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Sample records for electrosurgical excisional procedure

  1. Pregnancy outcome after loop electrosurgical excision procedure: a systematic review.

    Science.gov (United States)

    Crane, Joan M G

    2003-11-01

    To examine the association of loop electrosurgical excision procedure (LEEP) and subsequent pregnancy outcomes. A computerized search of MEDLINE and PubMed was conducted using the keys words "pregnancy" and "loop electrosurgical excision procedure," "LEEP," "LETZ," "LLETZ," or "loop excision." References from identified publications were manually searched and cross referenced to identify additional relevant articles. Studies were included that compared women who had had LEEP to women who had not had the procedure and that reported on subsequent pregnancy outcomes. Studies were excluded if there was no control group, if the LEEP was performed during the pregnancy, or if only an abstract was available. Five of 36 articles identified met the criteria for systematic review. Women who had had LEEP were more likely to have preterm birth (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.18, 2.76; P = .006) and low birth weight infants (precipitous labor, labor induction, or neonatal intensive care unit admission. A subgroup analysis including only studies matching for smoking status revealed that preterm birth was still more common in women who had had LEEP (OR 2.53, 95% CI 1.42, 4.49; P = .001), but birth weight under 2500 g was no longer significantly different. LEEP appears to be associated with subsequent preterm birth, even when smoking status is matched. Studies with adequate sample size are needed to further evaluate the relationship of LEEP and preterm birth, controlling for potential confounders, including depth of the tissue sample.

  2. Loop electrosurgical excision procedure in vulvar intraepithelial neoplasia treatment.

    Science.gov (United States)

    Vlastos, Anne-Thérèse; Levy, Larry B; Malpica, Anais; Follen, Michele

    2002-10-01

    OBJECTIVE.: Our objective was to compare by response rate the therapeutic options of loop electrosurgical excision procedure (LEEP), laser therapy, and wide local excision in managing high-grade vulvar intraepithelial neoplasia in a pilot study for a randomized clinical trial. MATERIALS AND METHODS.: Between 1995 and 1999, 109 patients presenting with vulvar lesions were registered at a comprehensive cancer center and 2 associated colposcopy clinics. From these 109, we identified 74 patients with lesions histologically proven to be vulvar intraepithelial neoplasia who underwent treatment with CO2 laser, wide local excision, or LEEP. Clinical and pathological features were reviewed retrospectively. Wilcoxon rank sum test and life table analyses were used to compare groups. Response rates for this retrospective study will be used to calculate the sample size for a prospective clinical trial. RESULTS.: Our population was similar to others reported in the literature in age, range of diagnoses, and follow-up. Only 1 of 74 patients (1%) had invasive cancer. In a subset of 62 patients treated for the first time, LEEP and wide local excision were equal in their ability to achieve complete response. Laser ablation was the least successful of all methods (10/20 with laser, 3/20 with LEEP, and 2/22 with wide local excision experienced recurrences [p = .04]). No statistically significant differences among the 3 were noted in time to recurrence (p = .24). Age, age at first intercourse, and number of sexual partners were not correlated with recurrence and did not confound the results. Using a chi approximation, an alpha error of 0.05, and a power of 0.80, researchers should enroll 25 patients per arm if improvement over standard therapy is expected to be 40%, 45 if expected to be 30%, and 95 if expected to be 20%. CONCLUSIONS.: Because of differences in recurrence rate and length of hospital stay and indications of potential differences in cost found in this pilot, LEEP merits

  3. Effects of Music Listening During Loop Electrosurgical Excision Procedure on Pain and Anxiety: A Randomized Trial.

    Science.gov (United States)

    Chantawong, Nopwaree; Charoenkwan, Kittipat

    2017-10-01

    The aim of the study was to compare pain, anxiety, and satisfaction between women, who listened to music, and those who did not during loop electrosurgical excision procedure (LEEP). Participants were randomly assigned into two groups. In group 1 (music), the participants listened to relaxing instrumental music through the stereo headset from the time of arrival at the preoperative waiting room until the procedure completed. For group 2 (control), the participants underwent LEEP without music listening. The women rated pain, anxiety, and satisfaction according to 10-cm visual analog scales. Pain was assessed at the time of speculum insertion (baseline pain) and immediately after the LEEP completed (procedural pain). Anxiety and satisfaction were examined just before starting the LEEP and 10 minutes after the procedure completed. One hundred fifty patients (74 in music group and 76 in control group) participated. Mean baseline pain scores after speculum insertion were comparable between the groups (3.7 in the music group vs. 3.5 in the control group, p = .55). Mean procedural pain scores were not different between the groups (4.7 in the music group vs. 5.2 in the control group, p = .32). The differences of the procedural pain scores from baseline were statistically comparable between the study groups (0.9 in the music group vs. 1.7 in the control group, p = .15). There were no significant differences in anxiety and satisfaction scores at any time points assessed between the groups. The effects of music listening on reducing pain and anxiety during LEEP could not be demonstrated in this study.

  4. Loop electrosurgical excision procedure and risk of preterm birth: a systematic review and meta-analysis.

    Science.gov (United States)

    Conner, Shayna N; Frey, Heather A; Cahill, Alison G; Macones, George A; Colditz, Graham A; Tuuli, Methodius G

    2014-04-01

    To assess whether loop electrosurgical excision procedure (LEEP) increases the risk for preterm birth before 37 weeks of gestation and clarify whether the increased risk for preterm birth is attributable to the procedure itself or to risk factors associated with cervical dysplasia. Two authors performed a search of the relevant data through February 2013 using PubMed, Embase, Scopus, CENTRAL, and ClinicalTrials.gov. We included observational studies that compared rates of preterm birth in women with prior LEEP with women with no history of cervical excision. Nineteen of 559 identified studies met selection criteria. We compared women with a history of LEEP with two unexposed groups without a history of cervical excision: 1) women with an unknown or no history of cervical dysplasia; and 2) women with a history of cervical dysplasia but no cervical excision. The primary outcome was preterm birth before 37 weeks of gestation. Secondary outcomes were preterm birth before 34 weeks of gestation, spontaneous preterm birth, preterm premature rupture of membranes, and perinatal mortality. DerSimonian-Laird random effects models were used. We assessed heterogeneity between studies using the Q and I tests. Stratified analyses and metaregression were performed to assess confounding. Nineteen studies were included with a total of 6,589 patients with a history of LEEP and 1,415,015 without. Overall, LEEP was associated with an increased risk of preterm birth before 37 weeks of gestation (pooled relative risk 1.61, 95% confidence interval [CI] 1.35-1.92). However, no increased risk was found when women with a history of LEEP were compared with women with a history cervical dysplasia but no cervical excision (pooled relative risk 1.08, 95% CI 0.88-1.33). Women with a history of LEEP have similar risk of preterm birth when compared with women with prior dysplasia but no cervical excision. Common risk factors for both preterm birth and dysplasia likely explain findings of

  5. 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

  6. Electrosurgical plasmas

    Energy Technology Data Exchange (ETDEWEB)

    Stalder, Kenneth R; McMillen, Donald F; Woloszko, Jean [ArthroCare Corp., Sunnyvale, CA 94085-3523 (United States)

    2005-06-07

    Electrosurgical medical devices based on repetitively pulsed nonequilibrium micron-scale to millimetre-scale plasma discharges in saline solutions are described. The formation of vapour layers (bubbles) around active electrodes appears to be a common feature at moderate (<300 V rms) voltages, and dissociation, excitation and ionization of the vapour in these bubbles produces chemical conditions that are thought to be the source of beneficial tissue removal and treatment. Experimental data are discussed, as are the results of modelling efforts of the plasma chemistry. Hydroxyl radicals, hydrogen atoms and other species are observed spectroscopically and their interactions with collagen, a common component of tissue encountered in surgical situations, are considered. Several pathways by which hydroxyl radicals interacting with collagen can lead to tissue removal are discussed.

  7. Electrosurgical units.

    Science.gov (United States)

    1997-11-01

    Electrosurgical units (ESUs) have been used for decades for surgical cutting and hemostasis. In this study, we evaluate eight full-featured, high-power, solid-state ESUs from four suppliers. We examined these units--all of which can be used for the vast majority of electrosurgical applications--for performance and safety, human factors design, and maintenance and durability. We found that all the evaluated units performed well in our testing and met our safety requirements; thus, we rated them all Acceptable. We did, however, identify a few noteworthy differences that separated some of the evaluated units from each other, as well as from the majority of units that have been in use for a decade or more. The most important of these factors were (i) the availability of new types of output modes (e.g., non-power-controlled modes, low-voltage modes) that produce differences in surgical effect and (2) the presence of certain characteristics and features (e.g., cutting modes with a broad power curve, programmable settings-memory features) that users indicated were helpful. Although we considered these distinguishing factors to be significant, we recognize that the full clinical impact of these developments has not yet been realized. And the ability of an institution to take advantage of any benefits such developments could offer will depend to a large degree on user technique. In this Evaluation, we also present a comprehensive overview of ESU technology; a Technology Management Guide, in which we offer strategies for managing the risks associated with electrosurgery; and an ESU Purchasing Guide, in which we offer guidance for determining the type and model of ESU that will best meet an institution's needs. In a future issue of Health Devices (scheduled for early 1998), we will be publishing an Evaluation of several moderate-power ESUs. These devices can be used for most of the same applications as the high-power units, but they cost much less.

  8. [Diagnosis and treatment value of colposcopy and loop electrosurgical excision procedure in microinvasive cervical cancer: analysis of 135 cases].

    Science.gov (United States)

    Xiao, F Y; Wang, Q; Zheng, R L; Chen, M; Su, T T; Sui, L

    2016-03-01

    To explore the sensitivity and specificity of colposcopy directed biopsy (CDB) and the value of loop electrosurgical excision procedure (LEEP) for the diagnosis and treatment of microinvasive cervical cancer (MCC). One hundred and thirty five patients with MCC were diagnosed with LEEP in Obstetrics and Gynecology Hospital, Fudan University from April 2008 to November 2010, and were retrospectively analyzed on CDB diagnoses and following treatment after LEEP. According to patient's desire for preservation of fertility and cone margin status, following strategies after LEEP included follow-up, second LEEP, hysterectomy, modified radical hysterectomy and radical hysterectomy. Single and multiple factors related to residual lesions after LEEP were analysed with Pearson Chi-square test and logistic regression model, respectively. CDB diagnosed MCC with a sensitivity of 4.4 % (6/135), specificity of 100.0% (4 680/4 680), and false negative rate of 95.6% (129/135). Among the 135 patients, 29 did not receive further treatment in our hospital and lost contact. One hundred and six patients had secondary treatment or follow-up in our hospital, 4 of among which were closely followed up; one hundred and two received further treatment, which included 6 cases with second LEEP (3 received extrafascial hysterectomy after repeat LEEP), 59 cases hysterectomy, 14 cases modified radical hysterectomy and 26 cases radical hysterectomy. For factors related to residual lesions after LEEP, single factor analysis showed that the ratio of residual lesion in patients aged 27-39, 40-49 and 50-65 years were respectively 19.0% (11/58), 15.4% (10/65) and 5/12 (χ(2)=4.505, P=0.105). Residual lesions occurred in 24.7% (23/93) of patients with positive LEEP margins, which was more than that 7.1% (3/42) of patients with negative LEEP margins (χ(2)=5.756, P=0.016). The ratio of residual lesions in patients with positive endocervical, ectocervical and deep stromal margins were respectively 29

  9. Are Incisional and Excisional Skin Tension Lines Biomechanically Different? Understanding the Interplay between Elastin and Collagen during Surgical Procedures

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    Sharad P. Paul

    2017-06-01

    Full Text Available Background: Since Langer’s first foray into studying cutaneous lines, although people have studied skin lines across the body, there has not been a study that elucidates changes to skin structure of elastin and collagen at different load levels. This study set out to look at whether incisional lines and excisional lines have different biodynamics and have to be considered differently. Materials and Methods: For this study, we used a two-photon microscopic camera using optimal wavelengths to detect collagen and elastin. Measurements were taken in 5 patients at the center of the excisional wound (high-load and at the ends of the wound (tapered end of the ellipse where effectively the wound is an incisional wound. Results: Wounds were observed after they were surgically closed. When incisional wounds were observed, where there was minimal tension (< 1.5 N force we found that, in each case, elastin stretched and collagen buckled, revealing mostly elastin. Where larger defects were created after excisions (as in the figure where a skin cancer had been removed, where forces to close wounds were typically greater than 2N, we noted that the image revealed mostly collagen, suggesting that the reverse had occurred (i.e. collagen stretched and elastin buckled. Conclusion: This difference between tension loads on skin and the interplay between collagen and elastin has never before been elucidated for incisional and excisional wounds, and in the author’s view has great research interest for a cutaneous surgeon seeking to identify the best skin lines to utilize to minimize scarring.

  10. Loop electrosurgical excision of the cervix and risk for spontaneous preterm delivery in twin pregnancies

    DEFF Research Database (Denmark)

    Noehr, Bugge; Jensen, Allan; Frederiksen, Kirsten

    2009-01-01

    OBJECTIVE: To investigate the association between three cervical procedures (biopsy with no treatment, ablation, and loop electrosurgical excision procedure [LEEP]) and subsequent spontaneous preterm delivery in twin pregnancies using population-based data from various nationwide registries. METH...

  11. Clinical and radiographic comparison of primary molars after formocresol and electrosurgical pulpotomy: A randomized clinical trial

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    Bahrololoomi Zahra

    2008-01-01

    Full Text Available Background: Vital pulpotomy is a single-stage procedure defined as the surgical amputation of the coronal portion of exposed vital pulp, usually as a means of preserving the vitality and function of the remaining radicular portion. Objectives : The aim of this study was to compare the clinical and radiographic success rates for electrosurgical vs formocresol pulpotomy in human primary molar teeth. Settings and Design: This was a prospective, randomized clinical trial. Materials and Methods: In this randomized clinical trial, pulpotomies were performed on 70 primary molars in children aged 5-10 years. The teeth were treated using either a conventional formocresol (35 teeth or electrosurgical technique (35 teeth. Following the pulpotomy procedure, the teeth were evaluated for clinical and radiographic success for three, six and nine months. The teeth were evaluated for the presence of pain, abscess, fistula, mobility, internal and external resorption, and radiolucency. Statistical Analysis : The data were assessed with Fishers′ Exact test. Results: After nine months of follow-up, the clinical and radiographic success rates were 96 and 84% respectively in the electrosurgical group and 100 and 96.8% respectively in the formocresol group. There was no statistically significant difference between the success rates in the two groups ( P > 0.05. Conclusions: Our results showed the failure rates for electrosurgical pulpotomy to be equal to those for formocresol pulpotomy. Although electrosurgical pulpotomy is a nonpharmacological technique giving favorable results, it is still a preservative technique. Further studies using larger samples and longer evaluation periods are recommended.

  12. Prostate heating patterns comparing electrosurgical transurethral resection and vaporization: a prospective randomized study.

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    Patel, A; Fuchs, G J; Gutiérrez-Aceves, J; Ryan, T P

    1997-01-01

    A prospective study was performed to determine if transurethral electrosurgical vaporization of the prostate is associated with unseen heat damage to vital periprostatic structures compared to conventional loop resection. In addition, energy consumption and its relationship to observed tissue temperature at the prostate periphery were evaluated for each treatment. Patients with moderate to severe symptoms of benign prostatic bladder outflow obstruction and objective evidence of diminished flow or acute urinary retention were randomized to undergo either transurethral loop resection or electrosurgical vaporization after stratification for gland volume. Instrumentation was standardized for both groups except for the monopolar electrode used. The radiofrequency power source in the study was a new computer controlled generator with a constant power delivery feature. Regional tissue heating patterns were evaluated with optical fiber probes in real time. Four stationary sites were chosen for temperature measurements, namely the lateral lobe of the prostate, neurovascular bundle beside the prostatic apex at the level of the external sphincter, and anterior rectal wall at the level of the prostatic base and apex. A pull back technique was used to search for hot points in the long axis of the probe (3-dimensional temperature mapping) in 2 patients from each group. Incident generator panel power settings for the electrosurgical vaporization treatments were equivalent to those commonly used for loop resection (150 watts) and were adjusted up or down as needed. Prostate electrosurgical vaporization was possible at generator panel settings that were nearly equivalent to those for transurethral resection of the prostate (130 to 190 watts). No significant rectal or sphincteric heating was detected with either procedure. Conductive cooling of the neurovascular bundles was observed in 2 patients in each group toward the end of the operation. More energy was used per minute of

  13. Laser ablation of surgical margins after excisional partial vulvectomy for VIN: Effect on recurrence.

    Science.gov (United States)

    Brown, John V; Goldstein, Bram H; Rettenmaier, Mark A; Aylward, Michelle M; Graham, Cheri L; Micha, John P

    2005-05-01

    To determine the recurrence rates in patients who underwent different surgical treatments for vulvar intraepithelial neoplasia (VIN) 2 and 3. Data on every patient who underwent surgical treatment for VIN 2 or 3 between January 1994 and December 2002 by a single gynecologic oncologist were retrospectively reviewed. The recurrence rates for 3 different surgical therapies were analyzed using Fischer's exact test. Thirty-three patients, who had a median age of 46 years (range, 31-80), were identified. The preoperative biopsy demonstrated VIN 2 or 3 in 9.1% and 90.9% of the patients, respectively. The following primary surgical procedures were employed: 16 patients (48.4%) underwent excisional partial vulvectomy with CO2 laser ablation of the margins, 10 patients (30.3%) had CO2 laser ablation alone, 6 patients (18.2%) had an excisional partial vulvectomy, and 1 patient (3.0%) was. treated with the ultrasonic surgical aspirator. No patient had invasive disease. Recurrent disease was seen in 7 patients (70.0%) treated by laser alone, 3 patients (50.0%) who had an excisional partial vulvectomy and 1 patient (6.25%) who underwent a combined laser and excisional partial vulvectomy (p = 0.0016). The results of this small study suggest that laser and excisional partial vulvectomy for the treatment of VIN 2 and 3 may be associated with a lower recurrence rate than either modality alone. A larger study will be needed to confirm these results.

  14. A simple approach to calculate active power of electrosurgical units

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    André Luiz Regis Monteiro

    Full Text Available Abstract Introduction: Despite of more than a hundred years of electrosurgery, only a few electrosurgical equipment manufacturers have developed methods to regulate the active power delivered to the patient, usually around an arbitrary setpoint. In fact, no manufacturer has a method to measure the active power actually delivered to the load. Measuring the delivered power and computing it fast enough so as to avoid injury to the organic tissue is challenging. If voltage and current signals can be sampled in time and discretized in the frequency domain, a simple and very fast multiplication process can be used to determine the active power. Methods This paper presents an approach for measuring active power at the output power stage of electrosurgical units with mathematical shortcuts based on a simple multiplication procedure of discretized variables – frequency domain vectors – obtained through Discrete Fourier Transform (DFT applied on time-sampled voltage and current vectors. Results Comparative results between simulations and a practical experiment are presented – all being in accordance with the requirements of the applicable industry standards. Conclusion An analysis is presented comparing the active power analytically obtained through well-known voltage and current signals against a computational methodology based on vector manipulation using DFT only for time-to-frequency domain transformation. The greatest advantage of this method is to determine the active power of noisy and phased out signals with neither complex DFT or ordinary transform methodologies nor sophisticated computing techniques such as convolution. All results presented errors substantially lower than the thresholds defined by the applicable standards.

  15. Metabolic signature of electrosurgical liver dissection.

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    Witigo von Schönfels

    Full Text Available BACKGROUND AND AIMS: High frequency electrosurgery has a key role in the broadening application of liver surgery. Its molecular signature, i.e. the metabolites evolving from electrocauterization which may inhibit hepatic wound healing, have not been systematically studied. METHODS: Human liver samples were thus obtained during surgery before and after electrosurgical dissection and subjected to a two-stage metabolomic screening experiment (discovery sample: N = 18, replication sample: N = 20 using gas chromatography/mass spectrometry. RESULTS: In a set of 208 chemically defined metabolites, electrosurgical dissection lead to a distinct metabolic signature resulting in a separation in the first two dimensions of a principal components analysis. Six metabolites including glycolic acid, azelaic acid, 2-n-pentylfuran, dihydroactinidiolide, 2-butenal and n-pentanal were consistently increased after electrosurgery meeting the discovery (p<2.0 × 10(-4 and the replication thresholds (p<3.5 × 10(-3. Azelaic acid, a lipid peroxidation product from the fragmentation of abundant sn-2 linoleoyl residues, was most abundant and increased 8.1-fold after electrosurgical liver dissection (preplication = 1.6 × 10(-4. The corresponding phospholipid hexadecyl azelaoyl glycerophosphocholine inhibited wound healing and tissue remodelling in scratch- and proliferation assays of hepatic stellate cells and cholangiocytes, and caused apoptosis dose-dependently in vitro, which may explain in part the tissue damage due to electrosurgery. CONCLUSION: Hepatic electrosurgery generates a metabolic signature with characteristic lipid peroxidation products. Among these, azelaic acid shows a dose-dependent toxicity in liver cells and inhibits wound healing. These observations potentially pave the way for pharmacological intervention prior liver surgery to modify the metabolic response and prevent postoperative complications.

  16. Clinical and radiographic comparison of primary molars treated by formocresol and electrosurgical pulpotomy

    Directory of Open Access Journals (Sweden)

    Bahrololoomi Z.

    2005-07-01

    Full Text Available Background and Aim: Pulpotomy is one of the routine methods for pulp therapy of primary teeth. At present it is a fact that ideal agent for this has not been discovered. The aim of this study was to compare the clinical and radiographic success rates of electrosurgical pulpotomy versus formocresol pulpotomy in human primary molar teeth. Materials and Methods: In this clinical trial study, pulpotomy was performed on 68 primary molars in children aged from 5 to 10 years. The teeth were treated using either a conventional formocresol (35 teeth, or electrosurgical technique (33 teeth. Following the pulpotomy procedure, the teeth were evaluated regarding clinical and radiographic success for 3, 6 and 9 months periods. The teeth were evaluated clinically and radiographically for the presence of pain, abscess, fistula, mobility, internal and external resorption and radiolucency. Finally clinical and radiographic data were collected and analyzed with Fisher exact test using P0/05. Conclusion: Although electrosurgical pulpotomy is a nonpharmacological and easy to use technique, further investigations with longer evaluation periods are suggested.

  17. Assessment of electrosurgical hand controls integrated into a laparoscopic grasper

    NARCIS (Netherlands)

    Brown-Clerk, B.; Rousek, J.B.; Lowndes, B.R.; Eikhout, S.M.; Balogh, B.J.; Hallbeck, M.S.

    2011-01-01

    The aim of this study was to quantitatively and qualitatively determine the optimal ergonomic placement of novel electrosurgical hand controls integrated into a standard laparoscopic grasper to optimize functionality. This device will allow laparoscopic surgeons to hand-operate standard

  18. 21 CFR 878.4400 - Electrosurgical cutting and coagulation device and accessories.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Electrosurgical cutting and coagulation device and....4400 Electrosurgical cutting and coagulation device and accessories. (a) Identification. An electrosurgical cutting and coagulation device and accessories is a device intended to remove tissue and control...

  19. Loop electrosurgical excision of the cervix and subsequent risk for spontaneous preterm delivery: a population-based study of singleton deliveries during a 9-year period

    DEFF Research Database (Denmark)

    Noehr, Bugge; Jensen, Allan; Frederiksen, Kirsten

    2009-01-01

    OBJECTIVE: Our aim was to assess the association between loop electrosurgical excision procedure (LEEP) and the subsequent risk for spontaneous preterm delivery, with the use of population-based data from various nationwide registries. STUDY DESIGN: The study population consisted of all singleton...

  20. Parameters of atmospheric plasmas produced by electrosurgical devices

    Science.gov (United States)

    Keidar, Michael; Shashurin, Alexey; Canady, Jerome

    2013-10-01

    Electrosurgical systems are extensively utilized in general surgery, surgical oncology, plastic and reconstructive surgery etc. In this work we study plasma parameters created by electrosurgical system SS-200E/Argon 2 of US Medical Innovations. The maximal length of the discharge plasma column at which the discharge can be sustained was determined as function of discharge power and argon flow rate. Electrical parameters including discharge current and voltage were measured. Recently proposed Rayleigh microwave scattering method for temporally resolved density measurements of small-size atmospheric plasmas was utilized. Simultaneously, evolution of plasma column was observed using intensified charge-coupled device (ICCD) camera.

  1. The mechanical fingerprint of murine excisional wounds.

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    Pensalfini, Marco; Haertel, Eric; Hopf, Raoul; Wietecha, Mateusz; Werner, Sabine; Mazza, Edoardo

    2018-01-01

    A multiscale mechanics approach to the characterization of murine excisional wounds subjected to uniaxial tensile loading is presented. Local strain analysis at a physiological level of tension uncovers the presence of two distinct regions within the wound: i) a very compliant peripheral cushion and ii) a core area undergoing modest deformation. Microstructural visualizations of stretched wound specimens show negligible engagement of the collagen located in the center of a 7-day old wound; fibers remain coiled despite the applied tension, confirming the existence of a mechanically isolated wound core. The compliant cushion located at the wound periphery appears to protect the newly-formed tissue from excessive deformation during the phase of new tissue formation. The early remodeling phase (day 14) is characterized by a restored mechanical connection between far field and wound center. The latter remains less deformable, a characteristic possibly required for cell activities during tissue remodeling. The distribution of fibrillary collagens at these two time points corresponds well to the identified heterogeneity of mechanical properties of the wound region. This novel approach provides new insight into the mechanical properties of wounded skin and will be applicable to the analysis of compound-treated wounds or wounds in genetically modified tissue. Biophysical characterization of healing wounds is crucial to assess the recovery of the skin barrier function and the associated mechanobiological processes. For the first time, we performed highly resolved local deformation analysis to identify mechanical characteristics of the wound and its periphery. Our results reveal the presence of a compliant cushion surrounding a stiffer wound core; we refer to this heterogeneous mechanical behavior as "mechanical fingerprint" of the wound. The mechanical response is shown to progress towards that of the intact skin as healing takes place. Histology and multiphoton microscopy

  2. Magnet‑retained Prophylactic Appliance for Post‑excisional ...

    African Journals Online (AJOL)

    Magnet‑retained Prophylactic Appliance for Post‑excisional. Pressure Therapy and Custom‑made Acrylic Therapeutic. Pressure Appliance for Auricular Keloid: A Clinical Report. Manu Rathee, Renu Kundu. INTRODUCTION. Keloid is a cutaneous fibrous scar that represents disequilibrium in the dermal wound healing.

  3. Loop electrosurgical excision of the cervix and the subsequent risk of preterm delivery

    DEFF Research Database (Denmark)

    Nøhr, Bugge; Tabor, Ann; Frederiksen, Kirsten

    2007-01-01

    OBJECTIVES: To investigate the association between loop electrosurgical excision procedure (LEEP) and other potential risk factors, and subsequent preterm delivery (... a number of different lifestyle variables. We assessed the relationship between preterm delivery and potential risk factors, such as previous LEEP treatments, smoking during pregnancy, age, parity and previous preterm delivery. The cohort was followed until 2004, through linkages with the nationwide...... Pathology Data Bank and the Medical Birth Registry. RESULTS: Of the 14,982 deliveries in the cohort during follow up, 542 were preterm (21-37 weeks). Among deliveries with no previous LEEP, 3.5% ended as a preterm delivery, whereas this applied to 6.6% among deliveries following a LEEP, yielding...

  4. Excisional treatments of the cervix and effect on subsequent fertility: a retrospective cohort study.

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    Martyn, Fiona M; McAuliffe, Fionnuala M; Beggan, Caitlin; Downey, Paul; Flannelly, Grainne; Wingfield, Mary B

    2015-02-01

    Concerns exist regarding the impact of excisional treatments for cervical intraepithelial neoplasia (CIN) on subsequent pregnancy outcome yet few studies have addressed fertility following surgery. Retrospective cohort study. Set in the colposcopy service of National Maternity Hospital. A postal questionnaire was sent to 3590 women of reproductive age who attended colposcopy from 2001 to 2007; 1795 of these had at least one excisional treatment (surgical group) and 1795 had no treatment (non-surgical group). Records were reviewed to confirm the clinical details and volume of tissue excised. The main outcome measures were pregnancy and fertility rates as well as time to conception correlated with volume of tissue excised. Students' t-test, Mann-Whitney U-test, spearman correlation and Kruskal-Wallis tests were used during the analysis. 1355 Women (37.7%) responded. 537 Women had no treatment and 818 had at least one excision. A subsequent pregnancy was reported in 730 women (434 surgical and 296 non-surgical groups). No difference was detected between the groups in the reported pregnancy rates (p=0.56), the time to conception (p=0.37) or fertility problems (p=0.89). The volume of the excision did not affect fertility rates or time to conception. There were fewer pregnancies in women following a cold knife cone or more than one LLETZ treatment-significant surgery, (p=0.004) but no difference in their reported time to conception (p=0.54). One excisional treatment for CIN does not appear to affect subsequent fertility. Our study showed no delay in conception and no increased risk of problems conceiving in this group, even when controlling for the volume and depth of tissue removed. Women should be reassured by these results. Further work is required to evaluate the effect of cold knife cone biopsy and repeated LLETZ procedures on subsequent fertility. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  5. Electrosurgical injuries during robot assisted surgery: insights from the FDA MAUDE database

    Science.gov (United States)

    Fuller, Andrew; Vilos, George A.; Pautler, Stephen E.

    2012-02-01

    Introduction: The da Vinci surgical system requires the use of electrosurgical instruments. The re-use of such instruments creates the potential for stray electrical currents from capacitive coupling and/or insulation failure with subsequent injury. The morbidity of such injuries may negate many of the benefits of minimally invasive surgery. We sought to evaluate the rate and nature of electrosurgical injury (ESI) associated with this device. Methods: The Manufacturer and User Facility Device Experience (MAUDE) database is administered by the US Food and Drug Administration (FDA) and reports adverse events related to medical devices in the United States. We analyzed all incidents in the context of robotic surgery between January 2001 and June 2011 to identify those related to the use of electrosurgery. Results: In the past decade, a total of 605 reports have been submitted to the FDA with regard to adverse events related to the da Vinci robotic surgical platform. Of these, 24 (3.9%) were related to potential or actual ESI. Nine out of the 24 cases (37.5%) resulted in additional surgical intervention for repair. There were 6 bowel injuries of which only one was recognized and managed intra-operatively. The remainder required laparotomy between 5 and 8 days after the initial robotic procedure. Additionally, there were 3 skin burns. The remaining cases required conservative management or resulted in no harm. Conclusion: ESI in the context of robotic surgery is uncommon but remains under-recognized and under-reported. Surgeons performing robot assisted surgery should be aware that ESI can occur with robotic instruments and vigilance for intra- and post-operative complications is paramount.

  6. A Study on Performance and Safety Tests of Electrosurgical Equipment.

    Science.gov (United States)

    Tavakoli Golpaygani, A; Movahedi, M M; Reza, M

    2016-09-01

    Modern medicine employs a wide variety of instruments with different physiological effects and measurements. Periodic verifications are routinely used in legal metrology for industrial measuring instruments. The correct operation of electrosurgical generators is essential to ensure patient's safety and management of the risks associated with the use of high and low frequency electrical currents on human body. The metrological reliability of 20 electrosurgical equipment in six hospitals (3 private and 3 public) was evaluated in one of the provinces of Iran according to international and national standards. The achieved results show that HF leakage current of ground-referenced generators are more than isolated generators and the power analysis of only eight units delivered acceptable output values and the precision in the output power measurements was low. Results indicate a need for new and severe regulations on periodic performance verifications and medical equipment quality control program especially in high risk instruments. It is also necessary to provide training courses for operating staff in the field of meterology in medicine to be acquianted with critical parameters to get accuracy results with operation room equipment.

  7. A Study on Performance and Safety Tests of Electrosurgical Equipment

    Directory of Open Access Journals (Sweden)

    Tavakoli Golpaygani A.

    2016-09-01

    Full Text Available Introduction: Modern medicine employs a wide variety of instruments with different physiological effects and measurements. Periodic verifications are routinely used in legal metrology for industrial measuring instruments. The correct operation of electrosurgical generators is essential to ensure patient’s safety and management of the risks associated with the use of high and low frequency electrical currents on human body. Material and Methods: The metrological reliability of 20 electrosurgical equipment in six hospitals (3 private and 3 public was evaluated in one of the provinces of Iran according to international and national standards. Results: The achieved results show that HF leakage current of ground-referenced generators are more than isolated generators and the power analysis of only eight units delivered acceptable output values and the precision in the output power measurements was low. Conclusion: Results indicate a need for new and severe regulations on periodic performance verifications and medical equipment quality control program especially in high risk instruments. It is also necessary to provide training courses for operating staff in the field of meterology in medicine to be acquianted with critical parameters to get accuracy results with operation room equipment.

  8. Clinical and Radiographic Success of Electrosurgical Pulpectomy in Primary Teeth.

    Science.gov (United States)

    Sahebalam, Rasoul; Sarraf, Alireza; Jafarzadeh, Hamid; Jouybari-Moghaddam, Maryam; Seyed-Musavi, Samane

    2017-01-01

    A pulpectomy requires the swift extraction of the inflamed tissue. Moreover, the speed of treatment is especially important in the case of uncooperative children. Conventional pulpectomies, however, often require an extended treatment period, which can therefore cause problems with such patients. Electrosurgical methods have been applied to pulpotomies for a number of years. However, to the best of our knowledge, no studies to date have assessed its application to pulpectomies. The aim of this study was to compare clinical and radiographic success rates over a 6-month follow-up period between conventional and electrosurgical pulpectomies. A total of 50 children aged 4 to 8 years were enrolled in this randomized clinical trial. A pulpectomy of the first and second primary molar teeth was seen as the optimal treatment plan in all these patients. One group was treated using the conventional method (C group, 25 teeth) and the other with electrosurgery (ES group, 25 teeth). The patients were evaluated for the presence of pain, mobility, abscess, sinus tract, erythema, tenderness to percussion, internal and external root resorption, and radiolucency. Clinical and radiographic success rates and total working time were assessed. The Fisher's exact test and Mann-Whitney U-test were used for the statistical analysis. After 6 months of follow-up, the clinical and radiographic success rates were 90.5 and 85.7%, respectively, in the ES group, compared with 88.9 and 72.2%, respectively, in the C group. No statistically significant difference was observed between the two groups (p>0.05). Working time, however, was significantly shorter in the ES group (ppulpectomy with electrosurgery reduces treatment time, and is therefore quite useful in situations where duration of the treatment course is of crucial concern.

  9. Micro/nanostructured surface modification using femtosecond laser pulses on minimally invasive electrosurgical devices.

    Science.gov (United States)

    Lin, Chia-Cheng; Lin, Hao-Jan; Lin, Yun-Ho; Sugiatno, Erwan; Ruslin, Muhammad; Su, Chen-Yao; Ou, Keng-Liang; Cheng, Han-Yi

    2017-05-01

    The purpose of the present study was to examine thermal damage and a sticking problem in the tissue after the use of a minimally invasive electrosurgical device with a nanostructured surface treatment that uses a femtosecond laser pulse (FLP) technique. To safely use an electrosurgical device in clinical surgery, it is important to decrease thermal damage to surrounding tissues. The surface characteristics and morphology of the FLP layer were evaluated using optical microscopy, scanning electron microscopy, and transmission electron microscopy; element analysis was performed using energy-dispersive X-ray spectroscopy, grazing incidence X-ray diffraction, and X-ray photoelectron spectroscopy. In the animal model, monopolar electrosurgical devices were used to create lesions in the legs of 30 adult rats. Animals were sacrificed for investigations at 0, 3, 7, 14, and 28 days postoperatively. Results indicated that the thermal damage and sticking situations were reduced significantly when a minimally invasive electrosurgical instrument with an FLP layer was used. Temperatures decreased while film thickness increased. Thermographic data revealed that surgical temperatures in an animal model were significantly lower in the FLP electrosurgical device compared with that in the untreated one. Furthermore, the FLP device created a relatively small area of thermal damage. As already mentioned, the biomedical nanostructured layer reduced thermal damage and promoted the antisticking property with the use of a minimally invasive electrosurgical device. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 865-873, 2017. © 2016 Wiley Periodicals, Inc.

  10. Diode laser for excisional biopsy of peripheral ossifying fibroma

    Directory of Open Access Journals (Sweden)

    Kirti Chawla

    2014-01-01

    Full Text Available Peripheral Ossifying Fibroma is one of the commonest occurring reactive lesions on gingiva. It is associated with local irritational factors and often interferes with speech, mastication and maintenance of oral hygiene, in addition to being aesthetically unpleasant. It is usually treated with surgical excision using scalpel and removal of irritational factors, often resulting in mucogingival defect. Other modalities such as radiosurgery and electrocautery have also been used for its management, but they cause changes in microarchitecture of biopsy specimen, altering the histologic picture for true diagnosis. We are presenting a case of excisional biopsy of this lesion in an adult female using a diode laser with excellent post-operative results, without affecting microarchitecture of biopsy specimen. The patient is being followed for last 1 year and no sign of recurrence has been found. A diode laser may offer a good alternative modality for management of such cases.

  11. Excisional surgery for cancer cure: therapy at a cost.

    LENUS (Irish Health Repository)

    Coffey, J C

    2012-02-03

    Excisional surgery is one of the primary treatment modalities for cancer. Minimal residual disease (MRD) is the occult neoplastic disease that remains in situ after curative surgery. There is increasing evidence that tumour removal alters the growth of MRD, leading to perioperative tumour growth. Because neoplasia is a systemic disease, this phenomenon may be relevant to all patients undergoing surgery for cancer. In this review we discuss the published work that addresses the effects of tumour removal on subsequent tumour growth and the mechanisms by which tumour excision may alter residual tumour growth. In addition, we describe therapeutic approaches that may protect patients against any oncologically adverse effects of tumour removal. On the basis of the evidence presented, we propose a novel therapeutic paradigm; that the postoperative period represents a window of opportunity during which the patient may be further protected against the oncological effects of tumour removal.

  12. [Malfunctioning of infusion pumps due to interference from an electrosurgical unit].

    Science.gov (United States)

    Kawasaki, H; Egawa, H; Takasaki, M; Yokoyama, K

    1991-06-01

    We observed the incidence of pump errors by the interference from the electrosurgical unit (Vallylab, Force 4B) set at coagulation or cut mode, with three infusion pumps: Terumo STC-523, STC-525 and STC-525-01. The STC-525-01 painted with electrically conductive paint inside was used during electrosurgery on experimental basis. Malfunctioning of the STC-523 pump occurred frequently by using electrosurgical unit set at coagulation mode and placed close to the pump. The STC-525-01 showed markedly lower incidence of malfunctioning. Therefore, the STC-252-01 pump can be used safely during electrosurgery. Additionally, we discovered, through an estimation of radiated electrical field around the electrosurgical unit, the cable of an active electrode was important as an interference source. To minimize electrosurgical interferences, we propose the following recommendations; 1) keeping the infusion pump and its AC line as far as possible from the active electrode cable, 2) keeping the output of electrosurgical unit as low as possible, 3) operating the pump with its internal battery power supply, and 4) monitoring the operation of the pump while using electrosurgery.

  13. RF leakage current in electrosurgical units: Influence of the layout in taking measurements

    Energy Technology Data Exchange (ETDEWEB)

    Gentile, L; Palacios, P [Cardiology and Cardiovascular Surgery Institute, Favaloro Foundation Biomedical Engineering Department, Av. Belgrano 1746. Bs. As. (Argentina)

    2007-11-15

    The RF leakage current in electrosurgical units is a critical parameter to measure, because it may cause accidental burns in patients. The particular standard for electrosurgical units IEC 60601-2-2 indicates the maximum RF leakage levels and defines the elements and their layout to do these measurements. On this paper we show the RF leakage current values of 6 electrosurgical units. We did these measurements in two different ways: in the first one we measured in normal conditions of use in the operating rooms and in the second we followed the mentioned Standard. The results shows differences between one group and the other, observing higher RF leakage current values in the measurements that we did without following the standard's layout.

  14. Evaluation of minimally invasive excisional brain biopsy and intracranial brachytherapy catheter placement in dogs.

    Science.gov (United States)

    Packer, Rebecca A; Freeman, Lynetta J; Miller, Margaret A; Fauber, Amy E; Morrison, Wallace B

    2011-01-01

    To evaluate a technique for minimally invasive excisional brain biopsy and intracranial brachytherapy catheter placement in dogs. 5 healthy adult female dogs. Computed tomographic guidance was used to plan a biopsy trajectory to a selected area of brain with reference to a localizer grid. The procedure was performed through a 1-cm skin incision and 6-mm burr hole by use of a 9-gauge biopsy device. Five cylindrical samples (3 to 4 mm in diameter and 7 to 12 mm in length) were removed over 5 cycles of the vacuum-assisted tissue excision system, leaving approximately a 2-cm³ resection cavity. A balloon-tipped intracranial brachytherapy catheter was placed through the burr hole into the resection cavity, expanded with saline (0.9% NaCl) solution, and explanted 7 days later. 4 of 5 dogs survived the procedure. The fifth died because of iatrogenic brain damage. Neurologic deficits were unilateral and focal. Twenty-four hours after surgery, all surviving dogs were ambulatory, 2 dogs exhibited ipsiversive circling, 4 had contralateral proprioceptive deficits, 3 had contralateral menace response deficits, 2 had a reduced contralateral response to noxious nasal stimulation, and 1 had dull mentation with intermittent horizontal nystagmus and ventrolateral strabismus. Neurologic status improved throughout the study period. Histologic quality of biopsy specimens was excellent. This technique enabled histologic diagnosis from high-quality biopsy specimens obtained through a minimally invasive technique and has potential applications for multimodal treatment of deep brain tumors in dogs.

  15. Excisional Bleb Revision for Management of Failed Ahmed Glaucoma Valve.

    Science.gov (United States)

    Eslami, Yadollah; Fakhraie, Ghasem; Moghimi, Sasan; Zarei, Reza; Mohammadi, Masoud; Nabavi, Amin; Yaseri, Mehdi; Izadi, Ali

    2017-12-01

    To evaluate the outcome of excisonal bleb revision in patients with failed Ahmed glaucoma valve (AGV). In total, 29 patients with uncontrolled intraocular pressure (IOP) despite of maximal tolerated medical therapy at least 6 months after AGV implantation were enrolled in this prospective interventional case series. Excision of fibrotic tissue around the reservoir with application of mitomycin C 0.02% was performed. IOP, number of glaucoma medications were evaluated at baseline and 1 week and 1, 3, 6, and 12 months postoperatively. Complete and qualified success was defined as IOP≤21 mm Hg with or without glaucoma medications, respectively. Intraoperative and postopervative complications were also recorded. Mean IOP was reduced from 30±4.2 mm Hg at baseline to 19.2±3.1 mm Hg at 12-month follow-up visit (Pglaucoma medications was decrease from 3.2±0.5 at baseline to 1.9±0.7 at 12-month follow-up (Pglaucoma surgeries were significantly associated with the failure of excisonal bleb revision. Excisional bleb revision could be considered as a relatively effective alternative option for management of inadequate IOP control after AGV implantation.

  16. Low-level light stimulates excisional wound healing in mice.

    Science.gov (United States)

    Demidova-Rice, Tatiana N; Salomatina, Elena V; Yaroslavsky, Anna N; Herman, Ira M; Hamblin, Michael R

    2007-10-01

    Low levels of laser or non-coherent light, termed low-level light therapy (LLLT) have been reported to accelerate some phases of wound healing, but its clinical use remains controversial. A full thickness dorsal excisional wound in mice was treated with a single exposure to light of various wavelengths and fluences 30 minutes after wounding. Wound areas were measured until complete healing and immunofluorescence staining of tissue samples was carried out. Wound healing was significantly stimulated in BALB/c and SKH1 hairless mice but not in C57BL/6 mice. Illuminated wounds started to contract while control wounds initially expanded for the first 24 hours. We found a biphasic dose-response curve for fluence of 635-nm light with a maximum positive effect at 2 J/cm(2). Eight hundred twenty nanometer was found to be the best wavelength tested compared to 635, 670, and 720 nm. We found no difference between non-coherent 635+/-15-nm light from a lamp and coherent 633-nm light from a He/Ne laser. LLLT increased the number of alpha-smooth muscle actin (SMA)-positive cells at the wound edge. LLLT stimulates wound contraction in susceptible mouse strains but the mechanism remains uncertain. 2007 Wiley-Liss, Inc

  17. Late results in patients with Schatzki ring treated by endoscopic electrosurgical incision of the ring.

    Science.gov (United States)

    Guelrud, M; Villasmil, L; Mendez, R

    1987-04-01

    In 17 ambulatory patients with severe intermittent dysphagia an endoscopic electrosurgical radial incision of a Schatzki ring was made with a modified straight retractable sphincterotome. The incision was successfully accomplished with immediate relief of dysphagia in all patients. Fourteen patients remain asymptomatic with a mean follow-up of 46 months after the first treatment. Three patients required a second incision and they have been asymptomatic for more than 24 months. There was one mild bleeding episode. Endoscopic electrosurgical incision of the Schatzki ring is an effective therapeutic modality in selected patients.

  18. Understanding electrosurgical unit perturbations in order to address hospital operating room electromagnetic compatibility.

    Science.gov (United States)

    Fernández-Chimeno, Mireya; Quílez, Marcos; Silva, Ferran

    2006-06-01

    We analyze the radiated emissions from a low power electrosurgical unit (ESU). Measurements at a 3-meter distance are performed in order to find a suitable measurement setup intended to reproduce realistically the real working ESU behavior in a test lab. The broad-band and narrow-band characteristics of the perturbation are studied in order to address the other equipment immunity.

  19. Comparison of wound-healing characteristics with feedback circuit electrosurgical generators in a porcine model.

    Science.gov (United States)

    Pollinger, Harrison S; Mostafa, Gamal; Harold, Kristi L; Austin, Catherine E; Kercher, Kent W; Matthews, Brent D

    2003-12-01

    The type of incisional instrument used to create a surgical wound can influence the rate of wound healing and overall wound strength. The purpose of this study was to evaluate several facets of wound healing within incisions created in the small intestine, uterus, and skin in a porcine model by using feedback circuit electrosurgical generators and a standard steel scalpel blade in a porcine model. Eighteen pigs were evaluated by creating surgical incisions in the skin, uterus, and small intestine utilizing 2 computerized electrosurgical generators (FX, ValleyLab, Boulder, CO, and PEGASYS, Ethicon Endo-Surgery, Inc., Cincinnati, OH) and a scalpel blade. All incisions were reapproximated with absorbable suture. Incision sites were evaluated histologically at 3, 7, or 14 days postincision according to randomization. The skin and small intestine samples were tested for wound tensile strength at 7 and 14 days. There were no statistically significant differences demonstrated with tensile strength testing comparing the electrosurgical devices to the scalpel-blade incisions for skin or small intestine at all time points. The only significant difference detected with respect to wound tensile strength was when different organ types were compared, regardless of device used (i.e., skin, 19.5 N/cm2 vs. small intestine, 5.78 N/cm2). Histologic evaluation demonstrated that the wounds created by the electrosurgical generators displayed decreased overall wound healing at 3, 7, and 14 days compared to the scalpel group. These findings indicate that the electrosurgical devices tested delay wound healing at the surgical site, but fail to demonstrate any significant difference in overall wound tensile strength. Wound healing may occur at a more rapid rate when a traditional scalpel blade is used to create the surgical incision, but no difference in global wound dynamics could be detected.

  20. Noncontact electrosurgical grounding--a useful and safe tool in the initial surgical management of thermal injuries.

    Science.gov (United States)

    Liodaki, E; Stang, F H; Lohmeyer, J A; Bergmann, P A; Mailänder, P; Siemers, F

    2013-02-01

    Electrosurgical instruments - one of the useful and most-used instruments within the surgeon's armamentarium - are potentially dangerous by causing unanticipated direct burns; fire occurring as a result of electrosurgical instruments and electromagnetic interference with a pacemaker, defibrillator, or cardiac monitoring device. The Mega 2000 Patient Return Electrode System produced by Megadyne Medical Products is a noncontact electrode designed to provide adequate electrical return to facilitate function of electrocautery devices. We used this noncontact device in 67 patients (28 women, 39 men) with large burns during their stay in our burn unit and in 11 of these patients (4 women, 7 men) for escharotomies during admission in our burn care. The device functioned well in all cases, no additional cutaneous burns on the patients' body were noticed. This paper is a review of our experience with this noncontact electrosurgical grounding in burn surgery highlighting its advantages comparing with the conventional electrosurgical instruments. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

  1. Pathomorphological distinction between Er:YAG and diode lasers on the excisional biopsy of the oral mucosa

    Directory of Open Access Journals (Sweden)

    Georgi T. Tomov

    2013-02-01

    Full Text Available Background – In oral pathology, laser devices can provide important advantages, especially in the treatment of certain lesions. However, there is controversy about the use of some wavelengths in the analysis of suspected dysplastic or neoplastic lesions, raising doubt about the laser's suitability for use in biopsy procedures. The present pilot study evaluates the pathomorphological characteristics and suitability of Er:YAG and diode lasers for performing excisional biopsies in the oral mucosa with special emphasis on the extent of the thermal damage zone created. Material and Methods – 10 patients were randomly assigned to one diode or one Er:YAG laser groups. The Er:YAG laser(2940nm was used in a pulsed wave mode 200mJ/35Hz with a power of 7 W. Power settings for the diode laser(810 nm were 3 W in a pulsed mode. The thermal damage zone of the two lasers and intraoperative and postoperative complications were assessed and compared.All biopsy specimens were evaluated by optical microscopy by threeblinded pathologists. After establishing the pathomorphological diagnosis of the lesion assessed, the pathologists measured the maximal width of the peripheral thermal damage zone in the specimen in μm and classified it using appropriate index. Results – The peripheral thermal damage zone on the borders of the excisional biopsies was significantly smaller with the Er:YAG laser compared to the diode laser regarding values in μm or pathomorphological index scores. No postoperative complications occurred in any of the two groups. Conclusions – The Er:YAG laser seems to be appropriate for excisional biopsies of benign oral mucosal lesions. The Er:YAG laser offers clear advantages in terms of smaller thermal damage zones over the diode laser. Although in some samples thermal damage was minimally visible, in all samples histological evaluation was clearly possible. The study demonstrated that the Er:YAG laser can be safely used in oral biopsy

  2. Allergic contact dermatitis from 2-hydroxyethyl methacrylate in an adhesive on an electrosurgical earthing plate.

    Science.gov (United States)

    Kanerva, L; Alanko, K

    1998-01-01

    A highly (meth)acrylate-allergic patient underwent surgery because of nodular struma. Three days after her operation she developed an itching dermatitis on her left thigh. She came to our attention 18 days after the operation, because of an oozing, highly pruritic dermatitis, 8 x 19 cm in width on her left thigh, at the site where an electrosurgical earthing plate had been used during the surgery. It was revealed that the pressure-sensitive adhesive of the pad contained 2-hydroxyethyl methacrylate (2-HEMA) to which the patient earlier had had an allergic patch test reaction. The patient was negative on patch testing to other (meth)acrylates present in the pad. Patients should be questioned about possible methacrylate sensitivity before methacrylate-containing electrosurgical earthing plates are used during surgery. Allergic contact dermatitis caused by acrylic adhesives is briefly reviewed.

  3. Sensitization and development of allergic contact dermatitis caused by a single contact with an electrosurgical grounding plate containing acrylates.

    Science.gov (United States)

    Borelli, S; Nestlé, F O

    1998-01-01

    Acrylates are known as potent sensitizers which can cause sensitization even during patch testing. A single exposure to concentrated acrylates can induce primary sensitization and contact dermatitis. Here we describe a 50-year-old man who developed contact dermatitis at the site of an electrosurgical grounding plate 2 weeks after orthopedic surgery. Patch testing revealed positive reactions to the electrosurgical plate and its components hydroxyethyl acrylate and hydroxyethyl methacrylate. As the patient has never had contact with acrylate-containing materials before, there is a high probability of primary sensitization by a single contact with the grounding plate during surgery.

  4. Evaluation of residual disease using breast MRI after excisional biopsy for breast cancer.

    Science.gov (United States)

    Chae, Eun Young; Cha, Joo Hee; Kim, Hak Hee; Shin, Hee Jung; Kim, Hyunji; Lee, Jungbok; Cheung, Joo Yeon

    2013-05-01

    The purpose of our study was to assess the diagnostic performance of breast MRI in evaluating residual disease in patients after excisional biopsy for breast cancer on the basis of both morphologic and kinetic features. Of 5304 breast MRI examinations performed between January 2007 and December 2011, 308 evaluated postoperative sites after excisional biopsy of breast cancer. Among these, 203 patients who were not treated with chemotherapy or radiotherapy before MRI and underwent definitive surgery within 30 days after MRI were enrolled. MRI findings were analyzed on the basis of contrast-enhanced subtraction images. The enhancement patterns were classified into four categories: no enhancement (P1), thin regular rim enhancement (P2), thick or irregular rim enhancement (P3), and nodular or nonmasslike enhancement (P4) around the postoperative sites. The enhancement kinetics were assessed as follows: persistent, plateau, and washout pattern. From 207 breast MRI examinations in 203 patients, 144 breasts had residual breast cancer at histopathologic examination after definitive surgery. When P1 and P2 were considered negative for residual cancer and P3 and P4 were considered positive, the sensitivity, specificity, positive and negative predictive values, and accuracy were 79.9%, 73.0%, 87.1%, 61.3%, and 77.8%, respectively. The specificity and positive predictive value improved to 90.5% and 91.7%, when analyzed with washout enhancement kinetics as another positive finding for residual cancer. A statistically significant trend of decreasing specificity and positive predictive value (p breast MRI. Although the overlapping features of the postsurgical changes and malignant lesions remain as the limitations, dynamic contrast-enhanced breast MRI is a useful tool for residual disease prediction after excisional biopsy for breast cancer. Combined use of morphologic and kinetic evaluation parameters improved the diagnostic performance. We do not recommend that MRI be

  5. Photobiomodulation by helium neon and diode lasers in an excisional wound model: A single blinded trial.

    Science.gov (United States)

    Dixit, Snehil; Maiya, Arun; Rao, Laxmi; Rao, M Arjun; Shastry, Barkur Ananthakrishna; Ramachandra, L

    2012-01-01

    Application of different kinds of lasers in clinical and experimental studies causes photobiomodulation that works at localized cellular and humoral level on various biological systems. Increased numbers of fibroblasts, myofibroblast, and degranulation of mast cells have been the observed benefits post-irradiation. Was to find out the effect of irradiation with energy densities of 3.38 J/cm(2), 8 J/cm(2), and 18 J/cm(2) on animal tissue (albino wistar rats) in an excisional wound model and to assess changes in biochemical (hydroxyproline) and histopathological levels in excisional wound model. The animals were divided into 4 groups, which were labeled as L1, diode laser (18 J/cm(2)), L2 Helium-neon (He-Ne, 8 J/cm(2)), L3 diode laser (3.38 J/cm(2)), and sham treatment for control was depicted by C, respectively. Histological and hydroxyproline analysis was performed on 7, 14, 21 days of post-wounding. One-way analysis of variance, ANOVA and Bonferroni's multiple comparison tests were done for tissue hydroxyproline levels. There was no significant increase in the hydroxyproline content (P neon laser of 8 J/cm(2) intensity facilitated photo stimulation by tissue repair, but failed to show significant tissue hydroxyproline levels in excisional wound model.

  6. LONG TERM RESULTS AFTER STAPLED HEMORRHOIDOPEXY ALONE AND COMPLEMENTED BY EXCISIONAL HEMORRHOIDECTOMY: A RETROSPECTIVE COHORT STUDY.

    Science.gov (United States)

    Araujo, Sergio Eduardo Alonso; Horcel, Lucas de Araujo; Seid, Victor Edmond; Bertoncini, Alexandre Bruno; Klajner, Sidney

    2016-01-01

    Stapled hemorrhoidopexy is associated with less postoperative pain and faster recovery. However, it may be associated with a greater risk of symptomatic recurrence. We hypothesized that undertaking a limited surgical excision of hemorrhoid disease after stapling may be a valid approach for selected patients. To compare long-term results after stapled hemorrhoidopexy with and without complementation with closed excisional technique. In a retrospective uni-institutional cohort study, sixty-five (29 men) patients underwent stapled hemorrhoidopexy and 21 (13 men) underwent stapled hemorrhoidopexy with excision. The same surgeons operated on all cases. Patients underwent stapled hemorrhoidectomy associated with excisional surgery if symptoms attributable to external hemorrhoid piles were observed preoperatively, or if residual prolapse or bulky external disease was observed after the firing of the stapler. A closed excisional diathermy hemorrhoidectomy without vascular ligation was utilized in all complemented cases. All clinical variables were obtained from a questionnaire evaluation obtained through e-mail, telephone interview, or office follow-up. The median duration of postoperative follow-up was 48.5 (6-40) months. Patients with grades 3 and 4 hemorrhoid disease were operated on more frequently using stapled hemorrhoidopexy complemented with excisional technique (95.2% vs. 55.4%, p=0.001). Regarding respectively stapled hemorrhoidopexy and stapled hemorrhoidopexy complemented with excision, there was no difference between the techniques in relation to symptom recurrence (43% and 33%, p=0.45) and median interval between surgery and symptom recurrence (30 (8-84) and 38.8 (8-65) months, p=0.80). Eight (12.3%) patients were re-operated after stapled hemorrhoidopexy and 2 (9.6%), after hemorrhoidopexy with excision (p=0.78). Patient distribution in both groups according to the degree of postoperative satisfaction was similar (p=0.97). Stapled hemorrhoidopexy combined

  7. Photobiomodulation by helium neon and diode lasers in an excisional wound model: A single blinded trial

    Directory of Open Access Journals (Sweden)

    Snehil Dixit

    2012-01-01

    Full Text Available Background: Application of different kinds of lasers in clinical and experimental studies causes photobiomodulation that works at localized cellular and humoral level on various biological systems. Increased numbers of fibroblasts, myofibroblast, and degranulation of mast cells have been the observed benefits post-irradiation. Objective: Was to find out the effect of irradiation with energy densities of 3.38 J/cm 2 , 8 J/cm 2 , and 18 J/cm 2 on animal tissue (albino wistar rats in an excisional wound model and to assess changes in biochemical (hydroxyproline and histopathological levels in excisional wound model. Materials and Methods: The animals were divided into 4 groups, which were labeled as L1, diode laser (18 J/cm 2 , L2 Helium-neon (He-Ne, 8 J/cm 2 , L3 diode laser (3.38 J/cm 2 , and sham treatment for control was depicted by C, respectively. Histological and hydroxyproline analysis was performed on 7, 14, 21 days of post-wounding. One-way analysis of variance, ANOVA and Bonferroni′s multiple comparison tests were done for tissue hydroxyproline levels. Results: There was no significant increase in the hydroxyproline content (P < 0.005 when observed in study group and compared to controls. Whereas significant epithelizations was seen in group treated with He-Ne laser of intensity of 8 J/cm 2 . Conclusion: The experimental observations suggest that low intensity helium-neon laser of 8 J/cm 2 intensity facilitated photo stimulation by tissue repair, but failed to show significant tissue hydroxyproline levels in excisional wound model.

  8. Effect of pirfenidone delivered using layer-by-layer thin film on excisional wound healing.

    Science.gov (United States)

    Mandapalli, Praveen Kumar; Labala, Suman; Bojja, Jagadeesh; Venuganti, Venkata Vamsi Krishna

    2016-02-15

    The aim of this study was to evaluate the effect of a new anti-fibrotic agent, pirfenidone (PFD), delivered using polyelectrolyte multilayer films on excisional wound healing. Polyelectrolyte multilayer films were prepared by layer-by-layer (LbL) sequential adsorption of chitosan and sodium alginate. The UV-spectrophotometer, FTIR and differential scanning calorimeter were used to characterize the LbL thin films. The PFD was entrapped within the LbL thin films and its effect on excisional wound healing was studied in C57BL/6. The total protein, collagen content and TGF-β expression within the wound tissue were determined after application of PFD using LbL thin films, chitosan hydrogel and polyethylene glycol hydrogel. UV-spectrophotometer and FTIR studies showed a sequential adsorption of chitosan and alginate polymer layers to form LbL thin films. The thickness of LbL thin films with 15 bilayers was found to be 15 ± 2 μm. HPLC analysis showed a PFD loading efficiency of 1.0 ± 0.1mg in 1cm(2) area of LbL thin film. In vivo wound healing studies in C57BL/6 mice showed an accelerated (<9 days) wound contraction after treatment with the PFD compared with blank LbL thin film and commercial povidone-iodine gel (12 days). The collagen content within the wound tissue was significantly (p<0.05) less after treatment with PFD compared with blank film application. Western blot analysis showed gradual decrease in TGF-β expression within the wound tissue after treatment with PFD. This study for the first time demonstrated that new anti-fibrotic agent PFD loaded in LbL thin films can be utilized for excisional wound healing. Copyright © 2015 Elsevier B.V. All rights reserved.

  9. Outpatient vaginal hysterectomy: Comparison of conventional suture ligature versus electrosurgical bipolar vessel sealing.

    Science.gov (United States)

    Giraudet, G; Lucot, J P; Sanz, F; Rubod, C; Collinet, P; Cosson, M

    2017-05-01

    The aim of our study was to evaluate the feasibility of vaginal hysterectomy in an ambulatory care system and the best way to perform it between conventional and bipolar vessel sealing system ligatures. This was a prospective study of 32 patients with vaginal hysterectomy at Lille University Hospital between December 2013 and May 2015. Two surgical techniques were compared: conventional suture ligature (CSL) and electrosurgical bipolar vessel sealing (BVS). Patients stayed in classical hospitalization but were managed how if they were in an ambulatory unit to evaluate their capacity to come back home the same evening of the surgery. The evaluation of same-day discharge was based on Post Anesthetic Discharge Scoring System (PADSS) score?9/10 and Visual Analogic Scale (VAS) score?4/10. Other data collected were: operative time, uterus weight, peroperative bleeding, PADSS score at the 8th postoperative hour, VAS score at the 4th, 6th, 8th, 12th and 24th postoperative hours, the presence of postoperative nausea/vomiting and rehospitalization. In the BVS group, 93.8% of patients validated the combined score (PADSS+VAS) on the evening of the intervention against 50% of patients in the CSL group (P<0.05). Hundred percent of BVS group patients were discharged on the day after surgery against 87.5% in the CSL group. The VAS was significantly lower in the BVS group at the 8th (1.4), 12th (1.2) and 24th (1.3) postoperative hours. Operative time was significantly shorter in the BVS group. We found more events such as nausea/vomiting in the CSL group. Vaginal hysterectomy is feasible in an ambulatory care system most of times. By reducing postoperative pain, electrosurgical bipolar vessel sealing would promote outpatient hospitalization. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  10. [Optimum hepatic parenchymal dissection to prevent bile leak: a comparative study using electrosurgical and stapling devices in swine].

    Science.gov (United States)

    Ikeda, Tetsuo; Akahoshi, Tomohiko; Kawanaka, Hirofumi; Uchiyama, Hideaki; Yamashita, Yo-ichi; Morita, Masaru; Oki, Eiji; Saeki, Hiroshi; Sugimachi, Keishi; Ikegami, Toru; Yoshizumi, Tomoharu; Soejima, Yuji; Shirabe, Ken; Mimori, Koshi; Watanabe, Masayuki; Hashizume, Makoto; Maehara, Yoshihiko

    2013-12-01

    Bile leakage is a serious complication of liver resection, and its treatment is very time-consuming. In open liver resection, Glisson's sheaths are usually disconnected by ligation to the extent possible during the parenchyma dissection. However, in laparoscopic surgery, the ligation, suture, and hemostasis are more difficult than in open surgery. For this reason, in laparoscopic liver resection, liver parenchyma dissection is generally accomplished using electrosurgical or stapling devices. The purpose of this study was to verify the authenticity of electrosurgical devices attached an automatic irrigation function (AI) and stapling devices for laparoscopic liver parenchymal dissection. Four devices were used for liver parenchymal dissection in laparoscopic hepatic wedge resection, in pigs: monopolar high-frequency electric cautery attached AI (MCI) (n = 6), bipolar high-frequency electric cautery attached AI (BCI) (n = 6), bipolar tissue sealing system (LigaSure) attached AI (BSI) and an endoscopic stapling device (ECHELON FLEX ENDOPATH) (ES). In each group, burst pressures were tested using an electronic manometer, paying special attention to the location (s) of the first disruption (s). The dissected tissues were examined histologically. Pressures used in electrosurgical devices attach AI were significantly higher compared to pressures used in a ES (P automatic irrigation function are useful devices to dissect the liver parenchyma.

  11. Mechanical Stress Changes the Complex Interplay Between HO-1, Inflammation and Fibrosis, During Excisional Wound Repair.

    Science.gov (United States)

    Cremers, Niels A J; Suttorp, Maarten; Gerritsen, Marlous M; Wong, Ronald J; van Run-van Breda, Coby; van Dam, Gooitzen M; Brouwer, Katrien M; Kuijpers-Jagtman, Anne Marie; Carels, Carine E L; Lundvig, Ditte M S; Wagener, Frank A D T G

    2015-01-01

    Mechanical stress following surgery or injury can promote pathological wound healing and fibrosis, and lead to functional loss and esthetic problems. Splinted excisional wounds can be used as a model for inducing mechanical stress. The cytoprotective enzyme heme oxygenase-1 (HO-1) is thought to orchestrate the defense against inflammatory and oxidative insults that drive fibrosis. Here, we investigated the activation of the HO-1 system in a splinted and non-splinted full-thickness excisional wound model using HO-1-luc transgenic mice. Effects of splinting on wound closure, HO-1 promoter activity, and markers of inflammation and fibrosis were assessed. After seven days, splinted wounds were more than three times larger than non-splinted wounds, demonstrating a delay in wound closure. HO-1 promoter activity rapidly decreased following removal of the (epi)dermis, but was induced in both splinted and non-splinted wounds during skin repair. Splinting induced more HO-1 gene expression in 7-day wounds; however, HO-1 protein expression remained lower in the epidermis, likely due to lower numbers of keratinocytes in the re-epithelialization tissue. Higher numbers of F4/80-positive macrophages, αSMA-positive myofibroblasts, and increased levels of the inflammatory genes IL-1β, TNF-α, and COX-2 were present in 7-day splinted wounds. Surprisingly, mRNA expression of newly formed collagen (type III) was lower in 7-day wounds after splinting, whereas, VEGF and MMP-9 were increased. In summary, these data demonstrate that splinting delays cutaneous wound closure and HO-1 protein induction. The pro-inflammatory environment following splinting may facilitate higher myofibroblast numbers and increase the risk of fibrosis and scar formation. Therefore, inducing HO-1 activity against mechanical stress-induced inflammation and fibrosis may be an interesting strategy to prevent negative effects of surgery on growth and function in patients with orofacial clefts or in patients with

  12. Electrosurgical Smoke: Ultrafine Particle Measurements and Work Environment Quality in Different Operating Theatres

    Directory of Open Access Journals (Sweden)

    Francesco Romano

    2017-01-01

    Full Text Available Air cleanliness in operating theatres (OTs is an important factor for preserving the health of both the patient and the medical staff. Particle contamination in OTs depends mainly on the surgery process, ventilation principle, personnel clothing systems and working routines. In many open surgical operations, electrosurgical tools (ESTs are used for tissue cauterization. ESTs generate a significant airborne contamination, as surgical smoke. Surgical smoke is a work environment quality problem. Ordinary surgical masks and OT ventilation systems are inadequate to control this problem. This research work is based on numerous monitoring campaigns of ultrafine particle concentrations in OTs, equipped with upward displacement ventilation or with a downward unidirectional airflow system. Measurements performed during ten real surgeries highlight that the use of ESTs generates a quite sharp and relevant increase of particle concentration in the surgical area as well within the entire OT area. The measured contamination level in the OTs are linked to surgical operation, ventilation principle, and ESTs used. A better knowledge of airborne contamination is crucial for limiting the personnel’s exposure to surgical smoke. Research results highlight that downward unidirectional OTs can give better conditions for adequate ventilation and contaminant removal performances than OTs equipped with upward displacement ventilation systems.

  13. Electrosurgical Smoke: Ultrafine Particle Measurements and Work Environment Quality in Different Operating Theatres.

    Science.gov (United States)

    Romano, Francesco; Gustén, Jan; De Antonellis, Stefano; Joppolo, Cesare M

    2017-01-30

    Air cleanliness in operating theatres (OTs) is an important factor for preserving the health of both the patient and the medical staff. Particle contamination in OTs depends mainly on the surgery process, ventilation principle, personnel clothing systems and working routines. In many open surgical operations, electrosurgical tools (ESTs) are used for tissue cauterization. ESTs generate a significant airborne contamination, as surgical smoke. Surgical smoke is a work environment quality problem. Ordinary surgical masks and OT ventilation systems are inadequate to control this problem. This research work is based on numerous monitoring campaigns of ultrafine particle concentrations in OTs, equipped with upward displacement ventilation or with a downward unidirectional airflow system. Measurements performed during ten real surgeries highlight that the use of ESTs generates a quite sharp and relevant increase of particle concentration in the surgical area as well within the entire OT area. The measured contamination level in the OTs are linked to surgical operation, ventilation principle, and ESTs used. A better knowledge of airborne contamination is crucial for limiting the personnel's exposure to surgical smoke. Research results highlight that downward unidirectional OTs can give better conditions for adequate ventilation and contaminant removal performances than OTs equipped with upward displacement ventilation systems.

  14. Scar formation following excisional and burn injuries in a red Duroc pig model.

    Science.gov (United States)

    Blackstone, Britani N; Kim, Jayne Y; McFarland, Kevin L; Sen, Chandan K; Supp, Dorothy M; Bailey, J Kevin; Powell, Heather M

    2017-07-20

    Scar research is challenging because rodents do not naturally form excessive scars, and burn depth, size, and location cannot be controlled in human longitudinal studies. The female, red Duroc pig model has been shown to form robust scars with biological and anatomical similarities to human hypertrophic scars. To more closely mimic the mode of injury, recreate the complex chemical milieu of the burn wound environment and enhance scar development, an animal model of excessive burn-induced scarring was developed and compared with the more commonly used model, which involves excisional wounds created via dermatome. Standardized, full-thickness thermal wounds were created on the dorsum of female, red Duroc pigs. Wounds for the dermatome model were created using two different total dermatome settings: ∼1.5 mm and ≥ 1.9 mm. Results from analysis over 150 days showed that burn wounds healed at much slower rate and contracted more significantly than dermatome wounds of both settings. The burn scars were hairless, had mixed pigmentation, and displayed fourfold and twofold greater excess erythema values, respectively, compared with ∼1.5 mm and ≥ 1.9 mm deep dermatome injuries. Burn scars were less elastic, less pliable, and weaker than scars resulting from excisional injuries. Decorin and versican gene expression levels were elevated in the burn group at day 150 compared with both dermatome groups. In addition, transforming growth factor-beta 1 was significantly up-regulated in the burn group vs. the ∼1.5 mm deep dermatome group at all time points, and expression remained significantly elevated vs. both dermatome groups at day 150. Compared with scars from dermatome wounds, the burn scar model described here demonstrates greater similarity to human hypertrophic scar. Thus, this burn scar model may provide an improved platform for studying the pathophysiology of burn-related hypertrophic scarring, investigating current anti-scar therapies, and development of

  15. Excisional wound healing is delayed in a murine model of chronic kidney disease.

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    Akhil K Seth

    Full Text Available BACKGROUND: Approximately 15% of the United States population suffers from chronic kidney disease (CKD, often demonstrating an associated impairment in wound healing. This study outlines the development of a surgical murine model of CKD in order to investigate the mechanisms underlying this impairment. METHODS: CKD was induced in mice by partial cauterization of one kidney cortex and contralateral nephrectomy, modifying a previously published technique. After a minimum of 6-weeks, splinted, dorsal excisional wounds were created to permit assessment of wound healing parameters. Wounds were harvested on postoperative days (POD 0, 3, 7, and 14 for histological, immunofluorescent, and quantitative PCR (qPCR. RESULTS: CKD mice exhibited deranged blood chemistry and hematology profiles, including profound uremia and anemia. Significant decreases in re-epithelialization and granulation tissue deposition rates were found in uremic mice wounds relative to controls. On immunofluorescent analysis, uremic mice demonstrated significant reductions in cellular proliferation (BrdU and angiogenesis (CD31, with a concurrent increase in inflammation (CD45 as compared to controls. CKD mice also displayed differential expression of wound healing-related genes (VEGF, IL-1β, eNOS, iNOS on qPCR. CONCLUSIONS: These findings represent the first reported investigation of cutaneous healing in a CKD animal model. Ongoing studies of this significantly delayed wound healing phenotype include the establishment of renal failure model in diabetic strains to study the combined effects of CKD and diabetes.

  16. Excisional Wound Healing Is Delayed in a Murine Model of Chronic Kidney Disease

    Science.gov (United States)

    Seth, Akhil K.; De la Garza, Mauricio; Fang, Robert C.; Hong, Seok J.; Galiano, Robert D.

    2013-01-01

    Background Approximately 15% of the United States population suffers from chronic kidney disease (CKD), often demonstrating an associated impairment in wound healing. This study outlines the development of a surgical murine model of CKD in order to investigate the mechanisms underlying this impairment. Methods CKD was induced in mice by partial cauterization of one kidney cortex and contralateral nephrectomy, modifying a previously published technique. After a minimum of 6-weeks, splinted, dorsal excisional wounds were created to permit assessment of wound healing parameters. Wounds were harvested on postoperative days (POD) 0, 3, 7, and 14 for histological, immunofluorescent, and quantitative PCR (qPCR). Results CKD mice exhibited deranged blood chemistry and hematology profiles, including profound uremia and anemia. Significant decreases in re-epithelialization and granulation tissue deposition rates were found in uremic mice wounds relative to controls. On immunofluorescent analysis, uremic mice demonstrated significant reductions in cellular proliferation (BrdU) and angiogenesis (CD31), with a concurrent increase in inflammation (CD45) as compared to controls. CKD mice also displayed differential expression of wound healing-related genes (VEGF, IL-1β, eNOS, iNOS) on qPCR. Conclusions These findings represent the first reported investigation of cutaneous healing in a CKD animal model. Ongoing studies of this significantly delayed wound healing phenotype include the establishment of renal failure model in diabetic strains to study the combined effects of CKD and diabetes. PMID:23536900

  17. Diathermy excisional hemorrhoidectomy: a prospective randomized study comparing pedicle ligation and pedicle coagulation.

    Science.gov (United States)

    Bessa, Samer S

    2011-11-01

    In hemorrhoidectomy, pedicle coagulation has been claimed to be associated with less postoperative pain compared with pedicle ligation. This study was designed to compare the effects of pedicle ligation vs pedicle coagulation on postoperative pain in patients undergoing diathermy excisional hemorrhoidectomy. The study was conducted as a single-blind prospective randomized clinical trial. Patients were treated at a single tertiary-level teaching hospital (Main University Hospital) in Alexandria, Egypt, from February 2009 to October 2010. Patients with symptomatic grade III or IV hemorrhoids were eligible. Patients were randomly allocated to receive either pedicle coagulation or pedicle ligation during 3-quadrant diathermy excision hemorrhoidectomy. Patients reported postoperative pain daily on a visual analog scale (0-10, with 10 corresponding to the most severe pain) during the first 10 postoperative days. On-demand parenteral analgesic requirements were recorded during the first 24 hours after surgery. Operative time, postoperative complications, and wound healing rates at 6 weeks postoperatively were also recorded. No a priori power calculation could be performed, so it was not possible to tell whether nonsignificant differences were real or a result of chance. A total of 136 patients were randomly assigned, and 120 patients completed the study (60 in each group). The overall median pain score for the first 10 postoperative days was significantly lower in the pedicle coagulation group than in the pedicle ligation group (4.65 vs 6.56, P parenteral analgesic requirements during the first 24 hours postoperatively.

  18. Acticoat™ stimulates inflammation, but does not delay healing, in acute full-thickness excisional wounds.

    Science.gov (United States)

    Hartmann, Carol A; Rode, Heinz; Kramer, Beverley

    2016-12-01

    Acticoat™ has antimicrobial and anti-inflammatory effects which aid wound healing. However, in vitro studies indicate that Acticoat™ is cytotoxic and clinical and in vivo studies suggest that it may delay healing in acute wounds. Therefore, this study investigated the effects of Acticoat™ on healing in acute full-thickness excisional wounds. Using a porcine model, healing was assessed on days 3, 6, 9 and 15 post-wounding. Five wounds dressed with Acticoat™ and five wounds dressed with polyurethane film (control) were assessed per day (n = 40 wounds). The rate of healing, inflammatory response, restoration of the epithelium and blood vessel and collagen formation were evaluated. No difference was found in the rate of healing between wounds treated with Acticoat™ and the control wounds. Inflammation was increased in Acticoat™-treated wounds on day 3 post-wounding compared to the control wounds. However, by day 15 post-wounding, the epithelium of the Acticoat™-treated wounds closely resembled normal epithelium. Acticoat™-treated wounds also contained a higher proportion of mature blood vessels, and differences in collagen deposition were apparent. Despite inducing an inflammatory response, Acticoat™ did not delay healing in acute wounds. Conversely, the improved quality of the epithelium and blood vessels within Acticoat™-treated wounds indicates that Acticoat™ has a beneficial effect on healing. © 2015 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  19. Operating room fire prevention: creating an electrosurgical unit fire safety device.

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    Culp, William C; Kimbrough, Bradly A; Luna, Sarah; Maguddayao, Aris J

    2014-08-01

    To reduce the incidence of surgical fires. Operating room fires represent a potentially life-threatening hazard and are triggered by the electrosurgical unit (ESU) pencil. Carbon dioxide is a fire suppressant and is a routinely used medical gas. We hypothesize that a shroud of protective carbon dioxide covering the tip of the ESU pencil displaces oxygen, thereby preventing fire ignition. Using 3-dimensional modeling techniques, a polymer sleeve was created and attached to an ESU pencil. This sleeve was connected to a carbon dioxide source and directed the gas through multiple precisely angled ports, generating a cone of fire-suppressive carbon dioxide surrounding the active pencil tip. This device was evaluated in a flammability test chamber containing 21%, 50%, and 100% oxygen with sustained ESU activation. The sleeve was tested with and without carbon dioxide (control) until a fuel was ignited or 30 seconds elapsed. Time to ignition was measured by high-speed videography. Fires were ignited with each control trial (15/15 trials). The control group median ± SD ignition time in 21% oxygen was 3.0 ± 2.4 seconds, in 50% oxygen was 0.1 ± 1.8 seconds, and in 100% oxygen was 0.03 ± 0.1 seconds. No fire was observed when the fire safety device was used in all concentrations of oxygen (0/15 trials; P fire ignition was 76% to 100%. A sleeve creating a cone of protective carbon dioxide gas enshrouding the sparks from an ESU pencil effectively prevents fire in a high-flammability model. Clinical application of this device may reduce the incidence of operating room fires.

  20. Conization Using an Electrosurgical Knife for Cervical Intraepithelial Neoplasia and Microinvasive Carcinoma.

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    Libing Xiang

    Full Text Available The aim of the present study was to evaluate the incidences of margin involvement, disease relapse, and complications in patients who had undergone conization using an electrosurgical knife (EKC for cervical intraepithelial neoplasia (CIN or microinvasive carcinomas (micro-CAs.A retrospective case series analysis was performed with a total of 1359 patients who underwent EKC in Fudan University Shanghai Cancer Center between June 2004 and July 2010.The median age of the patients was 39 years old (range: 19-72. Conization revealed the presence of CIN in 1113 (81.9% patients, micro-CA in 72 (5.3% patients and invasive carcinomas in 44 (3.2% patients. The remaining 130 (9.6% patients were free of diseases in the cone specimens. Positive surgical margins, or endocervical curettages (ECCs were found in 90 (7.6% patients with CINs or micro-CAs. Three factors were associated with positive margins and ECCs and included age (>50 years; odds ratio (OR, 3.0, P<0.01, postmenopausal status (OR, 3.1, P<0.01 and microinvasive disease (OR, 2.7, P<0.01. One thousand and eighty-nine (92.0% patients were followed-up regularly for a median follow-up duration of 46 months (range: 24-106 months. Disease relapse was documented in 50 (4.6% patients. Eighty-two (6.0% cases experienced surgical complications that needed to be addressed, including early or late hemorrhages, infections, cervical stenosis, etc.Our patients demonstrated that EKC was an alternative technique for diagnosis and treatment of CIN or micro-CAs with relatively low rate of recurrence and acceptable rate of complications. A randomized clinical trial is warranted to compare EKC, CKC and LEEP in the management of CIN or micro-CA.

  1. Specific sizes of hyaluronan oligosaccharides stimulate fibroblast migration and excisional wound repair.

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    Cornelia Tolg

    Full Text Available The extracellular matrix polysaccharide hyaluronan (HA plays a key role in both fibrotic and regenerative tissue repair. Accumulation of high molecular weight HA is typical of regenerative repair, which is associated with minimal inflammation and fibrosis, while fragmentation of HA is typical of postnatal wounds, which heal in the presence of inflammation and transient fibrosis. It is generally considered that HA oligosaccharides and fragments of a wide size range support these processes of adult, fibrotic wound repair yet the consequences of sized HA fragments/oligosaccharides to each repair stage is not well characterized. Here, we compared the effects of native HA, HA oligosaccharide mixtures and individual sizes (4-10 mer oligosaccharides, 5 and, 40 kDa of HA oligosaccharides and fragments, on fibroblast migration in scratch wound assays and on excisional skin wound repair in vivo. We confirm that 4-10 mer mixtures significantly stimulated scratch wound repair and further report that only the 6 and 8 mer oligosaccharides in this mixture are responsible for this effect. The HA 6 mer promoted wound closure, accumulation of wound M1 and M2 macrophages and the M2 cytokine TGFβ1, but did not increase myofibroblast differentiation. The effect of 6 mer HA on wound closure required both RHAMM and CD44 expression. In contrast, The 40 kDa HA fragment inhibited wound closure, increased the number of wound macrophages but had no effect on TGFβ1 accumulation or subsequent fibrosis. These results show that specific sizes of HA polymer have unique effects on postnatal wound repair. The ability of 6 mer HA to promote wound closure and inflammation resolution without increased myofibroblast differentiation suggests that this HA oligosaccharide could be useful for treatment of delayed or inefficient wound repair where minimal fibrosis is advantageous.

  2. Tissue responses to postoperative laser therapy in diabetic rats submitted to excisional wounds.

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    Cristiano de Loura Santana

    Full Text Available In a previous study about low-level laser therapy biomodulation on a full-thickness burn model we showed that single and fractionated dose regimens increased wound healing and leukocyte influx similarly when compared with untreated control. In order to verify if this finding would be similar in an impaired wound model, we investigated the effect of single and multiple irradiations on wound closure rate, type of inflammatory infiltrate, myofibroblasts, collagen deposition, and optical retardation of collagen in diabetic rats. Female Wistar rats in the same estrous cycle had diabetes induced with streptozotocin and an 8-mm excisional wound performed with a punch. The experimental groups were: control group--untreated ulcer; single-dose group--ulcer submitted to single dose of diode laser therapy (λ = 660 ± 2 nm; P = 30 mW; energy density: 4 J/cm2 and fractionated-dose group--ulcer submitted to 1 J/cm2 laser therapy on Days 1, 3, 8, and 10. The ulcers were photographed on the experimental days and after euthanasia tissue samples were routinely processed for histological and immunohistochemistry analyses. Independently of the energy density, laser therapy accelerated wound closure by approximately 40% in the first three days in comparison to the control group. Laser therapy increased acute inflammatory infiltrate until Day 3. Both laser groups exhibited more myofibroblasts and better collagen organization than the control group. The findings demonstrate that low-level laser therapy in the immediate postoperative period can enhance the tissue repair process in a diabetes model. Similar effects were achieved with laser therapy applied a single time with an energy density of 4 J/cm2 and applied four times with an energy density of 1 J/cm2. The application of laser therapy in the inflammatory phase was the most important factor to the enhancement of the tissue repair process.

  3. Tissue responses to postoperative laser therapy in diabetic rats submitted to excisional wounds.

    Science.gov (United States)

    de Loura Santana, Cristiano; Silva, Daniela de Fátima Teixeira; Deana, Alessandro Melo; Prates, Renato Araujo; Souza, Amanda Pires; Gomes, Mariana Teixeira; de Azevedo Sampaio, Brunna Pileggi; Shibuya, Josiane Ferraretto; Bussadori, Sandra Kalil; Mesquita-Ferrari, Raquel Agnelli; Fernandes, Kristianne Porta Santos; França, Cristiane Miranda

    2015-01-01

    In a previous study about low-level laser therapy biomodulation on a full-thickness burn model we showed that single and fractionated dose regimens increased wound healing and leukocyte influx similarly when compared with untreated control. In order to verify if this finding would be similar in an impaired wound model, we investigated the effect of single and multiple irradiations on wound closure rate, type of inflammatory infiltrate, myofibroblasts, collagen deposition, and optical retardation of collagen in diabetic rats. Female Wistar rats in the same estrous cycle had diabetes induced with streptozotocin and an 8-mm excisional wound performed with a punch. The experimental groups were: control group--untreated ulcer; single-dose group--ulcer submitted to single dose of diode laser therapy (λ = 660 ± 2 nm; P = 30 mW; energy density: 4 J/cm2) and fractionated-dose group--ulcer submitted to 1 J/cm2 laser therapy on Days 1, 3, 8, and 10. The ulcers were photographed on the experimental days and after euthanasia tissue samples were routinely processed for histological and immunohistochemistry analyses. Independently of the energy density, laser therapy accelerated wound closure by approximately 40% in the first three days in comparison to the control group. Laser therapy increased acute inflammatory infiltrate until Day 3. Both laser groups exhibited more myofibroblasts and better collagen organization than the control group. The findings demonstrate that low-level laser therapy in the immediate postoperative period can enhance the tissue repair process in a diabetes model. Similar effects were achieved with laser therapy applied a single time with an energy density of 4 J/cm2 and applied four times with an energy density of 1 J/cm2. The application of laser therapy in the inflammatory phase was the most important factor to the enhancement of the tissue repair process.

  4. Effects of microcurrent therapy on excisional elastic cartilage defects in young rats.

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    Tangerino Filho, Edson Pereira; Fachi, José Luis; Vasconcelos, Israel Costa; Dos Santos, Glaucia Maria Tech; Mendonça, Fernanda Aparecida Sampaio; de Aro, Andrea Aparecida; Pimentel, Edson Rosa; Esquisatto, Marcelo Augusto Marretto

    2016-06-01

    The effects of microcurrent application on the elastic cartilage defects in the outer ear of young animals were analyzed. Sixty male Wistar rats were divided into a control (CG) and a treated group (TG). An excisional lesion was created in the right outer ear of each animal. Daily treatment was started after 24h and consisted of the application of a low-intensity (20μA) continuous electrical current to the site of injury for 5min. The animals were euthanized after 7, 14 and 28 days of injury and the samples were submitted to analyses. In CG, areas of newly formed cartilage and intense basophilia were seen at 28 days, while in TG the same observations were made already at 14 days. The percentage of birefringent collagen fibers was higher in CG at 28 days. The number of connective tissue cells and granulocytes was significantly higher in TG. Ultrastructural analysis revealed the presence of chondrocytes in TG at 14 days, while these cells were observed in CG only at 28 days. Cuprolinic blue staining and the amount of glycosaminoglycans were significantly higher in TG at 14 days and 28 days. The amount of hydroxyproline was significantly higher in TG at all time points studied. The active isoform of MMP-2 was higher activity in TG at 14 days. Immunoblotting for type II collagen and decorin was positive in both groups and at all time points. The treatment stimulated the proliferation and differentiation of connective tissue cells, the deposition of glycosaminoglycans and collagen, and the structural reorganization of these elements during elastic cartilage repair. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Comparison of stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease (eTHoS): a pragmatic, multicentre, randomised controlled trial.

    Science.gov (United States)

    Watson, Angus J M; Hudson, Jemma; Wood, Jessica; Kilonzo, Mary; Brown, Steven R; McDonald, Alison; Norrie, John; Bruhn, Hanne; Cook, Jonathan A

    2016-11-12

    Two commonly performed surgical interventions are available for severe (grade II-IV) haemorrhoids; traditional excisional surgery and stapled haemorrhoidopexy. Uncertainty exists as to which is most effective. The eTHoS trial was designed to establish the clinical effectiveness and cost-effectiveness of stapled haemorrhoidopexy compared with traditional excisional surgery. The eTHoS trial was a large, open-label, multicentre, parallel-group, pragmatic randomised controlled trial done in adult participants (aged 18 years or older) referred to hospital for surgical treatment for grade II-IV haemorrhoids. Participants were randomly assigned (1:1) to receive either traditional excisional surgery or stapled haemorrhoidopexy. Randomisation was minimised according to baseline EuroQol 5 dimensions 3 level score (EQ-5D-3L), haemorrhoid grade, sex, and centre with an automated system to stapled haemorrhoidopexy or traditional excisional surgery. The primary outcome was area under the quality of life curve (AUC) measured with the EQ-5D-3L descriptive system over 24 months, assessed according to the randomised groups. The primary outcome measure was analysed using linear regression with adjustment for the minimisation variables. This trial is registered with the ISRCTN registry, number ISRCTN80061723. Between Jan 13, 2011, and Aug 1, 2014, 777 patients were randomised (389 to receive stapled haemorrhoidopexy and 388 to receive traditional excisional surgery). Stapled haemorrhoidopexy was less painful than traditional excisional surgery in the short term and surgical complication rates were similar between groups. The EQ-5D-3L AUC score was higher in the traditional excisional surgery group than the stapled haemorrhoidopexy group over 24 months; mean difference -0·073 (95% CI -0·140 to -0·006; p=0·0342). EQ-5D-3L was higher for stapled haemorrhoidopexy in the first 6 weeks after surgery, the traditional excisional surgery group had significantly better quality of life

  6. Use of core biopsy in diagnosing cervical lymphadenopathy: a viable alternative to surgical excisional biopsy of lymph nodes?

    Science.gov (United States)

    Allin, D; David, S; Jacob, A; Mir, N; Giles, A; Gibbins, N

    2017-03-01

    OBJECTIVES Lymphoma often presents with a neck mass and while fine-needle aspiration cytology may be suggestive, tissue biopsy is required for reliable diagnosis and classification of a lymphoma that is sufficient to deliver the correct treatment for the patient. Traditionally, excisional biopsy of a lymph node has been the standard method of tissue sampling, providing ample tissue for assessment. However, this requires theatre time, and preceding fine-needle aspiration cytology, which may incur a delay. With careful use of tissue, coupled with advances in immunohistochemical and molecular investigative techniques, core biopsy provides a possible alternative to traditional fine-needle aspiration and excisional biopsy. In this study, we aimed to determine the efficacy of diagnosing neck masses. METHOD A retrospective analysis was performed of patients being investigated for a neck mass who were undergoing ultrasound-guided core biopsies of cervical lymph nodes over a 17-month period. The final histology report was scrutinised to assess whether adequate tissue was obtained to allow for full tissue diagnosis. RESULTS Over the 17-month period analysed, 70 patients with cervical lymphadenopathy underwent core biopsy. Of these, 63 (90%) were diagnostic for either lymphoma or other pathology and did not require further tissue sampling. Overall, 19 patients were diagnosed with lymphoma, of which only 1 required further biopsy due to inconclusive initial core biopsy. CONCLUSIONS Current guidelines for investigating lymphomas require that excisional biopsy be performed to obtain ample tissue to allow full nodal architecture assessment and ancillary investigation to reach an accurate histological classification. Within our head and neck multidisciplinary team, however, it is considered that results from core biopsies can be obtained in a more timely fashion and with histological accuracy equal to those of open biopsy. The results obtained demonstrate that core biopsy is an

  7. Injectable Polyurethane Composite Scaffolds Delay Wound Contraction and Support Cellular Infiltration and Remodeling in Rat Excisional Wounds

    Science.gov (United States)

    Adolph, Elizabeth J.; Hafeman, Andrea E.; Davidson, Jeffrey M.; Nanney, Lillian B.; Guelcher, Scott A.

    2011-01-01

    Injectable scaffolds present compelling opportunities for wound repair and regeneration due to their ability to fill irregularly shaped defects and deliver biologics such as growth factors. In this study, we investigated the properties of injectable polyurethane biocomposite scaffolds and their application in cutaneous wound repair using a rat excisional model. The scaffolds have a minimal reaction exotherm and clinically relevant working and setting times. Moreover, the biocomposites have mechanical and thermal properties consistent with rubbery elastomers. In the rat excisional wound model, injection of settable biocomposite scaffolds stented the wounds at early time points, resulting in a regenerative rather than a scarring phenotype at later time points. Measurements of wound width and thickness revealed that the treated wounds were less contracted at day 7 compared to blank wounds. Analysis of cell proliferation and apoptosis showed that the scaffolds were biocompatible and supported tissue ingrowth. Myofibroblast formation and collagen fiber organization provided evidence that the scaffolds have a positive effect on extracellular matrix remodeling by disrupting the formation of an aligned matrix under elevated tension. In summary, we have developed an injectable biodegradable polyurethane biocomposite scaffold that enhances cutaneous wound healing in a rat model. PMID:22105887

  8. Biodegradable lysine-derived polyurethane scaffolds promote healing in a porcine full-thickness excisional wound model.

    Science.gov (United States)

    Adolph, Elizabeth J; Pollins, Alonda C; Cardwell, Nancy L; Davidson, Jeffrey M; Guelcher, Scott A; Nanney, Lillian B

    2014-01-01

    Lysine-derived polyurethane scaffolds (LTI-PUR) support cutaneous wound healing in loose-skinned small animal models. Due to the physiological and anatomical similarities of human and pig skin, we investigated the capacity of LTI-PUR scaffolds to support wound healing in a porcine excisional wound model. Modifications to scaffold design included the addition of carboxymethylcellulose (CMC) as a porogen to increase interconnectivity and an additional plasma treatment (Plasma) to decrease surface hydrophobicity. All LTI-PUR scaffold and formulations supported cellular infiltration and were biodegradable. At 15 days, CMC and plasma scaffolds simulated increased macrophages more so than LTI PUR or no treatment. This response was consistent with macrophage-mediated oxidative degradation of the lysine component of the scaffolds. Cell proliferation was similar in control and scaffold-treated wounds at 8 and 15 days. Neither apoptosis nor blood vessel area density showed significant differences in the presence of any of the scaffold variations compared with untreated wounds, providing further evidence that these synthetic biomaterials had no adverse effects on those pivotal wound healing processes. During the critical phase of granulation tissue formation in full thickness porcine excisional wounds, LTI-PUR scaffolds supported tissue infiltration, while undergoing biodegradation. Modifications to scaffold fabrication modify the reparative process. This study emphasizes the biocompatibility and favorable cellular responses of PUR scaffolding formulations in a clinically relevant animal model.

  9. Diagnostic ultrasound-guided excisional testicular biopsy for small (< 1 cm incidental nodules. A single institution experience

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    Andrea Fabiani

    2014-12-01

    Full Text Available Introduction and objectives: The widespread use of scrotal ultrasound (SUS has led to a marked increase in the number of incidentally detected testicular lesions. A small incidental nodule (STN has defined as a non palpable (< 10 mm, asymptomatic solid lesion with normal levels of oncological testicular markers. Nowadays the lack of agreement on the topic causes managing problems to andrologists. We present our experience consisting in 8 cases of STN discovered by SUS performed for different clinical indications. Matherial and methods: We retrieved from our ultrasonographic files the clinical information about 717 patients evaluated for andrological problems. Patients with STN underwent to a complete clinical history and physical examination as well as oncological testicular markers measurement and ormonal assessment and then received a diagnostic ultrasound guided excisional biopsy (DEB. Surgical approach was performed through an inguinal incision. Using the coordinates previously obtained from preoperative SUS, STN was localized by intraoperative SUS. The lesion was enucleated and sent to the Pathology department for frozen section examination (FSE. Biopsies of affected testis (TB were also performed. Post-excision ultrasound has been used to confirm the complete removal of the nodule. Whether pathological findings were benign, testis sparing surgery (TSS was performed. Immediate radical orchidectomy (IRO was performed if FSE and TB findings suggested a malignant lesion. Results: STNs were discovered in 8 patients (1,1%. Very small lesions (< 5 mm were detected in 50% of cases. We performed four IRO and four DEB with consequent TSS. In one case we performed a delayed radical orchidectomy (DRO. At FSE pathologist reported 3 Leydig cell tumor and 3 seminoma and an inflammatory regressive lesion in one case. FSE on TB reported intratesticular neoplasia (TIN in three cases. In one case nodule wasn’t sent to FSE. We observed a concordance between

  10. Primary Simple Limbal Epithelial Transplantation Along With Excisional Biopsy in the Management of Extensive Ocular Surface Squamous Neoplasia.

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    Mittal, Vikas; Narang, Purvasha; Menon, Vikas; Mittal, Ruchi; Honavar, Santosh

    2016-12-01

    To describe the utility of simple limbal epithelial transplantation (SLET) along with tumor excision in the management of extensive ocular surface squamous neoplasia (OSSN) to avoid limbal stem cell deficiency (LSCD). This case report describes the management of a 75-year-old man clinically diagnosed with OSSN involving more than 3 quadrants of limbus. The excisional biopsy of tumor along with 4-mm healthy margin led to a complete loss of the limbus, which was restored by limbal epithelial cell transplantation using the SLET technique in the same setting. The tumor was found adherent to the episclera in the superotemporal quadrant and required episcleral and superficial lamellar scleral dissection. The entire tumor could be excised, and complete reepithelialization of the cornea was seen within 2 weeks. Histopathology showed tumor cells infiltrating the stroma and base of the excision biopsy, suggesting invasive squamous cell carcinoma. The excised margins were tumor free. To prevent recurrence, the patient underwent radiotherapy (plaque brachytherapy). After a follow-up period of 2 years, a successful outcome in the form of a stable ocular surface, no tumor recurrence, and no signs of LSCD was achieved in our patient. Restoration of limbal stem cells using SLET technique in an extensive OSSN in the primary setting may be pertinent to a good outcome.

  11. Evaluation of a transection method for distal pancreatectomy: A comparative study on the use of electrosurgical and stapling devices in swine.

    Science.gov (United States)

    Ikeda, Tetsuo; Akahoshi, Tomohiko; Kawanaka, Hirofumi; Uchiyama, Hideaki; Yamashita, Yo-ichi; Morita, Masaru; Oki, Eiji; Saeki, Hiroshi; Sugimachi, Keishi; Ikegami, Toru; Yoshizumi, Tomoharu; Soejima, Yuji; Shirabe, Ken; Mimori, Koshi; Watanabe, Masayuki; Hashizume, Makoto; Maehara, Yoshihiko

    2013-12-01

    Despite marked improvements in pancreatic surgery, the high incidence of pancreatic fistula and high morbidity after resection persists. The objective of this study was to evaluate the role of electrosurgical and stapling devices as an alternative to traditional methods of stump closure in an animal model of distal pancreatectomy. Four devices were used for transection of the pancreatic body : a bi-polar thermofusion system attached to an automatic irrigation function (BI, n = 3), a bi-polar tissue sealer (BS, n = 3), an ultrasonic scissor (US, n = 3), and an endoscopic stapling device (ES, n = 3). For each group, burst pressure was tested using an electronic manometer, with a focus on the location (s) of the first disruption (s). Histological examination was performed for the dissected surfaces. The transection line, including staples, was embedded in a polyester resin, and histological examination was performed for these polished sections of the resin. Pressure was significantly higher for BI (P < 0.01) than that for the other devices. In contrast, thermal denaturation of the pancreas parenchyma was observed at a depth of approximately 1 mm from the dissected portion for BS, while it extended beyond 15 mm for BI. The staple line was the first disruption point for all of ES cases. The pellicle of the pancreas is likely to be deficient after a surgical operation. If the pellicle is preserved, the strength of the pellicle may be insufficient for complete closure with high stapling mechanical pressure or the protein coagulation of usually used electrosurgical devices.

  12. Curcuma purpurascens BI. rhizome accelerates rat excisional wound healing: involvement of Hsp70/Bax proteins, antioxidant defense, and angiogenesis activity

    Science.gov (United States)

    Rouhollahi, Elham; Moghadamtousi, Soheil Zorofchian; Hajiaghaalipour, Fatemeh; Zahedifard, Maryam; Tayeby, Faezeh; Awang, Khalijah; Abdulla, Mahmood Ameen; Mohamed, Zahurin

    2015-01-01

    Purpose Curcuma purpurascens BI. is a member of Zingiberaceae family. The purpose of this study is to investigate the wound healing properties of hexane extract of C. purpurascens rhizome (HECP) against excisional wound healing in rats. Materials and methods Twenty four rats were randomly divided into 4 groups: A) negative control (blank placebo, acacia gum), B) low dose of HECP, C) high dose of HECP, and D) positive control, with 6 rats in each group. Full-thickness incisions (approximately 2.00 cm) were made on the neck area of each rat. Groups 1–4 were treated two-times a day for 20 days with blank placebo, HECP (100 mg/kg), HECP (200 mg/kg), and intrasite gel as a positive control, respectively. After 20 days, hematoxylin and eosin and Masson’s trichrome stainings were employed to investigate the histopathological alterations. Protein expressions of Bax and Hsp70 were examined in the wound tissues using immunohistochemistry analysis. In addition, levels of enzymatic antioxidants and malondialdehyde representing lipid peroxidation were measured in wound tissue homogenates. Results Macroscopic evaluation of wounds showed conspicuous elevation in wound contraction after topical administration of HECP at both doses. Moreover, histopathological analysis revealed noteworthy reduction in the scar width correlated with the enhanced collagen content and fibroblast cells, accompanied by a reduction of inflammatory cells in the granulation tissues. At the molecular level, HECP facilitates wound-healing process by downregulating Bax and upregulating Hsp70 protein at the wound site. The formation of new blood vessel was observed in Masson’s trichrome staining of wounds treated with HECP (100 and 200 mg/kg). In addition, HECP administration caused a significant surge in enzymatic antioxidant activities and a decline in lipid peroxidation. Conclusion These findings suggested that HECP accelerated wound-healing process in rats via antioxidant activity, angiogenesis

  13. Evaluation of a novel electrosurgical sealing mode in an ex vivo and in vivo porcine model.

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    Thiel, Karolin; Linzenbold, Walter; Enderle, Markus D; Nold, B; Königsrainer, Alfred; Schenk, Martin; Thiel, Christian

    2017-09-18

    Bipolar vessel sealing has been successfully introduced in a variety of procedures like prostatectomy, hysterectomy, and nephrectomy. In this study, we evaluated a new sealing mode-the thermoSEAL® mode (TSM)-operated with the VIO3 generator in an ex vivo and in vivo animal study and compared the results with the commercially available BiClamp mode (BCM), operated with the VIO300D generator. Two different instruments were used in combination with both modes, BiCision® and BiClamp® 201T (Erbe Elektromedizin GmbH). In the ex vivo experiment, the sealing of renal arteries was evaluated using both instruments and modes. For the in vivo study, different types of arteries and veins were sealed using both modes and instruments in a side-by-side comparison for acute complications in a total of four animals. Mean burst pressure was in all cases significantly above 360 mmHg (p vivo setting was significantly shorter for TSM compared to BCM: BiCision® (3.7 ± 0.4 vs. 7.1 ± 0.3 s; p vivo study was significantly shorter for TSM in combination with BiCision® for arteries [TSM 3.0 ± 0.7 s vs. BCM 6.5 ± 1.3 s, (p 90%) were noted for both instruments and modes. While both modes used with two different instruments reveal high safety characterized by a high burst pressure, low thermal damage (ex vivo) zones, and high sealing rates (in vivo), the thermoSEAL® mode convinces by its fast sealing speed probably helping to reduce operation time.

  14. Rapid evaporative ionisation mass spectrometry of electrosurgical vapours for the identification of breast pathology: towards an intelligent knife for breast cancer surgery.

    Science.gov (United States)

    St John, Edward R; Balog, Julia; McKenzie, James S; Rossi, Merja; Covington, April; Muirhead, Laura; Bodai, Zsolt; Rosini, Francesca; Speller, Abigail V M; Shousha, Sami; Ramakrishnan, Rathi; Darzi, Ara; Takats, Zoltan; Leff, Daniel R

    2017-05-23

    Re-operation for positive resection margins following breast-conserving surgery occurs frequently (average = 20-25%), is cost-inefficient, and leads to physical and psychological morbidity. Current margin assessment techniques are slow and labour intensive. Rapid evaporative ionisation mass spectrometry (REIMS) rapidly identifies dissected tissues by determination of tissue structural lipid profiles through on-line chemical analysis of electrosurgical aerosol toward real-time margin assessment. Electrosurgical aerosol produced from ex-vivo and in-vivo breast samples was aspirated into a mass spectrometer (MS) using a monopolar hand-piece. Tissue identification results obtained by multivariate statistical analysis of MS data were validated by histopathology. Ex-vivo classification models were constructed from a mass spectral database of normal and tumour breast samples. Univariate and tandem MS analysis of significant peaks was conducted to identify biochemical differences between normal and cancerous tissues. An ex-vivo classification model was used in combination with bespoke recognition software, as an intelligent knife (iKnife), to predict the diagnosis for an ex-vivo validation set. Intraoperative REIMS data were acquired during breast surgery and time-synchronized to operative videos. A classification model using histologically validated spectral data acquired from 932 sampling points in normal tissue and 226 in tumour tissue provided 93.4% sensitivity and 94.9% specificity. Tandem MS identified 63 phospholipids and 6 triglyceride species responsible for 24 spectral differences between tissue types. iKnife recognition accuracy with 260 newly acquired fresh and frozen breast tissue specimens (normal n = 161, tumour n = 99) provided sensitivity of 90.9% and specificity of 98.8%. The ex-vivo and intra-operative method produced visually comparable high intensity spectra. iKnife interpretation of intra-operative electrosurgical vapours, including data

  15. Benign core biopsy of probably benign breast lesions 2 cm or larger: correlation with excisional biopsy and long-term follow-up

    Directory of Open Access Journals (Sweden)

    Hyun Kyung Jung

    2014-07-01

    Full Text Available Purpose: To evaluate the accuracy of benign core biopsy of probably benign breast lesions (category 3 2 cm or larger on the basis of excisional biopsy and long-term follow-up. Methods: We retrospectively reviewed 146 category 3 lesions in 146 patients 2 cm or larger which were diagnosed as benign by ultrasound (US-guided core biopsy. Patients were initially diagnosed as benign at core needle biopsy and then followed up with excisional biopsy (surgical excision, n=91; US-guided vacuum assisted excision, n=35 or breast ultrasonography (n=20. Results: Of the 126 patients who underwent surgical excision or US-guided vacuum-assisted excision, 114 patients were diagnosed with benign lesions, 10 patients with borderline lesions (benign phyllodes tumor, and two patients with malignant phyllodes tumors. The probabilities of lesions being benign, borderline and malignant were 91.8% (134/146, 6.8% (10/146, and 1.4% (2/146, respectively. Of 13 patients who had growing masses on follow-up ultrasonography, three (23.1% were non-benign (two benign phyllodes tumors and one malignant phyllodes tumor. Conclusion: US-guided core needle biopsy of probably benign breast mass 2 cm or larger was accurate (98.6% enough to rule out malignancy. But, it was difficult to rule out borderline lesions even when they were diagnosed as benign.

  16. Benign core biopsy of probably benign breast lesions 2 cm or larger: correlation with excisional biopsy and long-term follow-up

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    Jung, Hyun Kyung; Moon, Hee Jung; Kim, Min Jung; Kim, Eun Kyung [Dept. of Diagnostic Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2014-10-15

    To evaluate the accuracy of benign core biopsy of probably benign breast lesions (category 3) 2 cm or larger on the basis of excisional biopsy and long-term follow-up. We retrospectively reviewed 146 category 3 lesions in 146 patients 2 cm or larger which were diagnosed as benign by ultrasound (US)-guided core biopsy. Patients were initially diagnosed as benign at core needle biopsy and then followed up with excisional biopsy (surgical excision, n=91; US-guided vacuum assisted excision, n=35) or breast ultrasonography (n=20). Of the 126 patients who underwent surgical excision or US-guided vacuum-assisted excision, 114 patients were diagnosed with benign lesions, 10 patients with borderline lesions (benign phyllodes tumor), and two patients with malignant phyllodes tumors. The probabilities of lesions being benign, borderline and malignant were 91.8% (134/146), 6.8% (10/146), and 1.4% (2/146), respectively. Of 13 patients who had growing masses on follow-up ultrasonography, three (23.1%) were non-benign (two benign phyllodes tumors and one malignant phyllodes tumor). US-guided core needle biopsy of probably benign breast mass 2 cm or larger was accurate (98.6%) enough to rule out malignancy. But, it was difficult to rule out borderline lesions even when they were diagnosed as benign.

  17. [Selective biopsy of the sentinel lymph node in patients with breast cancer and previous excisional biopsy: is there a change in the reliability of the technique according to time from surgery?].

    Science.gov (United States)

    Sabaté-Llobera, A; Notta, P C; Benítez-Segura, A; López-Ojeda, A; Pernas-Simon, S; Boya-Román, M P; Bajén, M T

    2015-01-01

    To assess the influence of time on the reliability of sentinel lymph node biopsy (SLNB) in breast cancer patients with previous excisional biopsy (EB), analyzing both the sentinel lymph node detection and the lymph node recurrence rate. Thirty-six patients with cT1/T2 N0 breast cancer and previous EB of the lesion underwent a lymphoscintigraphy after subdermal periareolar administration of radiocolloid, the day before SLNB. Patients were classified into two groups, one including 12 patients with up to 29 days elapsed between EB and SLNB (group A), and another with the remaining 24 in which time between both procedures was of 30 days or more (group B). Scintigraphic and surgical detection of the sentinel lymph node, histological status of the sentinel lymph node and of the axillary lymph node dissection, if performed, and lymphatic recurrences during follow-up, were analyzed. Sentinel lymph node visualization at the lymphoscintigraphy and surgical detection were 100% in both groups. Histologically, three patients showed macrometastasis in the sentinel lymph node, one from group A and two from group B. None of the patients, not even those with malignancy of the sentinel lymph node, relapsed after a medium follow-up of 49.5 months (24-75). Time elapsed between EB and SLNB does not influence the reliability of this latter technique as long as a superficial injection of the radiopharmaceutical is performed, proving a very high detection rate of the sentinel lymph node without evidence of lymphatic relapse during follow-up. Copyright © 2014 Elsevier España, S.L.U. and SEMNIM. All rights reserved.

  18. Acute skin lesions after surgical procedures: a clinical approach.

    Science.gov (United States)

    Borrego, L

    2013-11-01

    In the hospital setting, dermatologists are often required to evaluate inflammatory skin lesions arising during surgical procedures performed in other departments. These lesions can be of physical or chemical origin. Povidone iodine is the most common reported cause of such lesions. If this antiseptic solution remains in contact with the skin in liquid form for a long period of time, it can give rise to serious irritant contact dermatitis in dependent or occluded areas. Less common causes of skin lesions after surgery include allergic contact dermatitis and burns under the dispersive electrode of the electrosurgical device. Most skin lesions that arise during surgical procedures are due to an incorrect application of antiseptic solutions. Special care must therefore be taken during the use of these solutions and, in particular, they should be allowed to dry. Copyright © 2012 Elsevier España, S.L. and AEDV. All rights reserved.

  19. Effects of the topical application of an ethyl acetate fraction from Vernonia scorpioides on excisional wounds infected with Staphylococcus aureus in rats

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    Maria Regina Orofino Kreuger

    2011-10-01

    Full Text Available We investigated the healing process on excisional wounds infected with Staphylococcus aureus in rats, treated with 50 µL of ethyl acetate III from Vernonia scorpioides (Lam. Pers., Asteraceae, rifamycin diethylamide B 25 mg, or saline. The lesions were measured daily and after seven days were surgically removed and histologically processed. The results indicate a favorable action of the EAIII, demonstrated by the increased wound contraction, smaller area of necrotic tissue, good development of granulation tissue, extensive extracellular matrix deposition and epithelial regeneration. This sub-fraction was phytochemically investigated in parallel studies, revealing the presence of sesquiterpene lactones (glaucolides and hirsutinolides such as diacethylpiptocarphol and related hirsutinolides, flavonoids and cinnamic acid derivatives and also a new polyacetylene, which have been previously published. Results support the effectiveness of V. scorpioides antimicrobial activity in infected wound healing in rats.

  20. Layer-by-Layer Thin Films for Co-Delivery of TGF-β siRNA and Epidermal Growth Factor to Improve Excisional Wound Healing.

    Science.gov (United States)

    Mandapalli, Praveen Kumar; Labala, Suman; Jose, Anup; Bhatnagar, Shubhmita; Janupally, Renuka; Sriram, Dharmarajan; Venuganti, Venkata Vamsi Krishna

    2017-04-01

    The major challenge with treatment of dermal wounds is accelerating healing process, while preventing the scar formation. Herein, we have fabricated layer-by-layer (LbL) polyelectrolyte multilayer films containing epidermal growth factor (EGF) and TGF-β siRNA to improve excisional wound healing and decrease scar formation. The chitosan and sodium alginate LbL thin films showed 13.0 MPa tensile strength and 2.22 N/cm 2 skin adhesion strength. The LbL thin films were found to be cytocompatible, where A431 epidermal keratinocytes adhered to the film and showed 86.2 ± 0.8% cell growth compared with cells cultured in the absence of LbL thin film. In contrast, LbL thin film did not promote the Escherichia coli and Staphylococcus aureus bacterial colony formation. In a C57BL/6 mouse excisional wound model, application of LbL thin films containing TGF-β siRNA significantly (p < 0.05) reduced the TGF-β protein expression and collagen production. The LbL thin films containing EGF showed improved wound contraction (<9 days post excision). The co-delivery of TGF-β siRNA and EGF using LbL thin films resulted in accelerated wound healing and decreased collagen deposition. Furthermore, the LbL thin films with TGF-β siRNA and EGF combination showed greater reepithelialization. Taken together, we have successfully demonstrated the co-delivery of TGF-β siRNA and EGF peptide using LbL thin films to promote wound healing and decrease scar formation.

  1. Vulvar procedures: biopsy, bartholin abscess treatment, and condyloma treatment.

    Science.gov (United States)

    Mayeaux, Edward J; Cooper, Danielle

    2013-12-01

    Several benign, premalignant, and malignant lesions may arise on the vulva, and multiple types of procedures may be used to diagnose and treat these conditions. Punch and shave biopsies may be used to diagnose most vulvar conditions, but lesions suspected of being melanomas may best be diagnosed with narrow-margin excisional biopsies. Bartholin gland cysts and abscesses may be treated with several different treatment modalities, the most common of which are fistulization and marsupialization. Genital warts may be treated with several medical and surgical modalities to relieve symptoms. Copyright © 2013 Elsevier Inc. All rights reserved.

  2. An Electrosurgical Endoknife with a Water-Jet Function (Flushknife Proves Its Merits in Colorectal Endoscopic Submucosal Dissection Especially for the Cases Which Should Be Removed En Bloc

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    Yoji Takeuchi

    2013-01-01

    Full Text Available Background. Previously, we reported that the Flushknife (electrosurgical endoknife with a water-jet function could reduce the operation time of colorectal endoscopic submucosal dissection (ESD however, suitable situation for the Flushknife was obscure. This subgroup analysis of a prospective randomized controlled trial was aimed to investigate the suitable situation for the Flushknife. Methods. A total of 48 superficial colorectal neoplasms that underwent ESD using either the Flexknife or the Flushknife in a referral center were enrolled. The differences of operation time between the Flexknife and the Flushknife groups in each subgroup (tumor size, location, and macroscopic type were analyzed. Results. Median (95% CI operation time calculated using survival curves was significantly shorter in the Flushknife group than in the Flexknife group (55.5 min [41, 78] versus 74.0 [57, 90] min; , Hazard Ratio HR: 0.53; 95% CI (0.29–0.97. In particular, the HR in patients with laterally spreading tumors-nongranular type (LST-NG in the Flushknife group was significantly smaller than in the Flexknife group (HR: 0.1650.17; 95% CI (0.04–0.66. There was a trend of decreasing HRs according to larger lesion size. Conclusions. The Flushknife proved its merits in colorectal ESD especially for the lesions which should be removed en bloc (LST-NG and large lesion.

  3. Safety and efficacy of radioactive seed localization with I-125 prior to lumpectomy and/or excisional biopsy

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    Sung, Janice S., E-mail: sungj@mskcc.org [Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); King, Valencia, E-mail: valeking2012@gmail.com [Washington Radiology Associates, 2141 K Street NW, Suite 900, Washington, DC 20037 (United States); Thornton, Cynthia M., E-mail: thorntoc@mskcc.org [Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Brooks, Jennifer D., E-mail: brooksj@mskcc.org [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 307 East 63rd Street, New York, NY 10065 (United States); Fry, Charles W., E-mail: fryc@mskcc.org [Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); El-Tamer, Mahmoud, E-mail: eltamerm@mskcc.org [Department of Surgery, Memorial Sloan-Kettering Cancer Center, 300 East 66th Street, New York, NY 10065 (United States); Dauer, Lawrence T., E-mail: dauerl@mskcc.org [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Brogi, Edi, E-mail: brogie@mskcc.org [Department of Pathology, Memorial Sloan-Kettering Cancer Center, 300 East 66th Street, New York, NY 10065 (United States); St Germain, Jean M., E-mail: stgermaj@mskcc.org [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Morris, Elizabeth A., E-mail: morrise@mskcc.org [Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

    2013-09-15

    Purpose: To evaluate the safety and efficacy of pre-operative I-125 radioactive seed localization (RSL) as an alternative to wire localization (WL). Methods: A waiver was granted by the institutional review board for this HIPAA compliant study. Review of 356 consecutive single site nonpalpable mammographic and ultrasound guided I-125 RSLs done between November 2011 and April 2012 was conducted. Preoperative mammograms and specimen radiographs were reviewed for seed-target distance, lesion location, and target/seed removal. During a brief surgical training period, 35 of 356 women had both RSL and wire localization (WL) of the same lesion. Chi-square and single sample t-tests were used to compare margin status and duration of procedures. Results: Of the 356 RSLs, 303 (85.1%) were performed ≥1 day before surgery. Mammographic guidance was used in 330 (93%) and ultrasound in 26 (7%). Mean seed to target distance was 1 mm (range 0–20 mm); all targeted lesions were retrieved. In 31 women in whom mammographic guidance was used for both RSL and WL, median procedure time was not significantly different (RSL 9.0 min; WL 7.0 min; p = 0.91), and median seed migration distance was <1 mm (range 0–15 mm). No difference was detected between margin status with RSL alone versus WL (p = 0.40 and p = 0.65 for positive and <1 mm margins, respectively). Two adverse events occurred requiring an additional wire/surgery. Conclusion: RSL ≥ 1 day before surgery is a safe effective procedure for pre-operative localization, with few adverse events and surgical outcomes comparable to those achieved with wire localization.

  4. Discordance between core needle biopsy (CNB) and excisional biopsy (EB) for estrogen receptor (ER), progesterone receptor (PgR) and HER2 status in early breast cancer (EBC).

    Science.gov (United States)

    Arnedos, M; Nerurkar, A; Osin, P; A'Hern, R; Smith, I E; Dowsett, M

    2009-12-01

    Analysis of estrogen receptor (ER), progesterone receptor (PgR) and HER2 status in early breast cancer (EBC) is increasingly being conducted in core needle biopsies (CNBs) taken at diagnosis but the concordance with the excisional biopsy (EB) is poorly documented. Patients with EBC presenting to The Royal Marsden Hospital from June 2005 to September 2007 who had CNB and subsequent EB were included. ER and PgR were determined by immunohistochemistry (IHC) and graded from 0 to 8 (Allred score). HER2 was determined by IHC and scored from 0 to 3+. FISH analysis was carried out in HER2 2+ cases and in discordant cases. In all, 336 pairs of samples were compared. ER was positive in 253 CNBs (75%) for 255 EBs (76%) and was discordant in six patients (1.8%). PgR was positive in 221 CNBs (66%) and 227 (67.6%) EBs being discordant in 52 cases (15%). HER2 was positive in 41 (12.4%) of the 331 CNBs in which it was determined compared with 44 (13.3%) EBs and discordant in four cases (1.2%). CNB can be used with confidence for ER and HER2 determination. For PgR, due to a substantial discordance between CNB and EB, results from CNB should be used with caution.

  5. Risco de complicações durante a cirurgia dermatológica: protocolo das exéreses em fuso Risk of complications during dermatologic surgery: protocol for excisional surgery

    Directory of Open Access Journals (Sweden)

    Eugênio Raul de Almeida Pimentel

    2005-10-01

    Full Text Available FUNDAMENTOS: A cirurgia dermatológica é prática comum no dia-a-dia do dermatologista, havendo portanto necessidade de estudos que demonstrem a segurança do procedimento. OBJETIVO: Criação de protocolo que avaliasse o risco de complicações durante e imediatamente após a cirurgia dermatológica, sobretudo em pacientes com co-morbidades clínicas. MÉTODOS: Foram realizadas 860 exéreses em fuso no período de janeiro de 2001 a novembro de 2003, sendo todas protocoladas segundo algumas variáveis - como idade e sexo do paciente, tipo de lesão excisada, doenças associadas e uso de medicações, tamanho do fuso, tempo de cirurgia, tipo e quantidade de anestésico utilizado e aferição da pressão arterial -, correlacionando-as ao risco de complicações. RESULTADOS: Dos 860 pacientes operados, 64,6% não apresentaram nenhuma complicação; 34,6% apresentaram elevação da pressão arterial sem repercussão clínica; 0,5% apresentaram sangramento importante que pôde ser controlado; dois pacientes apresentaram hipotensão arterial. CONCLUSÃO: A cirurgia dermatológica é muito segura, podendo ser realizada em consultórios ou ambulatorialmente, consistindo, na maioria dos casos, em procedimento pequeno e rápido, sendo o risco de complicações muito baixo.BACKGROUND: Dermatologic surgery is a common daily practice for dermatologists and it is necessary to carry out studies to demonstrate safety of these procedures. OBJECTIVES: To create a protocol to assess risk of complications during and immediately after dermatologic surgery, mainly in patients with comorbid conditions. METHODS: From January 2001 to November 2003, 860 excisional surgeries were performed and all procedures were recorded according to the following variables: age and sex, type of excised lesion, comorbidity, use of medications, size of elliptical excision, duration of surgery, amount and type of anesthetic used, blood pressure. The variables were correlated with risk of

  6. The SINS trial: A randomised controlled trial of excisional surgery versus imiquimod 5% cream for nodular and superficial basal cell carcinoma

    Directory of Open Access Journals (Sweden)

    Armstrong Sarah J

    2010-04-01

    Full Text Available Abstract Background Basal cell carcinoma is the commonest human cancer. Despite increasing incidence it remains poorly researched. While not life threatening it can cause significant cosmetic disfigurement. Imiquimod, a cream which enhances the body's immune response, may help deal with the number of cases that occur in low-risk sites, especially when good cosmetic results and home use without surgery are needed. This study aims 1. To compare excisional surgery with imiquimod cream for nodular or superficial basal cell carcinoma in low risk sites, with respect to 3 year clinical clearance, cost-effectiveness and cosmetic results. 2. To ascertain if certain phenotypic features and gene polymorphisms predict tumour responsiveness to treatment. Methods/Design Five hundred participants with low risk nodular or superficial basal cell carcinoma will be recruited from hospitals to this multi-centre, randomised, parallel group, controlled phase III trial. Treatment in the imiquimod group is for 6 weeks for superficial basal cell carcinoma and 12 weeks for nodular basal cell carcinoma. Both treatment groups are followed up in clinic for 3 years. Primary outcome variable: the proportion of participants with clinical evidence of success (no recurrence at 3 years. The primary outcome will be compared between the two treatment groups. Secondary outcomes include: i clinical success at 1, 2 and 5 years, ii time to first recurrence, iii cosmetic appearance of lesion site after treatment, iv level of pain, and v cost-effectiveness. Safety and tolerability data will also be reported. Discussion This study protocol describes a pragmatic randomised controlled trial which it is hoped will address the above uncertainties. Three-year results will be available towards the end of 2010. Trial registration Meta-register: NCT00066872, Eudract No. 2004-004506-24, ISRCTN48755084.

  7. Correlation of maximum breast carcinoma dimension on needle core biopsy and subsequent excisional biopsy: a retrospective study of 50 non-palpable imaging-detected cases.

    Science.gov (United States)

    Ozerdem, Ugur; Hoda, Syed A

    2014-09-01

    There are scant data on the correlation of maximum tumor dimension (MTD) in needle core biopsy (NCB) and in subsequent excisional biopsy (EXB) with various pre-NCB imaging studies (VIS)-especially in the context of screen-detected invasive carcinoma (SIC). Retrospectively studied were consecutive (2012-2013) non-palpable, SIC diagnosed on NCB with subsequent EXB. Data on MTD on VIS (either mammogram, or ultrasound, or MRI), NCB and EXC were analyzed. Mean MTD on VIS was 12.5mm (range: 0-45 mm). Mean MTD on NCB was 6.7 mm (range: 1-15 mm). Mean residual MTD on EXB was 12.9 mm (range: 0-40 mm). Mean number of NCB performed per SIC was 5 (range: 1-13). Overall, 81% of all NCB were involved by SIC. The difference between MTD at EXC and VIS was statistically not significant (p>0.05). Spearman correlation coefficient for MTD on VIS and EXC was r=0.8718 (pNCB-calculated by using Aperio whole slide scanning and NIH Image J image analysis was 95.5mm(3) (range: 4.3-887.5mm(3), median: 23 mm(3)). A Bland-Altman plot showed that MTD of ≥ 7 mm on EXB is a useful cut-off point predictive of (any) increase in MTD at EXB. Six of the 13 patients with MTDNCB (with a mean combined Nottingham grade score of 5 {r: 4-6} showed decrease in MTD at EXB. In this pilot study of SIC, (i) MTD on VIS was predictive of MTD on EXB, (ii) MTD of ≥ 7 mm on NCB was predictive of an increased MTD on EXB in most cases, with potential for "upstaging" tumors, and (iii) MTD of NCB was predictive of decreased MTD on EXB in 20.8% of (mostly grade I) SIC. Procured tissue volume on NCB contributed to decrease in MTD on EXB in small, low-grade carcinomas. Copyright © 2014 Elsevier GmbH. All rights reserved.

  8. Low Prevalence of Oral and Nasal Human Papillomavirus in Employees Performing CO2-laser Evaporation of Genital Warts or Loop Electrode Excision Procedure of Cervical Dysplasia

    DEFF Research Database (Denmark)

    Kofoed, Kristian; Norrbom, Christina; Forslund, Ola

    2015-01-01

    Risk of human papillomavirus (HPV) transmission during laser vaporisation of genital warts or loop electrode excision procedure is controversial. An oral rinse, a nasal swabs, history of HPV related diseases and data on HPV exposure were collected from 287 employees at departments of dermato......-venerology and gynaecology in Denmark. A mucosal HPV type was found among 5.8% of employees with experience of laser treatment of genital warts as compared to 1.7% of those with no experience (p = 0.12). HPV prevalence was not higher in employees participating in electrosurgical treatment or cryotherapy of genital warts...... cavity of health care personnel, however, employees at departments of dermato-venereology are at risk of acquiring hand warts....

  9. Photodigitizing procedures

    Science.gov (United States)

    Kilgore, P. D.; Gottbrath, J. H.

    1984-02-01

    This report documents procedures and programs for efficiently running the Photo Digitizing System at the Naval Biodynamics Laboratory. Procedures have been tested and have been found to be effective. Any future acquisitions of programs or changes to current programs should be incorporated in these procedures. On-going research programs use high speed instrumentation cameras to record the motion of test subjects during biodynamic experiments. The films are digitized and the 3-dimensional motion is reconstructed and analyzed. Experimental research is performed to determine the effects of aircraft crashes, ship motion, vibration, aircraft ejection and parachute opening forces on the health and performance of Navy personnel.

  10. A pragmatic multicentre randomised controlled trial comparing stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease: the eTHoS study.

    Science.gov (United States)

    Watson, Angus Jm; Cook, Jonathan; Hudson, Jemma; Kilonzo, Mary; Wood, Jessica; Bruhn, Hanne; Brown, Steven; Buckley, Brian; Curran, Finlay; Jayne, David; Loudon, Malcolm; Rajagopal, Ramesh; McDonald, Alison; Norrie, John

    2017-11-01

    Haemorrhoids are a benign anorectal condition and are highly prevalent in the UK population. Treatments involve clinic-based procedures and surgery. The surgical procedures available include stapled haemorrhoidopexy (SH) and traditional haemorrhoidectomy (TH), and over 25,000 operations are performed for haemorrhoids annually in the UK. The disease is therefore important both to patients and to health service commissioners. Debate remains as to which of these surgical procedures is the most clinically effective and cost-effective. The aim of this study was to compare the clinical effectiveness and cost-effectiveness of SH with that of TH. A large, open two-arm parallel-group pragmatic multicentre randomised controlled trial involving 32 UK hospitals and a within-trial cost-benefit analysis. A discrete choice experiment was conducted to estimate benefits (willingness to pay). Patients with grades II-IV haemorrhoids who had not previously undergone SH or TH were included in the study. Participants were randomised to receive either SH or TH. Randomisation was minimised at 1 : 1, in accordance with baseline EuroQol-5 Dimensions, three-level version (EQ-5D-3L) score, haemorrhoid grade, sex and centre, via an automated system. The primary outcome was area under the quality-of-life curve measured using the EQ-5D-3L descriptive system over 24 months, and the primary economic outcome was the incremental cost-effectiveness ratio. Secondary outcomes included disease-specific quality of life, recurrence, complications, further interventions and costs. Between January 2011 and August 2014, 777 patients were randomised (389 to receive SH and 388 to receive TH). There were 774 participants included in the analysis as a result of one post-randomisation exclusion in the SH arm and two in the TH arm. SH was less painful than TH in the short term. Surgical complications were similar in both arms. EQ-5D-3L score was higher for the SH arm in the first 6 weeks after surgery, but

  11. Ross procedure

    OpenAIRE

    Sievers, H.H.

    2012-01-01

    Introduction In 1967 Donald Ross introduced the subcoronary Ross procedure consisting of transplantation of the autologous pulmonary valve into aortic position. We describe our 15-year experience in Ross procedures. Methods 576 subcoronary operations have been performed (436 male and 140 female patients); the mean age was 45?11.9 years. (range, 13 to 70 years). The mean follow-up was 7?4.2 years (range, 0 to 16 years). There were 4597 patient years at follow-up with a clinical completeness of...

  12. Utility of recorded guided imagery and relaxing music in reducing patient pain and anxiety, and surgeon anxiety, during cutaneous surgical procedures: A single-blinded randomized controlled trial.

    Science.gov (United States)

    Alam, Murad; Roongpisuthipong, Wanjarus; Kim, Natalie A; Goyal, Amita; Swary, Jillian H; Brindise, Renata T; Iyengar, Sanjana; Pace, Natalie; West, Dennis P; Polavarapu, Mahesh; Yoo, Simon

    2016-09-01

    Guided imagery and music can reportedly reduce pain and anxiety during surgery, but no comparative study has been performed for cutaneous surgery to our knowledge. We sought to determine whether short-contact recorded guided imagery or relaxing music could reduce patient pain and anxiety, and surgeon anxiety, during cutaneous surgical procedures. Subjects were adults undergoing excisional surgery for basal and squamous cell carcinoma. Randomization was to guided imagery (n = 50), relaxing music (n = 54), or control group (n = 51). Primary outcomes were pain and anxiety measured using visual analog scale and 6-item short-form of the State-Trait Anxiety Inventory, respectively. Secondary outcomes were anxiety of surgeons measured by the 6-item short-form of the State-Trait Anxiety Inventory and physical stress of patients conveyed by vital signs, respectively. There were no significant differences in subjects' pain, anxiety, blood pressure, and pulse rate across groups. In the recorded guided imagery and the relaxing music group, surgeon anxiety was significantly lower than in the control group. Patients could not be blinded. Short-contact recorded guided imagery and relaxing music appear not to reduce patient pain and anxiety during excisional procedures under local anesthetic. However, surgeon anxiety may be reduced when patients are listening to such recordings. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  13. Fair Procedures.

    Science.gov (United States)

    Eaneman, Paulette S.; And Others

    These materials are part of the Project Benchmark series designed to teach secondary students about our legal concepts and systems. This unit focuses on individual rights and fair procedures under the law. The materials outline the Bill of Rights, due process guarantees, the right to a fair hearing, fair and unfair trials, search and seizure laws,…

  14. (TIPSS) procedure

    African Journals Online (AJOL)

    Enrique

    mental animals.7. In 1982, Colapinto and co-workers described the creation of percutaneous intrahepatic shunts in 6 human subjects.8 A tract was dilated through the ... REVIEW ARTICLE. 4. SA JOURNAL OF RADIOLOGY • October 2004. The transjugular intrahepatic porto- systemic shunt. (TIPSS) procedure — a review.

  15. Peritonectomy procedures.

    Science.gov (United States)

    Sugarbaker, P H

    1995-01-01

    OBJECTIVE: New surgical procedures designed to assist in the treatment of peritoneal surface malignancy were sought. BACKGROUND: Decisions regarding the treatment of cancer depend on the anatomic location of the malignancy and the biologic aggressiveness of the disease. Some patients may have isolated intra-abdominal seeding of malignancy of limited extent or of low biologic grade. In the past, these clinical situations have been regarded as lethal. METHODS: The cytoreductive approach may require six peritonectomy procedures to resect or strip cancer from all intra-abdominal surfaces. RESULTS: These are greater omentectomy-splenectomy; left upper quadrant peritonectomy; right upper quadrant peritonectomy; lesser omentectomy-cholecystectomy with stripping of the omental bursa; pelvic peritonectomy with sleeve resection of the sigmoid colon; and antrectomy. CONCLUSIONS: Peritonectomy procedures and preparation of the abdomen for early postoperative intraperitoneal chemotherapy were described. The author has used the cytoreductive approach to achieve long-term, disease-free survival in selected patients with peritoneal carcinomatosis, peritoneal sarcomatosis or mesothelioma. Images Figure 2. Figure 3. Figure 4. Figure 5. Figure 6. Figure 7. Figure 8. Figure 9. Figure 10. Figure 11. Figure 12. Figure 13. PMID:7826158

  16. Ross procedure.

    Science.gov (United States)

    Sievers, H H

    2012-01-01

    In 1967 Donald Ross introduced the subcoronary Ross procedure consisting of transplantation of the autologous pulmonary valve into aortic position. We describe our 15-year experience in Ross procedures. 576 subcoronary operations have been performed (436 male and 140 female patients); the mean age was 45±11.9 years. (range, 13 to 70 years). The mean follow-up was 7±4.2 years (range, 0 to 16 years). There were 4597 patient years at follow-up with a clinical completeness of 95% and echo completeness of 91%. There were two operative deaths (0.3%) and 31 patients with reoperation. The survival is similar to that of the normal population and the freedom from allo- and autograft reoperation is 87% at 15 years. Autograft regurgitation at last examination was grade 0 in 40%, trace in 54%, grade I in 19%, grade II in 4% and grade III in 0.4%; the pressure gradient was smaller than 5 mmHg in 57% and between 5 and 10 mmHg in 24%. Only 6% had a transvalvular pressure gradient of more than 10 mmHg. After 15 years of experience it can be concluded that the subcoronary technique provides near normal survival in adult patients, with excellent hemodynamics and acceptable rate of reoperations.

  17. Procedural knowledge

    Science.gov (United States)

    Georgeff, Michael P.; Lansky, Amy L.

    1986-01-01

    Much of commonsense knowledge about the real world is in the form of procedures or sequences of actions for achieving particular goals. In this paper, a formalism is presented for representing such knowledge using the notion of process. A declarative semantics for the representation is given, which allows a user to state facts about the effects of doing things in the problem domain of interest. An operational semantics is also provided, which shows how this knowledge can be used to achieve particular goals or to form intentions regarding their achievement. Given both semantics, the formalism additionally serves as an executable specification language suitable for constructing complex systems. A system based on this formalism is described, and examples involving control of an autonomous robot and fault diagnosis for NASA's Space Shuttle are provided.

  18. Procedural knowledge

    Energy Technology Data Exchange (ETDEWEB)

    Georgeff, M.P.; Lansky, A.L.

    1986-10-01

    Much of commonsense knowledge about the real world is in the form of procedures or sequences of actions for achieving particular goals. In this paper, a formalism is presented for representing such knowledge using the notion of process. A declarative semantics for the representation is given, which allows a user to state facts about the effects of doing things in the problem domain of interest. An operational semantics is also provided, which shows how this knowledge can be used to achieve particular goals or to form intentions regarding their achievement. Given both semantics, our formalism additionally serves as an executable specification language suitable for constructing complex systems. A system based on this formalism is described, and examples involving control of an autonomous robot and fault diagnosis for NASA's space shuttle are provided.

  19. Corrosion and wear in plasma electrosurgical devices

    Science.gov (United States)

    Gaspredes, J.; Ryan, T. P.; Stalder, K. R.; Woloszko, J.

    2017-02-01

    Data were previously reported on studies of the effects of electrical discharges on the corrosion and wear of simple, single-wire test devices immersed in isotonic saline 1 . This work showed that there are a wide variety of mechanisms that can explain various aspects of electrode mass loss, even with very simple electrode geometries and operating conditions. It was found that the electrode material composition played an important role. Subsequently, our studies were expanded to include more realistic device geometries and operating conditions. This paper shows the results of studies on wear characteristics of electrodes made from a variety of highly corrosion resistant metals and alloys, including Waspaloy, Hastelloy, Inconel, Havar, Monel, and other pure metals such as Hafnium. All of these metals underwent wear testing under clinically relevant conditions. Depending on the operating conditions, multiple discrete physical and chemical effects were observed at different locations on the surface of an individual millimeter-scale device electrode. Scanning electron microscope (SEM) micrographs, Energy-dispersive X-ray spectroscopy (EDS) and area loss data will be presented for a variety of test conditions and electrode materials.

  20. Vascular Access Procedures

    Science.gov (United States)

    ... News Physician Resources Professions Site Index A-Z Vascular Access Procedures A vascular access procedure inserts a flexible, ... the limitations of Vascular Access Procedures? What are Vascular Access Procedures? A vascular access procedure involves the insertion ...

  1. Low prevalence of oral and nasal human papillomavirus in employees performing CO2-laser evaporation of genital warts or loop electrode excision procedure of cervical dysplasia.

    Science.gov (United States)

    Kofoed, Kristian; Norrbom, Christina; Forslund, Ola; Møller, Charlotte; Frøding, Ligita P; Pedersen, Anders Elm; Markauskas, Algirdas; Blomberg, Maria; Baumgartner-Nielsen, Jane; Madsen, Jakob Torp; Strauss, Gitte; Madsen, Klaus G; Sand, Carsten

    2015-02-01

    Risk of human papillomavirus (HPV) transmission during laser vaporisation of genital warts or loop electrode excision procedure is controversial. An oral rinse, a nasal swabs, history of HPV related diseases and data on HPV exposure were collected from 287 employees at departments of dermato-venerology and gynaecology in Denmark. A mucosal HPV type was found among 5.8% of employees with experience of laser treatment of genital warts as compared to 1.7% of those with no experience (p = 0.12). HPV prevalence was not higher in employees participating in electrosurgical treatment or cryotherapy of genital warts, or loop electrode excision procedure compared with those who did not. HPV 6 or 11 were not detected in any samples. Hand warts after the age of 24 years was more common among dermatology than among non-dermatology personnel (18% vs. 8.0%, p = 0.03). Mucosal HPV types are infrequent in the oral and nasal cavity of health care personnel, however, employees at departments of dermato-venereology are at risk of acquiring hand warts.

  2. Bariatric Surgery Procedures

    Science.gov (United States)

    ... Center Access to Care Toolkit EHB Access Toolkit Bariatric Surgery Procedures Bariatric surgical procedures cause weight loss by ... minimally invasive techniques (laparoscopic surgery). The most common bariatric surgery procedures are gastric bypass, sleeve gastrectomy, adjustable gastric ...

  3. Cardiac Procedures and Surgeries

    Science.gov (United States)

    ... a heart is irreversibly damaged. Uses hearts from organ donation. Reason for the Procedure Recognized as a proven ... Reason for the Procedure Preferred treatment for many types of rapid heartbeats (arrhythmias) especially supraventricular tachyarrhythmias. Learn ...

  4. IC Treatment: Surgical Procedures

    Science.gov (United States)

    ... Profile Home Diagnosis & Treatment IC Treatments Surgical Procedures Surgical Procedures For people with interstitial cystitis (IC), the ... latest stories, news and events. Please leave this field empty Interstitial Cystitis Association 7918 Jones Branch Drive, ...

  5. The procedural egalitarian solution

    NARCIS (Netherlands)

    Dietzenbacher, Bas; Borm, Peter; Hendrickx, Ruud

    2017-01-01

    In this paper we introduce and analyze the procedural egalitarian solution for transferable utility games. This new concept is based on the result of a coalitional bargaining procedure in which egalitarian considerations play a central role. The procedural egalitarian solution is the first

  6. The Procedural Egalitarian Solution

    NARCIS (Netherlands)

    Dietzenbacher, Bas; Borm, Peter; Hendrickx, Ruud

    2016-01-01

    In this paper we introduce and analyze the procedural egalitarian solution for transferable utility games. This new concept is based on the result of a coalitional bargaining procedure in which egalitarian considerations play a central role. The procedural egalitarian solution is the first

  7. Finite element procedures

    CERN Document Server

    Bathe, Klaus-Jürgen

    2015-01-01

    Finite element procedures are now an important and frequently indispensable part of engineering analyses and scientific investigations. This book focuses on finite element procedures that are very useful and are widely employed. Formulations for the linear and nonlinear analyses of solids and structures, fluids, and multiphysics problems are presented, appropriate finite elements are discussed, and solution techniques for the governing finite element equations are given. The book presents general, reliable, and effective procedures that are fundamental and can be expected to be in use for a long time. The given procedures form also the foundations of recent developments in the field.

  8. Civil Procedure In Denmark

    DEFF Research Database (Denmark)

    Werlauff, Erik

    The book contains an up-to-date survey of Danish civil procedure after the profound Danish procedural reforms in 2007. It deals with questions concerning competence and function of Danish courts, commencement and preparation of civil cases, questions of evidence and burden of proof, international...

  9. Decision-making Procedures

    DEFF Research Database (Denmark)

    Aldashev, Gani; Kirchsteiger, Georg; Sebald, Alexander Christopher

    2009-01-01

    It is a persistent finding in psychology and experimental economics that people's behavior is not only shaped by outcomes but also by decision-making procedures. In this paper we develop a general framework capable of modelling these procedural concerns. Within the context of psychological games we...

  10. Play vs. Procedures

    DEFF Research Database (Denmark)

    Hammar, Emil

    Through the theories of play by Gadamer (2004) and Henricks (2006), I will show how the relationship between play and game can be understood as dialectic and disruptive, thus challenging understandings of how the procedures of games determine player activity and vice versa. As such, I posit some...... analytical consequences for understandings of digital games as procedurally fixed (Boghost, 2006; Flannagan, 2009; Bathwaite & Sharp, 2010). That is, if digital games are argued to be procedurally fixed and if play is an appropriative and dialectic activity, then it could be argued that the latter affects...... and alters the former, and vice versa. Consequently, if the appointed procedures of a game are no longer fixed and rigid in their conveyance of meaning, qua the appropriative and dissolving nature of play, then understandings of games as conveying a fixed meaning through their procedures are inadequate...

  11. Mastectomy -- The Surgical Procedure

    Science.gov (United States)

    ... Factors That Affect Prognosis And Treatment Breast Reconstruction Mastectomy - The Procedure A mastectomy is performed under general ... prognosis. Learn more about assessing axillary lymph nodes . Mastectomy with and without breast reconstruction Breast reconstruction Some ...

  12. Special Blood Donation Procedures

    Science.gov (United States)

    ... Blood Products Special Blood Donation Procedures Precautions and Adverse Reactions During Blood Transfusion (See Overview of Blood Transfusion .) Plateletpheresis (platelet donation) In plateletpheresis, a donor gives only platelets rather than whole blood. Whole ...

  13. Procedural sedation analgesia

    Directory of Open Access Journals (Sweden)

    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.

  14. Mobile Energy Laboratory Procedures

    Energy Technology Data Exchange (ETDEWEB)

    Armstrong, P.R.; Batishko, C.R.; Dittmer, A.L.; Hadley, D.L.; Stoops, J.L.

    1993-09-01

    Pacific Northwest Laboratory (PNL) has been tasked to plan and implement a framework for measuring and analyzing the efficiency of on-site energy conversion, distribution, and end-use application on federal facilities as part of its overall technical support to the US Department of Energy (DOE) Federal Energy Management Program (FEMP). The Mobile Energy Laboratory (MEL) Procedures establish guidelines for specific activities performed by PNL staff. PNL provided sophisticated energy monitoring, auditing, and analysis equipment for on-site evaluation of energy use efficiency. Specially trained engineers and technicians were provided to conduct tests in a safe and efficient manner with the assistance of host facility staff and contractors. Reports were produced to describe test procedures, results, and suggested courses of action. These reports may be used to justify changes in operating procedures, maintenance efforts, system designs, or energy-using equipment. The MEL capabilities can subsequently be used to assess the results of energy conservation projects. These procedures recognize the need for centralized NM administration, test procedure development, operator training, and technical oversight. This need is evidenced by increasing requests fbr MEL use and the economies available by having trained, full-time MEL operators and near continuous MEL operation. DOE will assign new equipment and upgrade existing equipment as new capabilities are developed. The equipment and trained technicians will be made available to federal agencies that provide funding for the direct costs associated with MEL use.

  15. Procedure and Program Examples

    Science.gov (United States)

    Britz, Dieter

    Here some modules, procedures and whole programs are described, that may be useful to the reader, as they have been, to the author. They are all in Fortran 90/95 and start with a generally useful module, that will be used in most procedures and programs in the examples, and another module useful for programs using a Rosenbrock variant. The source texts (except for the two modules) are not reproduced here, but can be downloaded from the web site www.springerlink.com/openurl.asp?genre=issue &issn=1616-6361&volume=666 (the two lines form one contiguous URL!).

  16. Preschooler test or procedure preparation

    Science.gov (United States)

    Preparing preschoolers for test/procedure; Test/procedure preparation - preschooler ... Preparing children for medical tests can reduce their anxiety. It can also make them less likely to cry and resist the procedure. Research shows that ...

  17. Toddler test or procedure preparation

    Science.gov (United States)

    Preparing toddler for test/procedure; Test/procedure preparation - toddler; Preparing for a medical test or procedure - toddler ... Before the test, know that your child will probably cry. Even if you prepare, your child may feel some discomfort or ...

  18. The TOMAX-procedure

    NARCIS (Netherlands)

    Overgoor, M.L.E.

    2015-01-01

    Most patients with a low spinal lesion (LSL) have intact erectile function but no penile sensation, which can lead to frustration. To tackle this problem, we designed TOMAX, TOMAXimize sensation, sexuality and quality of life, a surgical procedure in which a functional "groin” nerve is connected to

  19. Formalizing physical security procedures

    NARCIS (Netherlands)

    Meadows, C.; Pavlovic, Dusko

    Although the problems of physical security emerged more than 10,000 years before the problems of computer security, no formal methods have been developed for them, and the solutions have been evolving slowly, mostly through social procedures. But as the traffic on physical and social networks is now

  20. 3. Procedures and Recursion

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 1; Issue 6. Algorithms Procedures and Recursion. R K Shyamasundar. Series Article Volume 1 ... Author Affiliations. R K Shyamasundar1. Computer Science Group, Tata Institute of Fundamental Research, Homi Bhabha Road Mumbai 400 005, India.

  1. Juveniles in criminal procedure

    Directory of Open Access Journals (Sweden)

    Lukić Tatjana

    2012-01-01

    Full Text Available Taking into consideration the importance and role of children in modern society, as well as their position, this article has as its focus juveniles in criminal procedure. The existence of a separate juvenile justice system independent of the criminal law applicable to the adult offenders and general criminal procedure, as well as the periodic changes of the dominant approach in theory and practice reflects the ascendancy of different theoretical perspectives in the juvenile justice. In this paper, the authors scrutinize the models of responding to juvenile crime - justice and welfare model - as two models of the greatest importance in the present reaction of the society to the crimes conducted by the youngest delinquents at the beginning of the new century and millennium. Furthermore, the paper deals with a matter of international legal standards which, to a large extent, give shape to the legal framework for juvenile offenders and provide their rights and position in the criminal procedure. The authors refer to the internationally accepted documents on several levels. From the (almost universally accepted multilateral conventions on human rights, through the field of recommendations, rules and guidelines which are obeyed and enforced in practice of the juvenile justice although they are of non-binding nature, via the regional European legislative to the national provisions in a particular number of countries. On all the levels mentioned above the rights of the juveniles are regulated having in mind their possible role in the criminal procedure as a perpetrator of a criminal act, as a victim or as a witness. This paper also analyzes the criminal procedure with respect to juvenile perpetrators of the criminal acts in the Republic of Serbia and compliance of the provisions currently in vigor with the international legal standards contained in the international conventions and other internationally accepted and recognized instruments.

  2. Breast Cancer from the Excisional Scar of a Benign Mass

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Min Jung; Kim, Eun Kyung; Lee, Ji Young; Youk, Ji Hyun; Park, Byeong Woo; Kim, Hae Ryoung; Oh, Ki Keun [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2007-06-15

    Burns and chronic inflammation are well-known circumstances in which malignant transformation may occur during wound healing. There are many reports of malignancies developing from a burn scar; however, there are only a few reports of malignancy arising from chronic inflammation or from the skin of a surgical scar following excision of a benign mass, in any part of the body. There are only twelve reported cases of breast cancer developing from a surgical scar, moreover, there have been no reports in the last 30 years. This case is a recent example of breast cancer developing in a surgical scar that showed subtle changes on sequential sonograms. The imaging findings of this case were subtle but the mass that had been shrinking developed an angular margin in one region. These findings, along with the penetrating vascularity revealed on Doppler, prompted us to proceed to a biopsy of the lesion. It was of critical importance to compare the size and the shape of the lesion with previous ultrasounds in order to exclude malignancy in any iatrogenically altered lesion. Based on this case, we conclude that whenever a subtle change is detected, at a surgical site, a biopsy should be performed. Breast cancer developing from a surgical scar is rare; this type of malignancy has been reported in only 12 cases to date. Herein, we report on a 52-year-old female who developed infiltrating ductal carcinoma in a surgical scar following excision of a benign mass. Two years previously, the patient underwent surgery and radiotherapy for invasive ductal carcinoma of the contralateral breast. The initial appearance of the scar was similar to fat necrosis; it was observed to be progressively shrinking on follow-up sonography. On the two year follow-up ultrasound, the appearance changed, an angular margin and vascularity at the periphery of the scar were noted. A biopsy and subsequent excision of the scar were performed; the diagnosis of infiltrating ductal carcinoma of the scar was confirmed.

  3. Magnet‑retained Prophylactic Appliance for Post‑excisional ...

    African Journals Online (AJOL)

    Dental Sciences, Pandit Bhagwat Dayal Sharma University of. Health Sciences, Rohtak, Haryana, India ... in dental stone (Kalstone; Kalabhai Karson Pvt Ltd) with adequate land area to make the cast [Figure 2]. ... reduction is a minimally invasive treatment option for ear keloids. Radiation therapy has been accepted as a ...

  4. RNAV STAR Procedural Adherence

    Science.gov (United States)

    Stewart, Michael J.; Matthews, Bryan L.

    2017-01-01

    In this exploratory archival study we mined the performance of 24 major US airports area navigation standard terminal arrival routes (RNAV STARs) over the preceding three years. Overlaying radar track data on top of RNAV STAR routes provided a comparison between aircraft flight paths and the waypoint positions and altitude restrictions. NASA Ames Supercomputing resources were utilized to perform the data mining and processing. We investigated STARs by lateral transition path (full-lateral), vertical restrictions (full-lateral/full-vertical), and skipped waypoints (skips). In addition, we graphed altitudes and their frequencies of occurrence for altitude restrictions. Full-lateral compliance was generally greater than Full-lateral/full-vertical, but the delta between the rates was not always consistent. Full-lateral/full-vertical usage medians of the 2016 procedures ranged from 0 in KDEN (Denver) to 21 in KMEM (Memphis). Waypoint skips ranged from 0 to nearly 100 for specific waypoints. Altitudes restrictions were sometimes missed by systemic amounts in 1000 ft. increments from the restriction, creating multi-modal distributions. Other times, altitude misses looked to be more normally distributed around the restriction. This work is a preliminary investigation into the objective performance of instrument procedures and provides a framework to track how procedural concepts and design intervention function. In addition, this tool may aid in providing acceptability metrics as well as risk assessment information.

  5. Low Prevalence of Oral and Nasal Human Papillomavirus in Employees Performing CO2-laser Evaporation of Genital Warts or Loop Electrode Excision Procedure of Cervical Dysplasia

    DEFF Research Database (Denmark)

    Kofoed, Kristian; Norrbom, Christina; Forslund, Ola

    2014-01-01

    -venerology and gynaecology in Denmark. A mucosal HPV type was found among 5.8% of employees with experience of laser treatment of genital warts as compared to 1.7% of those with no experience (p = 0.12). HPV prevalence was not higher in employees participating in electrosurgical treatment or cryotherapy of genital warts...

  6. Coal pillar design procedures

    CSIR Research Space (South Africa)

    York, G

    2000-03-01

    Full Text Available Final Project Report Coal pillar design procedures G. York, I. Canbulat, B.W. Jack Research agency: CSIR Mining Technology Project number: COL 337 Date: March 2000 2 Executive Summary Examination of collapsed pillar cases outside of the empirical... in strength occurs with increasing specimen size. 45 40 35 30 25 20 15 10 5 0 20 40 60 80 100 120 140 160 UNIAX IA L COMPR EHEN SIV E S TR ENG TH (M Pa ) CUBE SIZE (cm) Figure 1...

  7. Regulations and Procedures Manual

    Energy Technology Data Exchange (ETDEWEB)

    Young, Lydia J. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2011-07-25

    The purpose of the Regulations and Procedures Manual (RPM) is to provide LBNL personnel with a reference to University and Lawrence Berkeley National Laboratory (LBNL or Laboratory) policies and regulations by outlining normal practices and answering most policy questions that arise in the day-to-day operations of Laboratory organizations. Much of the information in this manual has been condensed from detail provided in LBNL procedure manuals, Department of Energy (DOE) directives, and Contract DE-AC02-05CH11231. This manual is not intended, however, to replace any of those documents. RPM sections on personnel apply only to employees who are not represented by unions. Personnel policies pertaining to employees represented by unions may be found in their labor agreements. Questions concerning policy interpretation should be directed to the LBNL organization responsible for the particular policy. A link to the Managers Responsible for RPM Sections is available on the RPM home page. If it is not clear which organization is responsible for a policy, please contact Requirements Manager Lydia Young or the RPM Editor.

  8. Regulations and Procedures Manual

    Energy Technology Data Exchange (ETDEWEB)

    Young, Lydia [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2010-09-30

    The purpose of the Regulations and Procedures Manual (RPM) is to provide Laboratory personnel with a reference to University and Lawrence Berkeley National Laboratory policies and regulations by outlining the normal practices and answering most policy questions that arise in the day-to-day operations of Laboratory departments. Much of the information in this manual has been condensed from detail provided in Laboratory procedure manuals, Department of Energy (DOE) directives, and Contract DE-AC02-05CH11231. This manual is not intended, however, to replace any of those documents. The sections on personnel apply only to employees who are not represented by unions. Personnel policies pertaining to employees represented by unions may be found in their labor agreements. Questions concerning policy interpretation should be directed to the department responsible for the particular policy. A link to the Managers Responsible for RPM Sections is available on the RPM home page. If it is not clear which department should be called, please contact the Associate Laboratory Director of Operations.

  9. Radiotherapic procedures in vulvar carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Cintra e Oliveira, V. (Hospital dos Servidores Publicos de Sao Paulo (Brazil); Instituto de Radioterapia de Sao Paulo (Brazil)); Lima, G.R. de (Escola Paulista de Medicina, Sao Paulo (Brazil); Hospital dos Servidores Publicos de Sao Paulo (Brazil)); Peres, O. (Instituto de Radioterapia de Sao Paulo (Brazil))

    The cases of six patients with vulvar squamous carcinoma are discussed. The radiotherapic procedure employed in the treatment is presented and compared to other methods. The small morbidity of the therapeutic procedure followed is commented.

  10. FastStats: Obstetrical Procedures

    Science.gov (United States)

    ... Whooping Cough or Pertussis Family Life Marriage and Divorce Health Care and Insurance Access to Health Care ... Survey: 2010 table, Procedures by selected patient characteristics - Rate by procedure category and age [PDF - 168 KB] ...

  11. UV irradiance radiometers calibration procedure

    OpenAIRE

    Doctorovich I. V.; Butenko V. K.; Hodovaniouk V. N.; Fodchuk I. M.; Yuriev V. G.

    2008-01-01

    The paper deals with the problems arising at calibration of narrow-band spectral-sensitive radiometers. The procedure of irradiance unit transfer to UV radiometers — UV radiometers calibration procedure — is presented.

  12. Robust procedures in chemometrics

    DEFF Research Database (Denmark)

    Kotwa, Ewelina

    and comparing the Partial Least Squares (PLS) regression technique with its multi-way alternative, N-PLS. Results of the analysis indicated superiority of the three-way frame-work, potentially constituting a novel assessment of the sea water measurements. Particularly in the case of regression models......The general aim of the thesis was to contribute to the improvement of data analytical techniques within the chemometric field. Regardless the multivariate structure of the data, it is still common in some fields to perform uni-variate data analysis using only simple statistics such as sample mean...... if contamination in the data is present. For this becoming a standard procedure, further work is required, aiming at implementing reliable robust algorithms into standard statistical programs....

  13. Quantization Procedures; Sistemas de cuantificacion

    Energy Technology Data Exchange (ETDEWEB)

    Cabrera, J. A.; Martin, R.

    1976-07-01

    We present in this work a review of the conventional quantization procedure, the proposed by I.E. Segal and a new quantization procedure similar to this one for use in non linear problems. We apply this quantization procedures to different potentials and we obtain the appropriate equations of motion. It is shown that for the linear case the three procedures exposed are equivalent but for the non linear cases we obtain different equations of motion and different energy spectra. (Author) 16 refs.

  14. Skin simulators for dermatological procedures

    OpenAIRE

    Wang, Xiaojie; Albahrani, Yasser; Pan, Michael; Levitt, Jacob

    2015-01-01

    Background: A variety of skin simulators are available on which to practice procedures; however, choice of a suboptimal substitute compromises realism and productive practice. Objective: Skin simulators for basic dermatological procedures are reviewed. Methods: The authors’ anecdotal experience with various skin simulators for different procedures is shared. Results: The following simulators are suggested:  an unripe banana ...

  15. Developments in European Civil Procedures

    NARCIS (Netherlands)

    Cortés, P.; Mańko, R.; Cortés, P.

    2016-01-01

    This chapter is structured as follows. In Section B we explore the legal basis for the creation of European civil procedures and Europeanization of procedural private law in general. In Section C we provide an overview of existing EU instruments on civil procedure, which we propose to divide into

  16. Nursing Procedures. NAVMED P-5066.

    Science.gov (United States)

    Bureau of Medicine and Surgery (Navy), Washington, DC.

    The revised manual of nursing procedures covers fundamental nursing care, admission and discharge of the patient, assisting with therapeutic measures, pre- and postoperative care, diagnostic tests and procedures, and isolation technique. Each of the over 300 topics includes the purpose, equipment, and procedure to be used and, where relevant, such…

  17. [Costing nuclear medicine diagnostic procedures].

    Science.gov (United States)

    Markou, Pavlos

    2005-01-01

    To the Editor: Referring to a recent special report about the cost analysis of twenty-nine nuclear medicine procedures, I would like to clarify some basic aspects for determining costs of nuclear medicine procedure with various costing methodologies. Activity Based Costing (ABC) method, is a new approach in imaging services costing that can provide the most accurate cost data, but is difficult to perform in nuclear medicine diagnostic procedures. That is because ABC requires determining and analyzing all direct and indirect costs of each procedure, according all its activities. Traditional costing methods, like those for estimating incomes and expenses per procedure or fixed and variable costs per procedure, which are widely used in break-even point analysis and the method of ratio-of-costs-to-charges per procedure may be easily performed in nuclear medicine departments, to evaluate the variability and differences between costs and reimbursement - charges.

  18. NASA trend analysis procedures

    Science.gov (United States)

    1993-01-01

    This publication is primarily intended for use by NASA personnel engaged in managing or implementing trend analysis programs. 'Trend analysis' refers to the observation of current activity in the context of the past in order to infer the expected level of future activity. NASA trend analysis was divided into 5 categories: problem, performance, supportability, programmatic, and reliability. Problem trend analysis uncovers multiple occurrences of historical hardware or software problems or failures in order to focus future corrective action. Performance trend analysis observes changing levels of real-time or historical flight vehicle performance parameters such as temperatures, pressures, and flow rates as compared to specification or 'safe' limits. Supportability trend analysis assesses the adequacy of the spaceflight logistics system; example indicators are repair-turn-around time and parts stockage levels. Programmatic trend analysis uses quantitative indicators to evaluate the 'health' of NASA programs of all types. Finally, reliability trend analysis attempts to evaluate the growth of system reliability based on a decreasing rate of occurrence of hardware problems over time. Procedures for conducting all five types of trend analysis are provided in this publication, prepared through the joint efforts of the NASA Trend Analysis Working Group.

  19. AGREED-UPON PROCEDURES, PROCEDURES FOR AUDITING EUROPEAN GRANTS

    Directory of Open Access Journals (Sweden)

    Daniel Petru VARTEIU

    2016-12-01

    The audit of EU-funded projects is an audit based on agreed-upon procedures, which are established by the Managing Authority or the Intermediate Body. Agreed-upon procedures can be defined as engagements made in accordance with ISRS 4400, applicable to agreed-upon procedures, where the auditor undertakes to carry out the agreed-upon procedures and issue a report on factual findings. The report provided by the auditor does not express any assurance. It allows users to form their own opinions about the conformity of the expenses with the project budget as well as the eligibility of the expenses.

  20. Lesion procedures in psychiatric neurosurgery.

    Science.gov (United States)

    Patel, Shaun R; Aronson, Joshua P; Sheth, Sameer A; Eskandar, Emad N

    2013-01-01

    Lesion procedures for psychiatric indications have a history that spans more than a century. This review provides a brief history of psychiatric surgery and addresses the most recent literature on lesion surgery for the treatment of anxiety and mood disorders. Relevant data described in publications from the early 1900 s through the modern era regarding lesion procedures for psychiatric indications, both historical and current use, are reported. The early procedures of Burkhardt, Moniz, and Freeman are reviewed, followed by descriptions of the more refined techniques of Leksell, Knight, Foltz, White, and Kelly. The application of lesion procedures to obsessive-compulsive disorder, mood disorders, and addiction are discussed. Lesioning procedures have informed modern deep brain stimulation targets. Recent lesioning studies demonstrate the efficacy and durability of these procedures in severely disabled patients. Judicious application of these techniques should continue for appropriately selected patients with severe, refractory psychiatric disorders. Copyright © 2013. Published by Elsevier Inc.

  1. Characteristics of Mobile Payment Procedures

    OpenAIRE

    Kreyer, Nina; Pousttchi, Key; Turowski, Klaus

    2002-01-01

    Companies are not going to invest into the development of innovative applications or services unless these can be charged for appropriately. Thus, the existence of standardized and widely accepted mobile payment procedures is crucial for successful business-to-customer mobile commerce. The acceptance of mobile payment procedures depends on costs, security and convenience issues. For the latter, it is important that a procedure can be used over the different payment scenarios mobile commerce, ...

  2. Documenting Laboratory Procedures with Video.

    Science.gov (United States)

    Wyttenbach, Robert A

    2015-01-01

    Demonstrating laboratory procedures in person during class time can be time-consuming. When procedures are done under a microscope, live demonstration is also impractical because of the limited number of students who can view the demonstration at once. Creating videos beforehand, which students can watch before class and review during lab sessions, solves both of these problems. This article suggests ways to make and distribute high quality video of microscopic procedures.

  3. Electronic Procedures for Medical Operations

    Science.gov (United States)

    2015-01-01

    Electronic procedures are replacing text-based documents for recording the steps in performing medical operations aboard the International Space Station. S&K Aerospace, LLC, has developed a content-based electronic system-based on the Extensible Markup Language (XML) standard-that separates text from formatting standards and tags items contained in procedures so they can be recognized by other electronic systems. For example, to change a standard format, electronic procedures are changed in a single batch process, and the entire body of procedures will have the new format. Procedures can be quickly searched to determine which are affected by software and hardware changes. Similarly, procedures are easily shared with other electronic systems. The system also enables real-time data capture and automatic bookmarking of current procedure steps. In Phase II of the project, S&K Aerospace developed a Procedure Representation Language (PRL) and tools to support the creation and maintenance of electronic procedures for medical operations. The goal is to develop these tools in such a way that new advances can be inserted easily, leading to an eventual medical decision support system.

  4. Guidelines for hazard evaluation procedures

    National Research Council Canada - National Science Library

    2008-01-01

    ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxi 1 . Hazard Evaluation Procedures ... Management Overview ... ... Part I Preface 11 Introduction to the Guidelines 1.1 Background ... 1.2 Relationship...

  5. Pollutant Assessments Group procedures manual: Volume 2, Technical procedures

    Energy Technology Data Exchange (ETDEWEB)

    1992-03-01

    This is volume 2 of the manuals that describes the technical procedures currently in use by the Pollution Assessments Group. This manual incorporates new developments in hazardous waste assessment technology and administrative policy. Descriptions of the equipment, procedures and operations of such things as radiation detection, soil sampling, radionuclide monitoring, and equipment decontamination are included in this manual. (MB)

  6. Children Procedures and Treatment (Fertility Issues)

    Medline Plus

    Full Text Available ... Survivor Experiences Decision Making Advice Expert Videos Basic Fertility Info Common Oncofertility Questions Female Procedures & Treatment Male Procedures & Treatment Children Procedures & Treatment Speaker Bios ...

  7. The use of the Acucise technique for ureteropelvic junction obstruction: a trade-off between efficacy and invasiveness?

    NARCIS (Netherlands)

    Baard, Joyce; de Reijke, Theodorus M.; de La Rosette, Jean J. M. C. H.

    2007-01-01

    Open pyeloplasty is traditionally the recommended treatment for ureteropelvic junction obstruction. In the past decades, several less invasive procedures emerged with the advantages of lower morbidity and better patient tolerance. In 1993, an electrosurgical cutting balloon device called the Acucise

  8. Painful Ophthalmoplegia Following Dental Procedure

    OpenAIRE

    Simsek, Ilke Bahceci; Kiziloglu, Ozge Yabas; Ziylan, Sule

    2013-01-01

    This case report is about a 26-year-old patient complaining of painful diplopia shortly after a dental procedure. Magnetic resonance imaging demonstrated a mass lesion in the cavernous sinus that responded well to oral corticosteroids. The possible side effect of the intraoral local anaesthetic injection used during the dental procedure was questioned.

  9. Apexum: A Minimum Invasive Procedure.

    Science.gov (United States)

    Raisingani, Deepak

    2011-01-01

    The new Apexum procedure (Apexum Ltd, Or-Yehuda, Israel) is based on a minimally invasive removal of periapical chronically inflamed tissues through a root canal access. Apexum procedure (a novel method that allows for the removal or debulking of periapical tissues without using scalpels, periosteal elevators, or sutures) results in significant less postoperative discomfort or pain than conventional root canal treatment or than reported for conventional apical surgery. The removal or debulking of the periapical inflamed tissues, using the Apexum procedure, seems to enhance healing kinetics with no adverse events.

  10. Technology for Maintenance Procedure Validation

    National Research Council Canada - National Science Library

    Badler, Norman

    2001-01-01

    ...). The period of research covered activities from January 2000 through January 2001. The primary objective of this research was to explore the feasibility of validating aircraft maintenance procedures using human models...

  11. Surface Environmental Surveillance Procedures Manual

    Energy Technology Data Exchange (ETDEWEB)

    Hanf, RW; Dirkes, RL

    1990-02-01

    This manual establishes the procedures for the collection of environmental samples and the performance of radiation surveys and other field measurements. Responsibilities are defined for those personnel directly involved in the collection of samples and the performance of field measurements.

  12. Assisted Medical Procedures (AMP) Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Documentation and Development: The AMP was initially being developed as part the Advanced Integrated Clinical System (AICS)-Guided Medical Procedure System for the...

  13. Inference Procedures for Ordering Theory

    Science.gov (United States)

    Baker, Frank B.; Hubert, Lawrence J.

    1977-01-01

    Given a set of dichotomously scored items, ordering theory attempts to identify a hierarchy among those items. A graphic representation is presented for an empirically obtained hierarchy and a testing procedure to evaluate hypothesized hierarchical relationships. (Author/JKS)

  14. Construction inspection manual of procedures

    Science.gov (United States)

    2009-01-01

    This manual provides highway construction personnel with relevant, practical information in order to perform accurate inspections and provide relevant construction procedural information for the various roadway and structures items of work. It is the...

  15. Laparoscopic reversal of Hartmann's procedure

    DEFF Research Database (Denmark)

    Svenningsen, Peter Olsen; Bulut, Orhan; Jess, Per

    2010-01-01

    A change in procedure from open to laparoscopic reversal of Hartmann's colostomy was implemented at our department between May 2005 and December 2008. The aim of the study was to investigate if this change was beneficial for the patients.......A change in procedure from open to laparoscopic reversal of Hartmann's colostomy was implemented at our department between May 2005 and December 2008. The aim of the study was to investigate if this change was beneficial for the patients....

  16. Collected radiochemical and geochemical procedures

    Energy Technology Data Exchange (ETDEWEB)

    Kleinberg, J [comp.

    1990-05-01

    This revision of LA-1721, 4th Ed., Collected Radiochemical Procedures, reflects the activities of two groups in the Isotope and Nuclear Chemistry Division of the Los Alamos National Laboratory: INC-11, Nuclear and radiochemistry; and INC-7, Isotope Geochemistry. The procedures fall into five categories: I. Separation of Radionuclides from Uranium, Fission-Product Solutions, and Nuclear Debris; II. Separation of Products from Irradiated Targets; III. Preparation of Samples for Mass Spectrometric Analysis; IV. Dissolution Procedures; and V. Geochemical Procedures. With one exception, the first category of procedures is ordered by the positions of the elements in the Periodic Table, with separate parts on the Representative Elements (the A groups); the d-Transition Elements (the B groups and the Transition Triads); and the Lanthanides (Rare Earths) and Actinides (the 4f- and 5f-Transition Elements). The members of Group IIIB-- scandium, yttrium, and lanthanum--are included with the lanthanides, elements they resemble closely in chemistry and with which they occur in nature. The procedures dealing with the isolation of products from irradiated targets are arranged by target element.

  17. Prognostic value of endocervical sampling following loop excision of high grade intraepithelial neoplasia.

    Science.gov (United States)

    Cui, Yiwen; Sangi-Haghpeykar, Haleh; Patsner, Bruce; Bump, Jennifer M M; Williams-Brown, Marian Y; Binder, Gary L; Masand, Ramya P; Anderson, Matthew L

    2017-03-01

    To assess the role of additional biopsies performed with loop electrosurgical excisional procedure (LEEP) in predicting the likelihood of persistent high grade intraepithelial neoplasia. Clinicopathologic data were abstracted from women who underwent excision of high grade intraepithelial lesions between 2001 and 2014. Persistent disease was defined as uninterrupted high grade intraepithelial neoplasia, whereas recurrent disease was defined as disease diagnosed ≥1year after treatment with intervening normal evaluation. Chi-square and Fisher's exact tests were used to examine associations between demographic and histologic parameters and clinical outcomes. A total of 606 women underwent LEEP for high grade intraepithelial neoplasia (HSIL), of whom, 178 (29%) were additionally evaluated by endocervical curettage, 80 (13%), top hat and 99 (16%), both procedures. With mean follow-up of 1.9±1.5years, persistent disease was identified in 87 women (14%) while recurrent disease was diagnosed in 20 (3%). After adjusting for age, HIV status and histologic grade of disease, the presence of disease at the endocervical margin (aOR=2.2, 95% CL 1.8-5.5, p<0.0001), with endocervical curettage (aOR=2.39, 95% CL 1.2-9.9, p=0.025) or on top hat (aOR=4.0, 95% CL 1.1-16.2, p=0.04) correlated with the likelihood of persistent but not recurrent disease. Only endocervical margin status remained predictive (p=0.03) of outcome after controlling for pre-procedure likelihood of endocervical disease. Sensitivity of endocervical margin status for persistent disease was 56.9% with specificity of 72.2%. Positive predictive value (PPV) was 24.9% and negative predictive value (NPV) 90.9%. Despite frequent use of additional procedures to sample the endocervix, these strategies do not improve the ability of endocervical margin status to predict persistent or recurrent dysplasia. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Designing Flightdeck Procedures: Literature Resources

    Science.gov (United States)

    Feldman, Jolene; Barshi, Immanuel; Degani, Asaf; Loukopoulou, Loukia; Mauro, Robert

    2017-01-01

    This technical publication contains the titles, abstracts, summaries, descriptions, and/or annotations of available literature sources on procedure design and development, requirements, and guidance. It is designed to provide users with an easy access to available resources on the topic of procedure design, and with a sense of the contents of these sources. This repository of information is organized into the following publication sources: Research (e.g., journal articles, conference proceedings), Manufacturers' (e.g., operation manuals, newsletters), and Regulatory and/or Government (e.g., advisory circulars, reports). An additional section contains synopses of Accident/Incident Reports involving procedures. This work directly supports a comprehensive memorandum by Barshi, Mauro, Degani, & Loukopoulou (2016) that summarizes the results of a multi-year project, partially funded by the FAA, to develop technical reference materials that support guidance on the process of developing cockpit procedures (see "Designing Flightdeck Procedures" https://ntrs.nasa.gov/archive/nasa/casi.ntrs.nasa.gov/20160013263.pdf). An extensive treatment of this topic is presented in a forthcoming book by the same authors.

  19. Radiation control standards and procedures

    Energy Technology Data Exchange (ETDEWEB)

    1956-12-14

    This manual contains the Radiation Control Standards'' and Radiation Control Procedures'' at Hanford Operations which have been established to provide the necessary control radiation exposures within Irradiation Processing Department. Provision is also made for including, in the form of Bulletins'', other radiological information of general interest to IPD personnel. The purpose of the standards is to establish firm radiological limits within which the Irradiation Processing Department will operate, and to outline our radiation control program in sufficient detail to insure uniform and consistent application throughout all IPD facilities. Radiation Control Procedures are intended to prescribe the best method of accomplishing an objective within the limitations of the Radiation Control Standards. A procedure may be changed at any time provided the suggested changes is generally agreeable to management involved, and is consistent with department policies and the Radiation Control Standards.

  20. New procedure for departure formalities

    CERN Multimedia

    HR & GS Departments

    2011-01-01

    As part of the process of simplifying procedures and rationalising administrative processes, the HR and GS Departments have introduced new personalised departure formalities on EDH. These new formalities have applied to students leaving CERN since last year and from 17 October 2011 this procedure will be extended to the following categories of CERN personnel: Staff members, Fellows and Associates. It is planned to extend this electronic procedure to the users in due course. What purpose do departure formalities serve? The departure formalities are designed to ensure that members of the personnel contact all the relevant services in order to return any necessary items (equipment, cards, keys, dosimeter, electronic equipment, books, etc.) and are aware of all the benefits to which they are entitled on termination of their contract. The new departure formalities on EDH have the advantage of tailoring the list of services that each member of the personnel must visit to suit his individual contractual and p...

  1. Design Procedure for Hybrid Ventilation

    DEFF Research Database (Denmark)

    Heiselberg, Per; Tjelflaat, Per Olaf

    Mechanical and natural ventilation systems have developed separately during many years. The natural next step in this development is development of ventilation concepts that utilises and combines the best features from each system into a new type of ventilation system - Hybrid Ventilation....... Buildings with hybrid ventilation often include other sustainable technologies and an energy optimisation requires an integrated approach in the design of the building and its mechanical systems. Therefore, the hybrid ventilation design procedure differs from the design procedure for conventional HVAC....... The first ideas on a design procedure for hybrid ventilation is presented and the different types of design methods, that is needed in different phases of the design process, is discussed....

  2. Complications of the Latarjet procedure.

    Science.gov (United States)

    Gupta, Ashish; Delaney, Ruth; Petkin, Kalojan; Lafosse, Laurent

    2015-03-01

    The Latarjet procedure is an operation performed either arthroscopically or open for recurrent anterior shoulder instability, in the setting of glenoid bone loss; with good to excellent functional results. Despite excellent clinical results, the complication rates are reported between 15 and 30 %. Intraoperative complications such as graft malpositioning, neurovascular injury, and graft fracture can all be mitigated with meticulous surgical technique and understanding of the local anatomy. Nonunion and screw breakage are intermediate-term complications that occur in less than 5 % of patients. The long-term complications such as graft osteolysis are still an unsolved problem, and future research is required to understand the etiology and best treatment option. Recurrent instability after the Latarjet procedure can be managed with iliac crest bone graft reconstruction of the anterior glenoid. Shoulder arthritis is another complication reported after the Latarjet procedure, which poses additional challenges to both the surgeon and patient.

  3. Static Correctness of Hierarchical Procedures

    DEFF Research Database (Denmark)

    Schwartzbach, Michael Ignatieff

    1990-01-01

    basis for a general type hierarchy with static type checking, which enables first-order polymorphism combined with multiple inheritance and specialization in a language with assignments. We extend the results to include opaque types. An opaque version of a type is different from the original but has......A system of hierarchical, fully recursive types in a truly imperative language allows program fragments written for small types to be reused for all larger types. To exploit this property to enable type-safe hierarchical procedures, it is necessary to impose a static requirement on procedure calls....... We introduce an example language and prove the existence of a sound requirement which preserves static correctness while allowing hierarchical procedures. This requirement is further shown to be optimal, in the sense that it imposes as few restrictions as possible. This establishes the theoretical...

  4. Laparoscopic reversal of Hartmann's procedure

    DEFF Research Database (Denmark)

    Svenningsen, Peter Olsen; Bulut, Orhan; Jess, Per

    2010-01-01

    INTRODUCTION: A change in procedure from open to laparoscopic reversal of Hartmann's colostomy was implemented at our department between May 2005 and December 2008. The aim of the study was to investigate if this change was beneficial for the patients. MATERIAL AND METHODS: The medical records...... of all patients who underwent reversal of a colostomy after a primary Hartmann's procedure during the period May 2005 to December 2008 were reviewed retrospectively in a case-control study. RESULTS: A total of 43 patients were included. Twenty-one had a laparoscopic and 22 an open procedure. The two...... groups matched with regard to age, sex, American Society of Anestheologists (ASA) score, body mass index and indication for Hartmann's operation. A significantly longer operation time was found for laparoscopic than for open surgery (median 285 versus 158 minutes, p

  5. Procedural learning of unstructured categories.

    Science.gov (United States)

    Crossley, Matthew J; Madsen, Nils R; Ashby, F Gregory

    2012-12-01

    Unstructured categories are those in which the stimuli are assigned to each contrasting category randomly, and thus there is no rule- or similarity-based strategy for determining category membership. Intuition suggests that unstructured categories are likely to be learned via explicit memorization that is under the control of declarative memory. In contrast to this prediction, neuroimaging studies of unstructured-category learning have reported task-related activation in the striatum, but typically not in the hippocampus--results that seem more consistent with procedural learning than with a declarative-memory strategy. This article reports the first known behavioral test of whether unstructured-category learning is mediated by explicit strategies or by procedural learning. Our results suggest that the feedback-based learning of unstructured categories is mediated by procedural memory.

  6. Authentication Procedures - The Procedures and Integration Working Group

    Energy Technology Data Exchange (ETDEWEB)

    Kouzes, Richard T.; Bratcher, Leigh; Gosnell, Tom; Langner, Diana; MacArthur, D.; Mihalczo, John T.; Pura, Carolyn; Riedy, Alex; Rexroth, Paul; Scott, Mary; Springarn, Jay

    2001-05-31

    Authentication is how we establish trust in monitoring systems and measurements to verify compliance with, for example, the storage of nuclear weapons material. Authentication helps assure the monitoring party that accurate and reliable information is provided by any measurement system and that any irregularities are detected. The U.S. is developing its point of view on the procedures for authentication of monitoring systems now planned or contemplated for arms reduction and control applications. The authentication of a system utilizes a set of approaches, including: functional testing using trusted calibration sources, evaluation of documentation, evaluation of software, evaluation of hardware, random selection of hardware and software, tamper-indicating devices, and operational procedures. Authentication of measurement systems should occur throughout their lifecycles, starting with the elements of design, and moving to off-site authentication, on-siste authentication, and continuing with authentication following repair. The most important of these is the initial design of systems. Hardware and software design criteria and procurement decisions can make future authentication relatively straightforward or conversely very difficult. Facility decisions can likewise ease the procedures for authentication since reliable and effective monitoring systems and tampering indicating devices can help provide the assurance needed in the integrity of such items as measurement systems, spare equipment, and reference sources. This paper will summarize the results of the U.S. Authentication Task Force discussion on the role of procedures in authentication.

  7. Percutaneous injuries during surgical procedures.

    Science.gov (United States)

    Tokars, J I; Bell, D M; Culver, D H; Marcus, R; Mendelson, M H; Sloan, E P; Farber, B F; Fligner, D; Chamberland, M E; McKibben, P S

    1992-06-03

    To study the numbers and circumstances of percutaneous injuries (eg, needle sticks, cuts) that occur during surgical procedures. Surgical personnel risk infection with blood-borne pathogens from percutaneous injuries; some injuries might also place patients at risk by exposing them to a health care worker's blood. Observers present at 1382 surgical procedures recorded information about the procedure, the personnel present, and percutaneous injuries that occurred. Four US teaching hospitals during 1990. Operating room personnel in five surgical specialties. Numbers and circumstances of percutaneous injuries among surgical personnel and instances in which surgical instruments that had injured a worker recontacted the patient's surgical wound. Ninety-nine injuries occurred during 95 (6.9%) of the 1382 procedures. Seventy-six injuries (77%) were caused by suture needles and affected the nondominant hand (62 injuries [63%]), especially the distal forefinger. The risk of injury adjusted for confounding variables by logistic regression was higher during vaginal hysterectomy (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.6 to 7.5) and lower during certain orthopedic procedures (OR, 0.2; CI, 0.1 to 0.7) than during 11 other types of procedures (reference group; OR, 1.0). Use of fingers rather than an instrument to hold the tissue being sutured was associated with 35 injuries (35%). Eighty-eight injuries (89%) were sustained by resident or attending surgeons; in 28 (32%) of the 88 injuries in surgeons, the sharp object that caused the injury recontacted the patient. Percutaneous injuries occur regularly during surgery, placing surgical personnel and, to a lesser extent, patients at risk for infection with blood-borne pathogens. Many such injuries may be preventable with changes in devices, techniques, or protective equipment; all such measures require careful evaluation to determine their efficacy in reducing injury and their effect on patient care.

  8. Interventional chest procedures in pregnancy.

    LENUS (Irish Health Repository)

    Morgan, Ross K

    2012-02-01

    Interventional pulmonology encompasses diagnostic and therapeutic bronchoscopic procedures, and pleural interventions. In the last 10 years older techniques have been refined and exciting new technologies have extended the reach and application of the instruments used. The main areas within pulmonary medicine for which these interventions have a role are malignant and nonmalignant airway disease, pleural effusion, pneumothorax, and artificial airways. There are no data from well-designed prospective trials to guide recommendations for interventional pulmonary procedures in pregnancy. The recommendations provided in this article are based on critical review of reported case series, opinion from recognized experts, and personal observations.

  9. Interventional chest procedures in pregnancy.

    LENUS (Irish Health Repository)

    Morgan, Ross K

    2011-03-01

    Interventional pulmonology encompasses diagnostic and therapeutic bronchoscopic procedures, and pleural interventions. In the last 10 years older techniques have been refined and exciting new technologies have extended the reach and application of the instruments used. The main areas within pulmonary medicine for which these interventions have a role are malignant and nonmalignant airway disease, pleural effusion, pneumothorax, and artificial airways. There are no data from well-designed prospective trials to guide recommendations for interventional pulmonary procedures in pregnancy. The recommendations provided in this article are based on critical review of reported case series, opinion from recognized experts, and personal observations.

  10. Palliative procedures in lung cancer.

    Science.gov (United States)

    Masuda, Emi; Sista, Akhilesh K; Pua, Bradley B; Madoff, David C

    2013-06-01

    Palliative care aims to optimize comfort and function when cure is not possible. Image-guided interventions for palliative treatment of lung cancer is aimed at local control of advanced disease in the affected lung, adjacent mediastinal structures, or distant metastatic sites. These procedures include endovascular therapy for superior vena cava syndrome, bronchial artery embolization for hemoptysis associated with lung cancer, and ablation of osseous metastasis. Pathophysiology, clinical presentation, indications of these palliative treatments, procedural techniques, complications, and possible future interventions are discussed in this article.

  11. Children Procedures and Treatment (Fertility Issues)

    Medline Plus

    Full Text Available ... Advice Expert Videos Basic Fertility Info Common Oncofertility Questions Female Procedures & Treatment Male Procedures & Treatment Children Procedures & ... Consortium® Blog | Disclaimer | Contact Us | Site Map For questions about your fertility preservation options call 866-708- ...

  12. ANAESTHESIA FOR OPHTHALMIC SURGICAL PROCEDURES

    African Journals Online (AJOL)

    East African Medical Journal Vol. 91 No. 3 March 2014. ANAESTHESIA FOR OPHTHALMIC SURGICAL PROCEDURES. O. H. Onakpoya, MBBS, FWACS, FMCOphth, Ophthalmology Unit, Department of Surgery, College of Health Sciences,. Obafemi Awolowo University, F. D. Asudo, FDBSBCH (Dip Anaesth), FWACS, ...

  13. ProceduralCreatureGeneration.pdf

    OpenAIRE

    Robison, Barrie; LandonWright; Heck, Samantha; Soule, Terence; Gomez, Spencer

    2017-01-01

    This poster describes our approach to procedurally generating video game creatures through the evolution of digital genomes. The creature genomes are modeled in the Unity game engine using floating point variables to represent genes. The genetic values are then used to calculate game specific traits that can be tied to fitness functions during game design.

  14. Interventional procedures in the chest.

    Science.gov (United States)

    Vollmer Torrubiano, I; Sánchez González, M

    2016-05-01

    Many thoracic conditions will require an interventional procedure for diagnosis and/or treatment. For this reason, radiologists need to know the indications and the technique for each procedure. In this article, we review the various interventional procedures that radiologists should know and the indications for each procedure. We place special emphasis on the potential differences in the diagnostic results and complications between fine-needle aspiration and biopsy. We also discuss the indications for radiofrequency ablation of lung tumors and review the concepts related to the drainage of pulmonary abscesses. We devote special attention to the management of pleural effusion, covering the indications for thoracocentesis and when to use imaging guidance, and to the protocol for pleural drainage. We also discuss the indications for percutaneous treatment of pericardial effusion and the possible complications of this treatment. Finally, we discuss the interventional management of mediastinal lesions and provide practical advice about how to approach these lesions to avoid serious complications. Copyright © 2016 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  15. Adolescent test or procedure preparation

    Science.gov (United States)

    ... for a medical test or procedure can reduce anxiety, encourage cooperation, and help your teen develop coping skills. ... to be there. Do not show your own anxiety. Looking anxious will make your adolescent more upset and worried. Research suggests that children ...

  16. Arthroscopic latarjet procedure: safety evaluation in cadavers

    National Research Council Canada - National Science Library

    Gracitelli, Mauro Emilio Conforto; Ferreira, Arnaldo Amado; Benegas, Eduardo; Malavolta, Eduardo Angeli; Sunada, Edwin Eiji; Assunção, Jorge Henrique

    2013-01-01

    To evaluate the safety of arthroscopic Latarjet procedure in cadavers. : Twelve cadaveric shoulders underwent arthroscopic Latarjet procedure in our laboratory for arthroscopy, by four different surgeons...

  17. Scapular dyskinesis after Latarjet procedure.

    Science.gov (United States)

    Carbone, Stefano; Moroder, Philipp; Runer, Armin; Resch, Herbert; Gumina, Stefano; Hertel, Ralph

    2016-03-01

    Because of detachment of the pectoralis minor and variation of the vector of the conjoint tendons, we hypothesized that the Latarjet procedure may alter scapular position and motion. The purpose of this study was to evaluate scapular position and motion in patients who underwent a Latarjet or a modified iliac crest bone graft transfer (ICBGT) procedure (J-bone graft). Forty-six consecutive patients treated for recurrent anterior shoulder dislocation between 2010 and 2012 were retrospectively enrolled. Twenty-three were treated with a Latarjet and 23 with an ICBGT procedure. Twenty Latarjet and 20 ICBGT patients were available at a mean follow-up of 20 months (min, 12; max, 60). We recorded the Western Ontario Instability Index, the Rowe Score, and the Subjective Shoulder Value. Scapulothoracic position was studied according to the dyskinesis yes/no method. Intraobserver and interobserver reliability of the dyskinesis assessment was assessed. Intraobserver and interobserver reliability of scapula dyskinesis assessment was high (Latarjet: intratester, κ = 0.84; intertester, κ = 0.75; ICBGT: intratester, κ = 0.78; intertester, κ = 0.71). Scapular dyskinesis was observed after 5 of 20 Latarjet and after 0 of 20 ICBGT procedures (P = .047). Patients with dyskinesis had lower scores (Western Ontario Instability Index, P = .043; Rowe, P = .047; Subjective Shoulder Value, P = .046), but no statistically significant difference was found between the Latarjet and ICBGT groups. Two of the 5 scapular dyskinesis patients reached the SICK (Scapular malposition, Inferior medial scapular winging, Coracoid tenderness, and scapular dysKinesis) scapula syndrome definition. Scapular dyskinesis was found in 5 of 20 patients who underwent a Latarjet procedure. Dyskinesis may be related to the detachment of the pectoralis minor, and variation of the vector and the working length of the coracobrachialis and the short head of the biceps. Copyright © 2016 Journal of Shoulder and Elbow

  18. Visual loss after orthopedic procedures.

    Science.gov (United States)

    Kaeser, Pierre-François; Borruat, François-Xavier

    2011-02-01

    Perioperative visual loss (PVL) is a very rare and unpredictable complication of surgery performed at distance from the visual pathways, mostly after spine or cardiac procedures. We report 6 consecutive patients with PVL after routine orthopedic procedures (osteosynthesis for complex fracture of the femur [2], total hip arthroplasty [2], hip prosthesis arthroplasty [1], bilateral simultaneous total knee arthroplasty [1]) and reviewed the literature on the subject. An ischemic optic neuropathy was diagnosed in all cases, and visual loss was bilateral in 5 of 6 patients. Partial visual improvement occurred in only 3 of 11 eyes. No specific therapy is available for PVL. Postoperative visual disturbances should prompt without delay an ophthalmic evaluation because emergent correction of anemia, systemic hypotension, or hypovolemia might improve visual prognosis of PVL. Copyright © 2011 Elsevier Inc. All rights reserved.

  19. Cognitive procedures in sports psychology

    OpenAIRE

    Janez Rojšek

    2002-01-01

    Sport with its emphasised efficiency component clearly reflects cognitive contents and the way they are linked to experience and behaviour. Beliefs, subjective judgements, attitudes, etc. define the attitude to sport, training, competition and results. Their contents can be defined by a psychological examination. We assess their meaning, appropriateness or inappropriateness. They can also be changed by using diverse cognitive-behavioural or reeducative procedures. Psychological work is carrie...

  20. Surface Environmental Surveillance Procedures Manual

    Energy Technology Data Exchange (ETDEWEB)

    RW Hanf; TM Poston

    2000-09-20

    Environmental surveillance data are used in assessing the impact of current and past site operations on human health and the environment, demonstrating compliance with applicable local, state, and federal environmental regulations, and verifying the adequacy of containment and effluent controls. SESP sampling schedules are reviewed, revised, and published each calendar year in the Hanford Site Environmental Surveillance Master Sampling Schedule. Environmental samples are collected by SESP staff in accordance with the approved sample collection procedures documented in this manual.

  1. Repair Types, Procedures - Part 1

    Science.gov (United States)

    2010-05-01

    New Jersey, USA. Repair Types, Procedures – Part I RTO-EN-AVT-156 9 - 19 [5] Drieker R, Botello C, MacBeth S, and Grody J, “Aircraft Battle... MacBeth S, and Grody J, “Aircraft Battle Damage Assessment and Repair (ABDAR), Vol. III: Field Test Report,” AFRL-HE-WP-TR-2002-0039, July 2000. [8

  2. Skin simulators for dermatological procedures.

    Science.gov (United States)

    Wang, Xiaojie; Albahrani, Yasser; Pan, Michael; Levitt, Jacob

    2015-11-18

    A variety of skin simulators are available on which to practice procedures; however, choice of a suboptimal substitute compromises realism and productive practice. Skin simulators for basic dermatological procedures are reviewed. The authors' anecdotal experience with various skin simulators for different procedures is shared. The following simulators are suggested:  an unripe banana for elliptical excision, pork belly for undermining, pork belly for simple interrupted and buried suture, capped needle on a human shoulder for intramuscular injection, ripe tomato or hotdog with skin for intradermal injection, eggplant for shave biopsy, pork belly for punch biopsy, plastic tape over a dark surface for cryosurgery, and beef liver for electrosurgery.  Flaps are best practiced with foam sandwiched between foam tape or artificial anatomical models created specifically for this purpose. The utility of one simulator over another was not compared in a controlled study. Efficient, realistic skin simulators are readily available for practice, which should enhance the safety of the practitioner and improve outcomes of novices.

  3. INADMISSIBLE EVIDENCE IN CIVIL PROCEDURE

    Directory of Open Access Journals (Sweden)

    Mihajlo Dika

    2016-01-01

    Full Text Available This paper examines the exclusion of specific means of evidence as instruments for determining the object of evidence, as well as the taking of evidence in the framework of the Croatian civil procedure law. The introduction lays the grounds for classifying and qualifying exclusion of evidence (general, special; absolute, relative; removable, irremovable; direct, indirect, after which greater attention is paid to the so called absolute and relative type; exclusionary evidence of the direct relative type pertaining to the establishing of facts, and evidence dismissals. With regard to the indirect relative type, the paper examines exclusionary evidence concerning the object of evidence. The remainder of the paper focuses on illegally obtained evidence, while outlining the constitutional, statutory, judicature and doctrinaire premises of bearing for such evidence. Subsequently, the question of evidence obtained in violation of the Constitutional guarantee of respect and legal protection of private and family life, dignity, reputation and honour, as well as evidence obtained by breach of the Constitutional guarantee of freedom and secrecy of correspondence and all other forms of communication, and in violation of the right to safety and privacy of personal data, are discussed too. In addition, the paper analyses the institutions of preclusion of evidence and the so called informative evidence. Concluding, the author points to a lacking regulation of inadmissible evidence within the Croatian civil procedure law, underlining the need to determine de lege ferenda legal requirements with a view to operationalizing inadmissible evidence within the Croatian civil procedure law.

  4. Series expansion of the modified Einstein Procedure

    Science.gov (United States)

    Seema Chandrakant Shah-Fairbank

    2009-01-01

    This study examines calculating total sediment discharge based on the Modified Einstein Procedure (MEP). A new procedure based on the Series Expansion of the Modified Einstein Procedure (SEMEP) has been developed. This procedure contains four main modifications to MEP. First, SEMEP solves the Einstein integrals quickly and accurately based on a series expansion. Next,...

  5. PRINCIPLES AND PROCEDURES ON FISCAL

    Directory of Open Access Journals (Sweden)

    Morar Ioan Dan

    2011-07-01

    Full Text Available Fiscal science advertise in most analytical situations, while the principles reiterated by specialists in the field in various specialized works The two components of taxation, the tax system relating to the theoretical and the practical procedures relating to tax are marked by frequent references and invocations of the underlying principles to tax. This paper attempts a return on equity fiscal general vision as a principle often invoked and used to justify tax policies, but so often violated the laws fiscality . Also want to emphasize the importance of devising procedures to ensure fiscal equitable treatment of taxpayers. Specific approach of this paper is based on the notion that tax equity is based on equality before tax and social policies of the executive that would be more effective than using the other tax instruments. I want to emphasize that if the scientific approach to justify the unequal treatment of the tax law is based on the various social problems of the taxpayers, then deviates from the issue of tax fairness justification explaining the need to promote social policies usually more attractive to taxpayers. Modern tax techniques are believed to be promoted especially in order to ensure an increasing level of high efficiency at the expense of the taxpayers obligations to ensure equality before the law tax. On the other hand, tax inequities reaction generates multiple recipients from the first budget plan, but finalities unfair measures can not quantify and no timeline for the reaction, usually not known. But while statistics show fluctuations in budgetary revenues and often find in literature reviews and analysis relevant to a connection between changes in government policies, budget execution and outcome. The effects of inequality on tax on tax procedures and budgetary revenues are difficult to quantify and is among others to this work. Providing tax equity without combining it with the principles of discrimination and neutrality

  6. Instrument Calibration and Certification Procedure

    Energy Technology Data Exchange (ETDEWEB)

    Davis, R. Wesley [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2016-05-31

    The Amptec 640SL-2 is a 4-wire Kelvin failsafe resistance meter, designed to reliably use very low-test currents for its resistance measurements. The 640SL-1 is a 2-wire version, designed to support customers using the Reynolds Industries type 311 connector. For both versions, a passive (analog) dual function DC Milliameter/Voltmeter allows the user to verify the actual 640SL output current level and the open circuit voltage on the test leads. This procedure includes tests of essential performance parameters. Any malfunction noticed during calibration, whether specifically tested for or not, shall be corrected before calibration continues or is completed.

  7. Cognitive procedures in sports psychology

    Directory of Open Access Journals (Sweden)

    Janez Rojšek

    2002-05-01

    Full Text Available Sport with its emphasised efficiency component clearly reflects cognitive contents and the way they are linked to experience and behaviour. Beliefs, subjective judgements, attitudes, etc. define the attitude to sport, training, competition and results. Their contents can be defined by a psychological examination. We assess their meaning, appropriateness or inappropriateness. They can also be changed by using diverse cognitive-behavioural or reeducative procedures. Psychological work is carried out through systematic psychological preparation, crisis interventions and special psychological preparation within the framework of a training process. Cognitive forms of work represent a significant part of ideomotor, verbal, intellectual and situational training.

  8. EFFECTIVE PROCEDURES FOR EXECUTIVE'S PREPARATION

    Directory of Open Access Journals (Sweden)

    Elisabet Martínez Mondéjar

    2014-05-01

    The aim of this article is to present methodological procedure that facilitates the executives  work with teachers that are preparing themselves to by promoting post from their  workplace from  a manual directed towards counseling executives  on how to develop the focalization, the selection and the evaluation and promotion of its teachers that are preparing themselves to by promoting post  from the work system itself  of the different levels of management from the University of Pedagogical Sciences " Felix Varela Morales " of Villa Clara.

  9. Forthcoming indefinite contract review procedure

    CERN Multimedia

    Human Resources Department

    2011-01-01

    The vacancy notices for posts opened with a view to the award of an indefinite contract will be published in early April 2011. In the meantime, the list of posts to be opened this spring is available at the following address: Indefinite contract posts - spring 2011 A second exercise will take place in autumn 2011 and, as of 2012, the indefinite contract award procedure will only be held once a year, in autumn. For more information please consult: https://hr-recruit.web.cern.ch/hr-recruit/staff/IndefiniteContracts.asp  

  10. [Procedural learning disorder: neuropsychological characteristics].

    Science.gov (United States)

    Crespo-Eguílaz, N; Narbona, J

    This research aims at neurocognitive delineation of the core features of procedural learning disorder (PLD), otherwise labeled as motor coordination disorder or non-verbal learning disorder. A sample of 209 correlative outpatients (73% males), aged 6-12 years, all of them having QI ranging from 81 to 120, was clustered into the following neurobehavioural groups: PLD (n = 16), PLD plus attention deficit hyperactivity disorder (ADHD) (n = 37), ADHD combined type (n = 47), ADHD predominantly inattentive type (n = 23), specific language impairment (n = 68), and semantic-pragmatic language impairment (n = 18). Two additional groups of patients were included for some comparisons: children with periventricular leukomalacia (PVL) without learning disability (n = 8) or associating PLD (n = 17). A set of behavioural scales and neurocognitive tests was used to evaluate verbal and non-verbal IQ, attention, impulsivity control, visuo-motor coordination, declarative memory, procedural memory and learning, formal and functional dimensions of language, peer relationships and academic achievement. Parametric analysis were used to test the differences and similarities of neurobehavioural variables between groups. Our results allow us to conclude that PLD implies a difficult acquisition of automatized motor, cognitive and communicative abilities required in school work and peer social relationships. PLD is different from autistic spectrum disorders. It is frequently associated to inattentive ADHD. Operational criteria for diagnosis of PLD are proposed, according to our results. A bilateral posterior parietal dysfunction is a plausible explanation of its physiopathology. Preserved general intelligence and formal linguistic abilities are the clues for intervention designs.

  11. Esophageal Carcinoma Following Bariatric Procedures

    Science.gov (United States)

    Leeman, Matthew F.; Richardson, J. David

    2004-01-01

    Background: The long-term success of bariatric operations for weight reduction has been well documented, but their potential effects on the risk of esophageal cancer have not been evaluated. Methods: We performed operations on 3 patients for esophageal cancer following bariatric operations: 2 had Roux-en-Y gastric bypass, and 1 underwent vertical banded gastroplasty. All of these patients had adenocarcinoma at the gastroesophageal junction; 1 involved the entire intrathoracic esophagus. Results: The intervals between the weight-loss operations and cancer diagnoses were 21, 16, and 14 years. All 3 patients had symptoms of reflux for many years before dysphagia developed and cancer was diagnosed. We performed a limited esophagogastrectomy, a classic IvorLewis procedure, and a total esophagectomy with jejunal free-tissue transfer from stomach to cervical esophagus. Two patients had positive lymph nodes. One patient is alive at 6 years; 2 died at 13 and 15 months after undergoing operation for recurrent cancer. Conclusion: The effect of bariatric operations on gastroesophageal reflux is not known, although gastric bypass has been advocated as the “ultimate antireflux procedure.” The presence of esophageal cancer in these 3 patients years after the weight loss operation is worrisome. We believe that patients who develop new symptoms should have endoscopic evaluation and that epidemiologic studies on the incidence of esophageal cancer occurring years after bariatric operation should be performed. PMID:15554284

  12. Cardiovascular procedures/diagnostic techniques and therapeutic procedures

    Energy Technology Data Exchange (ETDEWEB)

    Tilkian, A.G.; Daily, E.K.

    1986-01-01

    This book covers the technical and therapeutic aspects of cardiovascular procedures in immense detail. There are large and appropriate diagrams and tables. The topics of the chapters are tools for catheterization, venous access, arterial access, hemodynamic monitoring, cardiac catheterization and coronary arteriography, ergonovine provocation testing for coronary artery spasm, pulmonary angiography, endomyocredial biopsy, electrophysiologic studies, pericardiocentesis and drainage, intraaortic balloon pumping, direct current cardioversion and defibrilaltion, pacemaker implantation of the automatic implantable cardioverter/defibrillator, coronary angioplasty, thrombolytic therapy, transluminal catheter extraction and resolution of intracardiac catheter knots, cardiopulmonary resuscitation, contrast media toxicity and allergic reactions, radiation hazards, and medicolegal concerns. An appendix and index follow these chapters. In general, each chapter covers historical aspects, indications, complications, techniques, and preoperative and postoperative care.

  13. Physiotherapy following elective orthopaedic procedures.

    Science.gov (United States)

    De Kleijn, P; Blamey, G; Zourikian, N; Dalzell, R; Lobet, S

    2006-07-01

    As haemophilic arthropathy and chronic synovitis are still the most important clinical features in people with haemophilia, different kinds of invasive and orthopaedic procedures have become more common during the last decades. The availability of clotting factor has made arthroplasty of one, or even multiple joints possible. This article highlights the role of physiotherapy before and after such procedures. Synovectomies are sometimes advocated in people with haemophilia to stop repetitive cycles of intra-articular bleeds and/or chronic synovitis. The synovectomy itself, however, does not solve the muscle atrophy, loss of range of motion (ROM), instability and poor propriocepsis, often developed during many years. The key is in taking advantage of the subsequent, relatively safe, bleed-free period to address these important issues. Although the preoperative ROM is the most important variable influencing the postoperative ROM after total knee arthroplasty, there are a few key points that should be considered to improve the outcome. Early mobilization, either manual or by means of a continuous passive mobilization machine, can be an optimal solution during the very first postoperative days. Muscle isometric contractions and light open kinetic chain exercises should also be started in order to restore the quadriceps control. Partial weight bearing can be started shortly after, because of quadriceps inhibition and to avoid excessive swelling. The use of continuous clotting factor replacement permits earlier and intensive rehabilitation during the postoperative period. During the rehabilitation of shoulder arthroplasty restoring the function of the rotator cuff is of utmost importance. Often the rotator cuff muscles are inhibited in the presence of pain and loss of ROM. Physiotherapy also assists in improving pain and maintaining ROM and strength. Functional weight-bearing tasks, such as using the upper limbs to sit and stand, are often discouraged during the first 6

  14. 12 CFR 303.221 - Filing procedures.

    Science.gov (United States)

    2010-01-01

    ... PROCEDURES Section 19 of the FDI Act (Consent to Service of Persons Convicted of Certain Criminal Offenses) § 303.221 Filing procedures. (a) Where to file. An application under section 19 of the FDI Act shall be...

  15. Children Procedures and Treatment (Fertility Issues)

    Medline Plus

    Full Text Available Oncofertility Consortium Children Procedures and Treatment Share My Story Share my story! Children Procedures and Treatment Is ovarian tissue cryopreservation available to girls under 18? How can ...

  16. 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

  17. Electronic Procedures for Medical Operations Project

    Data.gov (United States)

    National Aeronautics and Space Administration — We propose an alternative to using Microsoft Word for representing medical procedures that will make the procedures easier to construct and maintain, particularly...

  18. Procedure Integrated Development Environment (PRIDE) Project

    Data.gov (United States)

    National Aeronautics and Space Administration — NASA captures and distributes operational knowledge in the form of procedures. These procedures are created and accessed by a range of people performing many...

  19. 14 CFR 302.705 - Further procedures.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Further procedures. 302.705 Section 302.705 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION PROCEEDINGS) PROCEDURAL... administrative law judge. ...

  20. International Criminal Procedure: Principles and Rules

    NARCIS (Netherlands)

    Sluiter, G.; Friman, H.; Linton, S; Vasiliev, S.V.; Zappalà, S.

    2013-01-01

    Identifies and crystallizes the rules and principles of international criminal procedure, based on painstaking analysis of existing case law and practice Provides a comprehensive overview of the procedural law of international criminal tribunals from Nuremberg to the recently established Cambodian

  1. Geometric procedures for civil engineers

    CERN Document Server

    Tonias, Elias C

    2016-01-01

    This book provides a multitude of geometric constructions usually encountered in civil engineering and surveying practice.  A detailed geometric solution is provided to each construction as well as a step-by-step set of programming instructions for incorporation into a computing system. The volume is comprised of 12 chapters and appendices that may be grouped in three major parts: the first is intended for those who love geometry for its own sake and its evolution through the ages, in general, and, more specifically, with the introduction of the computer. The second section addresses geometric features used in the book and provides support procedures used by the constructions presented. The remaining chapters and the appendices contain the various constructions. The volume is ideal for engineering practitioners in civil and construction engineering and allied areas.

  2. Glaucoma and Corneal Transplant Procedures

    Directory of Open Access Journals (Sweden)

    Ammar M. Al-Mahmood

    2012-01-01

    Full Text Available Glaucoma after corneal transplantation is a leading cause of ocular morbidity after penetrating keratoplasty. The incidence reported is highly variable and a number of etiologic factors have been identified. A number of treatment options are available; surgical intervention for IOP control is associated with a high incidence of graft failure. IOP elevation is less frequently seen following deep anterior lamellar keratoplasty. Descemet's striping-automated endothelial keratoplasty is also associated with postprocedure intraocular pressure elevation and secondary glaucoma and presents unique surgical challenges in patients with preexisting glaucoma surgeries. Glaucoma exists in up to three-quarters of patients who undergo keratoprosthesis surgery and the management if often challenging. The aim of this paper is to highlight the incidence, etiology, and management of glaucoma following different corneal transplant procedures. It also focuses on the challenges in the diagnosis of glaucoma and intraocular pressure monitoring in this group of patients.

  3. Radiological Work Planning and Procedures

    CERN Document Server

    Kurtz, J E

    2000-01-01

    Each facility is tasked with maintaining personnel radiation exposure as low as reasonably achievable (ALARA). A continued effort is required to meet this goal by developing and implementing improvements to technical work documents (TWDs) and work performance. A review of selected TWDs from most facilities shows there is a need to incorporate more radiological control requirements into the TWD. The Radioactive Work Permit (RWP) provides a mechanism to place some of the requirements but does not provide all the information needed by the worker as he/she is accomplishing the steps of the TWD. Requiring the engineers, planners and procedure writers to put the radiological control requirements in the work steps would be very easy if all personnel had a strong background in radiological work planning and radiological controls. Unfortunately, many of these personnel do not have the background necessary to include these requirements without assistance by the Radiological Control organization at each facility. In add...

  4. 21 CFR 211.142 - Warehousing procedures.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Warehousing procedures. 211.142 Section 211.142 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS....142 Warehousing procedures. Written procedures describing the warehousing of drug products shall be...

  5. Encoding and Decoding Procedures for Arrangements

    Directory of Open Access Journals (Sweden)

    Alexander A. Babaev

    2012-05-01

    Full Text Available This article discusses an algorithm based on the encoding procedure for representing a set of arrangement elements as a single number. Also the author provides the procedure for the inverse transformation of the code into arrangement elements. In addition the Article includes recommendations on the use of the above procedures in combinatorial algorithms of optimization.

  6. 34 CFR 300.181 - Hearing procedures.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false Hearing procedures. 300.181 Section 300.181 Education... DISABILITIES State Eligibility Department Procedures § 300.181 Hearing procedures. (a) As used in §§ 300.179... assist the resolution of the matter, the Hearing Official or Hearing Panel gives each party, in addition...

  7. 10 CFR 4.336 - Compliance procedure.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Compliance procedure. 4.336 Section 4.336 Energy NUCLEAR... Amended Investigation, Conciliation, and Enforcement Procedures § 4.336 Compliance procedure. (a) NRC may... these regulations. (b) NRC will limit any termination under § 4.336(a)(1) to the particular recipient...

  8. 75 FR 32273 - Representation Election Procedure

    Science.gov (United States)

    2010-06-08

    ... 29 CFR Parts 1202 and 1206 RIN 3140-ZA00 Representation Election Procedure AGENCY: National Mediation... delaying the effective date of its rule regarding representation election procedures from June 10, 2010 to... Representation Election Procedure Rule have been made. The NMB will notify participants if there are any further...

  9. 76 FR 37291 - Representation Case Procedures

    Science.gov (United States)

    2011-06-27

    ... BOARD 29 CFR Parts 101, 102, 103 RIN 3142-AAO8 Representation Case Procedures AGENCY: National Labor... amendments to the Board's rules governing representation case procedures, published at 76 FR 15307 (June 22, 2011) and make other proposals for improving representation case procedures. DATES: The meeting will be...

  10. 25 CFR 11.313 - Trial procedure.

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Trial procedure. 11.313 Section 11.313 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAW AND ORDER COURTS OF INDIAN OFFENSES AND LAW AND ORDER CODE Criminal Procedure § 11.313 Trial procedure. (a) The time and place of court sessions, and all other...

  11. 46 CFR 154.665 - Welding procedures.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 5 2010-10-01 2010-10-01 false Welding procedures. 154.665 Section 154.665 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CERTAIN BULK DANGEROUS CARGOES SAFETY STANDARDS... Construction § 154.665 Welding procedures. Welding procedure tests for cargo tanks for a design temperature...

  12. 40 CFR 205.54 - Test procedures.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Test procedures. 205.54 Section 205.54 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) NOISE ABATEMENT PROGRAMS TRANSPORTATION EQUIPMENT NOISE EMISSION CONTROLS Medium and Heavy Trucks § 205.54 Test procedures. The procedures described...

  13. Procedural Learning and Individual Differences in Language

    Science.gov (United States)

    Lee, Joanna C.; Tomblin, J. Bruce

    2015-01-01

    The aim of the current study was to examine different aspects of procedural memory in young adults who varied with regard to their language abilities. We selected a sample of procedural memory tasks, each of which represented a unique type of procedural learning, and has been linked, at least partially, to the functionality of the corticostriatal…

  14. Medical Service Clinical Laboratory Procedures--Bacteriology.

    Science.gov (United States)

    Department of the Army, Washington, DC.

    This manual presents laboratory procedures for the differentiation and identification of disease agents from clinical materials. Included are procedures for the collection of specimens, preparation of culture media, pure culture methods, cultivation of the microorganisms in natural and simulated natural environments, and procedures in…

  15. 16 CFR 1.88 - Implementing procedures.

    Science.gov (United States)

    2010-01-01

    ... Commercial Practices FEDERAL TRADE COMMISSION ORGANIZATION, PROCEDURES AND RULES OF PRACTICE GENERAL PROCEDURES Procedures for Implementation of the National Environmental Policy Act of 1969 § 1.88 Implementing... environmental impact statement is needed and in its preparation. (b) The Commission will determine finally...

  16. 14 CFR 13.131 - Other procedures.

    Science.gov (United States)

    2010-01-01

    ... Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES INVESTIGATIVE AND ENFORCEMENT PROCEDURES Formal Fact-Finding Investigation Under an Order of Investigation § 13.131 Other procedures. Any question concerning the scope or conduct of a formal investigation not...

  17. Procedural Attack! Procedural Generation for Populated Virtual Cities: A Survey

    Directory of Open Access Journals (Sweden)

    Werner Gaisbauer

    2017-06-01

    Full Text Available On the one hand, creating rich virtual worlds "by hand" like in the game Grand Theft Auto V is hugely expensive and limited to large studios. On the other hand, procedural content generation (PCG allows tiny teams to create huge worlds like Hello Games did with only four people (in the beginning for the recently released game No Man's Sky. Following in the footsteps of Hello Games, this paper tries to equip the reader with an overview about the state-of-the-art of how to build such a virtual world, i.e., a populated virtual city with buildings, streets, parks, vegetation, humans, and vehicles, using just PCG assets. Each PCG asset that is envisioned to bring the city to life is grouped and discussed in detail and the latest research trends in PCG are presented together with open questions. Using the above-mentioned PCG assets, instead of months, a city can be built in a mere couple of minutes by a user without much experience in designing 3D assets. The city can then be used for many applications like games, virtual reality (VR, or film.

  18. Physiological and biochemical changes with Vamana procedure

    Science.gov (United States)

    Gupta, Bharti; Mahapatra, Sushil C.; Makhija, Renu; Kumar, Adarsh; Jirankalgikar, Nikhil M.; Padhi, Madan M.; Devalla, Ramesh Babu

    2012-01-01

    Vamana Karma (therapeutic emesis) primarily a Samshodhana Karma (purification procedure) is one of the five Pradhana Karmas (chief procedures) of Panchakarma. It is mentioned in Ayurvedic texts that a person after Samyak Vamana (proper Vamana) experiences lightness of the body, Hrit (precordium), Kantha (throat/voice), and Shirah (head) and weakness. This procedure is effectively used in healthy and ailing persons for purification of body and extraction of Doshas (especially Kapha) in Ayurvedic system. It has been found worth to observe the physiological and biochemical changes during Vamana and after the procedure to understand the effect/safety margins of the procedure in healthy volunteers. PMID:23723640

  19. Writer`s guide for technical procedures

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-12-01

    A primary objective of operations conducted in the US Department of Energy (DOE) complex is safety. Procedures are a critical element of maintaining a safety envelope to ensure safe facility operation. This DOE Writer`s Guide for Technical Procedures addresses the content, format, and style of technical procedures that prescribe production, operation of equipment and facilities, and maintenance activities. The DOE Writer`s Guide for Management Control Procedures and DOE Writer`s Guide for Emergency and Alarm Response Procedures are being developed to assist writers in developing nontechnical procedures. DOE is providing this guide to assist writers across the DOE complex in producing accurate, complete, and usable procedures that promote safe and efficient operations that comply with DOE orders, including DOE Order 5480.19, Conduct of Operations for DOE Facilities, and 5480.6, Safety of Department of Energy-Owned Nuclear Reactors.

  20. HUMAN RELIABILITY ANALYSIS FOR COMPUTERIZED PROCEDURES

    Energy Technology Data Exchange (ETDEWEB)

    Ronald L. Boring; David I. Gertman; Katya Le Blanc

    2011-09-01

    This paper provides a characterization of human reliability analysis (HRA) issues for computerized procedures in nuclear power plant control rooms. It is beyond the scope of this paper to propose a new HRA approach or to recommend specific methods or refinements to those methods. Rather, this paper provides a review of HRA as applied to traditional paper-based procedures, followed by a discussion of what specific factors should additionally be considered in HRAs for computerized procedures. Performance shaping factors and failure modes unique to computerized procedures are highlighted. Since there is no definitive guide to HRA for paper-based procedures, this paper also serves to clarify the existing guidance on paper-based procedures before delving into the unique aspects of computerized procedures.

  1. 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.

  2. DACS upgrade acceptance test procedure

    Energy Technology Data Exchange (ETDEWEB)

    Zuehlke, A.C.

    1994-09-28

    The readiness of the Data Acquisition and Control System (DACS) to provide monitoring and control of the mixer pump, directional drive system, and the instrumentation associated with the SY-101 tank and support systems, and the proper functioning of the DACS with new Model 984-785 Programmable Logic Controllers (PLCs), new MODBUS PLUS version 2.01 software for the PLCs, and version 3.72 of the GENESIS software will be systematically evaluated by performance of this procedure. The DACS, which is housed in a trailer located just outside of the north fence at the SY tank farm, receives input signals from a variety of sensors located in and around the SY-101 tanks. These sensors provide information such as: tank vapor space and ventilation system H{sub 2} concentration; tank waste temperature; tank pressure; waste density; operating pump parameters such as speed, flow, rotational position, discharge pressure, and internal temperature; strain (for major equipment); and waste level. The output of these sensors is conditioned and transmitted to the DACS computers where these signals are displayed, recorded, and monitored for out-of-specification conditions. If abnormal conditions are detected, then, in certain situations, the DACS automatically generates alarms and causes the system to abort pump operations.

  3. Crisis management and warning procedures

    Directory of Open Access Journals (Sweden)

    Valérie November

    2009-03-01

    territoriale du risque s’avère nécessaire.Based on two flood events that recently affected new housing areas in very different political, organisational and hydrological contexts, this article examines the practices of actors involved in emergency and crisis situations in Switzerland. In both cases, the actors are identified – through their role and their position in the various procedures related to crisis management – and an inventory is made of the documents used. The study examines how the flood events were managed, identifies the organisational changes that followed the crises, and determines how the risk was conceived and to what extent it was formalised by the different actors both before and after the floods. Finally new forecasting and warning procedures that were set up following the events are described. The study shows that floods have a decisive impact on the production of knowledge, but that this phenomenon varies according to the actors. Events such as floods also sometimes reveal the existence of "latent" knowledge, or knowledge that is available but has not yet been integrated into institutional procedures. In terms of both forecasting and crisis management, these events also provide the opportunity to test information channels and to identify and correct any problems relating to organisation, cooperation or the reliability of means of communication. Among other things, the risks and crises related to flooding modify the dynamics and policies of the local area as a result of readjustments in the networks of actors. The introduction of emergency and crisis management measures appears more effective, however, than the reorganisation of planning and development procedures, a process which generally takes a lot longer. Nevertheless, since the recollection of events tends to fade with time, it is important that risks find a more concrete form of spatial expression on the landscape.

  4. Anxiety in preoperative anesthetic procedures.

    Science.gov (United States)

    Valenzuela Millán, Jaquelyn; Barrera Serrano, José René; Ornelas Aguirre, José Manuel

    2010-01-01

    Preoperative anxiety is a common and poorly evaluated condition in patients who will undergo an anesthetic and surgical intervention. The objective of this study was to determine the prevalence of anxiety in a group of patients undergoing elective surgery, as assessed by the Amsterdam Anxiety Preoperative and Information (AAPI) scale. We studied 135 patients scheduled for elective surgery applying the AAPI scale 24 h before the surgical procedure to evaluate the presence of anxiety and patient characteristics. A descriptive analysis with mean +/- standard deviation for categorical variables was done. For intragroup differences, chi(2) test was used. Pearson correlation for the association between anxiety and postoperative complications was carried out. A value of p =0.05 was considered significant. One hundred six patients were surgically treated, 88% were female (average age 44 +/- 12 years). Some degree of preoperative anxiety was present in 72 patients (76%; p = 0.001) with a grade point average on the AAPI scale equal to 17 +/- 7 points, of which 95 (70%, OR = 5.08; p = 0.002) were females. Results of this study suggest the presence of high levels of preoperative anxiety in patients scheduled for elective surgery. The origin of the anxiety appears to be related to many factors that can be evaluated in pre-anesthetic consultation. Further study is needed to prevent the presence of this disorder.

  5. Augmented reality in surgical procedures

    Science.gov (United States)

    Samset, E.; Schmalstieg, D.; Vander Sloten, J.; Freudenthal, A.; Declerck, J.; Casciaro, S.; Rideng, Ø.; Gersak, B.

    2008-02-01

    Minimally invasive therapy (MIT) is one of the most important trends in modern medicine. It includes a wide range of therapies in videoscopic surgery and interventional radiology and is performed through small incisions. It reduces hospital stay-time by allowing faster recovery and offers substantially improved cost-effectiveness for the hospital and the society. However, the introduction of MIT has also led to new problems. The manipulation of structures within the body through small incisions reduces dexterity and tactile feedback. It requires a different approach than conventional surgical procedures, since eye-hand co-ordination is not based on direct vision, but more predominantly on image guidance via endoscopes or radiological imaging modalities. ARIS*ER is a multidisciplinary consortium developing a new generation of decision support tools for MIT by augmenting visual and sensorial feedback. We will present tools based on novel concepts in visualization, robotics and haptics providing tailored solutions for a range of clinical applications. Examples from radio-frequency ablation of liver-tumors, laparoscopic liver surgery and minimally invasive cardiac surgery will be presented. Demonstrators were developed with the aim to provide a seamless workflow for the clinical user conducting image-guided therapy.

  6. Spot-to-Beam Procedure

    CERN Document Server

    Seidov, Zakir F; Yahalom, Asher

    2004-01-01

    We describe the interactive "STB" (spot_to_beam) MATHEMATICA procedure for a) approximating the spot image at the screen as ellipse, b) getting five parameters of the elliptic beam (two diameters, center coordinates, and orientation angle). The basic idea is to "map" the reference holes at screen onto the X-Y plane normal to the beam direction (Z-axis). All distortions of the image, e.g., due to camera-screen disposition can be, in principle, taken into account,assuming that the hole positions at screen and the orientation of the screen are known. With the non-linear LMS fitting, the "curved-coordinate-system" of the holes at image is transferred to the Cartesian coordinate system at XY-plane. Then the fitting ellipse is found in this latter system, by solving the system of N linear equations for 5 unknown parameters of beam ellipse, where N>5 is a number of reference points on edge of spot image. The examples of the real measurements at various screens will be demonstrated. The accuracy of beam diameters is ...

  7. Photogrammetry procedures applied to anthropometry.

    Science.gov (United States)

    Okimoto, Maria Lúcialeite Ribeiro; Klein, Alison Alfred

    2012-01-01

    This study aims to evaluate the reliability and establish procedures for the use of digital photogrammetry in anthropometric measurements of the human hand. The methodology included the construction of a platform to allow the placement of the hand always equivalent to a distance of the camera lens and to annul the effects of parallax. We developed a software to perform the measurements from the images and built up a subject of proof in a cast from a negative mold, this object was subjected to measurements with digital photogrammetry using the data collection platform in caliper and the Coordinate Measuring Machine (MMC). The results of the application of photogrammetry in the data collection segment hand, allow us to conclude that photogrammetry is an effective presenting precision coefficient below 0.940. Within normal and acceptable values, given the magnitude of the data used in anthropometry. It was concluded photogrammetry then be reliable, accurate and efficient for carrying out anthropometric surveys of population, and presents less difficulty to collect in-place.

  8. INITIATION AND CONDUCT OF ADMINISTRATIVE PROCEDURE

    Directory of Open Access Journals (Sweden)

    Milan Stipic

    2013-12-01

    Full Text Available General administrative procedure act contains legal norms that are valid for all identical cases. In addition to the general, there are special administrative procedures, customized to the specific administrative areas. Procedure initiation is regulated. Administrative procedure can be initiated at the request of the proponent and ex officio. When the official determines that the conditions for the conduct of administrative procedure are met, before making a decision, all the facts and circumstances relevant to the resolution of administrative matter have to be identified. When there are no legal requirements for the initiation of procedures, the official shall make a decision to reject the application of the party. The procedure is initiated ex officio when stipulated by law or when protection of public interest requires it. When initiating procedure ex officio, the public authority shall take into consideration the petition or other information that indicate the need to protect the public interest. In such cases the applicant is not a party, and the official is obliged to notify the applicant, if initiation of procedures is not accepted ex officio. Based on the notification, the applicant has a right to complain, including the situation when there is no response within the prescribed period of 30 days. Public authority may, therefore it is not obliged to, initiate administrative procedure by public announcement only in a situation where the parties are unknown, while it is obliged to initiate procedure by public announcement when this method of initiating the procedure is prescribed by law. Initiation of procedure with public announcement occurs in rare cases. Due to the application of efficiency and cost-effectiveness principle, two or more administrative procedures can be merged into one procedure by a conclusion. The condition for this is that the rights or obligations of the parties are based on the same legal basis and on the same or

  9. Risk of persistent and recurrent cervical neoplasia following incidentally detected adenocarcinoma in situ.

    Science.gov (United States)

    Munro, Aime; Codde, Jim; Spilsbury, Katrina; Steel, Nerida; Stewart, Colin J R; Salfinger, Stuart G; Tan, Jason; Mohan, Ganendra R; Leung, Yee; Semmens, James B; O'Leary, Peter; Williams, Vincent; Cohen, Paul A

    2017-03-01

    Adenocarcinoma in situ of the uterine cervix is a precursor to cervical adenocarcinoma and may coexist with both adenocarcinoma and high-grade squamous dysplasia (cervical intraepithelial neoplasia 2 and 3). Up to 60% of adenocarcinoma in situ lesions are detected incidentally following excisional biopsies performed for the treatment of cervical intraepithelial neoplasia 2/3. To date there are no data regarding risk factors for persisting or progressive cervical neoplasia in these patients. We sought to investigate patient outcomes following incidentally detected cervical adenocarcinoma in situ after loop electrosurgical excision procedure or cold knife cone biopsy performed for the treatment of high-grade cervical intraepithelial neoplasia. We conducted a retrospective, population-based cohort study of Western Australian patients with an incidental diagnosis of adenocarcinoma in situ from 2001 through 2012. Primary outcomes were persistent or recurrent cervical intraepithelial neoplasia 2/3 and or adenocarcinoma in situ, and invasive adenocarcinoma during follow-up (neoplasia 2/3, 23 (7.7%) had adenocarcinoma in situ, and 3 (1.0%) had adenocarcinoma diagnosed during the follow-up and surveillance periods. Age >30 years, pure adenocarcinoma in situ lesions, and larger lesions (>8 mm) were associated with a greater risk of disease persistence or recurrence. Following the incidental detection of adenocarcinoma in situ, age >30 years, pure adenocarcinoma in situ lesions, and lesions >8 mm were significantly associated with disease persistence/recurrence. In younger women, incidentally detected adenocarcinoma in situ that coexists with cervical intraepithelial neoplasia 2/3 and is <8 mm extent with clear margins may not require reexcision. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Preparation, property of the complex of carboxymethyl chitosan grafted copolymer with iodine and application of it in cervical antibacterial biomembrane

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Yu [School of Materials Science and Engineering, Beijing Institute of Technology, Beijing 100081 (China); Yang, Yumin; Liao, Qingping [Zhejiang Sanchuang Biological Technology Co., Ltd., Jiaxing, Zhejiang Province 314031 (China); Yang, Wei [School of Materials Science and Engineering, Beijing Institute of Technology, Beijing 100081 (China); Ma, Wanfeng [Zhejiang Sanchuang Biological Technology Co., Ltd., Jiaxing, Zhejiang Province 314031 (China); Zhao, Jian [Department of Gynaecology and Obstetrics, The First Hospital of Peking University, Beijing 100034 (China); Zheng, Xionggao [School of Materials Science and Engineering, Beijing Institute of Technology, Beijing 100081 (China); Yang, Yang [Zhejiang Sanchuang Biological Technology Co., Ltd., Jiaxing, Zhejiang Province 314031 (China); Chen, Rui [Department of Gynaecology and Obstetrics, The First Hospital of Peking University, Beijing 100034 (China)

    2016-10-01

    Cervical erosion is one of the common diseases of women. The loop electrosurgical excisional procedure (LEEP) has been used widely in the treatment of the cervical diseases. However, there are no effective wound dressings for the postoperative care to protect the wound area from further infection, leading to increased secretion and longer healing time. Iodine is a widely used inorganic antibacterial agent with many advantages. However, the carrier for stable iodine complex antibacterial agents is lack. In the present study, a novel iodine carrier, Carboxymethyl chitosan-g-(poly(sodium acrylate)-co-polyvinylpyrrolidone) (CMCTS-g-(PAANa-co-PVP), was prepared by graft copolymerization of sodium acrylate (AANa) and N-vinylpyrrolidone (NVP) to a carboxymethyl chitosan (CMCTS) skeleton. The obtained structure could combine prominent property of poly(sodium acrylate) (PAANa) anionic polyelectrolyte segment and good complex property of polyvinylpyrrolidone (PVP) segment to iodine. The bioactivity of CMCTS could also be kept. The properties of the complex, CMCTS-g-(PAANa-co-PVP)-I{sub 2}, were studied. The in vitro experiment shows that it has broad-spectrum bactericidal effects to virus, fungus, gram-positive bacteria and gram-negative bacteria. A CMCTS-g-(PAANa-co-PVP)-I{sub 2} complex contained cervical antibacterial biomembrane (CABM) was prepared. The iodine release from the CABM is pH-dependent. The clinic trial results indicate that CABM has better treatment effectiveness than the conventional treatment in the postoperative care of the LEEP operation. - Highlights: • The multifunctional iodine complexing carrier CMCTS-g-(PAANa-co-PVP) was prepared. • CMCTS-g-(PAANa-co-PVP)-I{sub 2} with high antibacterial property and bio-safety was studied. • By compositing it with CMCTS and gelatin further, CABM with multifunction was deduced. • The releasing properties of the activated iodine from CABM showed pH sensitivity. • CABM showed good treating effect for

  11. The mediation procedure in Romania

    Directory of Open Access Journals (Sweden)

    Alexandrina Zaharia

    2009-06-01

    Full Text Available The mediation activity as an alternative way of solving conflicts occupies an important place in modernsociety. Currently, the mediation reached its maturity worldwide being adopted without reservations.The future of solving conflicts is undoubtedly closely related to mediation. XXth century is the century of solvingconflicts amiably outside the court room. In Romania and the mediation profession were regulated by the Law no.192/2006, on the basis of the idea that mediation is one of the major themes of the reform strategy of the judicialsystem 2005-2007. By adopting the mentioned law it was followed the idea of reducing the volume of activitycourts, and therefore, relieve them of as many cases, with the direct effect on the quality of justice. Mediation is avoluntary process in which the parties with a neutral and impartial third party, without power of decision - themediator - who is qualified to assist the parties to negotiate, facilitating the communication between them andhelping them to reach a unanimous effective and sustainable agreement. The parties may resort to mediation beforeor after triggering a trial. Mediation can be applied, in principle, on any type of conflict. However, theRomanian legislator has established special stipulations on conflict mediation in criminal, civil and familylaw. Although not expressly provided, the stipulations regarding the civil conflicts and also apply to commercialconflicts. Therefore, the mediation is applicable to most types of lawsuits, except those relating to personalrights. As a "win- win" principle, the mediation does not convert any of the parties defeated or victorious; allthose involved have gained by applying this procedure.

  12. 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.

  13. Forensic procedures for facial-composite construction

    OpenAIRE

    Fodarella, Cristina; Kuivaniemi-Smith, Heidi; Gawrylowicz, Julie; Frowd, Charlie

    2015-01-01

    Purpose – The paper provides a detailed description of standard procedures for constructing facial composites. These procedures are relevant to forensic practice and are contained in the technical papers of this special issue; the purpose of this paper is also to provide an expanding reference of procedures for future research on facial composites and facial-composite systems. \\ud Design/methodology/approach – A detailed account is given of the interaction between practitioner and witness for...

  14. Information Security - Data Loss Prevention Procedure

    Science.gov (United States)

    The purpose of this procedure is to extend and provide specificity to the Environmental Protection Agency (EPA) Information Security Policy regarding data loss prevention and digital rights management.

  15. Laboratory rat procedural techniques: manual and DVD

    National Research Council Canada - National Science Library

    Bogdanske, John J

    2011-01-01

    .... The manual contains handouts with color illustrations and descriptive text for each technique, including the purpose and application of the procedure, recommended skills, and necessary supplies...

  16. Laboratory mouse procedural techniques: manual and DVD

    National Research Council Canada - National Science Library

    Bogdanske, John J

    2011-01-01

    .... The manual contains handouts with color illustrations and descriptive text for each technique, including the purpose and application of the procedure, recommended skills, and necessary supplies...

  17. Virtual reality simulation of basic pulmonary procedures

    DEFF Research Database (Denmark)

    Konge, Lars; Arendrup, Henrik; von Buchwald, Christian

    2011-01-01

    Background: Virtual reality (VR) bronchoscopy simulators have been available for more than a decade, and have been recognized as an important aid in bronchoscopy training. The existing literature has only examined the role of VR simulators in diagnostic bronchoscopy. The aim of this study...... procedures, each on a VR bronchoscopy simulator. They performed 3 diagnostic bronchoscopies, 2 bronchoalveolar lavages, and 3 procedures in which they used all the available biopsy tools (needle, brush, and forceps) that could be used for tumors of increasing procedural difficulty. After the procedures...

  18. 12 CFR 211.9 - Investment procedures.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 2 2010-01-01 2010-01-01 false Investment procedures. 211.9 Section 211.9... Investment procedures. (a) General provisions. 5 Direct and indirect investments shall be made in accordance... investments in excess of the limitations therein based on capital and surplus. (1) Minimum capital adequacy...

  19. Procedural lawmaking at the International Criminal Tribunals

    NARCIS (Netherlands)

    Sluiter, G.; Darcy, S.; Powderly, J.

    2011-01-01

    This chapter examines the role played by the judges in creating the procedural rules which govern the functioning of the ad hoc Tribunals. Noting that the bench had been tasked with devising its own rules of procedure and evidence, it queries whether judicial lawmaking in this context at the

  20. 38 CFR 61.63 - Procedural error.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Procedural error. 61.63 Section 61.63 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) VA HOMELESS PROVIDERS GRANT AND PER DIEM PROGRAM § 61.63 Procedural error. If an application would have been...

  1. 20 CFR 656.20 - Audit procedures.

    Science.gov (United States)

    2010-04-01

    ... FOR PERMANENT EMPLOYMENT OF ALIENS IN THE UNITED STATES Labor Certification Process § 656.20 Audit procedures. (a) Review of the labor certification application may lead to an audit of the application... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Audit procedures. 656.20 Section 656.20...

  2. 40 CFR 152.164 - Classification procedures.

    Science.gov (United States)

    2010-07-01

    ... physical properties, in common. (b) Classification reviews. The Agency may conduct classification reviews... 40 Protection of Environment 23 2010-07-01 2010-07-01 false Classification procedures. 152.164... PESTICIDE REGISTRATION AND CLASSIFICATION PROCEDURES Classification of Pesticides § 152.164 Classification...

  3. Procedures for ground-water investigations

    Energy Technology Data Exchange (ETDEWEB)

    1992-12-01

    This manual was developed by the Pacific Northwest Laboratory (PNL) to document the procedures used to carry out and control the technical aspects of ground-water investigations at the PNL. Ground-water monitoring procedures are developed and used in accordance with the PNL Quality Assurance Program.

  4. 25 CFR 225.21 - Negotiation procedures.

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Negotiation procedures. 225.21 Section 225.21 Indians... SOLID MINERALS AGREEMENTS Minerals Agreements § 225.21 Negotiation procedures. (a) An Indian mineral... information during the negotiation process. The Secretary shall provide advice, assistance, and information to...

  5. 29 CFR 1606.6 - Selection procedures.

    Science.gov (United States)

    2010-07-01

    ... BECAUSE OF NATIONAL ORIGIN § 1606.6 Selection procedures. (a)(1) In investigating an employer's selection procedures (including those identified below) for adverse impact on the basis of national origin, the... adverse impact, validation and recordkeeping requirements for national origin groups. (2) Because height...

  6. April 2006. 32 Major Orthopaedic Procedures

    African Journals Online (AJOL)

    user

    2006-04-01

    Apr 1, 2006 ... procedures to correct post polio deformities was registered. Conclusion: Over the two past decades, a significant change in trends of major orthopaedic procedures occurred. The shift towards operative fixation of fractures demands importing expensive implants. The implication of such a change needs to ...

  7. 45 CFR 77.6 - Emergency procedures.

    Science.gov (United States)

    2010-10-01

    ... LETTER OF CREDIT ADMINISTRATION § 77.6 Emergency procedures. (a) Should the Department determine that it... its letter of credit without taking remedial action prior to the procedures specified in § 77.5, it... notify the recipient organization orally of the remedial action within one business day of its imposition...

  8. 33 CFR 273.14 - Planning procedures.

    Science.gov (United States)

    2010-07-01

    ... 33 Navigation and Navigable Waters 3 2010-07-01 2010-07-01 false Planning procedures. 273.14... DEFENSE AQUATIC PLANT CONTROL § 273.14 Planning procedures. Investigation of new problems and/or... preliminary report based on reconnaissance-type investigations. If it is determined that further planning of a...

  9. Motives for cosmetic procedures in Saudi women.

    Science.gov (United States)

    Al-Natour, Sahar H

    2014-01-01

    The media-fuelled obsession with beauty in modern society has led more women to seek elective cosmetic procedures to meet the portrayed ideals of beauty in different cultures. This study gives insights into incentives and desires to undergo cosmetic procedures in a conservative society with strict religious practices where women are veiled. Questionnaire data were obtained from 509 Saudi women who responded to a survey distributed randomly to a sample of Saudi women aged 17 to 72 years. At least 1 elective cosmetic procedure was performed in 42% of the women, of whom 77.8% wore a veil. Another 33% considered having a procedure. The motives for seeking a cosmetic procedure were to improve self-esteem in 83.7%, attract a husband in 63.3%, or prevent a husband from seeking another wife in 36.2%. The decision to seek a procedure was affected by the media, with high peer influence. Motivation for elective cosmetic procedures in Saudi women is influenced by a combination of emotional and cultural factors, level of education, marital status, and religious beliefs. The veil is not an impediment for seeking such procedures. The limitation of the study was missing data analysis as some items in the questionnaire were completed inaccurately or left unanswered.

  10. 12 CFR 611.501 - Procedures.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Procedures. 611.501 Section 611.501 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM ORGANIZATION Transfer of Authorities § 611.501 Procedures. (a) The boards of directors of a bank and an association which seek to transfer authorities may...

  11. 12 CFR 611.510 - Approval procedures.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Approval procedures. 611.510 Section 611.510 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM ORGANIZATION Transfer of Authorities § 611.510 Approval procedures. (a) Upon receipt of approval of a resolution by the Farm Credit...

  12. 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....

  13. 76 FR 72368 - Representation Case Procedures

    Science.gov (United States)

    2011-11-23

    ...-AAO8 Representation Case Procedures AGENCY: National Labor Relations Board. ACTION: Proposed rule... of petitions relating to the representation of employees for purposes of collective bargaining with... to the Board's rules governing representation-case procedures. A copy of the NPRM may also be...

  14. 34 CFR 104.36 - Procedural safeguards.

    Science.gov (United States)

    2010-07-01

    ... Preschool, Elementary, and Secondary Education § 104.36 Procedural safeguards. A recipient that operates a... 34 Education 1 2010-07-01 2010-07-01 false Procedural safeguards. 104.36 Section 104.36 Education Regulations of the Offices of the Department of Education OFFICE FOR CIVIL RIGHTS, DEPARTMENT OF EDUCATION...

  15. 22 CFR 217.61 - Procedures.

    Science.gov (United States)

    2010-04-01

    ... applicable to title VI of the Civil Rights Act of 1964 apply to this part. These procedures are found in... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Procedures. 217.61 Section 217.61 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR...

  16. 22 CFR 227.405 - Penalty procedures.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Penalty procedures. 227.405 Section 227.405 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT NEW RESTRICTIONS ON LOBBYING Penalties and Enforcement § 227.405 Penalty procedures. Agencies shall impose and collect civil penalties pursuant to the...

  17. 49 CFR 1108.8 - Arbitration procedures.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 8 2010-10-01 2010-10-01 false Arbitration procedures. 1108.8 Section 1108.8... OF TRANSPORTATION RULES OF PRACTICE ARBITRATION OF CERTAIN DISPUTES SUBJECT TO THE STATUTORY JURISDICTION OF THE SURFACE TRANSPORTATION BOARD § 1108.8 Arbitration procedures. (a) The Arbitrator will...

  18. Extended Resin Composite Restorations: Techniques and Procedures

    NARCIS (Netherlands)

    Loomans, B.A.C.; Hilton, T.

    2016-01-01

    This article gives an overview of the state of the art of different restorative treatment procedures and techniques needed for placing extended posterior resin composite restorations. Clinical aspects related to the procedure are discussed and reviewed based on the current literature, such as the

  19. 40 CFR 140.5 - Analytical procedures.

    Science.gov (United States)

    2010-07-01

    ... 140.5 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) MARINE SANITATION DEVICE STANDARD § 140.5 Analytical procedures. In determining the composition and quality of effluent discharge from marine sanitation devices, the procedures contained in 40 CFR part 136...

  20. W-087 Acceptance test procedure. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Joshi, A.W.

    1997-06-10

    This Acceptance Test Procedure/Operational Test Procedure (ATP/OTP) has been prepared to demonstrate that the Electrical/Instrumentation and Mechanical systems function as required by project criteria and to verify proper operation of the integrated system including the interlocks.

  1. 49 CFR 27.125 - Compliance procedure.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false Compliance procedure. 27.125 Section 27.125... OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Enforcement § 27.125 Compliance procedure. (a... responsible Departmental official may recommend suspension or termination of, or refusal to grant or to...

  2. 31 CFR 361.3 - Shipping procedure.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Shipping procedure. 361.3 Section 361.3 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE... § 361.3 Shipping procedure. Shipments of valuables shall be made so as to provide the greatest possible...

  3. 48 CFR 26.403 - Procedures.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Procedures. 26.403 Section 26.403 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION SOCIOECONOMIC PROGRAMS OTHER SOCIOECONOMIC PROGRAMS Food Donations to Nonprofit Organizations 26.403 Procedures. (a) In accordance with the Federal Food Donation Act of...

  4. 49 CFR 195.214 - Welding procedures.

    Science.gov (United States)

    2010-10-01

    ... accordance with welding procedures qualified under Section 5 of API 1104 or Section IX of the ASME Boiler and Pressure Vessel Code (incorporated by reference, see § 195.3) . The quality of the test welds used to... 49 Transportation 3 2010-10-01 2010-10-01 false Welding procedures. 195.214 Section 195.214...

  5. 7 CFR 1753.57 - Procedures.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 11 2010-01-01 2010-01-01 false Procedures. 1753.57 Section 1753.57 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE TELECOMMUNICATIONS SYSTEM CONSTRUCTION POLICIES AND PROCEDURES Outside Plant Major Construction by Force Account...

  6. 48 CFR 3.705 - Procedures.

    Science.gov (United States)

    2010-10-01

    ... under the terms of the contracts involved. (c) Decision-making process. Agency procedures governing the voiding and rescinding decision-making process shall be as informal as is practicable, consistent with the... BUSINESS PRACTICES AND PERSONAL CONFLICTS OF INTEREST Voiding and Rescinding Contracts 3.705 Procedures. (a...

  7. 38 CFR 17.257 - Awards procedures.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Awards procedures. 17.257 Section 17.257 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Grants for Exchange of Information § 17.257 Awards procedures. Applications for grants for planning or implementing...

  8. 38 CFR 17.355 - Awards procedures.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Awards procedures. 17.355 Section 17.355 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Grants to the Republic of the Philippines § 17.355 Awards procedures. All applications for grants to the...

  9. Grid - a fast threshold tracking procedure

    DEFF Research Database (Denmark)

    Fereczkowski, Michal; Dau, Torsten; MacDonald, Ewen

    2016-01-01

    A new procedure, called “grid”, is evaluated that allows rapid acquisition of threshold curves for psychophysics and, in particular, psychoacoustic, experiments. In this method, the parameterresponse space is sampled in two dimensions within a single run. This allows the procedure to focus more e...

  10. 49 CFR 107.616 - Payment procedures.

    Science.gov (United States)

    2010-10-01

    ... Department's e-Commerce Internet site. Access to this service is provided at http://hazmat.dot.gov/regs... 49 Transportation 2 2010-10-01 2010-10-01 false Payment procedures. 107.616 Section 107.616... PROGRAM PROCEDURES Registration of Persons Who Offer or Transport Hazardous Materials § 107.616 Payment...

  11. Procedure to Generate the MPACT Multigroup Library

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kang Seog [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2015-12-17

    The CASL neutronics simulator MPACT is under development for the neutronics and T-H coupled simulation for the light water reactor. The objective of this document is focused on reviewing the current procedure to generate the MPACT multigroup library. Detailed methodologies and procedures are included in this document for further discussion to improve the MPACT multigroup library.

  12. 10 CFR 474.4 - Test procedures.

    Science.gov (United States)

    2010-01-01

    ...; PETROLEUM-EQUIVALENT FUEL ECONOMY CALCULATION § 474.4 Test procedures. (a) The electric vehicle energy... Schedule and Urban Dynamometer Driving Schedule test cycles at 40 CFR parts 86 and 600. (b) The “Special... 10 Energy 3 2010-01-01 2010-01-01 false Test procedures. 474.4 Section 474.4 Energy DEPARTMENT OF...

  13. 32 CFR 623.4 - Accounting procedures.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Accounting procedures. 623.4 Section 623.4... ARMY MATERIEL § 623.4 Accounting procedures. (a) Loan document format. (1) When the lending accountable... property accounting purposes. (3) Loans will be processed by accountable property officers according to...

  14. Parliamentary Pastries: Learning Parliamentary Procedure through Cookies

    Science.gov (United States)

    Toupence, Rachelle H.

    2008-01-01

    Parliamentary procedure is an integral part of the business of many recreation organizations, but students often perceive it to be difficult and irrelevant to their professional preparation. The activity uses the creation of a cookie recipe to practice the basic meeting business functions in parliamentary procedure. The cookie meeting is an active…

  15. 49 CFR 1105.10 - Board procedures.

    Science.gov (United States)

    2010-10-01

    ... OF TRANSPORTATION RULES OF PRACTICE PROCEDURES FOR IMPLEMENTATION OF ENVIRONMENTAL LAWS § 1105.10 Board procedures. (a) Environmental Impact Statements—(1) Prefiling Notice. Where an environmental... Environmental Analysis with written notice of its forthcoming proposal at least 6 months prior to filing its...

  16. 28 CFR 541.63 - Hearing procedure.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Hearing procedure. 541.63 Section 541.63 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT INMATE DISCIPLINE AND SPECIAL HOUSING UNITS Procedures for Handling of HIV Positive Inmates Who Pose Danger to Others...

  17. 7 CFR 632.42 - Violation procedures.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 6 2010-01-01 2010-01-01 false Violation procedures. 632.42 Section 632.42..., DEPARTMENT OF AGRICULTURE LONG TERM CONTRACTING RURAL ABANDONED MINE PROGRAM Appeals and Violations § 632.42 Violation procedures. (a) Scope. This section prescribes the regulations dealing with contract violations...

  18. In-Trail Procedure (ITP) Algorithm Design

    Science.gov (United States)

    Munoz, Cesar A.; Siminiceanu, Radu I.

    2007-01-01

    The primary objective of this document is to provide a detailed description of the In-Trail Procedure (ITP) algorithm, which is part of the Airborne Traffic Situational Awareness In-Trail Procedure (ATSA-ITP) application. To this end, the document presents a high level description of the ITP Algorithm and a prototype implementation of this algorithm in the programming language C.

  19. 27 CFR 44.227 - Customs procedure.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2010-04-01 2010-04-01 false Customs procedure. 44.227..., WITHOUT PAYMENT OF TAX, OR WITH DRAWBACK OF TAX Drawback of Tax § 44.227 Customs procedure. The customs... having inspected the articles and supervised the lading thereof on the export carrier, the customs...

  20. 34 CFR 668.13 - Certification procedures.

    Science.gov (United States)

    2010-07-01

    ... section, “provisional certification” means that the Secretary certifies that an institution has... 34 Education 3 2010-07-01 2010-07-01 false Certification procedures. 668.13 Section 668.13... Title IV, HEA Programs § 668.13 Certification procedures. (a) Requirements for certification. (1) The...

  1. 42 CFR 460.54 - Termination procedures.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Termination procedures. 460.54 Section 460.54 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... ELDERLY (PACE) Sanctions, Enforcement Actions, and Termination § 460.54 Termination procedures. (a) Except...

  2. 12 CFR 509.204 - Hearing Procedure.

    Science.gov (United States)

    2010-01-01

    ... PROCEDURE IN ADJUDICATORY PROCEEDINGS Special Rules § 509.204 Hearing Procedure. (a) (1) The Director shall... filings to the Office of the Chief Counsel, Business Transactions Division. The Office of the Chief Counsel, Business Transactions Division shall serve in the manner provided in § 509.11 of this part, each...

  3. 47 CFR 36.412 - Apportionment procedures.

    Science.gov (United States)

    2010-10-01

    ... revenues, (2) Less operating expenses, (3) Less operating taxes except the net income tax being apportioned... proportion of total fixed charges which non-operating net investments are of total operating and non... PROCEDURES; STANDARD PROCEDURES FOR SEPARATING TELECOMMUNICATIONS PROPERTY COSTS, REVENUES, EXPENSES, TAXES...

  4. The Sauvé-Kapandji Procedure

    National Research Council Canada - National Science Library

    Lluch, Alberto

    2013-01-01

    .... This is known as the Sauvé-Kapandji (S-K) procedure. The Sauvé-Kapandji differs from the Darrach procedure in that it preserves ulnar support of the wrist, as the distal radioulnar ligaments and ulnocarpal ligaments are maintained...

  5. 5 CFR 179.308 - Accelerated procedures.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Accelerated procedures. 179.308 Section 179.308 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS CLAIMS COLLECTION STANDARDS Administrative Offset § 179.308 Accelerated procedures. OPM may make an administrative...

  6. 5 CFR 179.304 - Notification procedures.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Notification procedures. 179.304 Section 179.304 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS CLAIMS COLLECTION STANDARDS Administrative Offset § 179.304 Notification procedures. Before collecting any debt...

  7. 14 CFR 1212.202 - Identification procedures.

    Science.gov (United States)

    2010-01-01

    ... REGULATIONS Access to Records § 1212.202 Identification procedures. (a) The system manager will release records to the requester or representative in person only upon production of satisfactory identification... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Identification procedures. 1212.202 Section...

  8. Pollutant Assessments Group Procedures Manual: Volume 1, Administrative and support procedures

    Energy Technology Data Exchange (ETDEWEB)

    1992-03-01

    This manual describes procedures currently in use by the Pollutant Assessments Group. The manual is divided into two volumes: Volume 1 includes administrative and support procedures, and Volume 2 includes technical procedures. These procedures are revised in an ongoing process to incorporate new developments in hazardous waste assessment technology and changes in administrative policy. Format inconsistencies will be corrected in subsequent revisions of individual procedures. The purpose of the Pollutant Assessments Groups Procedures Manual is to provide a standardized set of procedures documenting in an auditable manner the activities performed by the Pollutant Assessments Group (PAG) of the Health and Safety Research Division (HASRD) of the Environmental Measurements and Applications Section (EMAS) at Oak Ridge National Laboratory (ORNL). The Procedures Manual ensures that the organizational, administrative, and technical activities of PAG conform properly to protocol outlined by funding organizations. This manual also ensures that the techniques and procedures used by PAG and other contractor personnel meet the requirements of applicable governmental, scientific, and industrial standards. The Procedures Manual is sufficiently comprehensive for use by PAG and contractor personnel in the planning, performance, and reporting of project activities and measurements. The Procedures Manual provides procedures for conducting field measurements and includes program planning, equipment operation, and quality assurance elements. Successive revisions of this manual will be archived in the PAG Document Control Department to facilitate tracking of the development of specific procedures.

  9. An identification procedure for foodborne microbial hazards.

    Science.gov (United States)

    van Gerwen, S J; de Wit, J C; Notermans, S; Zwietering, M H

    1997-08-19

    A stepwise and interactive identification procedure for foodborne microbial hazards has been developed in which use is made of several levels of detail ranging from rough hazard identification to comprehensive hazard identification. This approach allows one to tackle the most obvious hazards first, before focusing on less obvious hazards. The interactive character of the identification procedure is based on the use of several knowledge sources. Combination of knowledge sources, expressed in the use of knowledge rules, supports the user in systematically selecting hazards which may pose a real risk to the consumer. Due to the structured method and the clear definitions of the knowledge rules, the procedure is transparent and may be changed if necessary. The hazard identification procedure has been implemented as a computer program, resulting in a decision-supporting identification system. It provides a way to efficiently assess those hazards which may cause harm if not brought under control during processing. The procedure forms a basis for quantitative risk assessments.

  10. Validity of a frustration-induction procedure.

    Science.gov (United States)

    Henna, Elaine; Zilberman, Monica L; Gentil, Valentim; Gorenstein, Clarice

    2008-03-01

    To test a reliable and easily administered frustration-induction procedure for experimental research. One hundred volunteers (81 women, mean age +/- SD 34.2 +/- 8 years) physically and psychiatrically healthy submitted to the frustration induction procedure were prevented from reaching reward level scores. Subjective aggressiveness feelings related to frustration were self-rated in a 13-item visual analogue scale before and after the procedure. Significant increases in aggressiveness-related feelings were detected in 12 of the 13 items. This was consistent with the observed overt behavior of the subjects during the task. The frustration-induction procedure is a simple, easy to administer frustration-induction procedure that can be used in experimental studies in normal subjects.

  11. Restorative Procedures in Colonic Crohn Disease

    Science.gov (United States)

    Martin, Sean T.; Vogel, Jon D.

    2013-01-01

    Surgical management for refractory Crohn colitis often involves creation of a temporary or permanent stoma. Traditionally, the procedure of choice has been a total proctocolectomy with permanent ileostomy. However, restorative procedures that help to avoid a permanent stoma are being used with more frequency. In this article, the authors will address these procedures, including colocolonic anastomosis, ileorectal anastomosis, ileal pouch rectal anastomosis, and ileal pouch anal anastomosis. Factors that may influence one's decision to perform these procedures, such as patient age and nutritional status, medical comorbidities, sphincter function, desire to avoid a permanent ostomy, and prior medical therapy, will be discussed. Functional outcomes regarding these procedures will also be described. One should keep in mind that surgery does not cure Crohn disease and that postoperative long-term management is essential in preventing progression or recurrence of disease. PMID:24436657

  12. 78 FR 78713 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Science.gov (United States)

    2013-12-27

    ... Federal Aviation Administration 14 CFR Part 97 Standard Instrument Approach Procedures, and Takeoff... Standard Instrument Approach Procedures (SIAPs) and associated Takeoff Minimums and Obstacle Departure... from: 1. FAA Public Inquiry Center (APA-200), FAA Headquarters Building, 800 Independence Avenue SW...

  13. 77 FR 22475 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Science.gov (United States)

    2012-04-16

    ... Federal Aviation Administration 14 CFR Part 97 Standard Instrument Approach Procedures, and Takeoff... Standard Instrument Approach Procedures (SIAPs) and associated Takeoff Minimums and Obstacle Departure... from: 1. FAA Public Inquiry Center (APA-200), FAA Headquarters Building, 800 Independence Avenue SW...

  14. 78 FR 59808 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Science.gov (United States)

    2013-09-30

    ... Federal Aviation Administration 14 CFR Part 97 Standard Instrument Approach Procedures, and Takeoff... Standard Instrument Approach Procedures (SIAPs) and associated Takeoff Minimums and Obstacle Departure... from: 1. FAA Public Inquiry Center (APA-200), FAA Headquarters Building, 800 Independence Avenue SW...

  15. 78 FR 7650 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Science.gov (United States)

    2013-02-04

    ... Federal Aviation Administration 14 CFR Part 97 Standard Instrument Approach Procedures, and Takeoff... Standard Instrument Approach Procedures (SIAPs) and associated Takeoff Minimums and Obstacle Departure... from: 1. FAA Public Inquiry Center (APA-200), FAA Headquarters Building, 800 Independence Avenue SW...

  16. An XML Representation for Crew Procedures

    Science.gov (United States)

    Simpson, Richard C.

    2005-01-01

    NASA ensures safe operation of complex systems through the use of formally-documented procedures, which encode the operational knowledge of the system as derived from system experts. Crew members use procedure documentation on the ground for training purposes and on-board space shuttle and space station to guide their activities. Investigators at JSC are developing a new representation for procedures that is content-based (as opposed to display-based). Instead of specifying how a procedure should look on the printed page, the content-based representation will identify the components of a procedure and (more importantly) how the components are related (e.g., how the activities within a procedure are sequenced; what resources need to be available for each activity). This approach will allow different sets of rules to be created for displaying procedures on a computer screen, on a hand-held personal digital assistant (PDA), verbally, or on a printed page, and will also allow intelligent reasoning processes to automatically interpret and use procedure definitions. During his NASA fellowship, Dr. Simpson examined how various industries represent procedures (also called business processes or workflows), in areas such as manufacturing, accounting, shipping, or customer service. A useful method for designing and evaluating workflow representation languages is by determining their ability to encode various workflow patterns, which depict abstract relationships between the components of a procedure removed from the context of a specific procedure or industry. Investigators have used this type of analysis to evaluate how well-suited existing workflow representation languages are for various industries based on the workflow patterns that commonly arise across industry-specific procedures. Based on this type of analysis, it is already clear that existing workflow representations capture discrete flow of control (i.e., when one activity should start and stop based on when other

  17. Complications and recommended practices for electrosurgery in laparoscopy.

    Science.gov (United States)

    Wu, M P; Ou, C S; Chen, S L; Yen, E Y; Rowbotham, R

    2000-01-01

    Electrosurgery is one of the most commonly used energy systems in laparoscopic surgery. Two major categories of potential complications related to electrosurgery in laparoscopy are mechanical trauma and electrothermal injury. The latter can result from unrecognized energy transfer in the operational field or, less commonly, to unnoticed stray current outside the laparoscopic field of view. Stray current can result from insulation failure, direct coupling, or capacitive coupling. We reviewed the literature concerning essential biophysics of electrosurgery, including electrosurgical waveform differentiation, tissue effect, and variables that determine tissue effect. The incidence of electrosurgical injuries and possible mechanisms responsible for the injuries are discussed. Different types of injuries may result in different clinical manifestations and histopathological findings. Gross and microscopic pathological check-ups of the injury sites may distinguish between different mechanisms, and thus provide further clues postoperatively. Several recommended practices are proposed to avoid electrosurgical injury laparoscopically. To achieve electrosurgical safety and to prevent electrosurgical injuries, the surgical team should have a good understanding of the biophysics of electrosurgery, the basis of equipment and general tissue effects, as well as the surgeon's spatial orientation and hand-eye coordination. Some intraoperative adjuvant procedures and newly developed safety devices have become available may aid to improve electrosurgical safety. Knowledge of the biophysics of electrosurgery and the mechanisms of electrosurgical injury is important in recognizing potential complications of electrosurgery in laparoscopy. Procedures for prevention, intraoperative adjuvant maneuvers, early recognition of the injury with in-time salvage treatment, and alertness to postoperative warning signs can help reduce such complications.

  18. Hierarchical characterization procedures for dimensional metrology

    Science.gov (United States)

    MacKinnon, David; Beraldin, Jean-Angelo; Cournoyer, Luc; Carrier, Benjamin

    2011-03-01

    We present a series of dimensional metrology procedures for evaluating the geometrical performance of a 3D imaging system that have either been designed or modified from existing procedures to ensure, where possible, statistical traceability of each characteristic value from the certified reference surface to the certifying laboratory. Because there are currently no internationally-accepted standards for characterizing 3D imaging systems, these procedures have been designed to avoid using characteristic values provided by the vendors of 3D imaging systems. For this paper, we focus only on characteristics related to geometric surface properties, dividing them into surface form precision and surface fit trueness. These characteristics have been selected to be familiar to operators of 3D imaging systems that use Geometrical Dimensioning and Tolerancing (GD&T). The procedures for generating characteristic values would form the basis of either a volumetric or application-specific analysis of the characteristic profile of a 3D imaging system. We use a hierarchical approach in which each procedure builds on either certified reference values or previously-generated characteristic values. Starting from one of three classes of surface forms, we demonstrate how procedures for quantifying for flatness, roundness, angularity, diameter error, angle error, sphere-spacing error, and unidirectional and bidirectional plane-spacing error are built upon each other. We demonstrate how these procedures can be used as part of a process for characterizing the geometrical performance of a 3D imaging system.

  19. Judicial civil procedure dragging out in Kosovo

    Directory of Open Access Journals (Sweden)

    Rrustem Qehaja

    2016-03-01

    Full Text Available This article tends to deal with one of the most worrying issues in the judicial system of Kosovo the problem of judicial civil procedure dragging out. The article analyses the reasons of these dragging outs of the judicial civil procedure focusing on the context of one of the basic procedural principles in civil procedure-the principle of economy or efficiency in the courts. Dragging out of civil procedure in Kosovo has put in question not only the basic principles of civil procedure, but it also challenges the general principles related to human rights and freedoms sanctioned not only by the highest legal act of the country, but also with international treaties. The article tends to give a reflection to the most important reasons that effect and influence in these dragging outs of civil procedure, as well as, at the same time aims to give the necessary alternatives to pass through them by identifying dilemmas within the judicial practice. As a result, the motives of this scientific paper are exactly focused at the same time on identifying the dilemmas, as well as presenting ideas, to overstep them, including the judicial practice of the European Court of Human Rights on Article 6 of the European Convention on Human Rights, by which it is given the possibility to offering people efficient and within a reasonable time legal protection of their rights before national courts. For these reasons, the paper elaborates this issue based on both, the legal theory and judicial practice.

  20. 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.

  1. Pediatric dental rehabilitation procedures in the OR.

    Science.gov (United States)

    Haskins, D R

    1996-10-01

    Children with significant baby bottle tooth decay and children who are challenged by significant physical and emotional limitations are candidates for dental rehabilitaion procedures with general anesthesia. Rehabilitation of children's primary teeth is important to prevent pain, infection, and tooth loss. To provide skilled care for children undergoing dental rehabilitation procedures, perioperative nurses must understand normal dentition, tooth anatomy, and caries prevention and formation and be able to meet children's developmental and emotional needs. Perioperative nurses also must collaborate with dentists to maintain appropriate supply inventories that are unique to dental rehabilitation procedures.

  2. Radiation safety in nuclear medicine procedures

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Sang Geon; Kim, Ja Hae; Song, Ho Chun [Dept. of Nuclear Medicine, Medical Radiation Safety Research Center, Chonnam National University Hospital, Gwangju (Korea, Republic of)

    2017-03-15

    Since the nuclear disaster at the Fukushima Daiichi Nuclear Power Plant in 2011, radiation safety has become an important issue in nuclear medicine. Many structured guidelines or recommendations of various academic societies or international campaigns demonstrate important issues of radiation safety in nuclear medicine procedures. There are ongoing efforts to fulfill the basic principles of radiation protection in daily nuclear medicine practice. This article reviews important principles of radiation protection in nuclear medicine procedures. Useful references, important issues, future perspectives of the optimization of nuclear medicine procedures, and diagnostic reference level are also discussed.

  3. The modified procedures in coercivity scaling*

    Directory of Open Access Journals (Sweden)

    Najgebauer Mariusz

    2015-09-01

    Full Text Available The paper presents a scaling approach to the analysis of coercivity. The Widom-based procedure of coercivity scaling has been tested for non-oriented electrical steel. Due to insufficient results, the scaling procedure was improved relating to the method proposed by Van den Bossche. The modified procedure of coercivity scaling gave better results, in comparison to the original approach. The influence of particular parameters and a range of measurement data used in the estimations on the final effect of the coercivity scaling were discussed.

  4. Radiation Safety in Nuclear Medicine Procedures.

    Science.gov (United States)

    Cho, Sang-Geon; Kim, Jahae; Song, Ho-Chun

    2017-03-01

    Since the nuclear disaster at the Fukushima Daiichi Nuclear Power Plant in 2011, radiation safety has become an important issue in nuclear medicine. Many structured guidelines or recommendations of various academic societies or international campaigns demonstrate important issues of radiation safety in nuclear medicine procedures. There are ongoing efforts to fulfill the basic principles of radiation protection in daily nuclear medicine practice. This article reviews important principles of radiation protection in nuclear medicine procedures. Useful references, important issues, future perspectives of the optimization of nuclear medicine procedures, and diagnostic reference level are also discussed.

  5. Optimisation of interventional cardiology procedures; Optimisation des procedures en cardiologie interventionnelle

    Energy Technology Data Exchange (ETDEWEB)

    Bar, Olivier [SELARL, Cardiologie Interventionnelle Imagerie Cardiaque - CIIC, 8, place de la Cathedrale - 37042 Tours (France)

    2011-07-15

    Radiation-guided procedures in interventional cardiology include diagnostic and/or therapeutic procedures, primarily coronary catheterization and coronary angioplasty. Application of the principles of radiation protection and the use of optimised procedures are contributing to dose reduction while maintaining the radiological image quality necessary for performance of the procedures. The mandatory training in patient radiation protection and technical training in the use of radiology devices mean that implementing continuous optimisation of procedures is possible in practice. This optimisation approach is the basis of patient radiation protection; when associated with the wearing of protective equipment it also contributes to the radiation protection of the cardiologists. (author)

  6. Surgical team composition differs between laparoscopic and open procedures.

    Science.gov (United States)

    Zheng, Bin; Fung, Eric; Fu, Bo; Panton, Neely M; Swanström, Lee L

    2015-08-01

    Performing laparoscopic procedures requires different skill sets and team dynamics compared with open procedures. We evaluated team composition and procedure time between these two surgical approaches using data collected from hospitals in the United State and Canada. A total of 1,260 general surgical cases were reviewed retrospectively, recording the number of operation personnel, procedure complexity, and the procedure time. Laparoscopic procedures (n = 930), on average, had a higher procedure difficulty coding which led to a longer procedure time and involved more people in the surgical team than open procedures (n = 330). When we selected cases with matched procedure difficulty coding, laparoscopic procedures (n = 450) still required longer procedure times and involved more operative personnel than open procedures (n = 92). Increased laparoscopic team size and procedure time must be influenced by factors other than case difficulty. The factors may derive from inherent complexity of the surgical setting and team dynamics unique to laparoscopic procedures.

  7. Basic Stand Alone Medicare Outpatient Procedures PUF

    Data.gov (United States)

    U.S. Department of Health & Human Services — This release contains the Basic Stand Alone (BSA) Outpatient Procedures Public Use Files (PUF) with information from Medicare outpatient claims. The CMS BSA...

  8. 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.

  9. Devices and Procedures for Auditory Learning.

    Science.gov (United States)

    Ling, Daniel

    1986-01-01

    The article summarizes information on assistive devices (hearing aids, cochlear implants, tactile aids, visual aids) and rehabilitation procedures (auditory training, speechreading, cued speech, and speech production) to aid the auditory learning of the hearing impaired.(DB)

  10. 48 CFR 909.406-3 - Procedures.

    Science.gov (United States)

    2010-10-01

    ... PLANNING CONTRACTOR QUALIFICATIONS Debarment, Suspension, and Ineligibility 909.406-3 Procedures. (a... postponement in writing. At the meeting, the respondent, appearing personally or through an attorney or other...

  11. Small Optics Laser Damage Test Procedure

    Energy Technology Data Exchange (ETDEWEB)

    Wolfe, Justin [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2017-10-19

    This specification defines the requirements and procedure for laser damage testing of coatings and bare surfaces designated for small optics in the National Ignition Facility (NIF) at Lawrence Livermore National Laboratory (LLNL).

  12. Image-guided palliative care procedures.

    Science.gov (United States)

    Requarth, Jay

    2011-04-01

    The image-guided procedures discussed in this article are used to alleviate pain and suffering of patients with malignancies and/or multiple comorbidities. It is not possible to discuss the entire breadth of image-guided palliative procedures; only a few commonly requested procedures are reviewed: cholecystostomy, biliary decompression, enteral feeding and decompression tubes, chemical neurolysis (for pain control), cementoplasty, tunneled drainage catheters, transjugular intrahepatic portasystemic shunt pleurodesis, tube thoracostomy, thermal and chemical tumor ablation, transcatheter arterial chemoembolization, and selective internal radiation therapy. A decision tree is given with each procedure/disease. This review provides referring surgeons a framework for end-of-life treatment and palliation discussions. Copyright © 2011 Elsevier Inc. All rights reserved.

  13. The meaning of the administrative procedure

    Directory of Open Access Journals (Sweden)

    Martín Loo Gutiérrez

    2017-06-01

    Full Text Available The article seeks to present a substantive notion of the ‘administrative procedure’, that is, an understanding that departs from the merely procedural or formal meaning that has been consolidated in Chile from the definition adopted by the Administrative Procedures Act (“lbpa” and analyses the institutional purposes that have been assigned to the administrative procedure by foreign literature. The paper develops an explanation about the origins of this formal understanding and exposes the doctrine that has been consolidated in Europe to explain the institution from a substantial point of view. It is argued that this substantive notion can also be constructed in Chile from a systematic reading of some of the provisions of the law on administrative procedures.

  14. Alternative court procedures for DUI offenders.

    Science.gov (United States)

    1978-01-01

    The purpose of this report is to evaluate the need for alternative court procedures in Virginia for handling cases involving persons charged with driving under the influence of alcohol (DUI), with particular focus on the referral of DUI offenders to ...

  15. Femtosecond Lasers and Corneal Surgical Procedures.

    Science.gov (United States)

    Marino, Gustavo K; Santhiago, Marcony R; Wilson, Steven E

    2017-01-01

    Our purpose is to present a broad review about the principles, early history, evolution, applications, and complications of femtosecond lasers used in refractive and nonrefractive corneal surgical procedures. Femtosecond laser technology added not only safety, precision, and reproducibility to established corneal surgical procedures such as laser in situ keratomileusis (LASIK) and astigmatic keratotomy, but it also introduced new promising concepts such as the intrastromal lenticule procedures with refractive lenticule extraction (ReLEx). Over time, the refinements in laser optics and the overall design of femtosecond laser platforms led to it becoming an essential tool for corneal surgeons. In conclusion, femtosecond laser is a heavily utilized tool in refractive and nonrefractive corneal surgical procedures, and further technological advances are likely to expand its applications. Copyright 2017 Asia-Pacific Academy of Ophthalmology.

  16. 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

  17. Phenomenological Research Method, Design and Procedure: A ...

    African Journals Online (AJOL)

    Phenomenological Research Method, Design and Procedure: A Phenomenological Investigation of the Phenomenon of Being-in-Community as Experienced by Two Individuals Who Have Participated in a Community Building Workshop.

  18. Transesophageal echocardiography in NeoChord procedure

    Directory of Open Access Journals (Sweden)

    Pittarello Demetrio

    2015-01-01

    Full Text Available Background: Transapical off-pump mitral valve intervention with neochord implantation for degenerative mitral valve disease have been recently introduced in the surgical practice. The procedure is performed under 2D-3D transesophageal echocardiography guidance. Methods: The use of 3D real-time transesophageal echocardiography provides more accurate information than 2D echocardiography only in all the steps of the procedure. In particular 3D echocardiography is mandatory for preoperative assessment of the morphology of the valve, for correct positioning of the neochord on the diseased segment , for the final tensioning of the chordae and for the final evaluation of the surgical result. Result and Conclusion: This article is to outline the technical aspects of the transesophageal echocardiography guidance of the NeoChord procedure showing that the procedure can be performed only with a close and continuous interaction between the anesthesiologist and the cardiac surgeon.

  19. The Accelerated Procedure for Electrical Work (TPA)

    CERN Document Server

    Coelingh, G J

    2000-01-01

    The accelerated procedure for electrical work [in French: Travaux électriques selon Procédure Accélérée (TPA)] was introduced in October 1996. It allows the contractor to carry out minor electrical installation jobs (about 350 a year) independently. The special features of the TPA are that the number of hours to be worked is limited to 16 and the cost to less than 1000 CHF. This procedure has substantial advantages for both the requesters and ST division. Firstly, the requester benefits from direct contact with the contractor, prompt action and simplified invoicing. In addition, ST division, relieved of ordinary minor work, can concentrate on larger-scale projects and can take advantage of a simplified system of administration. The author sets out the course of the procedure, its advantages and drawbacks, the statistics and the results of a satisfaction questionnaire. This procedure could be adapted and extended to other operations linked to future contracts.

  20. Electronic Procedures for Medical Operations Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Electronic procedures are currently being used to document the steps in performing medical operations for the Space Shuttle and/or the International Space Station...

  1. Procedural Problems in LGBT Asylum Cases

    National Research Council Canada - National Science Library

    Lyra Jakuleviciene; Laurynas Bieksa; Egle Samuchovaite

    2012-01-01

    ...) attitudes are also frequent in many societies. However, the LGBT asylum seekers are frequently left outside the refugee definition due to many refugee qualification and procedural problems in LGBT cases...

  2. 32 CFR 159.6 - Procedures.

    Science.gov (United States)

    2010-07-01

    ... personnel (e.g., on a Web page and/or through contract terms), consistent with security considerations and... procedures for direction, control and the maintenance of communications with regard to the movement and...

  3. Procedure Verification and Validation Toolset Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The proposed research is aimed at investigating a procedure verification and validation toolset, which will allow the engineers who are responsible for developing...

  4. Children Procedures and Treatment (Fertility Issues)

    Medline Plus

    Full Text Available ... Survivor Stories Survivor Experiences Decision Making Advice Expert Videos Basic Fertility Info Common Oncofertility Questions Female Procedures & ... do things here }); } }); Home Patients Parents Partners Animations Videos Resources Support Search this site: Copyright © 2008-2016 ...

  5. YF-16 flight flutter test procedures

    Science.gov (United States)

    Brignac, W. J.; Ness, H. B.; Johnson, M. K.; Smith, L. M.

    1976-01-01

    The Random Decrement technique (Randomdec) was incorporated in procedures for flight testing of the YF-16 lightweight fighter prototype. Damping values obtained substantiate the adequacy of the flutter margin of safety. To confirm the structural modes which were being excited, a spectral analysis of each channel was performed using the AFFTC time/data 1923/50 time series analyzer. Inflight test procedure included the careful monitoring of strip charts, three axis pulses, rolls, and pullups.

  6. A procedure for evaluating environmental impact

    Science.gov (United States)

    Leopold, Luna Bergere; Clarke, Frank Eldridge; Hanshaw, Bruce B.; Balsley, James R.

    1971-01-01

    In a recent article in "Science" discussing the Environmental Policy Act of 1969, Gillette (1971) states "The law's instructions for preparing an impact report apparently are not specific enough to insure that an agency will fully, or even usefully, examine the environmental effects of the projects it plans." This report contains a procedure that may assist in developing uniform environmental impact statements. The Department of the Interior and the Council on Environmental Quality will appreciate comments on the procedure here proposed.

  7. Safety & Usage Procedure for Lithium Polymer Batteries

    OpenAIRE

    Naval Postgraduate School (U.S.)

    2014-01-01

    Version 1.4; July 2014 This document establishes procedures for safety and use of Lithium Polymer Battery technology in the Naval Postgraduate School (NPS), including Unmanned Aircraft Systems (UAS). All faculty, staff and students wishing to become Authorized Users of Lithium Polymer batteries shall be required to read and acknowledge this document and act in accordance with all procedures contained herein to be granted access to Lithium Polymer batteries.

  8. Electrical screening procedure for solid ionic conductors

    Science.gov (United States)

    Kautz, H. E.; Singer, J.; Fielder, W. L.; Fordyce, J. S.

    1973-01-01

    An electrical screening method has been developed for preliminary evaluation of polycrystalline specimens of candidates for use as solid ionic conductive electrolytes in batteries. The procedure measures dielectric loss and capacitance, from which are calculated an ac conductivity attributed provisionally to ions and an activation energy for that conductivity. Electronic conductivity is directly measured. The screening procedure applied to sodium beta-alumina yielded acceptable values for conductivity and activation energy.

  9. Arthroscopic Screw Removal After Arthroscopic Latarjet Procedure

    OpenAIRE

    Lafosse, Thibault; Amsallem, Lior; Delgrande, Damien; Gerometta, Antoine; Lafosse, Laurent

    2017-01-01

    Arthroscopic Latarjet procedure is an efficient and reliable approach for the treatment of shoulder instability. Nevertheless, the screws fixing the bone block may sometimes be responsible for pain and uncomfortable snapping in the shoulder that is triggered during active external rotation. We propose an all-arthroscopic technique for screw removal in cases of complications involving the screws from a Latarjet procedure. The all-arthroscopic screw removal is reliable and efficient. This proce...

  10. Effect of laser therapy on immune cells infiltrate after excisional wounds in diabetic rats.

    Science.gov (United States)

    de Loura Santana, Cristiano; de Fátima Teixeira Silva, Daniela; de Souza, Amanda Pires; Jacinto, Marcos Vinicius; Bussadori, Sandra Kalil; Mesquita-Ferrari, Raquel Agnelli; Fernandes, Kristianne Porta Santos; França, Cristiane Miranda

    2016-01-01

    Diabetes alters innate and specific immunity, causing an imbalanced tissue repair process. Very active neutrophils and macrophages are found for a long time in chronic wounds in those individuals. The aim of this study was to evaluate the response of the main effector cells of immunity (neutrophils, macrophages, and T lymphocytes) and to compare the effects of two laser therapy regimens in the postoperative treatment of excision wounds. Diabetes was induced in female Wistar rats and a punch was used to cause wounds in the dorsum of each individual. The animals were randomly allocated to a control group (CG), in which the wound was untreated, a single-dose laser group (SLG), in which the wound was submitted to single dose of laser therapy at wavelength of 660 nm, output power of 30 mW, energy density of 4 J/cm(2), and 26-second exposure time, and a fractionated-dose laser group (FLG), submitted to 1 J/cm(2) of laser therapy on Days 1, 3, 8, and 10. Euthanasia was performed on five animals from each group Days 1, 3, 8, 10, 15, and 22. The wound was removed and routinely processed for immunohistochemistry against elastase, CD3, CD68, and CD206 antibodies. The samples were photographed and labeled cells were counted by a blinded observer. The Kruskal-Wallis test was used for the statistical analysis. Neutrophils were predominant in the SLG on Day 1, whereas these cells were mostly found in the CG on Day 3 (P laser therapy can alter the composition of inflammatory infiltrate in diabetic wounds, leading to a more balanced response transiting from a rapid neutrophil infiltration through to M2 macrophage polarization, especially with a single application of 4 J/cm(2) in the immediate postoperative period. © 2015 Wiley Periodicals, Inc.

  11. Ligasure, Harmonic Scalpel versus conventional diathermy in excisional haemorrhoidectomy: a randomized controlled trial.

    Science.gov (United States)

    Talha, Ahmed; Bessa, Samer; Abdel Wahab, Moataza

    2017-04-01

    This study was designed to compare the surgical outcomes of haemorrhoidectomy performed by the Ligasure, Harmonic Scalpel with that performed by the conventional diathermy. A total of 180 patients were randomized to Ligasure, Harmonic Scalpel and diathermy haemorrhoidectomy, 60 patients for each group. The operative time, post-operative pain scores, parenteral analgesic requirements in the first 24 h, post-operative complications and wound healing rates were documented. The median operative time was 8 min (range, 7-18) for the Ligasure and Harmonic Scalpel groups and 18 min (range, 15-21) for the diathermy group (P Harmonic Scalpel groups than in the diathermy group (P Harmonic Scalpel groups (P Harmonic Scalpel groups had complete healing of wounds (P = 0 Harmonic Scalpel provide a superior alternative to conventional diathermy in haemorrhoidectomy with no difference between them in reducing the operative time, post-operative pain, analgesic requirements during the first 24 h and time to complete healing of wounds. © 2014 Royal Australasian College of Surgeons.

  12. Giant keloid of left buttock treated with post-excisional radiotherapy.

    Science.gov (United States)

    Troiano, Michele; Simeone, Anna; Scaramuzzi, Gerardo; Parisi, Salvatore; Guglielmi, Giuseppe

    2011-01-01

    Keloids are defined as excessive scar tissue formation extending beyond the area of the original skin injury and occurring in predisposed individuals. While no single treatment has proven widely effective, several series report excellent outcomes for keloids with post-surgery radiation therapy as described in the literature. We present a patient with recurrent giant keloid of left buttock after several surgical removals, that at physical examination shows the size of 40×22×10 cm in the largest dimension. Patient underwent a surgical excision of gluteal lesion and postoperative radiotherapy using photons at 8 MV of linear accelerator: the total dose delivered was 22 Gy in 11 days, with a daily fraction of 2 Gy. No relapse was showed at 36 months post-therapy. Several methods seem unsatisfactory for preventing keloid recurrence. The combination of surgery and adjuvant radiotherapy seems an excellent strategy to prevent recurrent disease.

  13. Adjuvant topical treatment with imiquimod 5% after excisional surgery for VIN 2/3.

    Science.gov (United States)

    Gentile, M; Bianchi, P; Sesti, F; Sopracordevole, F; Biamonti, A; Scirpa, P; Schimberni, M; Cozza, G; Marziani, R; Di Martino, G; Catalano, A; Milazzo, G N; Zinna, M; Caserta, D; Frega, A

    2014-10-01

    Vulvar intraepithelial neoplasia (VIN) is a premalignant lesion of the vulva. The incidence of VIN is increasing. The surgery is currently the gold standard therapy for VIN, but Imiquimod could be a completion to surgery. The aim of this study is to compare the overall complete response, the recurrence rate and the risk factors for recurrence among two groups of patients: women with high grade VIN underwent surgery and patients treated with surgery plus Imiquimod. 80 patients with histologically diagnosed VIN 2/3 were enrolled in this prospective study. Our patients were divided into two groups: 40 women underwent surgery (A) and 40 patients were treated with surgery plus Imiquimod (B). All women had a 5-year follow-up. Recurrence rate and complete response were evaluated. The following patients' characteristics were analyzed: smoke, multifocal disease, multicentric disease, degree of the lesion. In the group A recurrence rate was 44.8%, in the group B it was 48.4%. In both groups the presence of multifocal lesions (p = 0.02) and VIN 3 (p = 0.006) before treatment was associated with a higher risk of recurrence. This study found that surgery remains the principal approach for VIN with regard to relapse and complete response since the treatment with Imiquimod associated with surgery didn't show a lower recurrence rate. Although the surgical treatments remain the best therapeutic option for VIN with regard to recurrence and overall complete response, the combined therapy seems to be an interesting modality, but further studies are needed.

  14. [Choice of bariatric and metabolic surgical procedures].

    Science.gov (United States)

    Liang, Hui; Lin, Shibo; Guan, Wei

    2017-04-25

    Bariatric and metabolic surgery has become the clinical hot topic of the treatment of metabolic syndromes including obesity and diabetes mellitus, but how to choose the appropriate surgical procedure remains the difficult problem in clinical practice. Clinical guidelines of American Society for Metabolic and Bariatric Surgery(ASMBS)(version 2013) introduced the procedures of bariatric and metabolic surgery mainly including biliopancreatic diversion with duodenal switch(BPD-DS), laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy(LSG). To choose the appropriate bariatric and metabolic procedure, the surgeons should firstly understand the indications and the contraindications of each procedure. Procedure choice should also consider personal condition (body mass index, comorbidities and severity of diabetes), family and socioeconomic status (postoperative follow-up attendance, understanding of potential surgical risk of gastrectomy and patient's will), family and disease history (patients with high risk of gastric cancer should avoid LRYGB; patients with gastroesophageal reflux disease should avoid LSG) and associated personal factors of surgeons. With the practice of bariatric and metabolic surgery, the defects, especially long-term complications, of different procedures were found. For example, LRYGB resulted in higher incidence of postoperative anemia and marginal ulcer, high risk of gastric cancer as well as the requirement of vitamin supplementation and regular follow-up. Though LSG has lower surgical risk, its efficacy of diabetes mellitus remission and long-term weight loss are inferior to the LRYGB. These results pose challenges to the surgeons to balance the benefits and risks of the bariatric procedures. A lot of factors can affect the choice of bariatric and metabolic procedure. Surgeons should choose the procedure according to patient's condition with the consideration of the

  15. Redo autograft operations after the Ross procedure.

    Science.gov (United States)

    Brinkman, William T; Herbert, Morley A; Prince, Syma L; Ryan, Connor; Ryan, William H

    2012-05-01

    Autograft dilatation after the Ross procedure is the most common cause of late autograft failure. We looked at results after reoperation for autograft dysfunction using autograft sparing and composite root replacement techniques. Data were abstracted from our prospectively collected Ross registry for 160 consecutive patients who underwent a Ross procedure by a single surgeon between 1994 and 2008. Follow-up records were obtained, and the last echocardiographic report after reoperation was analyzed. Autograft reoperation was necessary in 17 patients, at a median interval of 6.9 years after the original procedure. Indications for reoperation were insufficiency with autograft dilatation in 16 patients, and without dilatation in 1 patient. Surgical procedures used at reoperation included autograft reimplantation in 6 patients (35.3%), autograft remodeling procedure in 1 patient (5.9%), composite root replacement with mechanical valved conduit in 5 patients (29.4%), composite root replacement with biologic valved conduit in 3 patients (17.6%), and mechanical aortic valve replacement in 2 patients (11.8%). At a median follow-up of 5.0 years after reoperation, freedom from greater than 2+ aortic insufficiency was 100% (17 of 17 patients) in both reimplantation and replacement groups. There was 1 death after reoperation (at >14 years) related to complications from systemic lupus erythematosus. There have been no strokes after autograft reimplantation. Autograft valve reimplantation and composite aortic root replacement are effective treatments for aortic root dilatation and aortic insufficiency after the Ross procedure. Echocardiographic follow-up demonstrates reasonable short-term function after autograft preservation procedures. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Reoperation rates following ankle ligament procedures performed with and without concomitant arthroscopic procedures.

    Science.gov (United States)

    Yasui, Youichi; Murawski, Christopher D; Wollstein, Adi; Kennedy, John G

    2017-06-01

    Over 50 % of the patients with chronic lateral ankle instability present with some degree of intra-articular pathology. To date, no consensus regarding the concomitant ankle arthroscopy procedures along with ankle ligament procedures has been reached. The purpose of current study was to investigate reoperation rates and postoperative complications following ankle ligament procedures with and without concomitant arthroscopic procedures. Reoperations and postoperative complications following ankle ligament procedures with and without concomitant arthroscopic procedures were investigated using the PearlDiver Patient Record Database (PearlDiver Technologies, Inc.; Fort Wayne, IN, USA) between 2007 and 2011. Ankle ligament procedures, including ligament repair and reconstruction, and ankle arthroscopic procedures were investigated as primary surgery. Subsequently, the reoperation procedures, including ankle ligament procedures, arthroscopic procedures, autologous osteochondral transplantation, and ankle arthrodesis, as well as wound complications and nerve injury following primary ankle ligament procedures were identified. In 8014 patients receiving ligament repair, the arthroscopic group had a significantly higher reoperation rate in comparison with the non-arthroscopic group (8.8 vs. 6.5 %, odds ratio: 1.1, [p arthroscopic group included 29 open arthrodesis procedures following the primary surgery, whereas arthroscopic group had none. Of the 8055 patients who received a ligament reconstruction, there was no significant difference in reoperation rate between the groups (5.9 vs. 5.9 %, odds ratio: 1.0, [n.s], 95 % CI 0.8-1.2). As seen in the ligament repair group, the non-arthroscopic group had a 4.9 % rate of ankle arthrodesis as a secondary procedure. Arthroscopic group had a significantly lower rate of wound dehiscence following ankle ligament procedures than non-arthroscopic group. Concomitant ankle arthroscopy procedures performed with ankle ligament

  17. Codification of administrative procedure and the sanction for errors of procedure

    Energy Technology Data Exchange (ETDEWEB)

    Meyer, H.

    1986-07-15

    The article deals with secs. 43-46 of the Act on Administrative Procedure, especially regarding the adjusting of procedural defects. The consequences of the 'Muelheim-Kaerlich decision' of the Federal Constitutional Court are described. The author has the opinion that the annulment of an administrative act is obligatory in case of infringement of constitutionally obligatory procedure, even if the decision was without alternative. (CW)

  18. The Influence of Parent Preprocedural Anxiety on Child Procedural Pain: Mediation by Child Procedural Anxiety

    OpenAIRE

    Bearden, Donald J.; Feinstein, Amanda; Cohen, Lindsey L.

    2012-01-01

    Objective Data suggest parents’ preprocedural anxiety is related to children's acute procedural anxiety and pain. This study examined the temporal relations among these constructs to determine whether children's anxiety mediates the relation between parents' anticipatory anxiety and children's procedural pain. Methods A total of 90 preschoolers receiving immunizations, their parents, and the nurses rated children's procedural anxiety and pain. Parents provided ratings of their own preprocedur...

  19. Using Gagne's theory to teach procedural skills.

    Science.gov (United States)

    Buscombe, Charlotte

    2013-10-01

    Many key medical procedures are performed every day in clinical practice to yield important diagnostic information and to help determine the disease response to intensive treatments. Training clinicians to perform procedures competently and confidently thus carries considerable weight, helping to assure patient safety, the obtainment of adequate samples and minimising patient discomfort. This article considers how Robert Gagne's instructional design model may be effectively used to design lesson plans and teach procedural skills in small group settings. Gagne's model is based upon the information-processing model of mental events that occur when adults are presented with various stimuli. It highlights nine specific instructional events, which correlate with crucial conditions of learning, and are arranged to maximally enhance the learning process, improve session flow and, ultimately, ensure lesson objectives are comprehensively addressed. This article uses the nine points described by Gagne to outline a comprehensive lesson guide for teaching psychomotor skills, using a bone-marrow aspirate procedure as an example. Each of Gagne's instructional events is considered with specific activities for each, and with the variety of activities delineated to meet diverse learning styles. Gagne's instructional events can produce an effective and comprehensive lesson plan for teaching procedural skills, preparing learners with various preferred learning styles to perform psychomotor skills competently in clinical practice. This lesson plan can be of use for both teachers and students across clinical specialties, encouragingly outlining how Gagne's systematic and widely referenced theory can be creatively and practically used. © 2013 John Wiley & Sons Ltd.

  20. Readability of Invasive Procedure Consent Forms.

    Science.gov (United States)

    Eltorai, Adam E M; Naqvi, Syed S; Ghanian, Soha; Eberson, Craig P; Weiss, Arnold-Peter C; Born, Christopher T; Daniels, Alan H

    2015-12-01

    Informed consent is a pillar of ethical medicine which requires patients to fully comprehend relevant issues including the risks, benefits, and alternatives of an intervention. Given the average reading skill of US adults is at the 8th grade level, the American Medical Association (AMA) and the National Institutes of Health (NIH) recommend patient information materials should not exceed a 6th grade reading level. We hypothesized that text provided in invasive procedure consent forms would exceed recommended readability guidelines for medical information. To test this hypothesis, we gathered procedure consent forms from all surgical inpatient hospitals in the state of Rhode Island. For each consent form, readability analysis was measured with the following measures: Flesch Reading Ease Formula, Flesch-Kincaid Grade Level, Fog Scale, SMOG Index, Coleman-Liau Index, Automated Readability Index, and Linsear Write Formula. These readability scores were used to calculate a composite Text Readability Consensus Grade Level. Invasive procedure consent forms were found to be written at an average of 15th grade level (i.e., third year of college), which is significantly higher than the average US adult reading level of 8th grade (p < 0.0001) and the AMA/NIH recommended readability guidelines for patient materials of 6th grade (p < 0.0001). Invasive procedure consent forms have readability levels which makes comprehension difficult or impossible for many patients. Efforts to improve the readability of procedural consent forms should improve patient understanding regarding their healthcare decisions. © 2015 Wiley Periodicals, Inc.

  1. Rehabilitation procedures in the management of spasticity.

    Science.gov (United States)

    Smania, N; Picelli, A; Munari, D; Geroin, C; Ianes, P; Waldner, A; Gandolfi, M

    2010-09-01

    Spasticity is a major disabling symptom in many patients with spinal and/or cerebral lesions. During functional movements, spasticity manifests itself within the complex condition of the "spastic movement disorder". The pathophysiology of the spastic movement disorder relies on multiple factors including abnormal supraspinal drive, abnormal control of reflex activities, and changes in muscle mechanical properties. The most widely used procedures for management of spasticity are represented by pharmacological treatment aimed at inhibiting reflex hyperexcitability. In the last decades, several non pharmacological procedures for treating spasticity have been put forward, including muscle stretching, muscle reinforcement, physical agents and pain management. These procedures may have both neurophysiological and biomechanical effects on the spastic movement disorder. In the present paper, the literature concerning non-pharmacological procedures in the treatment of spasticity was reviewed and discussed, taking into account the multifaceted pathophysiology of the spastic movement disorder. Although further research in this field is recommended, existing evidence supports the potential role of rehabilitation interventions as a therapeutic tool, which could be integrated with traditional pharmacological procedures in the management of the spastic movement disorder.

  2. Acts and procedures concerning procedure-related deaths in South Africa

    Directory of Open Access Journals (Sweden)

    Stefan Jansen van Vuuren

    2013-01-01

    Full Text Available Background: The act regarding procedure-related deaths in South Africa has changed recently (in 2007 and comprises a more encompassing description of possible procedure-related deaths. It subsequently includes unnatural deaths in cases where the patient died during aprocedure, or as a result of a procedure, or where it can be shown that any aspect of such a procedure has been a contributory cause. The act does not qualify the ‘procedure’ and by definition includes all procedures, including anaesthesia.Objective: The objective of this article is to bring awareness to general practitioners regarding the legal requirements when dealing with suspected procedure-related deaths, and to outline some of the regulations pertaining to the management of such incidents.Methods: A thorough study, interpretation and clarification of the new legislature on procedure-related deaths were performed.Discussion: The onus of deciding which procedure-related deaths are unnatural has been removed from the doctor as the new act includes all such deaths. Certain aspects of the acts remain difficult to interpret and consultation with the appointed forensic pathologist in your area is still essential in all cases of a suspected procedure-related death. Healthcare workers should acquaint themselves with all these regulations and acts that are readily available in the Government Gazette.

  3. Loop electrosurgical excision of the cervix and the subsequent risk of preterm delivery

    DEFF Research Database (Denmark)

    Nøhr, Bugge; Tabor, Ann; Frederiksen, Kirsten

    2007-01-01

    a number of different lifestyle variables. We assessed the relationship between preterm delivery and potential risk factors, such as previous LEEP treatments, smoking during pregnancy, age, parity and previous preterm delivery. The cohort was followed until 2004, through linkages with the nationwide...... a significantly increased risk of preterm birth after LEEP (OR=1.8; 95% CI: 1.1-2.9). The strongest risk factor for preterm delivery was a previous preterm delivery (OR=2.3; 95% CI: 1.4-3.7). Other significant risk factors were smoking during pregnancy and low educational status. CONCLUSION: Our study showed...

  4. 34 CFR 303.420 - Due process procedures.

    Science.gov (United States)

    2010-07-01

    ... procedures for resolving individual child complaints (i.e., complaints that generally affect only a single child or the child's family). These procedures require the appointment of a decision-maker who is... Children § 303.420 Due process procedures. Each system must include written procedures including procedures...

  5. Procedural specificity in laparoscopic simulator training

    DEFF Research Database (Denmark)

    Bjerrum, Flemming; Sørensen, Jette Led; Konge, Lars

    2014-01-01

    BACKGROUND: The use of structured curricula for minimally invasive surgery training is becoming increasingly popular. However, many laparoscopic training programs still use basic skills and isolated task training, despite increasing evidence to support the use of training models with higher...... functional resemblance, such as whole procedural modules. In contrast to basic skills training, procedural training involves several cognitive skills such as elements of planning, movement integration, and how to avoid adverse events. The objective of this trial is to investigate the specificity...... of procedural practice in laparoscopic simulator training. METHODS/DESIGN: A randomised single-centre educational superiority trial. Participants are 96 surgical novices (medical students) without prior laparoscopic experience. Participants start by practicing a series of basic skills tasks to a predefined...

  6. Still special? Harvesting procedures for industrial hemp

    Directory of Open Access Journals (Sweden)

    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.

  7. Legal procedures regarding state budget expenditure

    Directory of Open Access Journals (Sweden)

    Andrzej Borodo

    2016-03-01

    Full Text Available Government spending and the procedures for making them can be examined on the basis of many of public regulations, which are the legal grounds for these expenditure. The procedures of government spending can be studied in the field of personal expenditure of the state budget (including salaries, pensions and social benefits. Appropriate procedures are related to expenditure for purchases of goods and services and for making of public investments (e.g. public roads and buildings. An extensive area of expenditure is in the form of grants. There are special legal ways for transferring the budget grants to different legal organizations and entities. The state expenditure are fixed in the Budget Act. The implementation of the budgetary expenditure needs to take up, by state authorities and agencies, thousands of individual and concrete actions (e.g. the contracts, administrative decisions, other activities. That is, in the Budget Act fixed expenditure have, in principle, normative act features.

  8. Procedures for ground-water investigations

    Energy Technology Data Exchange (ETDEWEB)

    1989-09-01

    This manual was developed by the Pacific Northwest Laboratory (PNL) to document the procedures used to carry out and control the technical aspects of ground-water investigations at the PNL. Ground-water investigations are carried out to fulfill the requirements for the US Department of Energy (DOE) to meet the requirements of DOE Orders. Investigations are also performed for various clients to meet the requirements of the Resource Conservation and Recovery Act of 1976 (RCRA) and the Comprehensive Environmental Response, Compensation and Liability Act of 1980 (CERCLA). National standards including procedures published by the American Society for Testing and Materials (ASTM) and the US Geological Survey were utilized in developing the procedures contained in this manual.

  9. The Econometric Procedures of Specific Transaction Identification

    Directory of Open Access Journals (Sweden)

    Doszyń Mariusz

    2017-06-01

    Full Text Available The paper presents the econometric procedures of identifying specific transactions, in which atypical conditions or attributes may occur. These procedures are based on studentized and predictive residuals of the accordingly specified econometric models. The dependent variable is a unit transactional price, and explanatory variables are both the real properties’ attributes and accordingly defined artificial binary variables. The utility of the proposed method has been verified by means of a real market data base. The proposed procedures can be helpful during the property valuation process, making it possible to reject real properties that are specific (both from the point of view of the transaction conditions and the properties’ attributes and, consequently, to select an appropriate set of similar attributes that are essential for the valuation process.

  10. Neurovascular Compression After the Latarjet Procedure.

    Science.gov (United States)

    Galvin, Joseph W; Romanowski, James R; Boykin, Robert E; Eichinger, Josef K; Lafosse, Laurent

    2015-12-01

    The Latarjet procedure is an established and effective option for the treatment of recurrent anterior shoulder instability. Symptomatic compression of the vasculature around the shoulder and adjacent brachial plexus is uncommon and may be difficult to diagnose and treat. The purpose of this report is to describe a patient with neurovascular compression of the axillary artery and brachial plexus after an open Latarjet procedure. This is the first known report of documented combined vascular and neurologic thoracic outlet syndrome after a Latarjet procedure. Evaluation of this suspected problem requires a detailed clinical examination and a dynamic angiogram to verify which neurovascular structures are compressed. Treatment includes decompression of the brachial plexus and axillary vasculature by releasing tethering scar tissue or the remaining pectoralis minor that is creating a constricting sling effect. An arthroscopic approach provides for a careful and specific decompression. Additionally, the authors provide a review of the literature for neurologic complications and management for these complications. Copyright 2015, SLACK Incorporated.

  11. Minimally invasive aesthetic procedures in young adults

    Directory of Open Access Journals (Sweden)

    Wollina U

    2011-03-01

    Full Text Available Uwe Wollina1, Alberto Goldman21Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany; 2Clinica Goldman, Porto Alegre, Rio Grande du Sul, BrazilAbstract: Age is a significant factor in modifying specific needs when it comes to medical aesthetic procedures. In this review we will focus on young adults in their third decade of life and review minimally invasive aesthetic procedures other than cosmetics and cosmeceuticals. Correction of asymmetries, correction after body modifying procedures, and facial sculpturing are important issues for young adults. The implication of aesthetic medicine as part of preventive medicine is a major ethical challenge that differentiates aesthetic medicine from fashion.Keywords: acne scars, ice pick scars, boxcar scars, fillers 

  12. Learning procedures from interactive natural language instructions

    Science.gov (United States)

    Huffman, Scott B.; Laird, John E.

    1994-01-01

    Despite its ubiquity in human learning, very little work has been done in artificial intelligence on agents that learn from interactive natural language instructions. In this paper, the problem of learning procedures from interactive, situated instruction is examined in which the student is attempting to perform tasks within the instructional domain, and asks for instruction when it is needed. Presented is Instructo-Soar, a system that behaves and learns in response to interactive natural language instructions. Instructo-Soar learns completely new procedures from sequences of instruction, and also learns how to extend its knowledge of previously known procedures to new situations. These learning tasks require both inductive and analytic learning. Instructo-Soar exhibits a multiple execution learning process in which initial learning has a rote, episodic flavor, and later executions allow the initially learned knowledge to be generalized properly.

  13. Aerial photogrammetry procedure optimized for micro uav

    Directory of Open Access Journals (Sweden)

    T. Anai

    2014-06-01

    Full Text Available This paper proposes the automatic aerial photogrammetry procedure optimized for Micro UAV that has ability of autonomous flight. The most important goal of our proposed method is the reducing the processing cost for fully automatic reconstruction of DSM from a large amount of image obtained from Micro UAV. For this goal, we have developed automatic corresponding point generation procedure using feature point tracking algorithm considering position and attitude information, which obtained from onboard GPS-IMU integrated on Micro UAV. In addition, we have developed the automatic exterior orientation and registration procedure from the automatic generated corresponding points on each image and position and attitude information from Micro UAV. Moreover, in order to reconstruct precise DSM, we have developed the area base matching process which considering edge information. In this paper, we describe processing flow of our automatic aerial photogrammetry. Moreover, the accuracy assessment is also described. Furthermore, some application of automatic reconstruction of DSM will be desired.

  14. Efficient Reanalysis Procedures in Structural Topology Optimization

    DEFF Research Database (Denmark)

    Amir, Oded

    This thesis examines efficient solution procedures for the structural analysis problem within topology optimization. The research is motivated by the observation that when the nested approach to structural optimization is applied, most of the computational effort is invested in repeated solutions...... effort invested in the solution of the nested problem is even more dominant since nonlinear equation systems are to be solved repeatedly. Efficient procedures for nonlinear structural analysis are proposed, based on transferring solutions and factorized tangent stiffnesses from one design cycle...... is on the utilization of various approximations to the solution of the analysis problem, where the underlying model corresponds to linear elasticity. For computational environments that enable the direct solution of large linear equation systems using matrix factorization, we propose efficient procedures based...

  15. FRENCH CARDS - NEW PROCEDURE FOR INITIAL APPLICATION

    CERN Multimedia

    Human Resources Division

    2002-01-01

    The Human Resources Division would like to remind members of personnel that they are obliged to submit an application form for a French card as soon as they have a permanent address in either Switzerland or in France and they are actually living there. Following the rationalization of our administrative procedures, as of October 1st, 2002, the initial application procedure for a French card will now be as follows: The member of personnel should complete an application form. If necessary, an application form must also be completed for family members. These forms must then be transferred via e-mail to the appropriate Divisional Administrative Officer (DAO) who will forward them to the Cards Service. In parallel, the member of personnel should submit the necessary supporting documents to the Cards Service. The application form (Word format only), the procedural details, the necessary supporting documents as well as the conditions of issue are available here.   Human Resources Division Tel. 74469

  16. Endovascular thrombectomy and post-procedural headache

    DEFF Research Database (Denmark)

    Khan, Sabrina; Amin, Faisal Mohammad; Holtmannspötter, Markus

    2017-01-01

    (p = 0.022) within the first 3 months after EVT compared to 1 year before treatment, which was further evident at interview time (on average 1.6 years after EVT, p = 0.013). A minority of patients experienced headaches for the first time within 3 months of their EVT (migraine 2, TTH 9), which......BACKGROUND: We investigated the prevalence of post-procedural headache in patients who have undergone thrombectomy for ischemic stroke, and correlated history of migraine with risk of peri-procedural complications. A total of 314 patients underwent thrombectomy at the Danish National Hospital from...... persisted at interview time for subjects with migraine. Out of 12 subjects with peri-procedural complications, 2 had a history of migraine with aura. CONCLUSION: Thrombectomy leads to a significant decrease in previously known migraine, and new onset of headache in a small subset of patients. A history...

  17. 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.

  18. Trypanosomatid protozoa: a simplified DNA isolation procedure.

    Science.gov (United States)

    Rotureau, Brice; Gego, Audrey; Carme, Bernard

    2005-11-01

    A non-toxic and versatile protein salting-out DNA extraction method is here described for convenient and rapid extraction of nuclear DNA molecules from trypanosomatids. The procedure just involves four manipulations, does not require any organic solvent, and is performed in less than 1h in a single tube. DNA yields obtained were similar to those from commercial kits and phenol-chloroform procedures. Samples extracted by this method were suitable for PCR and subsequent analyses. The reduced manual labour involved was perceived as an important benefit in medical diagnosis routine use as well as for large-scale taxonomic and eco-epidemiological studies of trypanosomatids.

  19. Coordinate Measuring Machine Pit Artifact Inspection Procedure

    Energy Technology Data Exchange (ETDEWEB)

    Montano, Joshua D. [Los Alamos National Laboratory

    2012-07-31

    The goal of this document is to outline a procedure for dimensional measurement of Los Alamos National Laboratory's CMM Pit Artifact. This procedure will be used by the Manufacturing Practice's Inspection Technology Subgroup of the Interagency Manufacturing Operations Group and Joint Operations Weapon Operations Group (IMOG/JOWOG 39) round robin participants. The intent is to assess the state of industry within the Nuclear Weapons Complex for measurements made on this type of part and find which current measurement strategies and techniques produce the best results.

  20. Year 2000 TWRS Maintenance procedure review report

    Energy Technology Data Exchange (ETDEWEB)

    ADAMS, M.R.

    1999-02-24

    A concern exists that some equipment in use might contain microprocessors that are dependent upon a time date function. The majority of the software programming for microprocessors has only utilized a 2 digit identifier for the year. With the approach of the year 2000, (Y2K), there is concern that the date function will not be correctly recognized and some functions will not operate properly. TWRS maintenance procedures have been reviewed to identify equipment components that may not be Y2K compliant. Engineering judgment was utilized to eliminate procedures and equipment that is obviously not impacted by Y2K.

  1. Upper urinary tract. Pyelography and interventional procedures

    Energy Technology Data Exchange (ETDEWEB)

    Thomsen, H.S.; Dorph, S.

    Pyelography is superior to all other imaging techniques for the demonstration of fine detail in the pelveocalyceal system and the ureter. For almost 90 years it has been performed through a retrogradely inserted catheter, but during the recent 30 years antegrade injection via a transparenchymally inserted needle or catheter has become an accepted alternative, especially in case of dilated upper urinary tract. Both methods have their advantages and their disadvantages. This article presents a review of indications, techniques, and complications. Furthermore, interventional procedures on the upper urinary tract - such as stent placement and baloon dilatation - are now handled by the radiologist, mainly through an antegrade approach. These therapeutic procedures are also reviewed.

  2. Office Procedures in Refractory Chronic Rhinosinusitis.

    Science.gov (United States)

    Thamboo, Andrew; Patel, Zara M

    2017-02-01

    Office procedures in chronic rhinosinusitis (CRS) can be considered before and after medical management, as well as before and after surgical management. This article focuses specifically on refractory CRS, meaning those patients who have failed medical and surgical management already. The options available in the management of refractory CRS depend on the personnel, equipment, and instrumentation available in the office setting; surgeon experience; and patient suitability and tolerability. This article provides readers with possible procedural options that can be done in their clinics with indications, patient selection, potential complications, and postoperative considerations. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. A procedure for building product models

    DEFF Research Database (Denmark)

    Hvam, Lars; Riis, Jesper; Malis, Martin

    2001-01-01

    This article presents a procedure for building product models to support the specification processes dealing with sales, design of product variants and production preparation. The procedure includes, as the first phase, an analysis and redesign of the business processes, which are to be supported...... for the business processes they support, and properly structured and documented, in order to facilitate that the systems can be maintained continually and further developed. The research has been carried out at the Centre for Industrialisation of Engineering, Department of Manufacturing Engineering, Technical...

  4. Summative Mass Analysis of Algal Biomass - Integration of Analytical Procedures: Laboratory Analytical Procedure (LAP)

    Energy Technology Data Exchange (ETDEWEB)

    Laurens, Lieve M. L.

    2016-01-13

    This procedure guides the integration of laboratory analytical procedures to measure algal biomass constituents in an unambiguous manner and ultimately achieve mass balance closure for algal biomass samples. Many of these methods build on years of research in algal biomass analysis.

  5. Relationship of procedural numbers with meaningful procedural autonomy in general surgery residents.

    Science.gov (United States)

    Stride, Herbert P; George, Brian C; Williams, Reed G; Bohnen, Jordan D; Eaton, Megan J; Schuller, Mary C; Zhao, Lihui; Yang, Amy; Meyerson, Shari L; Scully, Rebecca; Dunnington, Gary L; Torbeck, Laura; Mullen, John T; Mandell, Samuel P; Choti, Michael; Foley, Eugene; Are, Chandrakanth; Auyang, Edward; Chipman, Jeffrey; Choi, Jennifer; Meier, Andreas; Smink, Douglas; Terhune, Kyla P; Wise, Paul; DaRosa, Debra; Soper, Nathaniel; Zwischenberger, Jay B; Lillemoe, Keith; Fryer, Jonathan P

    2017-12-23

    Concerns exist regarding the competency of general surgery graduates with performing core general surgery procedures. Current competence assessment incorporates minimal procedural numbers requirements. Based on the Zwisch scale we evaluated the level of autonomy achieved by categorical PGY1-5 general surgery residents at 14 U.S. general surgery resident training programs between September 1, 2015 and December 31, 2016. With 5 of the most commonly performed core general surgery procedures, we correlated the level of autonomy achieved by each resident with the number of procedures they had performed before the evaluation period, with the intent of identifying specific target numbers that would correlate with the achievement of meaningful autonomy for each procedure with most residents. Whereas a definitive target number was identified for laparoscopic appendectomy (i.e. 25), for the other 4 procedures studied (i.e. laparoscopic cholecystectomy, 52; open inguinal hernia repair, 42; ventral hernia repair, 35; and partial colectomy, 60), target numbers identified were less definitive and/or were higher than many residents will experience during their surgical residency training. We conclude that procedural target numbers are generally not effective in predicting procedural competence and should not be used as the basis for determining residents' readiness for independent practice. Copyright © 2017. Published by Elsevier Inc.

  6. 78 FR 68704 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Science.gov (United States)

    2013-11-15

    ... Federal Aviation Administration 14 CFR Part 97 Standard Instrument Approach Procedures, and Takeoff... Standard Instrument Approach Procedures (SIAPs) and associated Takeoff Minimums and Obstacle Departure..., individual SIAP and Takeoff Minimums and ODP copies may be obtained from: 1. FAA Public Inquiry Center (APA...

  7. 78 FR 78714 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Science.gov (United States)

    2013-12-27

    ... Federal Aviation Administration 14 CFR Part 97 Standard Instrument Approach Procedures, and Takeoff... Standard Instrument Approach Procedures (SIAPs) and associated Takeoff Minimums and Obstacle Departure..., individual SIAP and Takeoff Minimums and ODP copies may be obtained from: 1. FAA Public Inquiry Center (APA...

  8. 78 FR 15615 - Practice and Procedure; Pole Attachment Complaint Procedures; Allocation of Unusable Space Costs

    Science.gov (United States)

    2013-03-12

    ... sets forth the allocation of unusable space costs in the pole attachment rate formula for any... COMMISSION 47 CFR Part 1 Practice and Procedure; Pole Attachment Complaint Procedures; Allocation of Unusable Space Costs AGENCY: Federal Communications Commission. ACTION: Final rule; announcement of effective...

  9. 22 CFR 1423.5 - Selection of the unfair labor practice procedure or the negotiability procedure.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Selection of the unfair labor practice procedure or the negotiability procedure. 1423.5 Section 1423.5 Foreign Relations FOREIGN SERVICE LABOR...; AND THE FOREIGN SERVICE IMPASSE DISPUTES PANEL FOREIGN SERVICE LABOR RELATIONS BOARD AND GENERAL...

  10. 77 FR 3098 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Science.gov (United States)

    2012-01-23

    ... Part 97 [Docket No. 30822; Amdt. No. 3461] Standard Instrument Approach Procedures, and Takeoff... Standard Instrument Approach Procedures (SIAPs) and associated Takeoff Minimums and Obstacle Departure..., individual SIAP and Takeoff Minimums and ODP copies may be obtained from: 1. FAA Public Inquiry Center (APA...

  11. 75 FR 80680 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Science.gov (United States)

    2010-12-23

    ... 14 CFR Part 97 Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure.... SUMMARY: This rule establishes, amends, suspends, or revokes Standard Instrument Approach Procedures... Minimums and ODP copies may be obtained from: 1. FAA Public Inquiry Center (APA-200), FAA Headquarters...

  12. 77 FR 12454 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Science.gov (United States)

    2012-03-01

    ... Federal Aviation Administration 14 CFR Part 97 Standard Instrument Approach Procedures, and Takeoff... Standard Instrument Approach Procedures (SIAPs) and associated Takeoff Minimums and Obstacle Departure..., individual SIAP and Takeoff Minimums and ODP copies may be obtained from: 1. FAA Public Inquiry Center (APA...

  13. 76 FR 18381 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Science.gov (United States)

    2011-04-04

    ... Federal Aviation Administration 14 CFR Part 97 Standard Instrument Approach Procedures, and Takeoff... Standard Instrument Approach Procedures (SIAPs) and associated Takeoff Minimums and Obstacle Departure..., individual SIAP and Takeoff Minimums and ODP copies may be obtained from: 1. FAA Public Inquiry Center (APA...

  14. 77 FR 26667 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Science.gov (United States)

    2012-05-07

    ... Federal Aviation Administration 14 CFR Part 97 Standard Instrument Approach Procedures, and Takeoff... Standard Instrument Approach Procedures (SIAPs) and associated Takeoff Minimums and Obstacle Departure..., individual SIAP and Takeoff Minimums and ODP copies may be obtained from: 1. FAA Public Inquiry Center (APA...

  15. 77 FR 22477 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Science.gov (United States)

    2012-04-16

    ... Federal Aviation Administration 14 CFR Part 97 Standard Instrument Approach Procedures, and Takeoff... Standard Instrument Approach Procedures (SIAPs) and associated Takeoff Minimums and Obstacle Departure..., individual SIAP and Takeoff Minimums and ODP copies may be obtained from: 1.FAA Public Inquiry Center (APA...

  16. 77 FR 33085 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Science.gov (United States)

    2012-06-05

    ... Federal Aviation Administration 14 CFR Part 97 Standard Instrument Approach Procedures, and Takeoff... Standard Instrument Approach Procedures (SIAPs) and associated Takeoff Minimums and Obstacle Departure..., individual SIAP and Takeoff Minimums and ODP copies may be obtained from: 1. FAA Public Inquiry Center (APA...

  17. 75 FR 42310 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

    Science.gov (United States)

    2010-07-21

    ... Federal Aviation Administration 14 CFR Part 97 Standard Instrument Approach Procedures, and Takeoff... Standard Instrument Approach Procedures (SIAPs) and associated Takeoff Minimums and Obstacle Departure..., individual SIAP and Takeoff Minimums and ODP copies may be obtained from: 1. FAA Public Inquiry Center (APA...

  18. Procedural justice and intragroup status: Knowing where we stand in a group enhances reactions to procedures

    NARCIS (Netherlands)

    Prooijen, J.-W. van; Bos, K. van den; Wilke, H.A.M.

    2005-01-01

    The current research investigates the role of relative intragroup status as a moderator of peoples reactions to procedural justice. Based on a review of the procedural justice literature, the authors argue that information about intragroup status influences peoples reactions to variations in

  19. Randomized trial to examine procedure-to-procedure transfer in laparoscopic simulator training

    DEFF Research Database (Denmark)

    Bjerrum, F; Sorensen, J L; Konge, L

    2016-01-01

    -centre educational superiority trial. Surgical novices practised basic skills on a laparoscopic virtual reality simulator. On reaching proficiency, participants were randomized to proficiency-based training. The intervention group practised two procedures on the simulator (appendicectomy followed by salpingectomy......BACKGROUND: Laparoscopic simulation has become a standard component of surgical training, but there is limited knowledge regarding skills transfer between procedural tasks. The objective was to investigate the specificity of procedural simulator training. METHODS: This was randomized single......), whereas the control group trained on only one procedure (salpingectomy). The main outcomes were number of repetitions and time to proficiency for the second procedure. RESULTS: Ninety-six participants were randomized, of whom 74 per cent were women, with a median age of 26 years. The intervention group...

  20. 48 CFR 970.2704-2 - Procedures.

    Science.gov (United States)

    2010-10-01

    ... REGULATIONS DOE MANAGEMENT AND OPERATING CONTRACTS Patents, Data, and Copyrights 970.2704-2 Procedures. (a... leverage to acquire rights in a subcontractor's limited rights data or restricted computer software for... computer software except through the use of Alternate II or III to the clause at 48 CFR 52.227-14...

  1. 48 CFR 423.405 - Procedures.

    Science.gov (United States)

    2010-10-01

    ... identified as recycled content when purchasing supplies or services. Information on EPA designated products... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Procedures. 423.405 Section 423.405 Federal Acquisition Regulations System DEPARTMENT OF AGRICULTURE SOCIOECONOMIC PROGRAMS...

  2. A New Hemostasis Valve for Neuroendovascular Procedures

    Science.gov (United States)

    Namba, K.; Song, J.K.; Niimi, Y.; Heran, N.S.; Berenstein, A.

    2007-01-01

    Summary A hemostasis valve is routinely used in neuroendovascular procedures to decrease the risk of thromboembolism1,2. Recently, a new hemostasis valve that is designed to minimize blood loss has been introduced. We report our initial experience in using this new hemostasis valve. In neuroendovascular procedures, a hemostasis valve is commonly used for continuous irrigation of guide and microcatheters to decrease the risk of thromboembolism1,2,3. A conventional hemostasis valve has a rotating seal at the end, which is turned open or closed each time a wire or microcatheter/guidewire is introduced or extracted. Often this results in significant back bleeding. When a rotating seal is adjusted suboptimally during a wire or microcatheter manipulation, leakage of pressurized saline from the end of a hemostasis valve results in stagnation of blood within a guiding catheter, which becomes a potential source of emboli during a procedure. The Guardian Haemostasis Valve (Zerusa Limited, Galway, Ireland) is a new hemostasis valve that is designed to minimize blood loss during interventional procedures by minimizing the opening time of the valve during wire or microcatheter insertion. A continuous sealing mechanism during wire or microcatheter positioning minimizes blood loss and stagnation of blood within the guide catheter. We report our initial experience with the Guardian hemostasis valve. PMID:20566129

  3. Developing and implementing assessment moderation procedures ...

    African Journals Online (AJOL)

    This paper is intended to help draw assessment moderation procedures to significantly minimize discrepancies between teachers in marking lab reports. It also helps students to develop their report writing skills. A population of 193 students taking two chemistry laboratory courses and a team of three instructors were used ...

  4. 9 CFR 392.5 - Filing procedures.

    Science.gov (United States)

    2010-01-01

    ... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Filing procedures. 392.5 Section 392.5 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE FOOD SAFETY AND... interested person may file a petition with FSIS. For purposes of this part, an “interested person” is any...

  5. 19 CFR 10.68 - Procedure.

    Science.gov (United States)

    2010-04-01

    ... consisting of raw cotton are taken to and returned from Canada, the application on Customs Form 4455 shall be... 19 Customs Duties 1 2010-04-01 2010-04-01 false Procedure. 10.68 Section 10.68 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY ARTICLES...

  6. On generic representation of implicit induction procedures

    NARCIS (Netherlands)

    D. Naidich

    1996-01-01

    textabstractWe develop a generic representation of implicit induction proof procedures within the cover set induction framework. Our work further develops the approach of cover set induction on propositional orderings. We show that in order to represent a substantially wide range of implicit

  7. Computationally efficient analysis procedure for frames with ...

    African Journals Online (AJOL)

    Computationally-efficient analytical procedure that provides high-quality analysis results for two-dimensional skeletal structure with segmented (stepped) and linearly-tapered non-prismatic flexural members has been developed based on the stiffness method of structural analysis. A computer program coded in FORTRAN ...

  8. 18 CFR 157.204 - Application procedure.

    Science.gov (United States)

    2010-04-01

    ..., DEPARTMENT OF ENERGY REGULATIONS UNDER NATURAL GAS ACT APPLICATIONS FOR CERTIFICATES OF PUBLIC CONVENIENCE... gas company; the state under the laws of which the applicant is organized or authorized to do business... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Application procedure...

  9. A procedure for analysis of guyline tension.

    Science.gov (United States)

    Ward W. Carson; Jens E. Jorgensen; Stephen E. Reutebuch; William J. Bramwell

    1982-01-01

    Most cable logging operations use a spar held in place near the landing by a system of guylines and anchors. Safety and economic considerations require that overloads be avoided and that the spar remain stable. This paper presents a procedure and a computer program to estimate the guyline and anchor loads on a particular system configuration by a specific set of...

  10. 32 CFR 1285.5 - Procedures.

    Science.gov (United States)

    2010-07-01

    ... Defense Other Regulations Relating to National Defense DEFENSE LOGISTICS AGENCY MISCELLANEOUS DEFENSE LOGISTICS AGENCY FREEDOM OF INFORMATION ACT PROGRAM § 1285.5 Procedures. (a) FOIA channels. If DLA personnel... period of six years to meet the statute of limitations of claims requirement. (o) Special mail services...

  11. 7 CFR 249.15 - Closeout procedures.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 4 2010-01-01 2010-01-01 false Closeout procedures. 249.15 Section 249.15 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SENIOR FARMERS' MARKET NUTRITION PROGRAM (SFMNP) State Agency Provisions § 249...

  12. 77 FR 23176 - Revisions to Procedural Rules

    Science.gov (United States)

    2012-04-18

    ... FURTHER INFORMATION CONTACT section as the source for case-related information for advice on alternatives... the rights of all participants, including affected mail users. In this proceeding, the Commission... within 90 days of filing and would remove the formal hearing requirement from N-case procedural rules.\\7...

  13. On Realism of Architectural Procedural Models

    Czech Academy of Sciences Publication Activity Database

    Beneš, J.; Kelly, T.; Děchtěrenko, Filip; Křivánek, J.; Müller, P.

    2017-01-01

    Roč. 36, č. 2 (2017), s. 225-234 ISSN 0167-7055 Grant - others:AV ČR(CZ) StrategieAV21/14 Program:StrategieAV Institutional support: RVO:68081740 Keywords : realism * procedural modeling * architecture Subject RIV: IN - Informatics, Computer Science Impact factor: 1.611, year: 2016

  14. 34 CFR 303.528 - Reimbursement procedure.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false Reimbursement procedure. 303.528 Section 303.528 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND...

  15. K-Median: Random Sampling Procedure

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. K-Median: Random Sampling Procedure. Sample a set of 1/ + 1 points from P. Let Q = first 1/ points, p = last point. Let T = Avg. 1-Median cost of P, c=1-Median. Let B1 = B(c,T/ 2), B2 = B(p, T). Let P' = points in B1.

  16. 22 CFR 62.76 - Transfer procedures.

    Science.gov (United States)

    2010-04-01

    ... Foreign Relations DEPARTMENT OF STATE PUBLIC DIPLOMACY AND EXCHANGES EXCHANGE VISITOR PROGRAM Student and Exchange Visitor Information System (SEVIS) § 62.76 Transfer procedures. (a) Program sponsors may, pursuant...) The transfer sponsor shall validate the exchange visitor's participation in its program within 30...

  17. 6 CFR 27.335 - Hearing procedures.

    Science.gov (United States)

    2010-01-01

    ... Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CHEMICAL FACILITY ANTI-TERRORISM STANDARDS Orders and Adjudications § 27.335 Hearing procedures. (a) Any hearing shall be held as... under an oath or affirmation. (4) The hearing shall be recorded verbatim. (b)(1) A facility or other...

  18. 75 FR 26062 - Representation Election Procedure

    Science.gov (United States)

    2010-05-11

    ... CFR Parts 1202 and 1206 RIN 3140-ZA00 Representation Election Procedure AGENCY: National Mediation... provide that, in representation disputes, a majority of valid ballots cast will determine the craft or.../indicator of employee sentiment in representation disputes and provide employees with clear choices in...

  19. Optimization of somatic embryogenesis procedure for commercial ...

    African Journals Online (AJOL)

    Tuoyo Aghomotsegin

    2016-09-07

    Sep 7, 2016 ... from the Mars Center for Cocoa Science (MCCS) germplasm collection. Evaluation of a pilot scale production of plantlets from nine commercial cacao clones by somatic embryogenesis. Primary somatic embryogenesis procedures. Immature cacao flowers (approximately 900 in total), 6-8 mm in length, from ...

  20. 25 CFR 168.17 - Concurrence procedures.

    Science.gov (United States)

    2010-04-01

    ... PARTITIONED LANDS AREA § 168.17 Concurrence procedures. (a) Definitions. As used in this section, terms shall... permits are issued to persons residing on Hopi partitioned lands, which limit the grazing on range lands... a formal hearing to be held not sooner than 15 days from the date of the non-concurrence declaration...

  1. 34 CFR 300.304 - Evaluation procedures.

    Science.gov (United States)

    2010-07-01

    ... the child to be involved in and progress in the general education curriculum (or for a preschool child... 34 Education 2 2010-07-01 2010-07-01 false Evaluation procedures. 300.304 Section 300.304 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION...

  2. 45 CFR 605.36 - Procedural safeguards.

    Science.gov (United States)

    2010-10-01

    ... Preschool, Elementary, and Secondary Education § 605.36 Procedural safeguards. A recipient that operates a public elementary or secondary education program shall establish and implement, with respect to actions... the Education of the Handicapped Act is one means of meeting this requirement. ...

  3. 48 CFR 19.1007 - Procedures.

    Science.gov (United States)

    2010-10-01

    ... PROGRAMS SMALL BUSINESS PROGRAMS Small Business Competitiveness Demonstration Program 19.1007 Procedures... pursuant to the Small Business Competitiveness Demonstration Program. (b) Solicitations greater than the... will be competitive in terms of market price, quality, and delivery. If no such reasonable expectation...

  4. 45 CFR 2490.170 - Compliance procedures.

    Science.gov (United States)

    2010-10-01

    ... FOUNDATION ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE JAMES MADISON MEMORIAL FELLOWSHIP FOUNDATION § 2490.170 Compliance procedures. (a) Except as... Rehabilitation Act of 1973 (29 U.S.C. 791). (c) The Director of Administration and Finance shall be responsible...

  5. THE PROCEDURAL SKILLS OF RURAL HOSPITAL DOCTORS

    African Journals Online (AJOL)

    felt that they were coping and learning from the work under the supervision of peers or senior colleagues, and ... Without it, a vicious cycle is established leading to poor output and morale. The phenomenon of the .... coping positively with the procedural work on the one hand, as opposed to feeling stressed, particularly by ...

  6. General certification procedure of formation organizations

    CERN Document Server

    Int. At. Energy Agency, Wien

    2002-01-01

    This document presents the procedure dealing with the certification of formation organizations dispensing the formation and the risks prevention to the personnel of A or B category in nuclear facilities. This certification proves the organization ability to satisfy the ''F'' specification of the CEFRI. (A.L.B.)

  7. [Involvement of healthcare assistants in nursing procedures].

    Science.gov (United States)

    Dupuy, Olivier

    2015-02-01

    Healthcare assistants are authorised to perform nursing procedures in accordance with regulated conditions. They do not perform their functions autonomously but carry out their actions within the framework of the nurse's responsibilities. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  8. Contamination with explosives in analytical laboratory procedure.

    Science.gov (United States)

    Pawłowski, Wojciech; Matyjasek, Łukasz; Cieślak, Katarzyna; Karpińska, Monika

    2017-10-18

    The philosophy underlying the procedure with the trace from the moment of the securing of the evidence up to its ultimate inspection is of significance for the result achieved. Hands of the people who conduct investigative action or of the experts involved in examinations contaminated with explosives may adversely affect results of the analyses. The contamination effect is one of the most dangerous consequences of non-observance of the strict rules in handling the traces secured on the crime scene. The aim of this research work was to examine whether at all, and if so, with what an ease and at which stage of the analytical procedure there occurs a likely contamination of the evidence material with explosives such as TNT, RDX, PETN, NG. The analytical procedure employed consisted of the sampling stage, extraction from gauze swab, transfer of the extract and execution of an instrumental analysis based on gas chromatography with electron capture detector (ECD). The most significant contamination effect was observed during the analytical procedure for TNT, followed by a similar, yet less pronounced, for RDX and PETN. Contaminating the research material with nitroglycerin, known to be liquid under normal conditions, proved unsuccessful. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Children Procedures and Treatment (Fertility Issues)

    Medline Plus

    Full Text Available ... Share my story! Children Procedures and Treatment Is ovarian tissue cryopreservation available to girls under 18? How can a parent approach the subject of fertility preservation with their cancer-stricken child? How is the Oncofertility Consortium addressing ...

  10. PROCEDURE FOR ESTIMATING PERMANENT TOTAL ENCLOSURE COSTS

    Science.gov (United States)

    The paper discusses a procedure for estimating permanent total enclosure (PTE) costs. (NOTE: Industries that use add-on control devices must adequately capture emissions before delivering them to the control device. One way to capture emissions is to use PTEs, enclosures that mee...

  11. 32 CFR 552.214 - Procedures.

    Science.gov (United States)

    2010-07-01

    ... on the Installation of Aberdeen Proving Ground, Maryland § 552.214 Procedures. (a) Any person or... Ground must submit a written request to the Commander, U.S. Army Garrison, Aberdeen Proving Ground, ATTN: STEAP-CO, 2201 Aberdeen Boulevard, Aberdeen Proving Ground, Maryland 21005-5001. The request must be...

  12. 24 CFR 401.651 - Appeal procedures.

    Science.gov (United States)

    2010-04-01

    ...) OFFICE OF HOUSING AND OFFICE OF MULTIFAMILY HOUSING ASSISTANCE RESTRUCTURING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT MULTIFAMILY HOUSING MORTGAGE AND HOUSING ASSISTANCE RESTRUCTURING PROGRAM (MARK-TO... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Appeal procedures. 401.651 Section...

  13. 45 CFR 74.71 - Closeout procedures.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Closeout procedures. 74.71 Section 74.71 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION UNIFORM ADMINISTRATIVE REQUIREMENTS FOR AWARDS AND SUBAWARDS TO INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, OTHER NONPROFIT ORGANIZATIONS, AND COMMERCIAL ORGANIZATIONS...

  14. 48 CFR 832.006-4 - Procedures.

    Science.gov (United States)

    2010-10-01

    ... information and argument. The proceedings will be conducted in an informal manner and without the requirement... information, if any, provided by the contractor. (c) The SPE must provide a copy of each final determination... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Procedures. 832.006-4...

  15. Optimization of somatic embryogenesis procedure for commercial ...

    African Journals Online (AJOL)

    Optimization of somatic embryogenesis procedure for commercial clones of Theobroma cacao L. ... Overall, flower petals performed better than staminodes, and our best performing genotype yielded an average of 7-10 embryos produced in brown callus explants with embryogenic response during primary somatic ...

  16. Cloze Procedure and Written Language in Schizophrenia.

    Science.gov (United States)

    Manschreck, Theo C.; And Others

    1980-01-01

    Examines the relationship between relevant clinical symptoms and the predictability of language utterances in schizophrenia. Specifically, investigates the sensitivity of the Cloze procedure to various modes of language response, attempting to detect differences between language samples written by schizophrenics and controls. Analyzes experimental…

  17. 7 CFR 1219.39 - Board procedure.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Board procedure. 1219.39 Section 1219.39 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE HASS AVOCADO PROMOTION, RESEARCH...

  18. 7 CFR 915.30 - Procedure.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false Procedure. 915.30 Section 915.30 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE AVOCADOS GROWN IN SOUTH FLORIDA Order...

  19. 7 CFR 1219.40 - Committee procedure.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Committee procedure. 1219.40 Section 1219.40 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE HASS AVOCADO PROMOTION, RESEARCH...

  20. 49 CFR 192.225 - Welding procedures.

    Science.gov (United States)

    2010-10-01

    ... qualified under section 5 of API 1104 (incorporated by reference, see § 192.7) or section IX of the ASME Boiler and Pressure Vessel Code “ Welding and Brazing Qualifications” (incorporated by reference, see... 49 Transportation 3 2010-10-01 2010-10-01 false Welding procedures. 192.225 Section 192.225...

  1. Integrating Language Skills through a Dictogloss Procedure

    Science.gov (United States)

    Stewart, Benjamin Lee; Rodríguez Silva, Luis Humberto; Torres González, Juan Antonio

    2014-01-01

    In this article, the authors offer an alternative to traditional methods of teaching English that often included translating structures from the target language to the mother tongue. Although this method seems antiquated, it is still commonly practiced, as original dictogloss procedures were intended to provide an alternative to traditional…

  2. Mixed-reality simulation for neurosurgical procedures.

    Science.gov (United States)

    Bova, Frank J; Rajon, Didier A; Friedman, William A; Murad, Gregory J; Hoh, Daniel J; Jacob, R Patrick; Lampotang, Samsun; Lizdas, David E; Lombard, Gwen; Lister, J Richard

    2013-10-01

    Surgical education is moving rapidly to the use of simulation for technical training of residents and maintenance or upgrading of surgical skills in clinical practice. To optimize the learning exercise, it is essential that both visual and haptic cues are presented to best present a real-world experience. Many systems attempt to achieve this goal through a total virtual interface. To demonstrate that the most critical aspect in optimizing a simulation experience is to provide the visual and haptic cues, allowing the training to fully mimic the real-world environment. Our approach has been to create a mixed-reality system consisting of a physical and a virtual component. A physical model of the head or spine is created with a 3-dimensional printer using deidentified patient data. The model is linked to a virtual radiographic system or an image guidance platform. A variety of surgical challenges can be presented in which the trainee must use the same anatomic and radiographic references required during actual surgical procedures. Using the aforementioned techniques, we have created simulators for ventriculostomy, percutaneous stereotactic lesion procedure for trigeminal neuralgia, and spinal instrumentation. The design and implementation of these platforms are presented. The system has provided the residents an opportunity to understand and appreciate the complex 3-dimensional anatomy of the 3 neurosurgical procedures simulated. The systems have also provided an opportunity to break procedures down into critical segments, allowing the user to concentrate on specific areas of deficiency.

  3. 45 CFR 1225.8 - Precomplaint procedure.

    Science.gov (United States)

    2010-10-01

    ... discrimination with the EO Director within 15 calendar days of the aggrieved party's receipt of the notice. (d... party may be revealed once the agency has accepted a complaint of discrimination from the aggrieved... SERVICE VOLUNTEER DISCRIMINATION COMPLAINT PROCEDURE Processing Individual Complaints of Discrimination...

  4. 45 CFR 1225.9 - Complaint procedure.

    Science.gov (United States)

    2010-10-01

    ... VOLUNTEER DISCRIMINATION COMPLAINT PROCEDURE Processing Individual Complaints of Discrimination § 1225.9... above has followed, and the complaint states a charge of illegal discrimination. The agency will extend... a complaint because of failure of the aggrieved party to prosecute the complaint. If the complaint...

  5. 32 CFR 96.6 - Procedures.

    Science.gov (United States)

    2010-07-01

    ... information on enlistment applicants from the criminal justice system and from the DIS and shall review this... OF CRIMINAL HISTORY RECORD INFORMATION BY THE MILITARY SERVICES § 96.6 Procedures. (a) Under section 520a of title 10 U.S. Code, recruiters are authorized to request and receive criminal history record...

  6. 12 CFR 574.6 - Procedural requirements.

    Science.gov (United States)

    2010-01-01

    ... part: (i) By a savings and loan holding company for approval of acquisitions by a merger, consolidation... company; or (ii) By any company for approval of acquisitions by a merger, consolidation, or purchase of... means acceptable to the Office. (i) Additional procedures for acquisitions involving mergers...

  7. 14 CFR 1260.144 - Procurement procedures.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Procurement procedures. 1260.144 Section 1260.144 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION GRANTS AND COOPERATIVE... dimensioned in the metric system of measurement. (vi) Preference, to the extent practicable and economically...

  8. Imaging Procedures for Stranded Marine Mammals

    Science.gov (United States)

    2008-01-01

    sufficient to simply restrain the animal, or in the case of a captive animal, to train it to hold a position for 5 minutes or less. The procedure...Specimen condition Live Fresh dead Particular applications Trauma Neurological symptoms (aberrant behavior, seizures, tremors, circling) Soft

  9. 48 CFR 1503.500-71 - Procedures.

    Science.gov (United States)

    2010-10-01

    ... IMPROPER BUSINESS PRACTICES AND PERSONAL CONFLICTS OF INTEREST Contractor Responsibility To Avoid Improper Business Practices 1503.500-71 Procedures. (a) A contractor's system of management controls should provide for: (1) A written code of business ethics and conduct and an ethics training program for all...

  10. 28 CFR 2.72 - Hearing procedure.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Hearing procedure. 2.72 Section 2.72 Judicial Administration DEPARTMENT OF JUSTICE PAROLE, RELEASE, SUPERVISION AND RECOMMITMENT OF PRISONERS..., family members, relatives, friends of the prisoner, or other interested persons desiring to submit...

  11. 32 CFR 142.4 - Procedures.

    Science.gov (United States)

    2010-07-01

    ... obtained for public performance of copyrighted sound and video recordings. (b) Component procedures... appropriated funded playback equipment may not be used for reproduction of copyrighted sound or video... Department of Defense OFFICE OF THE SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN COPYRIGHTED SOUND...

  12. The need for culture sensitive diagnostic procedures

    NARCIS (Netherlands)

    Zandi, Tekleh; Havenaar, Johan M.; Limburg-Okken, Annechien G.; van Es, Hans; Sidali, Salah; Kadri, Nadia; van den Brink, Wim; Kahn, Rene S.

    Objective We examine the procedural validity of a standardized instrument for the diagnosis of psychotic disorders in Morocco. Method Twenty-nine patients from Casablanca, Morocco, with a psychotic or mood disorder were examined using the Comprehensive Assessment of Symptoms and History (CASH) an

  13. 48 CFR 19.1103 - Procedures.

    Science.gov (United States)

    2010-10-01

    ... PROGRAMS SMALL BUSINESS PROGRAMS Price Evaluation Adjustment for Small Disadvantaged Business Concerns 19.1103 Procedures. (a) Give offers from small disadvantaged business concerns a price evaluation... use of Government property to the offers before applying the price evaluation adjustment. (c) Do not...

  14. 5 CFR 752.203 - Procedures.

    Science.gov (United States)

    2010-01-01

    ... cause a conflict of interest or position, or an employee of the agency whose release from his or her official position would give rise to unreasonable costs or whose priority work assignments preclude his or... Procedures. (a) Employee entitlements. An employee under this subpart whose suspension is proposed under this...

  15. 22 CFR 33.8 - Claim procedures.

    Science.gov (United States)

    2010-04-01

    ... authenticated English translation. Claims must include: (1) The captain's sworn statement about the exact..., including: (i) The date and cost of acquisition supported by invoices or other acceptable proof of ownership... UNDER SECTION 7 § 33.8 Claim procedures. (a) Where and when to apply. Claims must be submitted to the...

  16. 7 CFR 14.5 - Procedure.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 1 2010-01-01 2010-01-01 false Procedure. 14.5 Section 14.5 Agriculture Office of the Secretary of Agriculture DETERMINING THE PRIMARY PURPOSE OF CERTAIN PAYMENTS FOR FEDERAL TAX PURPOSES § 14.5... be considered— (i) Authorizing legislation, legislative history, administrative regulation...

  17. 24 CFR 3.605 - Enforcement procedures.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Enforcement procedures. 3.605 Section 3.605 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL...

  18. 45 CFR 604.405 - Penalty procedures.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 3 2010-10-01 2010-10-01 false Penalty procedures. 604.405 Section 604.405 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION NEW RESTRICTIONS ON... penalties pursuant to the provisions of the Program Fraud and Civil Remedies Act, 31 U.S.C. sections 3803...

  19. 40 CFR 30.44 - Procurement procedures.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Procurement procedures. 30.44 Section 30.44 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER FEDERAL ASSISTANCE... procured. In competitive procurements, such a description shall not contain features which unduly restrict...

  20. Calibration procedure for fire resistance furnaces

    NARCIS (Netherlands)

    Twilt, L.; Leur, P.H.E. van de; Wickström, U.

    1996-01-01

    On behalf of CEN/TC 127 "Fire Safety in Buildings", a series of tests has been carried out to evaluate and complete the draft calibration procedure for fire resistance furnaces [4]. Fourteen laboratories in nine European countries participated in the test series, each carrying out one calibration

  1. 20 CFR 655.1293 - Special procedures.

    Science.gov (United States)

    2010-04-01

    ... FOREIGN WORKERS IN THE UNITED STATES Labor Certification Process for Temporary Agricultural Employment in the United States (H-2A Workers) § 655.1293 Special procedures. (a) Systematic process. This subpart... employers for the certification of employment of nonimmigrant workers in agricultural employment. (b...

  2. Medical Service Clinical Laboratory Procedures--Serology.

    Science.gov (United States)

    Department of the Army, Washington, DC.

    Presented are laboratory procedures of a serologic or immunologic nature for use in the diagnosis of a variety of infectious and noninfectious conditions. Included are tests for the detection of specific antibodies in the patient's serum, as well as immunologic tests for the detection of other products in the patient's serum and biological fluids.…

  3. 48 CFR 17.403 - Procedures.

    Science.gov (United States)

    2010-10-01

    ... CONTRACT TYPES SPECIAL CONTRACTING METHODS Leader Company Contracting 17.403 Procedures. (a) The contracting officer may award a prime contract to a— (1) Leader company, obligating it to subcontract a designated portion of the required end items to a specified follower company and to assist it to produce the...

  4. COGNITIVE FATIGUE FACILITATES PROCEDURAL SEQUENCE LEARNING

    Directory of Open Access Journals (Sweden)

    Guillermo eBorragán

    2016-03-01

    Full Text Available Enhanced procedural learning has been evidenced in conditions where cognitive control is diminished, including hypnosis, disruption of prefrontal activity and non-optimal time of the day. Another condition depleting the availability of controlled resources is cognitive fatigue. We tested the hypothesis that cognitive fatigue, eventually leading to diminished cognitive control, facilitates procedural sequence learning. In a two-day experiment, twenty-three young healthy adults were administered a serial reaction time task (SRTT following the induction of high or low levels of cognitive fatigue, in a counterbalanced order. Cognitive fatigue was induced using the Time load Dual-back (TloadDback paradigm, a dual working memory task that allows tailoring cognitive load levels to the individual's optimal performance capacity. In line with our hypothesis, reaction times in the SRTT were faster in the high- than in the low-level fatigue condition, and performance improvement showed more of a benefit from the sequential components than from motor. Altogether, our results suggest a paradoxical, facilitating impact of cognitive fatigue on procedural motor sequence learning. We propose that facilitated learning in the high-level fatigue condition stems from a reduction in the cognitive resources devoted to cognitive control processes that normally oppose automatic procedural acquisition mechanisms.

  5. Training Procedure to Evaluate Visible Emissions.

    Science.gov (United States)

    West Virginia Air Pollution Control Commission, Charleston.

    Described in this pamphlet is a procedure used by the West Virginia Air Pollution Control Commission to train personnel in evaluating visible emissions. For this purpose a "Smoke Observer's Training Unit" has been designed, a machine capable of generating both gray/black plumes for training in the use of Ringlemann readings and white plumes for…

  6. 32 CFR 191.6 - Procedures.

    Science.gov (United States)

    2010-07-01

    ... of this part are fully implemented and are in compliance with the spirit and intent of the DoD Human... candidates for employment at all levels. (6) Develop procedures for and implement all SEPs established under this part at the Component level. These SEPs shall be integral parts of the Civilian EEO Program and...

  7. Reassessment of coal pillar design procedure

    CSIR Research Space (South Africa)

    Madden, BJ

    1995-12-01

    Full Text Available The SIMRAC project COL 021A entitled “a reassessment of coal pillar design procedures” set out to achieve a coal pillar design procedure that takes cognisance of different geological and structural factors as well as the influence...

  8. Representing biodiversity: data and procedures for identifying ...

    Indian Academy of Sciences (India)

    These procedures use complementarity, a measure of the contribution each area in a region makes to the conservation goal, to estimate irreplaceability and flexibility, measures of the extent to which areas can be substituted for one another in order to take competing land uses into account. Persistence and vulnerability, ...

  9. 78 FR 21517 - Practices and Procedures

    Science.gov (United States)

    2013-04-11

    ... the body of the email or as an attachment in any common electronic format, including word processing applications, HTML or PDF. Commenters are asked to use a text format and not an image format for attachments... outlined in the Administrative Procedure Act (APA). However, an exemption from notice and comment...

  10. Procedural Modeling for Digital Cultural Heritage

    Directory of Open Access Journals (Sweden)

    Müller Pascal

    2009-01-01

    Full Text Available The rapid development of computer graphics and imaging provides the modern archeologist with several tools to realistically model and visualize archeological sites in 3D. This, however, creates a tension between veridical and realistic modeling. Visually compelling models may lead people to falsely believe that there exists very precise knowledge about the past appearance of a site. In order to make the underlying uncertainty visible, it has been proposed to encode this uncertainty with different levels of transparency in the rendering, or of decoloration of the textures. We argue that procedural modeling technology based on shape grammars provides an interesting alternative to such measures, as they tend to spoil the experience for the observer. Both its efficiency and compactness make procedural modeling a tool to produce multiple models, which together sample the space of possibilities. Variations between the different models express levels of uncertainty implicitly, while letting each individual model keeping its realistic appearance. The underlying, structural description makes the uncertainty explicit. Additionally, procedural modeling also yields the flexibility to incorporate changes as knowledge of an archeological site gets refined. Annotations explaining modeling decisions can be included. We demonstrate our procedural modeling implementation with several recent examples.

  11. 22 CFR 95.3 - Procedures.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Procedures. 95.3 Section 95.3 Foreign Relations... torture are made or the issue is otherwise brought to the Department's attention, appropriate policy and... Secretary as to whether or not to sign the surrender warrant. (b) Based on the resulting analysis of...

  12. [The systematic selection of speech audiometric procedures].

    Science.gov (United States)

    Steffens, T

    2017-03-01

    The impact of hearing loss on the ability to participate in verbal communication can be directly quantified through the use of speech audiometry. Advances in technology and the associated reduction in background noise interference for hearing aids have allowed the reproduction of very complex acoustic environments, analogous to those in which conversations occur in daily life. These capabilities have led to the creation of numerous advanced speech audiometry measures, test procedures and environments, far beyond the presentation of isolated words in an otherwise noise-free testing booth. The aim of this study was to develop a set of systematic criteria for the appropriate selection of speech audiometric material, which are presented in this article in relationship to the most widely used test procedures. Before an appropriate speech test can be selected from the numerous procedures available, the precise aims of the evaluation should be basically defined. Specific test characteristics, such as validity, objectivity, reliability and sensitivity are important for the selection of the correct test for the specific goals. A concrete understanding of the goals of the evaluation as well as of specific test criteria play a crucial role in the selection of speech audiometry testing procedures.

  13. Strategies and Procedures for Expediting Election Petitions

    African Journals Online (AJOL)

    Mofasony

    Strategies and Procedures for Expediting Election Petitions and Appeals. 323. In order to achieve expeditious resolution of electoral disputes, various attempts have been made using the rules of court to fast track election petitions. The most significant of all is the Practice Direction issued by the then president of the. Court of ...

  14. k-Means: Random Sampling Procedure

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. k-Means: Random Sampling Procedure. Optimal 1-Mean is. Approximation of Centroid (Inaba et al). S = random sample of size O(1/ ); Centroid of S is a (1+ )-approx centroid of P with constant probability.

  15. Extension Procedures for Confirmatory Factor Analysis

    Science.gov (United States)

    Nagy, Gabriel; Brunner, Martin; Lüdtke, Oliver; Greiff, Samuel

    2017-01-01

    We present factor extension procedures for confirmatory factor analysis that provide estimates of the relations of common and unique factors with external variables that do not undergo factor analysis. We present identification strategies that build upon restrictions of the pattern of correlations between unique factors and external variables. The…

  16. 5 CFR 9701.521 - Grievance procedures.

    Science.gov (United States)

    2010-01-01

    ... 9701.521 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Labor-Management Relations § 9701.521 Grievance procedures. (a)(1) Except as...

  17. [Conversional and endoscopic procedures following bariatric surgery].

    Science.gov (United States)

    Zorron, R; Bothe, C; Junghans, T; Pratschke, J; Benzing, C; Krenzien, F

    2016-10-01

    The Roux-en-Y gastric bypass (RYGB) is the therapy of choice in bariatric surgery. Sleeve gastrectomy and gastric banding are showing higher rates of treatment failure, reducing obesity-associated morbidity and body weight insufficiently. Moreover, gastroesophageal reflux disease (GERD) can occur refractory to medication. Therefore, a laparoscopic conversion to RYGB can be reasonable as long as specific conditions are fulfilled.Endoscopic procedures are currently being applied to revise bariatric procedures. Therapy failure following RYGB occurs in up to 20 % of cases. Transoral outlet reduction is the minimally invasive method of choice to reduce gastrojejunal anastomosis of the alimentary limb. The diameter of a gastric sleeve can be unwantedly enlarged as well; that can be reduced by placement of a longitudinal full-thickness suture.Severe hypoglycemic episodes can be present in patients following RYGB. Hypoglycemic episodes have to be diagnosed first and can be treated conventionally. Alternatively, a laparoscopic approach according to Branco-Zorron can be used for non-responders. Hypoglycemic episodes can thus be prevented and body weight reduction can be assured.Conversional and endoscopic procedures can be used in patients with treatment failure following bariatric surgery. Note that non-invasive approaches should have been applied intensively before a revisional procedure is performed.

  18. Applying Modeling Tools to Ground System Procedures

    Science.gov (United States)

    Di Pasquale, Peter

    2012-01-01

    As part of a long-term effort to revitalize the Ground Systems (GS) Engineering Section practices, Systems Modeling Language (SysML) and Business Process Model and Notation (BPMN) have been used to model existing GS products and the procedures GS engineers use to produce them.

  19. 28 CFR 545.11 - Procedures.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Procedures. 545.11 Section 545.11 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT WORK AND... minimum payment schedule for UNICOR or non-UNICOR work assignments, set forth in paragraphs (b)(1) and (b...

  20. 78 FR 35812 - Revisions to Procedural Rules

    Science.gov (United States)

    2013-06-14

    ... processes in N-Cases. Id. at 12- 20. These alternatives include Commission-led discovery, as opposed to participant-led discovery; limits on the number of interrogatories; and clearer and stricter boundaries for....S., 391 F.3d 338 (1st Cir. 2004) in asserting that the Administrative Procedure Act (APA) ``provides...

  1. The Sauvé-Kapandji Procedure

    Science.gov (United States)

    Lluch, Alberto

    2013-01-01

    Arthrodesis is the most reliable and durable surgical procedure for the treatment of a joint disorder, and its only disadvantage is the loss of motion of the fused joint. The distal radioulnar joint can be arthrodesed, while forearm pronation and supination are maintained or even improved by creating a pseudoarthrosis of the ulna just proximal to the arthrodesis. This is known as the Sauvé-Kapandji (S-K) procedure. The Sauvé-Kapandji differs from the Darrach procedure in that it preserves ulnar support of the wrist, as the distal radioulnar ligaments and ulnocarpal ligaments are maintained. Aesthetic appearance is also superior after the S-K procedure, as the normal prominence of the ulnar head, most noticeable when the forearm is in pronation, is maintained. However, the S-K is not free of possible complications, such as nonunion or delayed union of the arthrodesis, fibrous or osseous union at the pseudoarthrosis, and painful instability at the proximal ulna stump. All of these complications can be prevented if a careful surgical technique is used. PMID:24436787

  2. 7 CFR 1207.325 - Procedure.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Procedure. 1207.325 Section 1207.325 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE POTATO RESEARCH AND PROMOTION PLAN...

  3. 7 CFR 1207.505 - Procedure.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Procedure. 1207.505 Section 1207.505 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE POTATO RESEARCH AND PROMOTION PLAN...

  4. Procedures to establish National Rules of Behavior

    Science.gov (United States)

    The purpose of this procedure is to establish the EPA National Rules of Behavior to comply with OMB Circular A-130, regarding rules of behavior for users of information systems applicable to all users of EPA information and information systems for users.

  5. Addressing violations of international criminal procedure

    NARCIS (Netherlands)

    Pitcher, K.M.; Abels, D.; Dolman, M.M.; Vriend, K.C.J.

    2013-01-01

    This chapter provides an overview of the law and practice of the ICTY, ICTR and ICC with respect to procedural violations, including how such international criminal tribunals have dealt with the unique severity of the crimes falling within their jurisdiction in this context. The picture that emerges

  6. Addressing Violations of International Criminal Procedure

    NARCIS (Netherlands)

    Pitcher, K.

    2013-01-01

    This chapter provides an overview of the law and practice of the ICTY, ICTR and ICC with respect to procedural violations, including how such international criminal tribunals have dealt with the unique severity of the crimes falling within their jurisdiction in this context. The picture that emerges

  7. 28 CFR 549.51 - Approval procedures.

    Science.gov (United States)

    2010-07-01

    ... SERVICES Plastic Surgery § 549.51 Approval procedures. The Clinical Director shall consider individually any request from an inmate or a BOP medical consultant. (a) In circumstances where plastic surgery is... the Clinical Director recommends plastic surgery for the good order and security of the institution...

  8. 36 CFR 1275.26 - Access procedures.

    Science.gov (United States)

    2010-07-01

    ... THE NIXON ADMINISTRATION Preservation and Protection § 1275.26 Access procedures. (a) The Archivist.... (b) Entry to the records storage areas will be provided by the Archivist only to archival... whom represents the Archivist, will be present at all times that records storage areas are occupied. (c...

  9. PROCEDURE FOR LOCALLY RAISING THE GROUND ARTIFICIALLY

    NARCIS (Netherlands)

    Schuiling, R.D.

    1991-01-01

    Abstract of corresponding document: WO 8909251 (A1) The present invention relates to a procedure for locally raising the ground artificially, wherein an equivalent quantity of the calcite (CaCO3) present in the porous underground limestone formations is converted into gypsum (CaSO4.2H2O) by

  10. Low Cost, Simple, Intrauterine Insemination Procedure with ...

    African Journals Online (AJOL)

    There is an increased need for low cost procedures in treating infertility particularly in developing countries. Intrauterine insemination was used long before the advent of in vitro fertilization. During the last 30 years however, intrauterine insemination has evolved with the introduction of ovulation stimulating protocols and ...

  11. 7 CFR 959.32 - Procedure.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false Procedure. 959.32 Section 959.32 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements... in person. (b) The committee may meet by telephone, telegraph, or other means of communication and...

  12. 7 CFR 948.61 - Procedure.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false Procedure. 948.61 Section 948.61 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements... members, to vote by mail, telegraph, telephone, or other means of communication, provided that any such...

  13. 7 CFR 982.37 - Procedure.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false Procedure. 982.37 Section 982.37 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements... person. (b) The Board may vote by mail, telephone, telegraph, or other means of communication: Provided...

  14. 7 CFR 966.32 - Procedure.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false Procedure. 966.32 Section 966.32 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements... means of communication, and any vote cast at such a meeting shall be promptly confirmed in writing...

  15. 7 CFR 958.21 - Procedure.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false Procedure. 958.21 Section 958.21 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements... provide for voting by telephone, telegraph, or other means of communication and any such vote shall be...

  16. 7 CFR 947.26 - Procedure.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false Procedure. 947.26 Section 947.26 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements...) The committee may provide for meeting by telephone, telegraph, or other means of communication and any...

  17. 7 CFR 916.32 - Procedure.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false Procedure. 916.32 Section 916.32 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements... communication, such as facsimile, and any votes so cast shall be confirmed promptly in writing: Provided, That...

  18. 7 CFR 983.43 - Procedure.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false Procedure. 983.43 Section 983.43 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements... through the use of a conference telephone or similar communication equipment, as long as all members...

  19. 7 CFR 955.28 - Procedure.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false Procedure. 955.28 Section 955.28 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements... provide for meetings by telephone, telegraph, or other means of communication, and any vote cast orally at...

  20. 7 CFR 930.32 - Procedure.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false Procedure. 930.32 Section 930.32 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements... communication. Votes so cast shall be promptly confirmed in writing. (c) All meetings of the Board are open to...

  1. 7 CFR 920.32 - Procedure.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false Procedure. 920.32 Section 920.32 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements... of communication, and any votes so cast shall be confirmed promptly in writing; Provided, That if an...

  2. The European Procedure on Reduced Value Claims

    Directory of Open Access Journals (Sweden)

    Alexandrina Zaharia

    2009-06-01

    Full Text Available Maintaining and developing the area of freedom, security and justice is a major objective of theEuropean Community, which guarantees the free movement of persons. As a result of litigations regardingthe applications with a reduced value arising among physical or legal persons, it was felt the need for acommunity legislation that would guarantee identical conditions, both for creditors and debtors throughoutthe entire European Union territory. The European procedure regarding the debts recovery of reducedvalue facilitates the access to justice and it is characterized by simplifying and expediting the settling of thetransboundary litigations, reducing costs, the recognition and execution of the court order in a MemberState given in another Member State. This procedure is available to litigants as an alternative to theprocedures provided by the laws of Member States. The Regulation (EC no. 861/2007 establishing aEuropean procedure regarding the applications with reduced value applies in civil and commercial matters inthe transboundary cases, regardless the nature of the court when the application value, without taking intoaccount the interest, expenditures and other costs, does not exceed 2000 Euro at the time of receiving theapplication form by the competent court. This procedure does not apply to revenue, customs oradministrative matters or in regard to state responsibility for acts or omissions in exercising the publicauthority, and other matters specifically referred to in the Regulation. A cause is transboundary in naturewhen one of the parties has its habitual residence in a Member State, other than the one where the courtreceives such application. The proper procedure of application resolution for the recovery of debts withreduced value is governed by the rules of procedural law of the Member State in which the proceedings areconducted, and the execution of court of law is made by state legislation in which it takes place. The

  3. Sleeve gastrectomy and anti-reflux procedures.

    Science.gov (United States)

    Crawford, Christopher; Gibbens, Kyle; Lomelin, Daniel; Krause, Crystal; Simorov, Anton; Oleynikov, Dmitry

    2017-03-01

    Obesity is an epidemic in the USA that continues to grow, becoming a leading cause of premature avoidable death. Bariatric surgery has become an effective solution for obesity and its comorbidities, and one of the most commonly utilized procedures, the sleeve gastrectomy, can lead to an increase in gastroesophageal reflux following the operation. While these data are controversial, sometimes operative intervention can be necessary to provide durable relief for this problem. We performed an extensive literature review examining the different methods of anti-reflux procedures that are available both before and after a sleeve gastrectomy. We reviewed several different types of anti-reflux procedures, including those that supplement the lower esophageal sphincter anatomy, such as magnetic sphincter augmentation and radiofrequency ablation procedures. Re-operation was also discussed as a possible treatment of reflux in sleeve gastrectomy, especially if the original sleeve becomes dilated or if a conversion to a Roux-en-Y gastric bypass or biliopancreatic diversion is deemed necessary. Sleeve gastrectomy with concomitant anti-reflux procedure was also reviewed, including the anti-reflux gastroplasty, hiatal hernia repair, and limited fundoplication. A number of techniques can be used to mitigate the severity of reflux, either by maintaining the normal anatomic structures that limit reflux or by supplementing these structures with a plication or gastroplasty. Individuals with existing severe reflux should not be considered for a sleeve gastrectomy. New techniques that incorporate plication at the time of the index sleeve gastrectomy show some improvement, but these are in small series that will need to be further evaluated. The only proven method of treating intractable reflux after sleeve gastrectomy is conversion to a Roux-en-Y gastric bypass.

  4. Long-term skill proceduralization in schizophrenia.

    Science.gov (United States)

    Rémillard, Sophie; Pourcher, Emmanuelle; Cohen, Henri

    2010-01-01

    Previous studies had revealed no specific effect under haloperidol (typical) and risperidone (atypical) neuroleptic (NLP) treatments for schizophrenia (SZ) on a variety of neurocognitive functions relying on the dopaminergic meso-cortico-limbic system (Rémillard et al., 2005, 2008). Considering the different affinities of D2 dopamine receptors for typical and atypical NLPs, these drugs may differentially affect the functions of the striatum, a determinant brain structure involved in procedural learning. The influence of risperidone (2-6 mg) and haloperidol (2-40 mg) on a nonmotor procedural task involving semantically related pairs of words with inverted letters was investigated in this double-blind study. The performance of 26 patients with SZ, randomly assigned to risperidone or haloperidol, was compared to that of 18 healthy controls at baseline, 3, 6, and 12 months. Results revealed that all patients with SZ exhibited slower reading speed of the word pairs than healthy controls at all assessment periods. In addition, procedural learning - characterized as a significant decrease in the time taken to read aloud the target word pairs - was more impaired in the haloperidol- than in the risperidone-treated group at all assessment periods. Healthy controls showed steady improvement in reading speed over the 12 months of the study, in contrast to SZ patients, who reached a plateau in their capacity to improve mirror-reading skill over time. However, all SZ participants in the study showed near normal learning profiles from exposure to semantic associations embedded in the procedural memory task, providing evidence for the preservation of associative connections in the semantic network of these patients. The observed impairment in procedural learning in SZ may thus reflect, at least in part, the influence of neuroleptic medication on striatal functions.

  5. Surgical procedures in pinniped and cetacean species.

    Science.gov (United States)

    Higgins, Jennifer L; Hendrickson, Dean A

    2013-12-01

    Significant advances in veterinary diagnostic and surgical techniques have been made over the past several decades. Many of these advances, however, have not reached the field of marine mammal medicine. A number of limitations exist: risks of anesthesia, anatomical challenges, difficulties with wound closure, environmental constraints, equipment limitations, and perceived risks. Despite these limitations, surgical treatments have been successfully utilized in marine mammals. While surgery is performed in pinnipeds more frequently than in cetaceans, studies conducted in the 1960s and 1970s on dolphin sleep and hearing demonstrated that general anesthesia can be successfully induced in cetaceans. Since this pioneering work, a small number of successful surgeries have been performed in dolphins under both general anesthesia and heavy sedation. While these surgical procedures in pinnipeds and cetaceans have typically been limited to wound management, dentistry, ophthalmic procedures, fracture repair, and superficial biopsy, a number of abdominal surgeries have also been performed. Recently there have been pioneering successes in the application of minimally invasive surgery in marine mammals. Many of the anatomical challenges that almost prohibit traditional laparotomies in cetacean species and present challenges in pinnipeds can be overcome through the use of laparoscopic techniques. Due to the limited number of pinnipeds and cetaceans in captivity and, thus, the limited case load for veterinarians serving marine mammal species, it is vital for knowledge of surgical procedures to be shared among those in the field. This paper reviews case reports of surgical procedures, both traditional and laparoscopic, in pinnipeds and cetaceans. Limitations to performing surgical procedures in marine mammals are discussed and surgical case reports analyzed in an effort to determine challenges that must be overcome in order to make surgery a more feasible diagnostic and treatment

  6. Characterizing cardiopulmonary arrest during interventional radiology procedures.

    Science.gov (United States)

    Rueb, George Richard; Brady, William J; Gilliland, Charles A; Patrie, James T; Saad, Wael E; Sabri, Saher S; Park, Auh W; Stone, James R; Angle, John F

    2013-12-01

    Careful case selection and preparation can prevent most cardiopulmonary arrest (CPA) in the interventional radiology (IR) suite. A series of CPAs was analyzed to provide insight into risk factors for these events. A single-institution CPA database was used to identify all code team activations from January 1, 2005, to May 30, 2011, in the IR department. Medical records were searched for medical history, American Society of Anesthesiologists (ASA) classification, moderate sedation, and outcomes. Procedural data and procedure classification was acquired from the HI-IQ database. There were 36,489 procedures and 23 CPAs during the study period. Of the 23 patients with CPAs, 12 (52%) were male and 11 (48%) female, and average age was 57 years ± 19 (standard deviation). Risk factors included a 56% incidence of diabetes mellitus, 48% incidence of hypertension, and 78% incidence of renal failure. Of the patients with kidney disease, 56% were chronically dialysis-dependent, and an additional 9% were undergoing central venous catheter placement for new hemodialysis. Seventy-eight percent had ASA status of III or greater, and 57% underwent moderate sedation during the procedure. Relative risk of a CPA during dialysis shunt interventions versus arterial interventions was 3.6 (95% confidence interval, 1.0-11.3; P = .045). Eight of 23 (35%) died: one (12%) during resuscitation and seven (88%) after resuscitation (P = .070). The most common comorbidity of patients with CPA in IR was kidney disease, and the most patients who had CPA underwent dialysis access-related procedures. Copyright © 2013 SIR. Published by Elsevier Inc. All rights reserved.

  7. [Mood induction procedures: a critical review].

    Science.gov (United States)

    Gilet, A-L

    2008-06-01

    For a long period in the history of psychological research, emotion and cognition have been studied independently, as if one were irrelevant to the other. The renewed interest of researchers for the study of the relations between cognition and emotion has led to the development of a range of laboratory methods for inducing temporary mood states. This paper aims to review the main mood induction procedures allowing the induction of a negative mood as well as a positive mood, developed since the pioneer study of Schachter and Singer [Psychol Rev 69 (1962) 379-399] and to account for the usefulness and problems related to the use of such techniques. The first part of this paper deals with the detailed presentation of some of the most popular mood induction procedures according to their type: simple (use of only one mood induction technique) or combined (association of two or more techniques at once). The earliest of the modern techniques is the Velten Mood Induction Procedure [Behav Res Ther 6 (1968) 473-482], which involves reading aloud sixty self-referent statements progressing from relative neutral mood to negative mood or dysphoria. Some researchers have varied the procedure slightly by changing the number of the statements [Behav Res Ther 21 (1983) 233-239, Br J Clin Psychol 21 (1982) 111-117, J Pers Soc Psychol 35 (1977) 625-636]. Various other mood induction procedures have been developed including music induction [Cogn Emotion 11 (1997) 403-432, Br J Med Psychol 55 (1982) 127-138], film clip induction [J Pers Soc Psychol 20 (1971) 37-43, Cogn Emotion 7 (1993) 171-193, Rottenberg J, Ray RR, Gross JJ. Emotion elicitation using films. In: Coan JA, Allen JJB, editors. The handbook of emotion elicitation and assessment. New York: Oxford University Press, 2007], autobiographical recall [J Clin Psychol 36 (1980) 215-226, Jallais C. Effets des humeurs positives et négatives sur les structures de connaissances de type script. Thèse de doctorat non publi

  8. Elective plastic surgical procedures in adolescence.

    Science.gov (United States)

    McGrath, Mary H; Schooler, Wesley G

    2004-10-01

    Adolescent patients are seeking plastic surgery to correct deformities or perceived deformities in increasing numbers. It is essential for the physician to understand the influence of perceived body image irregularity that motivates patients of all ages to request plastic surgery. The increased demand for plastic surgical procedures among young patients is caused partially to increased media exposure to the available procedures offered by plastic surgeons. A successful aesthetic procedure can have a positive influence on a mature, well-motivated teenager, while surgery on a psychologically unstable adolescent can be damaging to the patient. The American Society for Aesthetic Plastic Surgery has developed guidelines for the appropriate selection of teenagers for aesthetic plastic surgery [26]. First, the physician must "assess physical maturity, because operating on a feature that has not yet fully developed could interfere with growth or negate the benefits of surgery in later years." Second, the physician should explore emotional maturity and expectations of the teenager. The teenager should understand the goals and limitations of the proposed surgery and have realistic expectations. Third, only board certified plastic surgeons who operate in accredited facilities should perform these procedures, to ensure the safety of the teenager and the quality of the procedure. Finally, teenagers and their parents should understand the risks of surgery, postoperative restrictions on activity, and typical recovery times. The referring physician and surgeon must be aware of the positive or negative effects that plastic surgery can have on the life of a teenager and be able to select patients who have the motivation, maturity, psychosocial, and emotional attributes that will lead to patient satisfaction.

  9. Standardized Procedure Content And Data Structure Based On Human Factors Requirements For Computer-Based Procedures

    Energy Technology Data Exchange (ETDEWEB)

    Bly, Aaron; Oxstrand, Johanna; Le Blanc, Katya L

    2015-02-01

    Most activities that involve human interaction with systems in a nuclear power plant are guided by procedures. Traditionally, the use of procedures has been a paper-based process that supports safe operation of the nuclear power industry. However, the nuclear industry is constantly trying to find ways to decrease the human error rate, especially the human errors associated with procedure use. Advances in digital technology make computer-based procedures (CBPs) a valid option that provides further enhancement of safety by improving human performance related to procedure use. The transition from paper-based procedures (PBPs) to CBPs creates a need for a computer-based procedure system (CBPS). A CBPS needs to have the ability to perform logical operations in order to adjust to the inputs received from either users or real time data from plant status databases. Without the ability for logical operations the procedure is just an electronic copy of the paper-based procedure. In order to provide the CBPS with the information it needs to display the procedure steps to the user, special care is needed in the format used to deliver all data and instructions to create the steps. The procedure should be broken down into basic elements and formatted in a standard method for the CBPS. One way to build the underlying data architecture is to use an Extensible Markup Language (XML) schema, which utilizes basic elements to build each step in the smart procedure. The attributes of each step will determine the type of functionality that the system will generate for that step. The CBPS will provide the context for the step to deliver referential information, request a decision, or accept input from the user. The XML schema needs to provide all data necessary for the system to accurately perform each step without the need for the procedure writer to reprogram the CBPS. The research team at the Idaho National Laboratory has developed a prototype CBPS for field workers as well as the

  10. Hybrid procedures for peripheral obstructive disease.

    Science.gov (United States)

    Schrijver, A M; Moll, F L; De Vries, J P Pm

    2010-12-01

    The incidence and prevalence of high-risk patients suffering from critical limb ischemia due to multilevel arterial obstructive disease is growing rapidly. Invasive surgical procedures to restore inflow to the crural and pedal circulation in case of TransAtlantic InterSociety Consensus C and D (TASC) lesions of the iliacofemoral arteries are related with substantial morbidity and mortality. The mid-term and long-term outcomes of sole percutaneous revascularization procedures are disappointing for TASC C and D lesions. Hybrid endovascular and open surgical revascularization procedures might be of benefit because of its less invasive character, no need for extensive venous graft material, and the ability to overcome long-segment arterial obstructions. The common femoral artery (CFA) plays a central role in most of the hybrid procedures. CFA desobstruction, in combination with open iliac angioplasty or open superficial femoral artery (SFA) angioplasty, and CFA desobstruction with remote endarterectomy of the superficial femoral artery, are commonplace. Another valuable hybrid technique is open angioplasty of the SFA and one-staged distal origin bypass grafting. Hybrid techniques can safely be performed in the vascular operating room providing that the inventory is equipped for endovascular interventions. Vascular surgeons with thorough experience in open transluminal angioplasty, whether or not in cooperation with interventional radiologists or angiologists, will have the lead in the preoperative and perioperative planning. No randomized controlled trials have been published comparing hybrid techniques and open surgical reconstructions, or sole endvascular methods for multilevel peripheral arterial disease. During the last decade, multiple prospective and retrospective series have been reported concerning hybrid techniques, all with good initial technical success (up to 95%) and acceptable 30-day morbidity and mortality rates. Mid-term and long-term patency rates are

  11. Optimization Procedure for Wideband Matched Feed Design

    DEFF Research Database (Denmark)

    Palvig, Michael Forum; Jørgensen, Erik; Meincke, Peter

    2016-01-01

    and reflector system can be efficiently optimized. This allows the design parameters of the matched feed to be directly related to the desired design goals in the secondary pattern over a specified band. Using this procedure, we present a design of a die-castable axially corrugated matched feed horn......The inherently high cross polarization of prime focus offset reflector antennas can be compensated by launching higher order modes in the feed horn. Traditionally, the bandwidth of such systems is in the order of a few percent. We present a novel design procedure where the entire matched feed...... that provides an XPD improvement better than 7 dB over a 12% bandwidth for a reflector with an f/D of 0.5. An investigation of the mode requirement for an arbitrary circular aperture feed is also presented....

  12. Sepsis and multiorgan failure following TVT procedure.

    Science.gov (United States)

    Stec, Piotr; Connell, Rowan

    2014-04-01

    Tension-free vaginal tape (TVT), is a commonly performed, low risk procedure for treatment of stress urinary incontinence (SUI). Severe complications are rare, but can be potentially life threatening. We present a case of 66 year old patient who sustained bladder perforation at the time of TVT procedure and subsequently developed sepsis rapidly leading to multi-organ failure and triggering sequence of serious complications. During her inpatient stay she required ITU admission, emergency laparotomy, TVT mesh removal, bowel resection due to ischemic colitis and anticoagulation for pulmonary embolism. Despite of clinical picture of sepsis her microbiology tests were almost consistently negative. This case emphasise importance of awareness and quick recognition of TVT related complications. Patient ultimately survived and recovered thanks to timely and coordinated management by the multidisciplinary team of doctors.

  13. Skin resurfacing procedures: new and emerging options

    Directory of Open Access Journals (Sweden)

    Loesch MM

    2014-08-01

    Full Text Available Mathew M Loesch,1 Ally-Khan Somani,1 Melanie M Kingsley,1 Jeffrey B Travers,1–3 Dan F Spandau1,41Department of Dermatology, 2Department of Pharmacology and Toxicology, 3Department of Pediatrics, 4Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, USAAbstract: The demand for skin resurfacing and rejuvenating procedures has progressively increased in the last decade and has sparked several advances within the skin resurfacing field that promote faster healing while minimizing downtime and side effects for patients. Several technological and procedural skin resurfacing developments are being integrated into clinical practices today allowing clinicians to treat a broader range of patients' skin types and pathologies than in years past, with noteworthy outcomes. This article will discuss some emerging and developing resurfacing therapies and treatments that are present today and soon to be available.Keywords: rejuvenation, wounding, non-melanoma skin cancer, therapy

  14. Veterinary students' recollection methods for surgical procedures

    DEFF Research Database (Denmark)

    Langebæk, Rikke; Tanggaard, Lene; Berendt, Mette

    2016-01-01

    When veterinary students face their first live animal surgeries, their level of anxiety is generally high and this can affect their ability to recall the procedure they are about to undertake. Multimodal teaching methods have previously been shown to enhance learning and facilitate recall; however......, student preferences for recollection methods when translating theory into practice have not been documented. The aim of this study was to investigate veterinary students' experience with recollection of a surgical procedure they were about to perform after using multiple methods for preparation. From...... a group of 171 veterinary students enrolled in a basic surgery course, 26 students were randomly selected to participate in semi-structured interviews. Results showed that 58% of the students used a visual, dynamic method of recollection, mentally visualizing the video they had watched as part...

  15. Kelly procedure for male primary epispadias.

    Science.gov (United States)

    Mishra, Pankaj; Rajendran, Simon; Asimakidou, Maria; Mushtaq, Imran

    2016-08-01

    Primary epispadias is a rare congenital malformation involving the urogenital system. In patients with epispadias, bladder closure enhances bladder growth and continence. Several steps were carried out to bring the bladder neck to the midline and allow tension-free bladder neck reconstruction and recreation of the natural angulation of urethra. The urethral plate and penile shaft were dissected and the corpora cavernosa separated, and then the bladder neck repair was performed. The urethral plate was tubularised and brought ventrally. The separated corpora were reapposed, avoiding torsion. The skin was reoriented to provide cover to the penis. The Kelly procedure improves cosmesis and continence by reconstructing a tension-free bladder neck repair and lengthening the penis. The video demonstrates the Kelly procedure for primary epispadias in a male child. Copyright © 2016. Published by Elsevier Ltd.

  16. Procedure to Measure Indoor Lighting Energy Performance

    Energy Technology Data Exchange (ETDEWEB)

    Deru, M.; Blair, N.; Torcellini, P.

    2005-10-01

    This document provides standard definitions of performance metrics and methods to determine them for the energy performance of building interior lighting systems. It can be used for existing buildings and for proposed buildings. The primary users for whom these documents are intended are building energy analysts and technicians who design, install, and operate data acquisition systems, and who analyze and report building energy performance data. Typical results from the use of this procedure are the monthly and annual energy used for lighting, energy savings from occupancy or daylighting controls, and the percent of the total building energy use that is used by the lighting system. The document is not specifically intended for retrofit applications. However, it does complement Measurement and Verification protocols that do not provide detailed performance metrics or measurement procedures.

  17. Ultrasound Guidance for Botulinum Neurotoxin Chemodenervation Procedures.

    Science.gov (United States)

    Alter, Katharine E; Karp, Barbara I

    2017-12-28

    Injections of botulinum neurotoxins (BoNTs) are prescribed by clinicians for a variety of disorders that cause over-activity of muscles; glands; pain and other structures. Accurately targeting the structure for injection is one of the principle goals when performing BoNTs procedures. Traditionally; injections have been guided by anatomic landmarks; palpation; range of motion; electromyography or electrical stimulation. Ultrasound (US) based imaging based guidance overcomes some of the limitations of traditional techniques. US and/or US combined with traditional guidance techniques is utilized and or recommended by many expert clinicians; authors and in practice guidelines by professional academies. This article reviews the advantages and disadvantages of available guidance techniques including US as well as technical aspects of US guidance and a focused literature review related to US guidance for chemodenervation procedures including BoNTs injection.

  18. Ultrasound Guidance for Botulinum Neurotoxin Chemodenervation Procedures

    Directory of Open Access Journals (Sweden)

    Katharine E. Alter

    2017-12-01

    Full Text Available Injections of botulinum neurotoxins (BoNTs are prescribed by clinicians for a variety of disorders that cause over-activity of muscles; glands; pain and other structures. Accurately targeting the structure for injection is one of the principle goals when performing BoNTs procedures. Traditionally; injections have been guided by anatomic landmarks; palpation; range of motion; electromyography or electrical stimulation. Ultrasound (US based imaging based guidance overcomes some of the limitations of traditional techniques. US and/or US combined with traditional guidance techniques is utilized and or recommended by many expert clinicians; authors and in practice guidelines by professional academies. This article reviews the advantages and disadvantages of available guidance techniques including US as well as technical aspects of US guidance and a focused literature review related to US guidance for chemodenervation procedures including BoNTs injection.

  19. Criminal justice procedures in civil commitment.

    Science.gov (United States)

    Slovenko, R

    1977-11-01

    The actions of federal district courts and state legislatures in recent years have resulted in the growing application of procedures of the criminal justice system to the civil commitment process. Increasingly patients can be confined only if they are dangerous to others, and increasingly due-process procedures of the criminal law are required, to the detriment of the patient's treatment and his survival in the community. The author says that allegations of patients' being railroaded into hospitals are, with few exceptions, fictitious. Abuses thet do exist should be handled through writs of habeas corpus and malpractice suits, remedies much more available now than in the past. The principal abuse in commitment occurs not when patients are admitted, the author believes, but at discharge, when so many patients are turned out into communities that lack proper services for them.

  20. Deriving directions through procedural task analysis.

    Science.gov (United States)

    Yuen, H K; D'Amico, M

    1998-01-01

    Task analysis is one of the essential components of activity analysis. Procedural task analysis involves breaking down an activity into a sequence of steps. Directions are the sequence of steps resulting from the task analysis (i.e., the product of the task analysis). Directions become a guide for caregivers or trainers use in teaching clients a specific skill. However, occupational therapy students often have difficulty in writing directions that are clear enough for caregivers or trainers to carry out. Books on activity analysis only provide examples of directions without giving guidelines on how to perform the writing process. The purposes of this paper are to describe the process of procedural task analysis and to provide a guideline for writing steps of directions.