS) as part of warm up procedures on knee joint position sense (KJPS) and the effect of dynamic stretching (DS) on KJPS is currently unknown. The aim of this study was to determine the effect of dynamic and static stretching as part warm up procedures on KJPS and knee extension and flexion strength. This study had a randomised cross-over design and ten healthy adults (20±1years) attended 3 visits during which baseline KJPS, at target angles of 20° and 45°, and knee extension and flexion strength tests were followed by 15min of cycling and either a rest period (CON), SS, or DS and repeat KJPS and strength tests. All participants performed all conditions, one condition per visit. There were warm up×stretching type interactions for KJPS at 20° (p=0.024) and 45° (p=0.018), and knee flexion (p=0.002) and extension (pwarm up procedures. However, the negative impact of SS on muscle strength limits the utility of SS before athletic performance. If stretching is to be performed as part of a warm up, DS should be favoured over SS. Copyright © 2017 Elsevier B.V. All rights reserved.

XML Syntax for Clinical Laboratory Procedure Manuals

OpenAIRE

Saadawi, Gilan; Harrison, James H.

2003-01-01

We have developed a document type description (DTD) in Extensable Markup Language (XML)1 for clinical laboratory procedures. Our XML syntax can adequately structure a variety of procedure types across different laboratories and is compatible with current procedure standards. The combination of this format with an XML content management system and appropriate style sheets will allow efficient procedure maintenance, distributed access, customized display and effective searching across a large b...

Comparison of 2015 Medicare relative value units for gender-specific procedures: Gynecologic and gynecologic-oncologic versus urologic CPT coding. Has time healed gender-worth?

Science.gov (United States)

Benoit, M F; Ma, J F; Upperman, B A

2017-02-01

In 1992, Congress implemented a relative value unit (RVU) payment system to set reimbursement for all procedures covered by Medicare. In 1997, data supported that a significant gender bias existed in reimbursement for gynecologic compared to urologic procedures. The present study was performed to compare work and total RVU's for gender specific procedures effective January 2015 and to evaluate if time has healed the gender-based RVU worth. Using the 2015 CPT codes, we compared work and total RVU's for 50 pairs of gender specific procedures. We also evaluated 2015 procedure related provider compensation. The groups were matched so that the procedures were anatomically similar. We also compared 2015 to 1997 RVU and fee schedules. Evaluation of work RVU's for the paired procedures revealed that in 36 cases (72%), male vs female procedures had a higher wRVU and tRVU. For total fee/reimbursement, 42 (84%) male based procedures were compensated at a higher rate than the paired female procedures. On average, male specific surgeries were reimbursed at an amount that was 27.67% higher for male procedures than for female-specific surgeries. Female procedure based work RVU's have increased minimally from 1997 to 2015. Time and effort have trended towards resolution of some gender-related procedure worth discrepancies but there are still significant RVU and compensation differences that should be further reviewed and modified as surgical time and effort highly correlate. Copyright © 2016. Published by Elsevier Inc.

Incorporating mesh-insensitive structural stress into the fatigue assessment procedure of common structural rules for bulk carriers

Directory of Open Access Journals (Sweden)

Seong-Min Kim

2015-01-01

Full Text Available This study introduces a fatigue assessment procedure using mesh-insensitive structural stress method based on the Common Structural Rules for Bulk Carriers by considering important factors, such as mean stress and thickness effects. The fatigue assessment result of mesh-insensitive structural stress method have been compared with CSR procedure based on equivalent notch stress at major hot spot points in the area near the ballast hold for a 180 K bulk carrier. The possibility of implementing mesh-insensitive structural stress method in the fatigue assessment procedure for ship structures is discussed.

Applying computer-based procedures in nuclear power plants

Energy Technology Data Exchange (ETDEWEB)

Oliveira, Mauro V. de; Carvalho, Paulo V.R. de; Santos, Isaac J.A.L. dos; Grecco, Claudio H.S. [Instituto de Engenharia Nuclear (IEN/CNEN-RJ), Rio de Janeiro, RJ (Brazil). Div. de Instrumentacao e Confiabilidade Humana], e-mail: mvitor@ien.gov.br, e-mail: paulov@ien.gov.br, e-mail: luquetti@ien.gov.br, e-mail: grecco@ien.gov.br; Bruno, Diego S. [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Escola Politecnica. Curso de Engenharia de Controle e Automacao], e-mail: diegosalomonebruno@gmail.com

2009-07-01

Plant operation procedures are used to guide operators in coping with normal, abnormal or emergency situations in a process control system. Historically, the plant procedures have been paper-based (PBP), with the digitalisation trend in these complex systems computer-based procedures (CBPs) are being developed to support procedure use. This work shows briefly the research on CBPs at the Human-System Interface Laboratory (LABIHS). The emergency operation procedure EOP-0 of the LABIHS NPP simulator was implemented in the ImPRO CBP system. The ImPRO system was chosen for test because it is available for download in the Internet. A preliminary operation test using the implemented procedure in the CBP system was realized and the results were compared to the operation through PBP use. (author)

The Development of CPSES Plug-in(CPMP) for APR1400 Computerized Procedure Effective Maintenance

Energy Technology Data Exchange (ETDEWEB)

Seong, No Kyu; Park, Jin Kyun; Jung, Yeon Sub [KHNP Central Research Institute, Daejeon (Korea, Republic of)

2014-10-15

The Computerized Procedure System (CPS) is one of the Man Machine Interface (MMI) resources of the Shin-Kori 3 and 4 nuclear power plants. The CPS is a computerized operator support system that enables operating crew to execute procedures in an accurate and fast manner. The Computerized Procedure (CP) is the XML data file in executable format that can be installed in the Procedure eXecution System (PXS) for execution. The CP contains specific information related to a particular procedure (i.e. LOCA). These computerized procedures such as Alarm Response Procedures (ARP) are separated into individual alarm procedure to maximize function interface between CPS and DCS. E.g. 'Procedure open by alarm list'. The procedure writer's burden to manage many procedures has been increased because of separated procedures. This paper introduces Computerized Procedure System Engineering System (CPSES) plug-in that is computerized procedure management program (CPMP) to reduce procedure writer's burden. This paper introduces the main features of CPMP. CPMP reduces procedure writer's or CPX maintainer's burden. This program is implemented and tested by program design requirement.

AMPT-induced monoamine depletion in humans: evaluation of two alternative [123I]IBZM SPECT procedures

International Nuclear Information System (INIS)

Boot, Erik; Booij, Jan; Hasler, Gregor; Zinkstok, Janneke R.; Haan, Lieuwe de; Linszen, Don H.; Amelsvoort, Therese A. van

2008-01-01

Acute monoamine depletion paradigms using alpha-methyl-para-tyrosine (AMPT) combined with single photon emission computed tomography (SPECT) have been used successfully to evaluate disturbances in central dopaminergic neurotransmission. However, severe side effects due to relatively high doses (4,500 to 8,000 mg) of AMPT have been reasons for study withdrawal. Thus, we assessed the effectiveness and tolerability of two alternative procedures, using lower doses of AMPT. Six healthy subjects underwent three measurements of striatal dopamine D 2 receptor (D 2 R)-binding potential (BP ND ) with SPECT and the selective radiolabeled D 2 R antagonist [ 123 I]IBZM. All subjects were scanned in the absence of pharmacological intervention (baseline) and after two different depletion procedures. In the first depletion session, over 6 h, subjects were administered 1,500 mg of AMPT before scanning. In the second depletion session, over 25 h, subjects were administered 40 mg AMPT/kg body weight. We also administered the Subjective Well-being Under Neuroleptic Treatment Scale, a self-report instrument designed to measure the subjective experience of patients on neuroleptic medication. We found no change of mean D 2 R BP ND after the first and short AMPT challenge compared to the baseline. However, we found a significant increase in striatal D 2 R BP ND binding after the AMPT challenge adjusted for bodyweight compared to both other regimen. Although subjective well-being worsened after the prolonged AMPT challenge, no severe side effects were reported. Our results imply a low-dosage, suitable alternative to the common AMPT procedure. The probability of side effects and study withdrawal can be reduced by this procedure. (orig.)

Trends in Medicare Reimbursement for Orthopedic Procedures: 2000 to 2016.

Science.gov (United States)

Eltorai, Adam E M; Durand, Wesley M; Haglin, Jack M; Rubin, Lee E; Weiss, Arnold-Peter C; Daniels, Alan H

2018-03-01

Understanding trends in reimbursement is critical to the financial sustainability of orthopedic practices. Little research has examined physician fee trends over time for orthopedic procedures. This study evaluated trends in Medicare reimbursements for orthopedic surgical procedures. The Medicare Physician Fee Schedule was examined for Current Procedural Terminology code values for the most common orthopedic and nonorthopedic procedures between 2000 and 2016. Prices were adjusted for inflation to 2016-dollar values. To assess mean growth rate for each procedure and subspecialty, compound annual growth rates were calculated. Year-to-year dollar amount changes were calculated for each procedure and subspecialty. Reimbursement trends for individual procedures and across subspecialties were compared. Between 2000 and 2016, annual reimbursements decreased for all orthopedic procedures examined except removal of orthopedic implant. The orthopedic procedures with the greatest mean annual decreases in reimbursement were shoulder arthroscopy/decompression, total knee replacement, and total hip replacement. The orthopedic procedures with the least annual reimbursement decreases were carpal tunnel release and repair of ankle fracture. Rate of Medicare procedure reimbursement change varied between subspecialties. Trauma had the smallest decrease in annual change compared with spine, sports, and hand. Annual reimbursement decreased at a significantly greater rate for adult reconstruction procedures than for any of the other subspecialties. These findings indicate that reimbursement for procedures has steadily decreased, with the most rapid decrease seen in adult reconstruction. [Orthopedics. 2018; 41(2):95-102.]. Copyright 2018, SLACK Incorporated.

50 CFR 260.103 - Operations and operating procedures shall be in accordance with an effective sanitation program.

Science.gov (United States)

2010-10-01

... be in accordance with an effective sanitation program. 260.103 Section 260.103 Wildlife and Fisheries... Operations and operating procedures shall be in accordance with an effective sanitation program. (a) All..., choppers, and containers which fail to meet appropriate and adequate sanitation requirements will be...

Pre-procedural antibiotics for endoscopic urological procedures: Initial experience in individuals with spinal cord injury and asymptomatic bacteriuria.

Science.gov (United States)

Chong, Julio T; Klausner, Adam P; Petrossian, Albert; Byrne, Michael D; Moore, Jewel R; Goetz, Lance L; Gater, David R; Grob, B Mayer

2015-03-01

The objective of this study was to compare the safety, efficacy, quality-of-life impact, and costs of a single dose or a longer course of pre-procedural antibiotics prior to elective endoscopic urological procedures in individuals with spinal cord injury and disorders (SCI/D) and asymptomatic bacteriuria. A prospective observational study. Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA. Sixty persons with SCI/D and asymptomatic bacteriuria scheduled to undergo elective endoscopic urological procedures. A single pre-procedural dose of antibiotics vs. a 3-5-day course of pre-procedural antibiotics. Objective and subjective measures of health, costs, and quality of life. There were no significant differences in vital signs, leukocytosis, adverse events, and overall satisfaction in individuals who received short-course vs. long-course antibiotics. There was a significant decrease in antibiotic cost (33.1 ± 47.6 vs. 3.6 ± 6.1 US$, P = 0.01) for individuals in the short-course group. In addition, there was greater pre-procedural anxiety (18 vs. 0%, P antibiotics. SCI/D individuals with asymptomatic bacteriuria may be able to safely undergo most endoscopic urological procedures with a single dose of pre-procedural antibiotics. However, further research is required and even appropriate pre-procedural antibiotics may not prevent severe infections.

Procedures for mastitis diagnosis and control.

Science.gov (United States)

Sears, P M; González, R N; Wilson, D J; Han, H R

1993-11-01

Procedures for mastitis diagnosis and control include culturing individual cow and bulk tank milk samples, antibiotic susceptibility testing, and evaluation of somatic cell count reports and clinical mastitis treatment records. Integrated use of such procedures is necessary for effective mastitis diagnosis and control.

The development of a purification procedure for saxitoxin-induced protein.

Science.gov (United States)

Smith, D S; Kitts, D D; Fenske, B; Owen, T G; Shyng, S

1995-02-01

A simple economical procedure for purifying saxitoxin-induced protein (SIP) from crude extracts of the small shore crab, Hemigrapsus oregenesis, was developed. (NH4)2SO4 precipitation, chymotrypsin digestion, heat treatment, gel filtration and ion-exchange-chromatography procedures were evaluated in purifying SIP. An enzyme immunoassay was used to determine the SIP yield and relative purity at each step of three procedures, thus permitting an assessment of the conditions required for maximum recovery. Response surface analysis was used in an attempt to determine the optimum temperature and exposure time for the heat treatment. A 20 min incubation at 65 degrees C was confirmed by electrophoretic analysis to be the best combination of time and temperature for achieving both an acceptable yield and purity of SIP. SIP in desalted concentrate was shown to be resistant to chymotrypsin proteolysis; however, this enzyme had deleterious effects on SIP purification at later stages of the procedure. The omission of the chymotrypsin digestion, and the inclusion of gel-filtration chromatography in the final clean-up step, resulted in the purification of SIP comparable with that achieved with affinity chromatography.

Assessment of the effects of different sample perfusion procedures on phase-contrast tomographic images of mouse spinal cord

Science.gov (United States)

Stefanutti, E.; Sierra, A.; Miocchi, P.; Massimi, L.; Brun, F.; Maugeri, L.; Bukreeva, I.; Nurmi, A.; Begani Provinciali, G.; Tromba, G.; Gröhn, O.; Giove, F.; Cedola, A.; Fratini, M.

2018-03-01

Synchrotron X-ray Phase Contrast micro-Tomography (SXrPCμT) is a powerful tool in the investigation of biological tissues, including the central nervous system (CNS), and it allows to simultaneously detect the vascular and neuronal network avoiding contrast agents or destructive sample preparations. However, specific sample preparation procedures aimed to optimize the achievable contrast- and signal-to-noise ratio (CNR and SNR, respectively) are required. Here we report and discuss the effects of perfusion with two different fixative agents (ethanol and paraformaldehyde) and with a widely used contrast medium (MICROFIL®) on mouse spinal cord. As a main result, we found that ethanol enhances contrast at the grey/white matter interface and increases the contrast in correspondence of vascular features and fibres, thus providing an adequate spatial resolution to visualise the vascular network at the microscale. On the other hand, ethanol is known to induce tissue dehydration, likely reducing cell dimensions below the spatial resolution limit imposed by the experimental technique. Nonetheless, neurons remain well visible using either perfused paraformaldehyde or MICROFIL® compound, as these latter media do not affect tissues with dehydration effects. Paraformaldehyde appears as the best compromise: it is not a contrast agent, like MICROFIL®, but it is less invasive than ethanol and permits to visualise well both cells and blood vessels. However, a quantitative estimation of the relative grey matter volume of each sample has led us to conclude that no significant alterations in the grey matter extension compared to the white matter occur as a consequence of the perfusion procedures tested in this study.

Student Non-Academic Discipline Procedures at Canadian Universities.

Science.gov (United States)

Williams, Tom; Schiralli, Martin

1993-01-01

Surveyed nonacademic disciplinary procedures in 50 Canadian universities through interviews and examination of written policies and procedures. Compared and contrasted such aspects as (1) authority for adjudicating and resolving cases; (2) scope of review mechanisms (just students or entire university community); (3) appeal process; (4) nature of…

A survey on the effectiveness of using GeoGebra software towards lecturers' conceptual knowledge and procedural mathematics

Science.gov (United States)

Wan Salleh, Masturah; Sulaiman, Hajar

2013-04-01

The use of technology in the teaching of mathematics at the university level has long been introduced; but many among the lecturers, especially those that have taught for many years, still opt for a traditional teaching method, that is, by lecture talk. One reason is that lecturers themselves were not exposed to the technologies available and how it can assist in the teaching and learning procedures (T&L) in mathematics. GeoGebra is a mathematical software which is open and free and has just recently been introduced in Malaysia. Compared with the software Cabri Geometry and Geometer's Sketchpad (GSP), which only focus on geometry, GeoGebra is able to connect geometry, algebra and numerical representation. Realizing this, the researchers have conducted a study to expose the university lecturers on the use of GeoGebra in T&L. The researchers chose to do the research on mathematics lecturers at the Department of Computer Science and Mathematics (JSKM), Universiti Teknologi Mara (UiTM), Penang. The objective of this study is to determine whether an exposure to GeoGebra software can affect the conceptual knowledge and procedural teaching of mathematics at the university level. This study is a combination of descriptive and qualitative. One session was conducted in an open workshop for all the 45 lecturers. From that total, four people were selected as a sample. The sample was selected by using a simple random sampling method. This study used materials in the form of modules during the workshop. In terms of conceptual knowledge, the results showed that the GeoGebra software is appropriate, relevant and highly effective for in-depth understanding of the selected topics. While the procedural aspects of teaching, it can be one of the teaching aids and considerably facilitate the lecturers.

Uncertainty Analysis of A Flood Risk Mapping Procedure Applied In Urban Areas

Science.gov (United States)

Krause, J.; Uhrich, S.; Bormann, H.; Diekkrüger, B.

In the framework of IRMA-Sponge program the presented study was part of the joint research project FRHYMAP (flood risk and hydrological mapping). A simple con- ceptual flooding model (FLOODMAP) has been developed to simulate flooded areas besides rivers within cities. FLOODMAP requires a minimum of input data (digital el- evation model (DEM), river line, water level plain) and parameters and calculates the flood extent as well as the spatial distribution of flood depths. of course the simulated model results are affected by errors and uncertainties. Possible sources of uncertain- ties are the model structure, model parameters and input data. Thus after the model validation (comparison of simulated water to observed extent, taken from airborne pictures) the uncertainty of the essential input data set (digital elevation model) was analysed. Monte Carlo simulations were performed to assess the effect of uncertain- ties concerning the statistics of DEM quality and to derive flooding probabilities from the set of simulations. The questions concerning a minimum resolution of a DEM re- quired for flood simulation and concerning the best aggregation procedure of a given DEM was answered by comparing the results obtained using all available standard GIS aggregation procedures. Seven different aggregation procedures were applied to high resolution DEMs (1-2m) in three cities (Bonn, Cologne, Luxembourg). Basing on this analysis the effect of 'uncertain' DEM data was estimated and compared with other sources of uncertainties. Especially socio-economic information and monetary transfer functions required for a damage risk analysis show a high uncertainty. There- fore this study helps to analyse the weak points of the flood risk and damage risk assessment procedure.

Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures.

Science.gov (United States)

Liu, Weiming; Bakker, Nicolaas A; Groen, Rob J M

2014-09-01

In this paper the authors systematically evaluate the results of different surgical procedures for chronic subdural hematoma (CSDH). The MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and other databases were scrutinized according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement, after which only randomized controlled trials (RCTs) and quasi-RCTs were included. At least 2 different neurosurgical procedures in the management of chronic subdural hematoma (CSDH) had to be evaluated. Included studies were assessed for the risk of bias. Recurrence rates, complications, and outcome including mortality were taken as outcome measures. Statistical heterogeneity in each meta-analysis was assessed using the T(2) (tau-squared), I(2), and chi-square tests. The DerSimonian-Laird method was used to calculate the summary estimates using the fixed-effect model in meta-analysis. Of the 297 studies identified, 19 RCTs were included. Of them, 7 studies evaluated the use of postoperative drainage, of which the meta-analysis showed a pooled OR of 0.36 (95% CI 0.21-0.60; p < 0.001) in favor of drainage. Four studies compared twist drill and bur hole procedures. No significant differences between the 2 methods were present, but heterogeneity was considered to be significant. Three studies directly compared the use of irrigation before drainage. A fixed-effects meta-analysis showed a pooled OR of 0.49 (95% CI 0.21-1.14; p = 0.10) in favor of irrigation. Two studies evaluated postoperative posture. The available data did not reveal a significant advantage in favor of the postoperative supine posture. Regarding positioning of the catheter used for drainage, it was shown that a frontal catheter led to a better outcome. One study compared duration of drainage, showing that 48 hours of drainage was as effective as 96 hours of drainage. Postoperative drainage has the advantage of reducing recurrence without increasing complications

Procedures for health risk assessment in Europe

NARCIS (Netherlands)

Seeley, M.R.; Tonner-Navarro, L.E.; Beck, B.D.; Deskin, R.; Feron, V.J.; Johanson, G.; Bolt, H.M.

2001-01-01

This report compares cancer classification systems, health risk assessment approaches, and procedures used for establishing occupational exposure limits (OELs), in various European countries and scientific organizations. The objectives were to highlight and compare key aspects of these processes and

MO-F-CAMPUS-I-01: A System for Automatically Calculating Organ and Effective Dose for Fluoroscopically-Guided Procedures

Energy Technology Data Exchange (ETDEWEB)

Xiong, Z; Vijayan, S; Rana, V; Rudin, S; Bednarek, D [Toshiba Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (United States)

2015-06-15

Purpose: A system was developed that automatically calculates the organ and effective dose for individual fluoroscopically-guided procedures using a log of the clinical exposure parameters. Methods: We have previously developed a dose tracking system (DTS) to provide a real-time color-coded 3D- mapping of skin dose. This software produces a log file of all geometry and exposure parameters for every x-ray pulse during a procedure. The data in the log files is input into PCXMC, a Monte Carlo program that calculates organ and effective dose for projections and exposure parameters set by the user. We developed a MATLAB program to read data from the log files produced by the DTS and to automatically generate the definition files in the format used by PCXMC. The processing is done at the end of a procedure after all exposures are completed. Since there are thousands of exposure pulses with various parameters for fluoroscopy, DA and DSA and at various projections, the data for exposures with similar parameters is grouped prior to entry into PCXMC to reduce the number of Monte Carlo calculations that need to be performed. Results: The software developed automatically transfers data from the DTS log file to PCXMC and runs the program for each grouping of exposure pulses. When the dose from all exposure events are calculated, the doses for each organ and all effective doses are summed to obtain procedure totals. For a complicated interventional procedure, the calculations can be completed on a PC without manual intervention in less than 30 minutes depending on the level of data grouping. Conclusion: This system allows organ dose to be calculated for individual procedures for every patient without tedious calculations or data entry so that estimates of stochastic risk can be obtained in addition to the deterministic risk estimate provided by the DTS. Partial support from NIH grant R01EB002873 and Toshiba Medical Systems Corp.

Administrative Procedure Act and mass procedures (illustrated by the nuclear licensing procedure)

International Nuclear Information System (INIS)

Naumann, R.

1977-01-01

The report deals with the administrative procedure law of 25.5.76 of the Fed. Government, esp. with its meaning for the administrative procedures for the permission for nuclear power plants, as fas ar so-called mass procedures are concerned. (UN) [de

A comparative evaluation of V and V procedures for conventional software and expert systems

International Nuclear Information System (INIS)

Saglietti, F.

1992-01-01

This paper presents some initial considerations on the particular features of artificial intelligence differing from conventional programs and rendering the V and V procedures more simple under certain points of view, but more complex with respect to others. On the basis of the characteristics identified, some existing testing strategies are presented and analyzed; an additional adequacy criterion is suggested in order to increase error detectability. The aim of this work is to extend the existing (though so far still incomplete) testing theories for conventional programs, such as to allow their application also to artificial intelligent systems. The ultimate goal of the present investigations is thus represented by a unified problem representation permitting to define adequate V and V procedures by adapting them to the specific software category considered. In particular, special criteria for Al testing should be included to the usual coverage requirements in order to capture also those faults, which seem to be typical for the expert reasoning

Review on patients radiation dose and frequency of procedures during medical exposure in Sudan

International Nuclear Information System (INIS)

Abu Baker, Samah Mohamed Nasr

2015-09-01

The aim of this study was to estimate patient dose, the annual frequency and the number of staff and devices in the medical applications of ionizing radiation in Sudan. Survey was conducted on diagnostic radiology, nuclear medicine and radiotherapy. With respect to diagnostic radiology, only patient radiation dose was estimated. The data for diagnostic radiology was obtained from 24 peer reviewed scientific published literatures during the years ( 2006 - 2015). The collected publications included about 64 Sudanese hospitals covering different types of diagnostic exams. A values of the effective dose for pediatrics and adult patients were within the ranges of similar worldwide values published by UNSCEAR report in 2008 with exceptional to fluoroscopy hysterosalpingography for adult patients. For nuclear medicine procedures, questionnaires were distributed to five hospitals representing the whole existing NM department in Sudan at the time of of study. The estimated total annual frequency of diagnostic procedures was 0.2 per 1000 population. The estimated total annual collective and annual per caput effective dose from all NM procedures were 16.268 man Sv and 0.5 μSv, respectively. Comparing the annual per caput effective dose with UNSCEAR value our results was less than the worldwide value and greater than the value for heath care level 111-1 v countries. Questionnaires were also distributed to collect data on radiotherapy procedures performed in the two existing radioisotopes Sudanese hospitals. The prescribed dose and the number of fractions were comparable between the two hospitals. The minimum prescribed dose was 20 Gy with 5 fractions for nasopharynx (NPH) palliative and the maximum prescribed dose was 64 Gy with 32 fractions for prostate.(Author)

Effect of Different Household Decontamination Procedures on Antioxidant Activity and Microbial Load of Vegetables

Directory of Open Access Journals (Sweden)

Alimohammadi M.*

2016-12-01

Full Text Available Abstract Aims: Decontamination procedures are different in each country, as the other applications of disinfection, and standards. The aim of this study was to evaluate the effects of household decontaminations and storage time on the antioxidant activity and microbial load of salad vegetables. Instrument & Methods: This analytic-descriptive study was conducted on 4 types of salad vegetables; cucumber, tomato, lettuce, and sweet basil. After washing, samples with storage time of 0 day were analyzed immediately. Other samples were held in 4°C for 3 and 5 days. Five different washing and decontamination methods were compared; water washing, detergent washing, benzalkonium chloride, sequential washing and Kanz disinfecting method. The Ferric Reducing Ability of Plasma assay was used to measure the antioxidant activity. Aerobic mesophyll bacteria and total coliforms were chosen as microbial load index. ANOVA and Tukey post-hoc tests were used to analyze the data. Findings: By increasing the storage time, the antioxidant activity of all types of vegetables reduced. There was a significant decrease in antioxidant activity in all types of vegetables using sequential washing method with water, detergent, and benzalkonium chloride and Kanz disinfection method. All washing methods were effective in decontamination for either mesophyll bacteria or total coliforms, except for total coliforms in lettuce. There was no significant difference in microbial load among first 4 methods of washing (p>0.05, but a significant difference was observed in Kanz disinfection method (p<0.05. Conclusion: Kanz disinfection is the most effective decontamination method to eliminate microorganisms index, which also reduce the antioxidant activity.

Encapsulation of hydrophobic dyes in polystyrene micro- and nanoparticles via swelling procedures.

Science.gov (United States)

Behnke, Thomas; Würth, Christian; Hoffmann, Katrin; Hübner, Martin; Panne, Ulrich; Resch-Genger, Ute

2011-05-01

Aiming at the derivation of a generalized procedure for the straightforward preparation of particles fluorescing in the visible and near-infrared (NIR) spectral region, different swelling procedures for the loading of the hydrophobic polarity-probe Nile Red into nano- and micrometer sized polystyrene particles were studied and compared with respect to the optical properties of the resulting particles. The effect of the amount of incorporated dye on the spectroscopic properties of the particles was investigated for differently sized beads with different surface chemistries, i.e., non-functionalized, amino-modified and PEG-grafted surfaces. Moreover, photostability and leaking studies were performed. The main criterion for the optimization of the dye loading procedures was a high and thermally and photochemically stable fluorescence output of the particles for the future application of these systems as fluorescent labels. © Springer Science+Business Media, LLC 2010

Face-off: A new identification procedure for child eyewitnesses.

Science.gov (United States)

Price, Heather L; Fitzgerald, Ryan J

2016-09-01

In 2 experiments, we introduce a new "face-off" procedure for child eyewitness identifications. The new procedure, which is premised on reducing the stimulus set size, was compared with the showup and simultaneous procedures in Experiment 1 and with modified versions of the simultaneous and elimination procedures in Experiment 2. Several benefits of the face-off procedure were observed: it was significantly more diagnostic than the showup procedure; it led to significantly more correct rejections of target-absent lineups than the simultaneous procedures in both experiments, and it led to greater information gain than the modified elimination and simultaneous procedures. The face-off procedure led to consistently more conservative responding than the simultaneous procedures in both experiments. Given the commonly cited concern that children are too lenient in their decision criteria for identification tasks, the face-off procedure may offer a concrete technique to reduce children's high choosing rates. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Painful procedures in children with cancer: comparison of moderate sedation and general anesthesia for lumbar puncture and bone marrow aspiration.

Science.gov (United States)

Iannalfi, Alberto; Bernini, Gabriella; Caprilli, Simona; Lippi, Alma; Tucci, Fabio; Messeri, Andrea

2005-12-01

The study was conducted to compare moderate sedation (MS) with general anesthesia (GA) in the management of frequently performed lumbar puncture or bone marrow aspiration (BMA) during the treatment of childhood cancer. The MS (14 patients for 30 procedures) was managed by non-anesthesiologists (combined nitrous oxide-midazolam +/- non-pharmacological techniques). The GA was managed by anesthesiologists (17 patients for 30 procedures). A neutral observer recorded side effects, use of sedative antagonists, recovery time, oncologist's evaluation, procedure behaviors check list (PBCL); subjective perceptions during the procedure with a questionnaire administered to children (>6 years) and their parents; drugs costs and professional resources. P-values compliance and cost-effectiveness as it relies on the contribution of non-pharmacological techniques. 2005 Wiley-Liss, Inc.

Efficacy of peritoneal dialysis during infusion and drainage procedures.

Science.gov (United States)

Baczyski, Daniel; Antosiewicz, Stefan; Waniewski, Jacek; Nowak, Zbigniew; Wakowicz, Zofia

2010-01-01

Inadequate dialysis is still a major cause of technique failure in peritoneal dialysis (PD). Mathematical models provide the possibility of direct and precise assessment of peritoneal transport of urea and creatinine throughout the dwell and allow calculation of optimal schedules, dwell times, and predicted adequacy of a prescribed regimen. Kinetic modeling is particularly important for automated PD. If the effectiveness of uremic toxin removal that takes place during infusion and drainage of dialysis fluid is not taken into account, the predicted adequacy of the whole PD session may be underestimated. ♢ To estimate the efficacy of urea and creatinine removal during the dialysis fluid exchange procedure. ♢ 17 patients treated with PD were included in the study. PD effectiveness during dialysate exchange was defined as the quotient k of removed amount of creatinine/BUN during the infusion and drainage of dialysate and during a dwell of the same duration as the dialysate exchange. ♢ The effectiveness of creatinine and urea removal was reduced during the exchange procedure (k(creat) = 0.68 ± 0.43 and k(BUN) = 0.87 ± 0.44) and differed between these 2 solutes (p = 0.0009). The k coefficients for urea and creatinine were well correlated (R(2) = 0.83). ♢ The effectiveness of peritoneal transport of creatinine and BUN during the inflow/outflow phase was relatively high compared to that during the same dwell time (68% and 87% respectively). This real effectiveness of the dialysate exchange procedure should be taken into account in the process of planning automated PD sessions, otherwise the predicted overall efficacy of creatinine and urea removal throughout the session may be underestimated. This underestimation is proportional to the number of dwells per day.

Surgical resident involvement is safe for common elective general surgery procedures.

Science.gov (United States)

Tseng, Warren H; Jin, Leah; Canter, Robert J; Martinez, Steve R; Khatri, Vijay P; Gauvin, Jeffrey; Bold, Richard J; Wisner, David; Taylor, Sandra; Chen, Steven L

2011-07-01

Outcomes of surgical resident training are under scrutiny with the changing milieu of surgical education. Few have investigated the effect of surgical resident involvement (SRI) on operative parameters. Examining 7 common general surgery procedures, we evaluated the effect of SRI on perioperative morbidity and mortality and operative time (OpT). The American College of Surgeons National Surgical Quality Improvement Program database (2005 to 2007) was used to identify 7 cases of nonemergent operations. Cases with simultaneous procedures were excluded. Logistic regression was performed across all procedures and within each procedure incorporating SRI, OpT, and risk-stratifying American College of Surgery National Surgical Quality Improvement Program morbidity and mortality probability scores, which incorporate multiple prognostic individual patient factors. Procedure-specific, SRI-stratified OpTs were compared using Wilcoxon rank-sum tests. A total of 71.3% of the 37,907 cases had SRI. Absolute 30-day morbidity for all cases with SRI and without SRI were 3.0% and 1.0%, respectively (p < 0.001); absolute 30-day mortality for all cases with SRI and without SRI were 0.1% and 0.08%, respectively (p < 0.001). After multivariate analysis by specific procedure, SRI was not associated with increased morbidity but was associated with decreased mortality during open right colectomy (odds ratio 0.32; p = 0.01). Across all procedures, SRI was associated with increased morbidity (odds ratio 1.14; p = 0.048) but decreased mortality (odds ratio 0.42; p < 0.001). Mean OpT for all procedures was consistently lower for cases without SRI. SRI has a measurable impact on both 30-day morbidity and mortality and OpT. These data have implications to the impact associated with surgical graduate medical education. Further studies to identify causes of patient morbidity and prevention strategies in surgical teaching environments are warranted. Copyright © 2011 American College of Surgeons

Martius procedure revisited for urethrovaginal fistula

Directory of Open Access Journals (Sweden)

N P Rangnekar

2000-01-01

Full Text Available Background: Urethrovaginal fistula is a dreadful com-plication of obstetric trauma due to prolonged labour or obstetric intervention commonly seen in developing coun-tries. Due to prolonged ischaemic changes, the fistula is resistant to healing. The strategic location of the fistula leads to postoperative impairment of continence mecha-nism. Anatomical repair was previously the commonest mode of surgical management, but was associated with a miserable cumulative cure rate ranging from 16-60%. Hence we tried to study the efficacy of Martius procedure in the management of urethrovaginal fistula. Material and Methods: We studied the outcome of 12 urethrovaginal fistulae, all caused by obstetric trauma, treated surgically with Martius procedure in 8 and with anatomical repair in 4, retrospectively. 9 patients had re-current fistulae while I patient had multiple fistulae. Pa-tients were followed up for the period ranging from 6 months to 4′/2 years for fistula healing, continence and postoperative complications like dvspareunia. Results: Cumulative cure rate ofMartius procedure was 87.5% with no postoperative stress incontinence, while fistula healing rate of anatomical repair was only 25% (I patient out of 4 which was also complicated by Intrin-sic Sphincter Deficiency (ISD. In case of recurrent fistu-lae the success rate of anatomical repair was 0% compared to 83.33% with Martius procedure. Conclusions: Martius procedure has shown much bet-ter overall cure rate compared to anatomical repair be-cause - a it provides better reinforcement to urethral suture line, b it provides better blood supply and lymph drainage to the ischaemic fistulous area, c provides sur-face for epithelialization and, d helps to maintain conti-nence. Hence we recommend Martius procedure as a surgical modality for the treatment of urethrovaginal fis-tula.

Ulnar artery: The Ulysses ultimate resort for coronary procedures.

Science.gov (United States)

Hahalis, George; Deftereos, Spyridon; Bertrand, Olivier F

2016-08-20

Despite the increasing worldwide adoption of the transradial access site, the ulnar artery (UA) only very infrequently serves as a primary option for coronary procedures. In contrast to the uncertainty surrounding previous reports regarding the feasibility and safety, recent data from larger registries and randomized trials provide more conclusive evidence that the transulnar route may be safely selected as an alternative arterial access approach. However, a default transulnar strategy appears time-consuming and is associated with higher crossover rates compared with the radial artery (RA). Once arterial access is obtained, the likelihood of a successful coronary procedure is high and similar between the two forearm arteries. The UA has similar flow-mediating vasodilating properties with and seems at least as vulnerable as the RA with regard to incident occlusion, with UA occlusion (UAO) rates being probably higher than previously anticipated. A learning curve effect may not be apparent for crossover rates among experienced radialists, but increasing experience is associated with reduction in the fluoroscopy time, contrast volume and frequency of large hematoma formation. The UA may represents an important alternative access site for coronary procedures, and experienced radial operators should obtain additional skills to perform the transulnar approach. Nevertheless, in view of this method's lower feasibility compared to the RA, an initial ulnar access strategy should be reserved for carefully selected patients to ensure satisfactory cannulation rates. Copyright © 2016 Hellenic Cardiological Society. Published by Elsevier B.V. All rights reserved.

Evaluating strategic environmental assessment in the Netherlands: Content, process and procedure as indissoluble criteria for effectiveness

NARCIS (Netherlands)

M.W. van Buuren (Arwin); S.G. Nooteboom (Sibout)

2009-01-01

textabstractTo assess the effectiveness of strategic environmental assessment (SEA) we distinguish between its contribution to the quality of the ultimate policy choice (usefulness, applicability), the procedural quality of the planning process (transparency, timeliness) and the quality of

Resolution Effects on the Mean Square Displacement as Obtained by the Self-Distribution-Function Procedure

International Nuclear Information System (INIS)

Benedetto, A; Magazù, S; Migliardo, F; Mondelli, C; Gonzalez, M A

2012-01-01

In the present contribution, a procedure for molecular motion characterization based on the evaluation of the Mean Square Displacement (MSD), through the Self-Distribution Function (SDF), is presented. It is shown how MSD, which represents an important observable for the characterization of dynamical properties, can be decomposed into different partial contributions associated to system dynamical processes within a specific spatial scale. It is also shown how the SDF procedure allows us to evaluate both total MSD and partial MSDs through total and partial SDFs. As a result, total MSD is the weighed sum of partial MSDs in which the weights are obtained by the fitting procedure of measured Elastic Incoherent Neutron Scattering (EINS) intensity. We apply SDF procedure to data collected,by IN13, IN10 and IN4 spectrometers (Institute Laue Langevin), on aqueous mixtures of two homologous disaccharides (sucrose and trehalose) and on dry and hydrated (H 2 O and D 2 O) lysozyme with and without disaccharides. It emerges that the hydrogen bond imposed network of the water-trehalose mixture appears to be stronger with respect to that of the water-sucrose mixture. This result can justify the higher bioprotectant effectiveness of trehalose. Furthermore, it emerges that partial MSDs of sucrose and trehalose are equivalent in the low Q domain (0÷1.7) Å −1 whereas they are different in the high Q domain (1.7÷4) Å −1 . This suggests that the higher structure sensitivity of sucrose should be related to the small spatial observation windows. Moreover, the role of the instrumental resolution in EINS is considered. The nature of the dynamical transition is highlighted and it is shown that it occurs when the system relaxation time becomes shorter than the instrumental energy time. Finally, the bioprotectants effect on protein dynamics and the amplitude of vibrations in lysozyme are presented.

A cost and time analysis of laryngology procedures in the endoscopy suite versus the operating room.

Science.gov (United States)

Hillel, Alexander T; Ochsner, Matthew C; Johns, Michael M; Klein, Adam M

2016-06-01

To assess the costs, charges, reimbursement, and efficiency of performing awake laryngology procedures in an endoscopy suite (ES) compared with like procedures performed in the operating room (OR). Retrospective review of billing records. Cost, charges, and reimbursements for the hospital, surgeon, and anesthesiologist were compared between ES injection laryngoplasty and laser excision procedures and matched case controls in the OR. Time spent in 1) the preoperative unit, 2) the operating or endoscopy suite, and 3) recovery unit were compared between OR and ES procedures. Hospital expenses were significantly less for ES procedures when compared to OR procedures. Reimbursement was similar for ES and OR injection laryngoplasty, though greater for OR laser excisions. Net balance (reimbursement-expenses) was greater for ES procedures. A predictive model of payer costs over a 3-year period showed similar costs for ES and OR laser procedures and reduced costs for ES compared to OR injection laryngoplasty. Times spent preoperatively and the procedure were significantly less for ES procedures. For individual laryngology procedures, the ES reduces time and costs compared to the OR, increasing otolaryngologist and hospital efficiency. This reveals cost and time savings of ES injection laryngoplasty, which occurs at a similar frequency as OR injection laryngoplasty. Given the increased frequency for ES laser procedures, total costs are similar for ES and OR laser excision of papilloma, which usually require repeated procedures. When regulated office space is unavailable, endoscopy rooms represent an alternative setting for unsedated laryngology procedures. NA Laryngoscope, 126:1385-1389, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

[Knapp procedure and modified Knapp procedure with Foster suture for the treatment of double elevator palsy].

Science.gov (United States)

Li, Y P; Zhang, W; Ding, J; Ma, H Z; Zhao, K X

2017-12-11

Objective: To investigate the efficacy of Knapp procedure and modified Knapp procedure with Foster suture in the treatment of double elevator palsy(DEP). Methods: Retrospective study. Twenty-two patients with congenital DEP were underwent Knapp procedure ( n= 15) and modified Knapp procedure( n= 7). The clinical data were retrospectively analyzed, including the preoperative and postoperative vertical deviation in the primary position, ocular motility, and binocular vision. Results: The average vertical deviation in the primary position was (34.7±8.6) prism diopters(PD) before surgery and (6.5±6.5) PD after surgery ( t= 30.41, P= 0.00) in the group underwent Knapp procedure. The mean preoperative and postoperative deviations of the group underwent modified procedure were respectively (38.6±14.6) PD and (5.7±9.3)PD ( t= 15.33, P= 0.00). The mean corrected vertical deviation of the latter (32.8±5.7) PD was greater than that of the former (28.1±3.6) PD( t=- 2.39, P= 0.03). The mean improved upgaze in the modified group (2.6±0.5) was more obvious than that in the Knapp group (1.9±0.6) ( t= 2.41, P= 0.02). There is no significant difference in the surgical effect on downgaze between two groups ( U =43.00, P= 0.54). Seven patients having binocular vision with abnormal head posture (AHP) before surgery obtained binocular single vision in the primary position and reading position after operations. AHP disappeared or reduced to less than 5°. The surgical outcomes were satisfied in 72.7% patients. But the patients with ≥40 PD preoperative vertical deviation were under-corrected and needed the further operations. Conclusions: Knapp procedure and modified Knapp procedure with Foster suture were the efficient procedures for treatment of DEP without restriction of ipsilateral inferior rectus. Both procedures can obviously correct the vertical deviation and improve upgaze without remarkable limitation of downgaze, which is good to obtain the binocular single vision in

Emergency procedures

International Nuclear Information System (INIS)

Abd Nasir Ibrahim; Azali Muhammad; Ab Razak Hamzah; Abd Aziz Mohamed; Mohammad Pauzi Ismail

2004-01-01

The following subjects are discussed - Emergency Procedures: emergency equipment, emergency procedures; emergency procedure involving X-Ray equipment; emergency procedure involving radioactive sources

Comparative assessment of supervision and decision-making procedures regarding sustainable development

International Nuclear Information System (INIS)

Carlevaro, F.; Garbely, M.; Genoud, S.

2002-01-01

This final report for the Swiss Federal Office of Energy (SFOE) presents the results of a study made on the possibilities of establishing a system of indicators that allows the monitoring of sustainable development and its effects, as stipulated in the Agenda 21. The report presents the findings of the study on criteria and indicators for sustainability in the energy area. The challenge posed by the synthesis of information from a system of indicators is discussed and four general approaches are proposed, compared and tested for the monitoring of sustainability in the energy area. These include the calculation of a composite index from several indicators, a similar process that uses statistical methods of dimensional reduction, methods for the measurement of productivity loaned from economics and a method for decision-making using multiple criteria. Examples for the four approaches are given and experience gained in their use - partly in other countries and in United Nations agencies - is discussed

Cost-effectiveness of kidney transplantation compared with chronic dialysis in end-stage renal disease

Directory of Open Access Journals (Sweden)

Diego Rosselli

2015-01-01

Full Text Available To estimate the costs and effectiveness measured in quality-adjusted life years (QALY of kidney transplantation compared with dialysis in adults suffering from end-stage renal disease from the perspective of the Colombian healthcare system, we designed a Markov model with monthly cycles over a five-year time horizon and eight transitional states, including death as an absorbing state. Transition probabilities were obtained from international registries, costs from different local sources [case studies, official tariffs (ISS 2001 + 35% for procedures and SISMED for medications]. Data were validated by an expert panel and we performed univariate, multivariate and probabilistic sensitivity analyses. Effectiveness indicators were months of life gained, months of dialysis averted and deaths prevented. The annual discount rate was 3% and the cost-utility threshold (willingness to pay was three times gross domestic product (GDP = USD 20,000 per QALY. The costs were adopted in US dollars (USD using the 2012 average exchange rate (1 USD = COP$ 1798. The discounted average total cost for five years was USD 76,718 for transplantation and USD 76,891 for dialysis, with utilities 2.98 and 2.10 QALY, respectively. Additionally, renal transplantation represented 6.9 months gained, 35 months in dialysis averted per patient and one death averted for each of the five patients transplanted in five years. We conclude that renal transplantation improves the overall survival rates and quality of life and is a cost-saving alternative compared with dialysis.

AMPT-induced monoamine depletion in humans: evaluation of two alternative [{sup 123}I]IBZM SPECT procedures

Energy Technology Data Exchange (ETDEWEB)

Boot, Erik [Academic Medical Centre (AMC), University of Amsterdam, Department of Psychiatry, Amsterdam (Netherlands); De Bruggen, Centre for People with Intellectual Disability, Zwammerdam (Netherlands); Booij, Jan [AMC, Department of Nuclear Medicine, Amsterdam (Netherlands); Hasler, Gregor [University Hospital, Department of Psychiatry, Zuerich (Switzerland); Zinkstok, Janneke R.; Haan, Lieuwe de; Linszen, Don H.; Amelsvoort, Therese A. van [Academic Medical Centre (AMC), University of Amsterdam, Department of Psychiatry, Amsterdam (Netherlands)

2008-07-15

Acute monoamine depletion paradigms using alpha-methyl-para-tyrosine (AMPT) combined with single photon emission computed tomography (SPECT) have been used successfully to evaluate disturbances in central dopaminergic neurotransmission. However, severe side effects due to relatively high doses (4,500 to 8,000 mg) of AMPT have been reasons for study withdrawal. Thus, we assessed the effectiveness and tolerability of two alternative procedures, using lower doses of AMPT. Six healthy subjects underwent three measurements of striatal dopamine D{sub 2} receptor (D{sub 2}R)-binding potential (BP{sub ND}) with SPECT and the selective radiolabeled D{sub 2}R antagonist [{sup 123}I]IBZM. All subjects were scanned in the absence of pharmacological intervention (baseline) and after two different depletion procedures. In the first depletion session, over 6 h, subjects were administered 1,500 mg of AMPT before scanning. In the second depletion session, over 25 h, subjects were administered 40 mg AMPT/kg body weight. We also administered the Subjective Well-being Under Neuroleptic Treatment Scale, a self-report instrument designed to measure the subjective experience of patients on neuroleptic medication. We found no change of mean D{sub 2}R BP{sub ND} after the first and short AMPT challenge compared to the baseline. However, we found a significant increase in striatal D{sub 2}R BP{sub ND} binding after the AMPT challenge adjusted for bodyweight compared to both other regimen. Although subjective well-being worsened after the prolonged AMPT challenge, no severe side effects were reported. Our results imply a low-dosage, suitable alternative to the common AMPT procedure. The probability of side effects and study withdrawal can be reduced by this procedure. (orig.)

Cost-effective cloud computing: a case study using the comparative genomics tool, roundup.

Science.gov (United States)

Kudtarkar, Parul; Deluca, Todd F; Fusaro, Vincent A; Tonellato, Peter J; Wall, Dennis P

2010-12-22

Comparative genomics resources, such as ortholog detection tools and repositories are rapidly increasing in scale and complexity. Cloud computing is an emerging technological paradigm that enables researchers to dynamically build a dedicated virtual cluster and may represent a valuable alternative for large computational tools in bioinformatics. In the present manuscript, we optimize the computation of a large-scale comparative genomics resource-Roundup-using cloud computing, describe the proper operating principles required to achieve computational efficiency on the cloud, and detail important procedures for improving cost-effectiveness to ensure maximal computation at minimal costs. Utilizing the comparative genomics tool, Roundup, as a case study, we computed orthologs among 902 fully sequenced genomes on Amazon's Elastic Compute Cloud. For managing the ortholog processes, we designed a strategy to deploy the web service, Elastic MapReduce, and maximize the use of the cloud while simultaneously minimizing costs. Specifically, we created a model to estimate cloud runtime based on the size and complexity of the genomes being compared that determines in advance the optimal order of the jobs to be submitted. We computed orthologous relationships for 245,323 genome-to-genome comparisons on Amazon's computing cloud, a computation that required just over 200 hours and cost $8,000 USD, at least 40% less than expected under a strategy in which genome comparisons were submitted to the cloud randomly with respect to runtime. Our cost savings projections were based on a model that not only demonstrates the optimal strategy for deploying RSD to the cloud, but also finds the optimal cluster size to minimize waste and maximize usage. Our cost-reduction model is readily adaptable for other comparative genomics tools and potentially of significant benefit to labs seeking to take advantage of the cloud as an alternative to local computing infrastructure.

The Effects of Two Direct Instruction Teaching Procedures to Basic Skills to Two Students with Disabilities

Directory of Open Access Journals (Sweden)

Annelie Fjortoft

2014-06-01

Full Text Available The first study focused on increasing her ability to identify letters and to write these letters. The research was conducted in a resource room setting located in a public school in a large urban school district. The effects of employing DI flashcards on letter recognition and letter writing were evaluated in a multiple baseline design. Overall the effects of the experiment were positive; the participant improved her accuracy letter identification accuracy and her skills at writing her letters from the alphabet. The time, cost, and effort needed for Experiment I was minimal and the student enjoyed the procedures. A second study was conducted with a first grade boy. We wanted to determine the effectiveness of Teach Your Child to Read in 100 Easy Lessons along with a DI flashcard procedure to improve a first grade student’s ability to identify sounds and sight words within a public school behavior intervention (BI classroom setting. Overall the effects of the second experiment were also quite positive. The participant improved his accuracy and ability to say the letter-sounds and target words. Suggestions for future research were made.

[Meta-analysis of randomized controlled trials comparing procedure for prolapse and hemorrhoids with Milligan-Morgan hemorrhoidectomy in the treatment of prolapsed hemorrhoids].

Science.gov (United States)

He, Ping; Chen, Hongliang

2015-12-01

To compare the safety and efficacy of procedure for prolapse and hemorrhoids (PPH) with Milligan-Morgan hemorrhoidectomy (MMH) in the treatment of prolapsed hemorrhoids. All the randomized controlled trials (RCT) comparing PPH with MMH in the treatment of prolapsed hemorrhoids published between January 1998 and January 2015 were retrieved from PubMed, Embase, Cochrane Library, CBM, CNKI, Wangfang, VIP databases. Hand search was applied in Chinese Journal of Gastrointestinal Surgery, Chinese Journal of Coloproctology and Journal of Colorectal and Anal Surgery from the library of Chengdu University of Traditional Chinese Medicine. Associated reference documents in enrolled trials were reviewed. The methodological quality of enrolled trials was evaluated according to the Cochrane handbook for systematic reviews of interventions. Meta-analysis was performed using RevMan 5.3 software. Sixteen RCTs recruiting 1411 patients were identified. Among them, 702 patients underwent PPH, and other 709 patients MMH. Meta-analysis showed that as compared to MMH, PPH had shorter operating time(WMD=-12.34, 95% CI:-17.87 to -6.80, P=0.000], shorter hospital stay (WMD=-1.48, 95% CI: -1.81 to -1.14, P=0.000) and shorter time to recover normal activity (WMD=-14.11, 95% CI: -24.51 to -3.70, P=0.008). Patients in PPH group experienced less pain at postoperative 24 h, postoperative 1 week and the first postoperative bowel movement (all P0.05). Satisfaction degree of patients in PPH group was better than that in MMH group (OR=2.36, 95% CI:1.36 to 4.07, P=0.002). Procedure for prolapse and hemorrhoids offers some short-term benefits over Milligan-Morgan hemorrhoidectomy, but is associated with a higher rate of recurrent disease.

The effects of local nitroglycerin on the surgical delay procedure in prefabricated flaps by vascular implant in rats.

Science.gov (United States)

Sá, Jairo Zacchê de; Aguiar, José Lamartine de Andrade; Cruz, Adriana Ferreira; Schuler, Alexandre Ricardo Pereira; Lima, José Ricardo Alves de; Marques, Olga Martins

2012-12-01

To evaluate the effect of local nitroglycerin on the viable area of a prefabricated flap for vascular implant in rats, and to investigate the surgical delay procedure. A femoral pedicle was implanted under the skin of the abdominal wall in forty Wistar rats. The animals were divided into four groups of ten: group 1 - without surgical delay procedure and local nitroglycerin; group 2 - with surgical delay procedure, but without local nitroglycerin; group 3 - without surgical delay procedure, but with local nitroglycerin; and group 4 - with simultaneous surgical delay procedure and local nitroglycerin. The percentages of the viable areas, in relation to the total flap, were calculated using AutoCAD R 14. The mean percentage value of the viable area was 8.9% in the group 1. 49.4% in the group 2; 8.4% in the group 3 and 1.1% in the group 4. There was significant difference between groups 1 and 2 (p=0.005), 1 and 4 (p=0.024), 2 and 3 (p=0.003), 2 and 4 (p=0.001). These results support the hypothesis that the closure of the arterial venous channels is responsible for the phenomenon of surgical delay procedure. Local nitroglycerin did not cause an increase in the prefabricated viable flap area by vascular implantation and decreased the viable flap area that underwent delay procedures.

A CFD-based aerodynamic design procedure for hypersonic wind-tunnel nozzles

Science.gov (United States)

Korte, John J.

1993-01-01

A new procedure which unifies the best of current classical design practices, computational fluid dynamics (CFD), and optimization procedures is demonstrated for designing the aerodynamic lines of hypersonic wind-tunnel nozzles. The new procedure can be used to design hypersonic wind tunnel nozzles with thick boundary layers where the classical design procedure has been shown to break down. An efficient CFD code, which solves the parabolized Navier-Stokes (PNS) equations using an explicit upwind algorithm, is coupled to a least-squares (LS) optimization procedure. A LS problem is formulated to minimize the difference between the computed flow field and the objective function, consisting of the centerline Mach number distribution and the exit Mach number and flow angle profiles. The aerodynamic lines of the nozzle are defined using a cubic spline, the slopes of which are optimized with the design procedure. The advantages of the new procedure are that it allows full use of powerful CFD codes in the design process, solves an optimization problem to determine the new contour, can be used to design new nozzles or improve sections of existing nozzles, and automatically compensates the nozzle contour for viscous effects as part of the unified design procedure. The new procedure is demonstrated by designing two Mach 15, a Mach 12, and a Mach 18 helium nozzles. The flexibility of the procedure is demonstrated by designing the two Mach 15 nozzles using different constraints, the first nozzle for a fixed length and exit diameter and the second nozzle for a fixed length and throat diameter. The computed flow field for the Mach 15 least squares parabolized Navier-Stokes (LS/PNS) designed nozzle is compared with the classically designed nozzle and demonstrates a significant improvement in the flow expansion process and uniform core region.

The appropriateness of the systematic framework to develop diagnosis procedures of nuclear power plants-an experimental verification

International Nuclear Information System (INIS)

Park, Jinkyun; Jung, Wondea

2006-01-01

It has been well recognized that a diagnosis procedure that allows operators to successfully identify the nature of an on-going event is inevitable for an effective and appropriate recovery. Unfortunately, studies for a framework that can suggest a unified and consistent process in constructing a serviceable diagnosis procedure seem to be scant. Thus, Park et al. have suggested a systematic framework that can be used to construct a useful diagnosis procedure. In addition, the diagnosis procedure that is currently in use at the reference nuclear power plant (NPP) is reformed in order to demonstrate the appropriateness of the suggested framework. However, the necessity of a well-designed experiment is proposed to confirm the appropriateness of the suggested framework. In this regard, in this study, an experiment is conducted using a full-scope simulator of the reference NPP. From the experiment, two sets of operators' diagnosis performance data are collected, and then they are compared to investigate the change of an operator's diagnosis performance with respect to two types of diagnosis procedures. As a result, it is shown that an operator's diagnosis performance is improved when the revised diagnosis procedure is used. Therefore, it is reasonable to conclude that the suggested framework is useful in constructing an effective diagnosis procedure

Effects of music on sedation depth and sedative use during pediatric dental procedures.

Science.gov (United States)

Ozkalayci, Ozlem; Araz, Coskun; Cehreli, Sevi Burcak; Tirali, Resmiye Ebru; Kayhan, Zeynep

2016-11-01

The study aimed to investigate the effects of listening to music or providing sound isolation on the depth of sedation and need for sedatives in pediatric dental patients. Prospective, randomized, and controlled study. Tertiary, university hospital. In total, 180 pediatric patients, American Society of Anesthesiologists physical status I and II, who were scheduled for dental procedures of tooth extraction, filling, amputation, and root treatment. Patients were categorized into 3 groups: music, isolation, and control. During the procedures, the patients in the music group listened to Vivaldi's The Four Seasons violin concertos by sound-isolating headphones, whereas the patients in the isolation group wore the headphones but did not listen to music. All patients were sedated by 0.1 mg/kg midazolam and 1 mg/kg propofol. During the procedure, an additional 0.5 mg/kg propofol was administered as required. Bispectral index was used for quantifying the depth of sedation, and total dosage of the propofol was used for sedative requirements. The patients' heart rates, oxygen saturations, and Observer's Assessment of Alertness and Sedation Scale and bispectral index scores, which were monitored during the operation, were similar among the groups. In terms of the amount of propofol used, the groups were similar. Prolonged postoperative recovery cases were found to be significantly frequent in the control group, according to the recovery duration measurements (P = .004). Listening to music or providing sound isolation during pediatric dental interventions did not alter the sedation level, amount of medication, and hemodynamic variables significantly. This result might be due to the deep sedation levels reached during the procedures. However, listening to music and providing sound isolation might have contributed in shortening the postoperative recovery duration of the patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Finishing procedures action on mechanical characteristics of pressed ceramics

Directory of Open Access Journals (Sweden)

Mohamed Abdel Moniem Ahmed

2018-06-01

Conclusions& significance: Grinding & finishing procedures of pressed ceramics showed significant effect Of drill speed and polishing technique over flexural strength, As Grinding with no finishing and polishing procedure showed lowest flexural Strength values followed by finishing and polishing procedure followed by finishing and polishing with polishing paste procedure.

Procedural and Logic Programming: A Comparison.

Science.gov (United States)

Watkins, Will; And Others

1988-01-01

Examines the similarities and fundamental differences between procedural programing and logic programing by comparing LogoWriter and PROLOG. Suggests that PROLOG may be a good first programing language for students to learn. (MVL)

Peroral endoscopic myotomy: An emerging minimally invasive procedure for achalasia

Science.gov (United States)

Vigneswaran, Yalini; Ujiki, Michael B

2015-01-01

Peroral endoscopic myotomy (POEM) is an emerging minimally invasive procedure for the treatment of achalasia. Due to the improvements in endoscopic technology and techniques, this procedure allows for submucosal tunneling to safely endoscopically create a myotomy across the hypertensive lower esophageal sphincter. In the hands of skilled operators and experienced centers, the most common complications of this procedure are related to insufflation and accumulation of gas in the chest and abdominal cavities with relatively low risks of devastating complications such as perforation or delayed bleeding. Several centers worldwide have demonstrated the feasibility of this procedure in not only early achalasia but also other indications such as redo myotomy, sigmoid esophagus and spastic esophagus. Short-term outcomes have showed great clinical efficacy comparable to laparoscopic Heller myotomy (LHM). Concerns related to postoperative gastroesophageal reflux remain, however several groups have demonstrated comparable clinical and objective measures of reflux to LHM. Although long-term outcomes are necessary to better understand durability of the procedure, POEM appears to be a promising new procedure. PMID:26468336

The Effect of Massage on Anticipatory Anxiety and Procedural Pain in Patients with Burn Injury.

Science.gov (United States)

Najafi Ghezeljeh, Tahereh; Mohades Ardebili, Fatimah; Rafii, Forough; Manafi, Farzad

2017-01-01

Pain related to burn injuries is one of the most troublesome pain intensity. This study aimed to investigate the effect of massage on anticipatory anxiety, procedural pain intensity, vital signs and relaxation level of patients with burn injury. In this quasi-experimental study, through convenience sampling, 60 hospitalized adult burn patients were selected from a specialized burn and reconstructive hospital. Subjects were assigned to massage and control groups through simple randomization. Massage was offered by using non aromatic oil about 10-15 minutes before wound care on intact part of the body once a day for 20 minutes on patients' bedside for 3 consecutive days. In the 3 days, the control group did not received any massage and were asked to stay at bed. Demographic and clinical characteristics and vital signs, Visual Analogue Scale and the Persian version of Burn Specific Pain Anxiety Scale were used to determine baseline and procedural pain, anxiety and relaxation levels and anticipatory anxiety. No significant difference was noted between mean score of pain intensity, anxiety and relaxation level, and vital signs in massage and control groups after intervention following wound care. In massage and control groups, there was no significant differences between mean scores of anticipatory anxiety before and after intervention. There was no significant difference between the mean scores of anticipatory anxiety in massage and control groups after intervention prior wound care. Massage was shown not to have any effect on anticipatory anxiety and procedural pain.

Laparoscopy is safe among patients with congestive heart failure undergoing general surgery procedures.

Science.gov (United States)

Speicher, Paul J; Ganapathi, Asvin M; Englum, Brian R; Vaslef, Steven N

2014-08-01

Over the past 2 decades, laparoscopy has been established as a superior technique in many general surgery procedures. Few studies, however, have examined the impact of the use of a laparoscopic approach in patients with symptomatic congestive heart failure (CHF). Because pneumoperitoneum has known effects on cardiopulmonary physiology, patients with CHF may be at increased risk. This study examines current trends in approaches to patients with CHF and effects on perioperative outcomes. The 2005-2011 National Surgical Quality Improvement Program Participant User File was used to identify patients who underwent the following general surgery procedures: Appendectomy, segmental colectomy, small bowel resection, ventral hernia repair, and splenectomy. Included for analysis were those with newly diagnosed CHF or chronic CHF with new signs or symptoms. Trends of use of laparoscopy were assessed across procedure types. The primary endpoint was 30-day mortality. The independent effect of laparoscopy in CHF was estimated with a multiple logistic regression model. A total of 265,198 patients were included for analysis, of whom 2,219 were identified as having new or recently worsened CHF. Of these patients, there were 1,300 (58.6%) colectomies, 486 (21.9%) small bowel resections, 216 (9.7%) ventral hernia repairs, 141 (6.4%) appendectomies, and 76 (3.4%) splenectomies. Laparoscopy was used less frequently in patients with CHF compared with their non-CHF counterparts, particularly for nonelective procedures. Baseline characteristics were similar for laparoscopy versus open procedures with the notable exception of urgent/emergent case status (36.4% vs 71.3%; P surgery procedures, particularly in urgent/emergent cases. Despite these patterns and apparent preferences, laparoscopy seems to offer a safe alternative in appropriately selected patients. Because morbidity and mortality were considerable regardless of approach, further understanding of appropriate management in this

Effect of saliva decontamination procedures on shear bond strength of a one-step adhesive system.

Science.gov (United States)

Ülker, E; Bilgin, S; Kahvecioğlu, F; Erkan, A I

2017-09-01

To evaluate the effect of different saliva decontamination procedures on the shear bond strength of a one-step universal adhesive system (Single Bond™ Universal Adhesive, 3M ESPE, St. Paul, MN, USA). The occlusal surfaces of 75 human third molars were ground to expose dentin. The teeth were divided into the following groups: Group 1 (control group): Single Bond™ Universal Adhesive was applied to the prepared tooth according to the manufacturer's recommendations and light cured; no contamination procedure was performed. Group 2: Bonding, light curing, saliva contamination, and dry. Group 3: Bonding, light curing, saliva contamination, rinse, and dry. Group 4: After the procedure performed in Group 2, reapplication of bonding. Group 5: After the procedure performed in Group 3, reapplication of bonding. Then, composite resins were applied with cylindrical-shaped plastic matrixes and light cured. For shear bond testing, a notch-shaped force transducer apparatus was applied to each specimen at the interface between the tooth and composite until failure occurred. The data were statistically analyzed using one-way ANOVA. One-way ANOVA revealed significant differences in shear bond strength between the control group and experimental Groups 2 and 4 (P 0.05). The present in vitro study showed that water rinsing is necessary if cured adhesive resin is contaminated with saliva to ensure adequate bond strength.

Automated Kick Control Procedure for an Influx in Managed Pressure Drilling Operations

Directory of Open Access Journals (Sweden)

Jing Zhou

2016-01-01

Full Text Available Within drilling of oil and gas wells, the Managed Pressure Drilling (MPD method with active control of wellbore pressure during drilling has partly evolved from conventional well control procedures. However, for MPD operations the instrumentation is typically more extensive compared to conventional drilling. Despite this, any influx of formation fluids (commonly known as a kick during MPD operations is typically handled by conventional well control methods, at least if the kick is estimated to be larger than a threshold value. Conventional well control procedures rely on manual control of the blow out preventer, pumps, and choke valves and do not capitalize on the benefits from the instrumentation level associated with MPD. This paper investigates two alternative well control procedures specially adapted to backpressure MPD: the dynamic shut-in (DSI procedure and the automatic kick control (AKC procedure. Both methods capitalize on improvements in Pressure While Drilling (PWD technology. A commercially available PWD tool buffers high-resolution pressure measurements, which can be used in an automated well control procedure. By using backpressure MPD, the choke valve opening is tuned automatically using a feedback-feedforward control method. The two procedures are evaluated using a high fidelity well flow model and cases from a North Sea drilling operation are simulated. The results show that using AKC procedure reduces the time needed to establish control of the well compared to DSI procedure. It also indicates that the AKC procedure reduces the total kick size compared to the DSI procedure, and thereby reduces the risk of lost circulation.

Helicopter Flight Procedures for Community Noise Reduction

Science.gov (United States)

Greenwood, Eric

2017-01-01

A computationally efficient, semiempirical noise model suitable for maneuvering flight noise prediction is used to evaluate the community noise impact of practical variations on several helicopter flight procedures typical of normal operations. Turns, "quick-stops," approaches, climbs, and combinations of these maneuvers are assessed. Relatively small variations in flight procedures are shown to cause significant changes to Sound Exposure Levels over a wide area. Guidelines are developed for helicopter pilots intended to provide effective strategies for reducing the negative effects of helicopter noise on the community. Finally, direct optimization of flight trajectories is conducted to identify low noise optimal flight procedures and quantify the magnitude of community noise reductions that can be obtained through tailored helicopter flight procedures. Physically realizable optimal turns and approaches are identified that achieve global noise reductions of as much as 10 dBA Sound Exposure Level.

Radiologically assisted percutaneous gastrostomy or enterostomy. A retrospective analysis of 90 procedures

International Nuclear Information System (INIS)

Mildenberger, P.; Oberholzer, K.; Kauczor, H.U.; Dueber, C.; Kurz, S.; Schild, H.; Thelen, M.

1996-01-01

To analyse retrospectively the indications, technique and results of radiologically induced gastrostomies or enterostomies. Radiologically assisted gastrostomies or enterostomies were induced in 90 patients, mostly with high grade obstructions due to head and neck tumours or oesophageal tumours. 19/90 patients had had previous resection of the oesophagus or gastric operations. A catheter was successfully introduced in all patients. In 11/90 patients this was followed by a two-stage procedure. In 16/90 patients puncture was performed under CT control because of some anatomical peculiarity. Serious complication occurred in 9/90 patients but in only one was surgery necessary. There were no deaths resulting from the procedure but mortality after 30 days was 6.7%. Radiologically assisted gastrostomies or enterostomies are a reliable and effective form of treatment even amongst difficult patients. The results and complications are comparable to those from endoscopic procedures. (orig.) [de

Long terms results of Draf 3 procedure

NARCIS (Netherlands)

Georgalas, C.; Hansen, F.; Videler, W. J. M.; Fokkens, W. J.

2011-01-01

To assess the effectiveness and factors associated with restenosis after Draf type III (Endoscopic Modified Lothrop) frontal sinus drainage procedure. Retrospective analysis of prospectively collected data. A hundred and twenty two consecutive patients undergoing Draf III procedure for recalcitrant

Overview of double dosimetry procedures for the determination of the effective dose to the interventional radiology staff

International Nuclear Information System (INIS)

Jaervinen, H.; Buls, N.; Clerinx, P.; Jansen, J.; Miljanic, S.; Nikodemova, D.; Ranogajec-Komor, M.; D'Errico, F.

2008-01-01

In interventional radiology, for an accurate determination of effective dose to the staff, measurements with two dosemeters have been recommended, one located above and one under the protective apron. Such 'double dosimetry' practices and the algorithms used for the determination of effective dose were reviewed in this study by circulating a questionnaire and by an extensive literature search. The results indicated that regulations for double dosimetry almost do not exist and there is no firm consensus on the most suitable calculation algorithms. The calculation of effective dose is mainly based on the single dosemeter measurements, in which either personal dose equivalent, directly, (dosemeter below the apron) or a fraction of personal dose equivalent (dosemeter above the apron) is taken as an assessment of effective dose. The most recent studies suggest that there might not be just one double dosimetry algorithm that would be optimum for all interventional radiology procedures. Further investigations in several critical configurations of interventional radiology procedures are needed to assess the suitability of the proposed algorithms. (authors)

Effects of Frequent Glove Change on Outcomes of Orthopaedic Surgical Procedures - A Multicenter Study on Surgical Gloves

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Nishit Palo

2017-10-01

Full Text Available Introduction: Intact surgical gloves are a barrier to microorganisms migration between surgical team members and the patient. The surgical gloves are changed at various junctures but the effects of changing gloves during surgical procedures on various surgical parameters or clinical outcomes are not established. Aim: To determine rationale of glove change during orthopaedic procedures, differences amongst surgical parameters with and without changing the surgical gloves and whether frequent glove change affected surgical parameters or clinical outcomes. Materials and Methods: A prospective multicenter study conducted at three centers from January 2014 to January 2016. A 250 patients were divided into 2 groups (n=125 each in Group 1, surgical team operated with regular changing of gloves. In Group 2, only 1 set of double gloves were worn throughout the procedure. Surgical parameters or clinical outcomes were assessed for both the groups. Statistical analyses included the median, mode, range, Interquartile Range (IQR and sample standard deviation (s and independent-samples t-test. Bacterial counts were expressed as median with (IQR. Results: Surgical Timing Difference was 10 (S.D.- 4.2 minutes more in Group-1 (<0.05, Surgical Cost was higher in Group-1 by Rs.150-450 (<0.05. Outer glove micro-perforation rate was 5.85% and 8.15% in group-1 and 2 respectively with no inner glove perforation or Surgical Site Infections. Outer glove micro perforations were proportional to duration of surgery; operations lasting 120-210 and 61-120 minutes had 66.6% and 37.2% micro perforation rates respectively (p<0.05. Conclusion: Under standard operating conditions, procedures performed without glove change are shorter and cost effective than procedures performed with regular glove change with similar surgical and functional results. Judicious use of surgical gloves is a patient and environment friendly option, thereby reducing the hospital’s biomedical waste load.

Heuristic procedures for transmission planning in competitive electricity markets

International Nuclear Information System (INIS)

Lu, Wene; Bompard, Ettore; Napoli, Roberto; Jiang, Xiuchen

2007-01-01

The network structure of the power system, in an electricity market under the pool model, may have severe impacts on market performance, reducing market efficiency considerably, especially when producers bid strategically. In this context network re-enforcement plays a major role and proper strategies of transmission planning need to be devised. This paper presents, for pool-model electricity markets, two heuristic procedures to select the most effective subset of lines that would reduce the impacts on the market, from a set of predefined candidate lines and within the allowed budget for network expansion. A set of indices that account for the economic impacts of the re-enforcing of the candidate lines, both in terms of construction cost and market efficiency, are proposed and used as sensitivity indices in the heuristic procedure. The proposed methods are applied and compared with reference to an 18-bus test system. (author)

Dispersant field testing : a review of procedures and considerations

International Nuclear Information System (INIS)

Fingas, M.F.

2004-01-01

The effectiveness of a dispersant is defined by the amount of oil that the dispersant puts into the water column compared to the amount of oil that was initially spilled. Effectiveness is generally determined visually in plumes of dispersed oil that are visible from ships and aircraft. This paper describes 25 specific issues and technical concerns regarding field testing of dispersant effectiveness. Recent field tests were reviewed and literature that relates to testing procedures was sited. The 25 factors that are important for the appropriate outcome of dispersant field experiments include: mass balance; proper controls; analytical method; differential plume movement; time lag and length of time followed; mathematics of calculation and integration; lower and upper limits of analytical methods; use of remote sensing; thickness measurement; behaviour of oil with surfactant content; surfactant stripping; tracking surface oil and dispersed oil; recovering surface oil; visibility of oil from the surface; background levels of hydrocarbons; fluorescence of dispersant; herding; emulsion breaking; application success; heterogeneity of slick and plume; deposition measurements; true analytical standards; effect of wind on dispersant and slick; dispersant run-off; and weathering of the oil. It was concluded that the most important factors are the ability to determine mass balance, use proper controls, analytical methods and to avoid procedures that give incorrect results. 34 refs., 4 tabs., 1 fig

The effectiveness of sexual harassment policies and procedures at higher education institutions in South Africa

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Pierre Joubert

2011-02-01

Research purpose: The aim of this study was to investigate the awareness levels of academic staff members at higher education institutions in South Africa of sexual harassment policies and procedures in their institutions. Motivation for the study: A number of high profile court cases emphasised the need for effective policies to reduce the incidence of sexual harassment complaints. Research design, approach and method: A cross-sectional survey design was conducted amongst 161 academic staff members, representing 10 higher education institutions in South Africa. The measuring instrument that was used is the Sexual Harassment Questionnaire (SHQ that was developed specifically for this study. Main findings: The results showed that despite indications that sexual harassment policies do exist and that they are regarded as effective tools in addressing sexual harassment, the implementation of such policies is not effective and few academic staff members received training and/or guidance on the utilisation of the policy. Significant correlation coefficients were found between the elements of an effective policy and between population group and some of the elements. Practical/managerial implications: Employers across the board should regularly conduct an audit to determine the level of awareness of sexual harassment policies and procedures and plan interventions. Contribution: No other study in South Africa attempted to measure the awareness levels of academics and its impact on the management of sexual harassment.

Effect of episodic and working memory impairments on semantic and cognitive procedural learning at alcohol treatment entry.

Science.gov (United States)

Pitel, Anne Lise; Witkowski, Thomas; Vabret, François; Guillery-Girard, Bérengère; Desgranges, Béatrice; Eustache, Francis; Beaunieux, Hélène

2007-02-01

Chronic alcoholism is known to impair the functioning of episodic and working memory, which may consequently reduce the ability to learn complex novel information. Nevertheless, semantic and cognitive procedural learning have not been properly explored at alcohol treatment entry, despite its potential clinical relevance. The goal of the present study was therefore to determine whether alcoholic patients, immediately after the weaning phase, are cognitively able to acquire complex new knowledge, given their episodic and working memory deficits. Twenty alcoholic inpatients with episodic memory and working memory deficits at alcohol treatment entry and a control group of 20 healthy subjects underwent a protocol of semantic acquisition and cognitive procedural learning. The semantic learning task consisted of the acquisition of 10 novel concepts, while subjects were administered the Tower of Toronto task to measure cognitive procedural learning. Analyses showed that although alcoholic subjects were able to acquire the category and features of the semantic concepts, albeit slowly, they presented impaired label learning. In the control group, executive functions and episodic memory predicted semantic learning in the first and second halves of the protocol, respectively. In addition to the cognitive processes involved in the learning strategies invoked by controls, alcoholic subjects seem to attempt to compensate for their impaired cognitive functions, invoking capacities of short-term passive storage. Regarding cognitive procedural learning, although the patients eventually achieved the same results as the controls, they failed to automate the procedure. Contrary to the control group, the alcoholic groups' learning performance was predicted by controlled cognitive functions throughout the protocol. At alcohol treatment entry, alcoholic patients with neuropsychological deficits have difficulty acquiring novel semantic and cognitive procedural knowledge. Compared with

The price of surgery: markup of operative procedures in the United States.

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Gani, Faiz; Makary, Martin A; Pawlik, Timothy M

2017-02-01

Despite cost containment efforts, the price for surgery is not subject to any regulations. We sought to characterize and compare variability in pricing for commonly performed major surgical procedures across the United States. Medicare claims corresponding to eight major surgical procedures (aortic aneurysm repair, aortic valvuloplasty, carotid endartectomy, coronary artery bypass grafting, esophagectomy, pancreatectomy, liver resection, and colectomy) were identified using the Medicare Provider Utilization and Payment Data Physician and Other Supplier Public Use File for 2013. For each procedure, total charges, Medicare-allowable costs, and total payments were recorded. A procedure-specific markup ratio (MR; ratio of total charges to Medicare-allowable costs) was calculated and compared between procedures and across states. Variation in MR was compared using a coefficient of variation (CoV). Among all providers, the median MR was 3.5 (interquartile range: 3.1-4.0). MR was noted to vary by procedure; ranging from 3.0 following colectomy to 6.0 following carotid endartectomy (P < 0.001). MR also varied for the same procedure; varying the least after liver resection (CoV = 0.24), while coronary artery bypass grafting pricing demonstrated the greatest variation in MR (CoV = 0.53). Compared with the national average, MR varied by 36% between states ranging from 1.8 to 13.0. Variation in MR was also noted within the same state varying by 15% within the state of Arkansas (CoV = 0.15) compared with 51% within the state of Wisconsin (CoV = 0.51). Significant variation was noted for the price of surgery by procedure as well as between and within different geographical regions. Greater scrutiny and transparency in the price of surgery is required to promote cost containment. Copyright © 2016 Elsevier Inc. All rights reserved.

Effective dose to staff from interventional procedures: Estimations from single and double dosimetry

International Nuclear Information System (INIS)

Kuipers, G.; Velders, X. L.

2009-01-01

The exposure of 11 physicians performing interventional procedures was measured by means of two personal dosemeters. One personal dosemeter was worn outside the lead apron and an additional under the lead apron. The study was set up in order to determine the added value of a dosemeter worn under the lead apron. With the doses measured, the effective doses of the physicians were estimated using an algorithm for single dosimetry and two algorithms for double dosimetry. The effective doses calculated with the single dosimetry algorithm ranged from 0.11 to 0.85 mSv in 4 weeks. With the double dosimetry algorithms, the effective doses ranged from 0.02 mSv to 0.47 mSv. The statistical analysis revealed no significant differences in the accuracy of the effective doses calculated with single or double dosimetry algorithms. It was concluded that the effective dose cannot be considered a more accurate estimate when two dosemeters are used instead of one. (authors)

Dosimetric evaluation of mammary tomosynthesis procedures

International Nuclear Information System (INIS)

Silva, Rayre Janaína Vieira; Perini, Ana Paula; Santos, William de Souza; Vedovato, Uly P.; Neves, Lucio Pereira

2017-01-01

This work presents the results of the research on the evaluation of radiation doses usually applied in mammary procedures, using the Monte Carlo method. A virtual environment was created, to mimic the procedures room, including the room, its components, patient and source. The spectrum was obtained from the literature. The percentage of energy deposited compared to energy deposited in the breast was determined, and the scattered radiation was absorbed in specific areas. The regions of the head and neck were the most affected by scattered radiation. (author)

State Token Petri Net modeling method for formal verification of computerized procedure including operator's interruptions of procedure execution flow

International Nuclear Information System (INIS)

Kim, Yun Goo; Seong, Poong Hyun

2012-01-01

The Computerized Procedure System (CPS) is one of the primary operating support systems in the digital Main Control Room. The CPS displays procedure on the computer screen in the form of a flow chart, and displays plant operating information along with procedure instructions. It also supports operator decision making by providing a system decision. A procedure flow should be correct and reliable, as an error would lead to operator misjudgement and inadequate control. In this paper we present a modeling for the CPS that enables formal verification based on Petri nets. The proposed State Token Petri Nets (STPN) also support modeling of a procedure flow that has various interruptions by the operator, according to the plant condition. STPN modeling is compared with Coloured Petri net when they are applied to Emergency Operating Computerized Procedure. A converting program for Computerized Procedure (CP) to STPN has been also developed. The formal verification and validation methods of CP with STPN increase the safety of a nuclear power plant and provide digital quality assurance means that are needed when the role and function of the CPS is increasing.

Chemical vs. herbal formulations as pre-procedural mouth rinses to combat aerosol production: A randomized controlled study

OpenAIRE

Koduganti Rekha Rani; Manasa Ambati; Jammula Surya Prasanna; Indumathy Pinnamaneni; Panthula Veerendranath Reddy; Dasari Rajashree

2014-01-01

Background: Disease transmission and barrier techniques are the key concerns during ultrasonic instrumentation as this procedure has the hazard of aerosol production which has a multitude of deleterious effects on the body. The aerosol produced can affect both the patient and the clinician. The aim of this study was to assess the importance of pre-procedural rinsing before scaling by ultrasonic instrumentation and to compare the efficacy of commercially available herbal mouth rinse and a Chlo...

Possibilities for application of comparative advertising and its effects

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Starčević Slađana

2006-01-01

Full Text Available In recent years, it has been evident that one form of competitive advertising gained in its importance - comparative advertising. Although its extensive use has probably been inspired by the belief that the perception of relative superiority of a brand compared to competition could be encouraged in that way, research evidence suggested mixed conclusions about its effectiveness. The paper summarizes the results of previous studies in this area, and in particular those which point out the factors that can influence effectiveness of comparative advertising. Additionally,, the paper summarizes the opinions of some authors about the long-term influence of this form of advertising on brand, and gives the recommendations for its more effective use. .

House officer procedure documentation using a personal digital assistant: a longitudinal study

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Lane David R

2006-01-01

Full Text Available Abstract Background Personal Digital Assistants (PDAs have been integrated into daily practice for many emergency physicians and house officers. Few objective data exist that quantify the effect of PDAs on documentation. The objective of this study was to determine whether use of a PDA would improve emergency medicine house officer documentation of procedures and patient resuscitations. Methods Twelve first-year Emergency Medicine (EM residents were provided a Palm V (Palm, Inc., Santa Clara, California, USA PDA. A customizable patient procedure and encounter program was constructed and loaded into each PDA. Residents were instructed to enter information on patients who had any of 20 procedures performed, were deemed clinically unstable, or on whom follow-up was obtained. These data were downloaded to the residency coordinator's desktop computer on a weekly basis for 36 months. The mean number of procedures and encounters performed per resident over a three year period were then compared with those of 12 historical controls from a previous residency class that had recorded the same information using a handwritten card system for 36 months. Means of both groups were compared a two-tailed Student's t test with a Bonferroni correction for multiple comparisons. One hundred randomly selected entries from both the PDA and handwritten groups were reviewed for completeness. Another group of 11 residents who had used both handwritten and PDA procedure logs for one year each were asked to complete a questionnaire regarding their satisfaction with the PDA system. Results Mean documentation of three procedures significantly increased in the PDA vs handwritten groups: conscious sedation 24.0 vs 0.03 (p = 0.001; thoracentesis 3.0 vs 0.0 (p = 0.001; and ED ultrasound 24.5 vs. 0.0 (p = 0.001. In the handwritten cohort, only the number of cardioversions/defibrillations (26.5 vs 11.5 was statistically increased (p = 0.001. Of the PDA entries, 100% were entered

Relations among conceptual knowledge, procedural knowledge, and procedural flexibility in two samples differing in prior knowledge.

Science.gov (United States)

Schneider, Michael; Rittle-Johnson, Bethany; Star, Jon R

2011-11-01

Competence in many domains rests on children developing conceptual and procedural knowledge, as well as procedural flexibility. However, research on the developmental relations between these different types of knowledge has yielded unclear results, in part because little attention has been paid to the validity of the measures or to the effects of prior knowledge on the relations. To overcome these problems, we modeled the three constructs in the domain of equation solving as latent factors and tested (a) whether the predictive relations between conceptual and procedural knowledge were bidirectional, (b) whether these interrelations were moderated by prior knowledge, and (c) how both constructs contributed to procedural flexibility. We analyzed data from 2 measurement points each from two samples (Ns = 228 and 304) of middle school students who differed in prior knowledge. Conceptual and procedural knowledge had stable bidirectional relations that were not moderated by prior knowledge. Both kinds of knowledge contributed independently to procedural flexibility. The results demonstrate how changes in complex knowledge structures contribute to competence development.

Newmark's Procedures in Persian Translation of Golding's Lord of the Flies

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Habibollah Mashhady

2015-03-01

Full Text Available Numerous frameworks and procedures have been proposed for translation. In this regard, the Newmark’s proposed procedures have been widely discussed in translation studies. Yet, few studies have ever applied his procedures simultaneously for describing and assessing translations. This paper is an attempt to compare the translation procedures used in two Persian translations of Golding's Lord of the Flies by Rafiee and Mansoori based on Newmark's translation procedures. The main question is if the translator’s procedures can be described and assessed by Newmark’s framework or not. To do so, first, some chapters of the English novel were randomly selected, and then, they were compared with their corresponding parts in the Persian translations. Then, comparisons were classified and analyzed in terms of transliteration, shift, synonymy, modulation, addition, omission, as well as mistranslation to find out which procedures were used more by the two translators, and to show the extent of the mistranslated items in the two translations. The results showed that Newmark’s procedures are nearly comprehensive and worked well for translating and assessing the translation of a literary work.

TVT-Exact and midurethral sling (SLING-IUFT) operative procedures: a randomized study.

Science.gov (United States)

Aniuliene, Rosita; Aniulis, Povilas; Skaudickas, Darijus

2015-01-01

The aim of the study is to compare results, effectiveness and complications of TVT exact and midurethral sling (SLING-IUFT) operations in the treatment of female stress urinary incontinence (SUI). A single center nonblind, randomized study of women with SUI who were randomized to TVT-Exact and SLING-IUFT was performed by one surgeon from April 2009 to April 2011. SUI was diagnosed on coughing and Valsalva test and urodynamics (cystometry and uroflowmetry) were assessed before operation and 1 year after surgery. This was a prospective randomized study. The follow up period was 12 months. 76 patients were operated using the TVT-Exact operation and 78 patients - using the SLING-IUFT operation. There was no statistically significant differences between groups for BMI, parity, menopausal status and prolapsed stage (no patients had cystocele greater than stage II). Mean operative time was significantly shorter in the SLING-IUFT group (19 ± 5.6 min.) compared with the TVT-Exact group (27 ± 7.1 min.). There were statistically significant differences in the effectiveness of both procedures: TVT-Exact - at 94.5% and SLING-IUFT - at 61.2% after one year. Hospital stay was statistically significantly shorter in the SLING-IUFT group (1. 2 ± 0.5 days) compared with the TVT-Exact group (3.5 ± 1.5 days). Statistically significantly fewer complications occurred in the SLING-IUFT group. the TVT-Exact and SLING-IUFT operations are both effective for surgical treatment of female stress urinary incontinence. The SLING-IUFT involved a shorter operation time and lower complications rate., the TVT-Exact procedure had statistically significantly more complications than the SLING-IUFT operation, but a higher effectiveness.

Still special? Harvesting procedures for industrial hemp

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Hans-Jörg Gusovius

2016-01-01

Full Text Available A multitude of different harvesting procedures is available after the re-approval of hemp growing in Germany about 20 years ago. Established, but as well recent machine developments enable the supply of raw materials for further processing or as food and feed materials. The necessary specialization level results in high but, compared to other established crops, not exceeding procedural costs. In this study, harvesting procedures and technologies are analyzed that are currently used under Northern European cultivation conditions. However, technological enhancements are still needed in order to improve the competitiveness of fibre hemp in the crop rotation as well as of hemp-based semi-finished and finished products.

Prospective Randomized Controlled Trial Comparing Plasmakinetic Vaporesection and Conventional Transurethral Resection of the Prostate

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Berry Tat-Chow Fung

2005-01-01

Conclusion: PKVP achieved comparable results to traditional TURP and was an effective and safe procedure. However, it did not demonstrate obvious advantages over TURP in this acute regional hospital regular TURP list setting.

Health Code Number (HCN) Development Procedure

Energy Technology Data Exchange (ETDEWEB)

Petrocchi, Rocky; Craig, Douglas K.; Bond, Jayne-Anne; Trott, Donna M.; Yu, Xiao-Ying

2013-09-01

This report provides the detailed description of health code numbers (HCNs) and the procedure of how each HCN is assigned. It contains many guidelines and rationales of HCNs. HCNs are used in the chemical mixture methodology (CMM), a method recommended by the department of energy (DOE) for assessing health effects as a result of exposures to airborne aerosols in an emergency. The procedure is a useful tool for proficient HCN code developers. Intense training and quality assurance with qualified HCN developers are required before an individual comprehends the procedure to develop HCNs for DOE.

On Procedural Freedom of Choice

NARCIS (Netherlands)

Arlegi, R.; Dimitrov, D.A.

2004-01-01

Numerous works in the last decade have analyzed the question of how to compare opportunity sets as a way to measure and evaluate individual freedom of choice.This paper defends that, in many contexts, external procedural aspects that are associated to an opportunity set should be taken into account

[Ultrasonography-guided therapeutic procedures in the neck region].

Science.gov (United States)

Brzac, Hrvojka Tomić

2009-12-01

Minimally invasive therapeutic procedures in medicine have become very popular because of the reduced risk compared to classic surgical treatment, speed of recovery, little or no side effects, and frequently lower cost. One of these methods is ultrasonography-guided percutaneous injection of 95% ethanol (PEIT, percutaneous ethanol injection therapy), which is especially suitable for the neck region. Other methods like laser photocoagulation (ILP) or radiofrequency ablation (RFA) are more aggressive and expensive. The procedure of sterile 95% ethanol injecting is performed on an outpatient basis, without preparation. A specific amount of alcohol is injected into the lesion using a thin spinal needle, under ultrasonography guidance. The amount of alcohol depends on the size of the lesion. Complications are rare and the procedure can be repeated several times. PEIT is used in the treatment of parathyroid glands, especially secondary hyperparathyroidism, thyroid nodules (toxic adenoma, goiters and cysts), other cysts on the neck, and cervical metastases of thyroid cancer. Direct ethanol injection into the tissue causes cellular dehydration and protein denaturation, followed by the development of necrosis, fibrosis, and thrombosis of the small blood vessels. In this way, reduction or disappearance of the nodes can be achieved, along with functional normalization (for parathyroid glands and toxic adenoma), with longer or shorter disease remission or complete recovery. Today, PEIT is mostly used in dialyzed patients with secondary hyperparathyroidism. The treatment gives best results in combination with vitamin D analogs, if 1-2 parathyroid glands are enlarged, and for residual parathyroid gland after parathyroidectomy. A success rate of 50%-70% has been reported, depending on the number of enlarged parathyroid glands. Therapeutic effect is manifested in the size reduction or complete fibrozation of the gland, reduction or disappearance of vascularization, and a decrease

Comparing eye tracking with electrooculography for measuring individual sentence comprehension duration

DEFF Research Database (Denmark)

Müller, Jana Annina; Wendt, Dorothea; Kollmeier, Birger

2016-01-01

The aim of this study was to validate a procedure for performing the audio-visual paradigm introduced by Wendt et al. (2015) with reduced practical challenges. The original paradigm records eye fixations using an eye tracker and calculates the duration of sentence comprehension based on a bootstrap...... procedure. In order to reduce practical challenges, we first reduced the measurement time by evaluating a smaller measurement set with fewer trials. The results of 16 listeners showed effects comparable to those obtained when testing the original full measurement set on a different collective of listeners...

Influences of palatoplasty by the push-back procedure on craniofacial morphology and growth.

Science.gov (United States)

Iwasaki, Hiroshi; Kudo, Motonori; Yamamoto, Yuko

2012-12-01

For patients with a cleft palate, the push-back procedure which accompanies posterior shifting of palatal flap is thought to be most effective way of. achieving adequate velopharyngeal function. In this study, we aimed to evaluate the influences of the push-back procedure on the craniofacial morphology and its growth. Using cephalometry we compared the craniofacial morphology and growth of three groups of Japanese children, living in the same region (Hokkaido, Japan). 1) 28 children (13 girls and 15 boys) with operated submucous cleft palates at the ages of 9 and 14 respectively. 2) 12 age-matched children (7 girls and 5 boys) with unoperated submucous cleft palates. 3) 60 age-matched non-cleft children (30 girls and 30 boys) with normal occlusion. None of them received dentofacial orthopaedic treatment. While the patients who had been operated on had significant differences in posterior upper facial height and inclination of the palatal plane when compared with non-cleft children or unoperated cleft children, they showed no statistically significant difference in anteroposterior positioning of anterior part of the maxilla, compared with the unoperated. The influences of palatoplasty by the push-back procedure with posterior positioning of the palatal flaps on craniofacial morphology are additional to the cleft palate, and of minor concern. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

Effect of low-level laser therapy on wound healing after depigmentation procedure: A clinical study

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Kirti Chawla

2016-01-01

Full Text Available Aim: The aim of the present study is to evaluate and compare the effects of low-level laser therapy (LLLT on wound healing after depigmentation procedure. Materials and Methods: In this study, 12 patients with bilateral melanin hyperpigmentation were treated with surgical stripping using a blade. After completion of the surgical process and bleeding stasis, any of the symmetrical surgical sites was randomly assigned for LLLT (test site using a defocused diode laser at 1 mm distance for 5 min. After every laser exposure, the surgical site was coated with plaque disclosing solution (erythrosine on the 3rd, 7th, and 15th day. A photograph of the surgical site was taken using a Digital SLR Camera, which was placed at 30 cm distance at 55 mm zoom, 1/100 shutter speed, f 14 aperture size, and ISO 4000 with a ring flash. The area of the stained parts of the photographs was evaluated using image analysis software. Results: At day 3, test site showed 1.26 ± 0.23 mm2 and control site showed 1.45 ± 0.21 mm2 stain uptake by the tissue which was statistically significant. At day 7 and day 15, the test sites exhibited 1.24 ± 0.30 mm2 and 1.12 ± 0.25 mm2 stain uptake, whereas the control site showed 1.37 ± 25 mm2 and 1.29 ± 0.28 mm2 staining, respectively, which were not statistically significant. Conclusion: Within the limitations of this study, the findings revealed that LLLT promotes wound healing after depigmentation procedure until the 3rd day. On the 7th and 15th day, the difference in healing was not statistically significant.

Radiation doses to patients in haemodynamic procedures

International Nuclear Information System (INIS)

Canadillas-Perdomo, B.; Catalan-Acosta, A.; Hernandez-Armas, J.; Perez-Martin, C.; Armas-Trujillo, D. de

2001-01-01

Interventional radio-cardiology gives high doses to patients due to high values of fluoroscopy times and large series of radiographic images. The main objective of the present work is the determination of de dose-area product (DAP) in patients of three different types of cardiology procedures with X-rays. The effective doses were estimated trough the organ doses values measured with thermoluminescent dosimeters (TLDs-100), suitable calibrated, placed in a phantom type Rando which was submitted to the same radiological conditions corresponding to the procedures made on patients. The values for the effective doses in the procedures CAD Seldinger was 6.20 mSv on average and 1.85mSv for pacemaker implants. (author)

Radiation doses to patients in haemodynamic procedures

Energy Technology Data Exchange (ETDEWEB)

Canadillas-Perdomo, B; Catalan-Acosta, A; Hernandez-Armas, J [Servicio de Fisica Medica, Hospital Universitario de Canarias, La Laguna, Tenerife (Spain); Perez-Martin, C [Servicio de Ingenieria Biomedica, Hospital Universitario de Canarias, La Laguna, Tenerife (Spain); Armas-Trujillo, D de [Servicio de Cardiologia, Hospital Universitario de Canarias, La Laguna, Tenerife (Spain)

2001-03-01

Interventional radio-cardiology gives high doses to patients due to high values of fluoroscopy times and large series of radiographic images. The main objective of the present work is the determination of de dose-area product (DAP) in patients of three different types of cardiology procedures with X-rays. The effective doses were estimated trough the organ doses values measured with thermoluminescent dosimeters (TLDs-100), suitable calibrated, placed in a phantom type Rando which was submitted to the same radiological conditions corresponding to the procedures made on patients. The values for the effective doses in the procedures CAD Seldinger was 6.20 mSv on average and 1.85mSv for pacemaker implants. (author)

Patients exposure assessment for radiographic procedures in diagnostic radiology

International Nuclear Information System (INIS)

Arandjic, D.; Ciraj-Bjelac, O.; Stankovic, K.; Lazarevic, Dj.; Ciraj-Bjelac, O.)

2007-01-01

In this work the results of dose assessment for the most frequent radiographic procedures in diagnostic radiology are shown. Entrance surface doses were assessed for 7 radiographic procedures. Three hospitals, six x-ray units in total, were enrolled in investigation. Patient doses were estimated based on results of x-ray tube output measurements. Finally, doses were compared with Diagnostic reference level. Higher dose values were observed for chest examinations. In comparison with results from other countries, doses from this procedure in Serbia are significantly higher. Estimated doses for other procedures were well below Diagnostic reference levels [sr

Estimating the subjective value of future rewards: comparison of adjusting-amount and adjusting-delay procedures.

Science.gov (United States)

Holt, Daniel D; Green, Leonard; Myerson, Joel

2012-07-01

The present study examined whether equivalent discounting of delayed rewards is observed with different experimental procedures. If the underlying decision-making process is the same, then similar patterns of results should be observed regardless of procedure, and similar estimates of the subjective value of future rewards (i.e., indifference points) should be obtained. Two experiments compared discounting on three types of procedure: adjusting-delay (AD), adjusting-immediate-amount (AIA), and adjusting-delayed-amount (ADA). For the two procedures for which discounting functions can be established (i.e., AD and AIA), a hyperboloid provided good fits to the data at both the group and individual levels, and individuals' discounting on one procedure tended to be correlated with their discounting on the other. Notably, the AIA procedure produced the more consistent estimates of the degree of discounting, and in particular, discounting on the AIA procedure was unaffected by the order in which choices were presented. Regardless of which of the three procedures was used, however, similar patterns of results were obtained: Participants systematically discounted the value of delayed rewards, and robust magnitude effects were observed. Although each procedure may have its own advantages and disadvantages, use of all three types of procedure in the present study provided converging evidence for common decision-making processes underlying the discounting of delayed rewards. Copyright © 2012 Elsevier B.V. All rights reserved.

Emergency Physician Awareness of Prehospital Procedures and Medications

Directory of Open Access Journals (Sweden)

Rachel Waldron

2014-07-01

Full Text Available Introduction: Maintaining patient safety during transition from prehospital to emergency department (ED care depends on effective handoff communication between providers. We sought to determine emergency physicians’ (EP knowledge of the care provided by paramedics in terms of both procedures and medications, and whether the use of a verbal report improved physician accuracy. Methods: We conducted a 2-phase observational survey of a convenience sample of EPs in an urban, academic ED. In this large ED paramedics have no direct contact with physicians for non-critical patients, giving their report instead to the triage nurse. In Phase 1, paramedics gave verbal report to the triage nurse only. In Phase 2, a research assistant (RA stationed in triage listened to this report and then repeated it back verbatim to the EPs caring for the patient. The RA then queried the EPs 90 minutes later regarding their patients’ prehospital procedures and medications. We compared the accuracy of these 2 reporting methods. Results: There were 163 surveys completed in Phase 1 and 116 in Phase 2. The oral report had no effect on EP awareness that the patient had been brought in by ambulance (86% in Phase 1 and 85% in Phase 2. The oral report did improve EP awareness of prehospital procedures, from 16% in Phase 1 to 45% in Phase 2, OR=4.28 (2.5-7.5. EPs were able to correctly identify all oral medications in 18% of Phase 1 cases and 47% of Phase 2 cases, and all IV medications in 42% of Phase 1 cases and 50% of Phase 2 cases. The verbal report led to a mild improvement in physician awareness of oral medications given, OR=4.0 (1.09-14.5, and no improvement in physician awareness of IV medications given, OR=1.33 (0.15-11.35. Using a composite score of procedures plus oral plus IV medications, physicians had all three categories correct in 15% of Phase 1 and 39% of Phase 2 cases (p<0.0001. Conclusion: EPs in our ED were unaware of many prehospital procedures and

FREY’S PROCEDURE- TO ANALYSE THE OUTCOME OF THIS PROCEDURE IN CHRONIC PANCREATITIS

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Shilpa Mariappa Casaba

2017-04-01

Full Text Available BACKGROUND Chronic Pancreatitis (CP is a progressive inflammatory disease characterised by debilitating pain and pancreatic insufficiency. There is enormous personal and socio-economic impact on impairment of quality of life, inability to work and even shortening of life expectancy. Although, pancreaticoduodenectomy had been considered the standard surgical procedure for patients with CP because of its high post-op complications with exocrine and endocrine insufficiency, it is not preferred. This has led to a hybrid procedure described by Frey’s, which is used in our study for CP. We aim to analyse the short-term and long-term outcomes of Frey’s procedure at a tertiary care center in patients with chronic pancreatitis. MATERIALS AND METHODS A retrospective review of all CP patients who underwent Frey procedure were reviewed from January 2007-January 2016. Perioperative variables, short-term (30 days and long-term (3 years outcomes were reviewed. Data are frequency (% or mean. RESULTS A total of 97 patients underwent Frey’s procedure. A total of 72 (70.7% were men and 25 (29.3% were women. Mean age was 38 years (range 14-66 years. Indications for surgery included intractable pain (n=97, 100% and obstructive jaundice (n=4, 4.3%. 9 patients (32.6% were diabetic preoperatively. Concomitant procedures include biliary drainage procedure was done for 4 patients (4.3%, i.e. choledochojejunostomy and splenectomy for 2 patients (2.1%, cholecystectomy (n=6, 6%. Short-term outcomes include surgical site infection (n=10, 10%, pancreatic leak (n=6, 5.82% and 2 patients required reoperation for bleeding and no mortality (30 days, diabetic ketoacidosis (n=2, 2%. Pancreatic carcinoma was detected in 3 (2.1% patients. Long-term outcomes include pain free status (n=80, 86.9%, median follow-up of 3 years. Redo pancreatic procedure was performed in 1 (4.3% for anastomotic leak. CONCLUSION Frey’s procedure is a safe and effective pain palliative option for CP

Estimating Effective Dose from Phantom Dose Measurements in Atrial Fibrillation Ablation Procedures and Comparison of MOSFET and TLD Detectors in a Small Animal Dosimetry Setting

Science.gov (United States)

Anderson-Evans, Colin David

Two different studies will be presented in this work. The first involves the calculation of effective dose from a phantom study which simulates an atrial fibrillation (AF) ablation procedure. The second involves the validation of metal-oxide semiconducting field effect transistors (MOSFET) for small animal dosimetry applications as well as improved characterization of the animal irradiators on Duke University's campus. Atrial Fibrillation is an ever increasing health risk in the United States. The most common type of cardiac arrhythmia, AF is associated with increased mortality and ischemic cerebrovascular events. Managing AF can include, among other treatments, an interventional procedure called catheter ablation. The procedure involves the use of biplane fluoroscopy during which a patient can be exposed to radiation for as much as two hours or more. The deleterious effects of radiation become a concern when dealing with long fluoroscopy times, and because the AF ablation procedure is elective, it makes relating the risks of radiation ever more essential. This study hopes to quantify the risk through the derivation of dose conversion coefficients (DCCs) from the dose-area product (DAP) with the intent that DCCs can be used to provide estimates of effective dose (ED) for typical AF ablation procedures. A bi-plane fluoroscopic and angiographic system was used for the simulated AF ablation procedures. For acquisition of organ dose measurements, 20 diagnostic MOSFET detectors were placed at selected organs in a male anthropomorphic phantom, and these detectors were attached to 4 bias supplies to obtain organ dose readings. The DAP was recorded from the system console and independently validated with an ionization chamber and radiochromic film. Bi-plane fluoroscopy was performed on the phantom for 10 minutes to acquire the dose rate for each organ, and the average clinical procedure time was multiplied by each organ dose rate to obtain individual organ doses. The