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Sample records for fluoroscopic guidance practice

  1. Shoulder, hip, and knee arthrography needle placement using fluoroscopic guidance: practice patterns of musculoskeletal radiologists in North America

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    Shortt, Conor P. [Thomas Jefferson University Hospital, Department of Radiology, Philadelphia, PA (United States); Hospital of the University of Pennsylvania, Department of Radiology, Philadelphia, PA (United States); Morrison, William B.; Deely, Diane M.; Gopez, Angela G.; Zoga, Adam C. [Thomas Jefferson University Hospital, Department of Radiology, Philadelphia, PA (United States); Roberts, Catherine C. [Mayo Clinic College of Medicine, Department of Radiology, Phoenix, AZ (United States)

    2009-04-15

    The aim of this study was to evaluate the range of techniques used by radiologists performing shoulder, hip, and knee arthrography using fluoroscopic guidance. Questionnaires on shoulder, hip, and knee arthrography were distributed to radiologists at a national radiology meeting. We enquired regarding years of experience, preferred approaches, needle gauge, gadolinium dilution, and volume injected. For each approach, the radiologist was asked their starting and end needle position based on a numbered and lettered grid superimposed on a radiograph. Sixty-eight questionnaires were returned. Sixty-eight radiologists performed shoulder and hip arthrography, and 65 performed knee arthrograms. Mean experience was 13.5 and 12.8 years, respectively. For magnetic resonance arthrography, a gadolinium dilution of 1/200 was used by 69-71%. For shoulder arthrography, an anterior approach was preferred by 65/68 (96%). The most common site of needle end position, for anterior and posterior approaches, was immediately lateral to the humeral cortex. A 22-gauge needle was used by 46/66 (70%). Mean injected volume was 12.7 ml (5-30). For hip arthrography, an anterior approach was preferred by 51/68 (75%). The most common site of needle end position, for anterior and lateral approaches, was along the lateral femoral head/neck junction. A 22-gauge needle was used by 53/68 (78%). Mean injected volume was 11.5 ml (5-20). For knee arthrography, a lateral approach was preferred by 41/64 (64%). The most common site of needle end position, for lateral and medial approaches, was mid-patellofemoral joint level. A 22-gauge needle was used by 36/65 (56%). Mean injected volume was 28.2 ml (5-60). Arthrographic approaches for the shoulder, hip, and knee vary among radiologists over a wide range of experience levels. (orig.)

  2. Combined CT and fluoroscopic guidance of balloon kyphoplasty versus fluoroscopy-only procedures

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    Amoretti, Nicolas; Marcy, Pierre-Yves; Lesbats-Jacquot, Virginie; Fonquerne, Marie-Eve; Hericord, Olivier; Maratos, Yvonne [Centre Hospitalier Universitaire de Nice, Service de Radiologie, Nice (France); Hovorka, Istvan [Centre Hospitalier Universitaire de Nice, Spine Surgery Department, Nice (France); Roux, Christian; Euller-Ziegler, Liana [Centre Hospitalier Universitaire de Nice, Rheumatology Department, Nice (France)

    2009-07-15

    To evaluate the performance of combined (computed tomography (CT) and fluoroscopic) guidance of balloon kyphoplasty in comparison to fluoroscopic guidance alone. Forty-one kyphoplasties were performed between January 2005 and March 2006 according to two different protocols. Study group 1 consisted of 20 consecutive patients with 20 balloon kyphoplasty procedures under dual guidance (CT scan and fluoroscopy) for osteoporotic or traumatic vertebral fractures. Study group 2 consisted of 21 consecutive patients in whom kyphoplasty was performed with fluoroscopy alone. Visualization of the pedicles, the final of the balloon position, and cement distribution were evaluated(1 - poor, 2 - intermediate, 3 - good). Combined use of CT and fluoroscopy (group 1) was superior in identifying the pedicles (100% versus 66.7%, p = 0.009) and balloon placement (100% versus 71.4%, p = 0.02) but not in monitoring of cement distribution within the vertebral body (100% versus 90.5%, p = 0.49). The difference between the two groups was more pronounced in the thoracic spine than in the lumbar spine. CT/fluoroscopic guidance of kyphoplasty combines safe CT-guided insertion of the osteointroducers and balloons as well as fluoroscopic real-time monitoring of polymethylmethacrylate injection. (orig.)

  3. Foreign body extraction from soft tissue by using CT and fluoroscopic guidance: a new technique

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    Amoretti, Nicolas; Marcy, Pierre-Yves; Lesbats-Jacquot, Virginie; Fonquerne, Marie-Eve; Maratos, Yvonne [Centre Hospitalier Universitaire de Nice, Radiology Department, Nice (France); Hauger, Olivier [Hopital Pellegrin, Unite d' Imagerie Osteo-articulaire, CHU de Bordeaux (France); Hovorka, Istvan; Boileau, Pascal [Centre Hopitalier Universitaire de Nice, Orthopaedic Department, Nice (France)

    2010-01-15

    We report on a new minimally invasive technique for the retrieval of a surgical pin fragment after accidental migration into the soft tissue of the shoulder in two patients. The technique is performed under local anaesthesia and uses combined CT and fluoroscopic guidance. The materials used were simple, combining a bone biopsy needle and an endoscopy clamp. Pin displacement was confirmed under fluoroscopic guidance and the clamp was used to withdraw the pin to the cutaneous entry point under CT (step-by-step) guidance. The CT slices provide perfect visualisation of the vascular or nervous structures as well as perfect positioning of the extremity of the trocar relative to the material to be removed. This intervention avoids a second surgical intervention with a longer incision and avoided repeated general anaesthesia. (orig.)

  4. Correction of malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance

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    Lee, Seung Ryong; Baek, Kyong Hee; Jung, Gyoo Sik; Huh, Jin Do; Joh, Young Duk; Rim, Hark [Kosin Medical College, Pusan (Korea, Republic of)

    1997-11-01

    To determine the efficacy of correction of a malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance. Between November 1994 and March 1997, we performed 15 manipulations in 12 patients in whom a dual-cuff, straight Tenckhoff peritoneal dialysis catheter had been implanted due to chronic renal failure. The causes of catheter malfunctioning were inadequate drainage of the dialysate(n=14) and painful dialysis(n=1). Under fluoroscopic guidance, adhesiolysis and repositioning of the malfunctioning catheter were performed with an Amplatz Super Stiff guidewire and the stiffener from a biliary drainage catheter. The results of procedures were categorized as either immediate or durable success, this latter being defined as adequate catheter function for at least one month after the procedure. Immediate success was achieved in 14 of 15 procedures (93%), and durable success in 7 of 15(47%). The mean duration of catheter function was 157 (range, 30 to 578) days. After manipulation, abdominal pain developed in eight patients and peritonitis in two, but with conservative treatment, these symptoms improved. The correction of a malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance is an effective means of restoring catheter function and may be an effective alternative to surgical reimplantation of the catheter, or hemodialysis.

  5. Percutaneous drainage of psoas abscess under real-time computed tomography fluoroscopic guidance

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    Yamagami, Takuji; Terayama, Koshi; Yoshimatsu, Rika; Matsumoto, Tomohiro; Miura, Hiroshi; Nishimura, Tsunehiko [Kyoto Prefectural University of Medicine, Department of Radiology, Graduate School of Medical Science, Kyoto (Japan)

    2009-03-15

    The goal of our study was to determine the usefulness of percutaneous abscess drainage under guidance of computed tomography (CT) fluoroscopy. Our subjects were 21 patients (seven women, 14 men; mean age 64 years; age range 30-87 years) who had undergone percutaneous drainage of 26 psoas abscess lesions under CT fluoroscopic guidance between May 2001 and January 2008. Drainage methods involved a needle puncture, insertion of a guidewire, serial dilations, and the exchange of the needle with a drainage tube. The procedures were guided by use of a helical CT scanner that provided real-time fluoroscopic reconstruction. Percutaneous drainage under real-time CT fluoroscopic guidance was successfully performed in every procedure. Use of real-time CT fluoroscopy allowed rapid assessment of needle, guidewire, and catheter placement. No patient had serious complications related to the drainage procedure. The mean procedure time required to drain one lesion was 35.6 {+-} 13.6 min. Mean period after the drainage procedure until complete disappearance of the abscess as confirmed by CT was 12.4 {+-} 10.0 days (range 3-46 days). CT fluoroscopy is useful in achieving accurate and safe drainage of abnormal psoas fluid collections. (orig.)

  6. Transthoracic fine needle aspiration biopsy of subcarinal lesion: oblique approach using biplane fluoroscopic guidance

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    Kim, Sung Tae; Jeon, Seok Chol; Choi, Yo Won; Seo, Heung Suk; Hahm, Chang Kok [School of Medicine, Hanyang University, Seoul (Korea, Republic of)

    1995-09-15

    To evaluate effectiveness of oblique approach under biplane fluoroscopic guidance in transthoracic fine needle aspiration biopsy. Fourteen consecutive patients underwent transthoracic fine needle aspiration biopsy for subcarinal lesions. Subcarina was the only accessible biopsy site in 13 patients. Subcarinal biopsy was performed to determine the presence of metastasis in an enlarged subcarinal lymph node in the remaining one patient. Before biopsy, we evaluated the size and location of the lesion on preliminary plain chest X-ray film and CT scan. Under dual projection fluoroscopic guidance, biopsy was performed through right posterior intercostal space with the patient prone by using oblique approach. On 15 degree LAO projection the needle was directed to the area anterior to the spine and advanced to the line extending through the posterior wall of the main bronchus. Cytologic diagnosis was made in 12 out of 14 patients(accuracy 85.7%). The final diagnosis consisted of 5 squamous cell carcinoma, 5 small cell carcinoma, 1 adenocarcinoma and 1 adenosquamous carcinoma. Pneumothorax developed in 2 patients(14%) and was managed by chest tube drainage. Mild hemoptysis was observed in 2. Transthoracic fine needle aspiration biopsy using oblique approach under biplane fluoroscopic guidance is a relatively safe and sensitive method for the histologic diagnosis of subcarinal lesion.

  7. Pediatric Percutaneous Osteoid Osteoma Ablation: Cone-Beam CT with Fluoroscopic Overlay Versus Conventional CT Guidance.

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    Perry, Brandon C; Monroe, Eric J; McKay, Tyler; Kanal, Kalpana M; Shivaram, Giridhar

    2017-05-11

    To compare technical success, clinical success, complications, radiation dose, and total room utilization time for osteoid osteoma thermal (radiofrequency or microwave) ablation using cone-beam computed tomography (CBCT) with two-axis fluoroscopic navigational overlay versus conventional computed tomography (CT) guidance. A retrospective review was performed to identify all osteoid osteoma ablations performed over a 5.5-year period at a single tertiary care pediatric hospital. Twenty-five ablations (15 radiofrequency and 10 microwave) in 23 patients undergoing fluoroscopic CBCT-guided osteoid osteoma ablation were compared to 35 ablations (35 radiofrequency) in 32 patients undergoing ablation via conventional CT guidance. Dose area product and dose length product were recorded for CBCT and conventional CT, respectively, and converted to effective doses. Technical success, clinical success (cessation of pain and medication use 1 month after ablation), complications, radiation dose, and total room utilization time were compared. All procedures were technically successful. Twenty-two of 25 (88.0%) CBCT and 31 of 35 (88.6%) conventional CT-guided ablations achieved immediate clinical success. There were two minor complications in each group and no major complications. Mean effective radiation dose was significantly lower for CBCT compared to CT guidance (0.12 vs. 0.39 mSv, p = 0.02). Mean total room utilization time for CBCT was longer (133.5 vs. 97.5 min, p = 0.0001). Fluoroscopic CBCT guidance for percutaneous osteoid osteoma ablation yields similar technical and clinical success, reduced radiation dose, and increased total room utilization time compared to conventional CT guidance.

  8. Transrectal Drainage of Deep Pelvic Abscesses Using a Combined Transrectal Sonographic and Fluoroscopic Guidance

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    Jeong, Kyung Soon; Lee, Eun Jung; Ko, Ji Ho; Joh, Young Duk [Gospel Hospital, Kosin University College of Medicine, Busan (Korea, Republic of); Jung, Gyoo Sik [Ulsan Hospital, Ulsan (Korea, Republic of)

    2005-09-15

    To evaluate the feasibility and clinical efficacy of transrectal drainage of a deep pelvic abscess using combined transrectal sonographic and fluoroscopic guidance. From March 1995 and August 2004, 17 patients (9 men; 8 women; mean age, 39 years) suffering from pelvic pain, fever and leukocytosis were enrolled in this retrospective study. Ultrasound (US) or computed tomography (CT), which was obtained prior to the procedure, showed pelvic fluid collections that were deemed unapproachable by the percutaneous trans abdominal routes. Transrectal drainage of the pelvic abscess was performed under combined transrectal sonographic and fluoroscopic guidance. The causes of the deep pelvic abscess were postoperative complications (n=7), complications associated with radiation (n=3) and chemotherapy (n=1) as well as unknown causes (n=6). A 7.5-MHz end-firing transrectal US probe with a needle biopsy guide attachment was advanced into the rectum. Once the abscess was identified, a needle was advanced via the biopsy guide and the abscess was punctured. Under US guidance, either a 0.018'or 0.035' guide wire was passed through the needle in the abscess. Under fluoroscopic guidance, the tract was dilated to the appropriate diameter with sequential fascial dilators, and a catheter was placed over the guide wire within the abscess. Clinical success of drainage was determined by a combination closure of the cavity on the follow up images and diminished leukocytosis. The technical and clinical success rate, complications, and patient's discomfort were analyzed. Drainage was technically successful in all patients and there were no serious complications. Surgery was eventually performed in two cases due to fistular formation with the rectum and leakage of the anastomosis site. The procedure was well tolerated in all but one patient who complained of discomfort while the catheter was inserted . The catheter did not interfere with defecation and there was no incidence of

  9. T-Fastener Gastropexy and Percutaneous Gastrostomy Under CT-Fluoroscopic Guidance in a Patient with Partial Gastrectomy

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    Siu-Cheung Chan

    2006-01-01

    Full Text Available The real-time images of computed tomography (CT-fluoroscopy provide an excellent means of guidance for percutaneous interventions. We describe the performance of T-fastener gastropexy and percutaneous gastrostomy under CT-fluoroscopic guidance in a 59-year-old woman who had received total pharyngolaryngectomy for hypopharyngeal cancer and partial gastrectomy with Billroth II anastomosis for bleeding gastric ulcer 10 years before this operation. The previous gastric operation altered the gastrointestinal anatomy and made conventional fluoroscopic-guided percutaneous gastrostomy extremely difficult and risky. The T-fastener gastropexy and percutaneous gastrostomy were accomplished smoothly in a single session using CT-fluoroscopic guidance. This modified method of percutaneous gastrostomy may be useful in patients with anatomic distortion due to previous gastric surgery.

  10. Percutaneous radiofrequency ablation for lung tumors beneath the rib under CT fluoroscopic guidance with gantry tilt

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    Suzuki, Takanobu; Yamagami, Takuji; Tanaka, Osamu; Yoshimatsu, Rika; Miura, Hiroshi; Nishimura, Tsunehiko (Dept. of Radiology, Graduate School of Medical Science, Kyoto Prefectural Univ. of Medicine, Kamigyo, Kyoto (Japan)), e-mail: yamagami@koto.kpu-m.ac.jp

    2010-05-15

    Background: Radiofrequency (RF) ablation of lung tumors has become a treatment of choice, especially for unresectable cases. However, RF ablation of small lung lesions located just beneath the rib is difficult. Purpose: To evaluate the efficacy and safety of gantry tilting for the performance of RF ablation of peripheral lesions located beneath the rib. Material and Methods: Our study was based on 18 of 293 lesions in the lung for which RF ablation was performed under CT scan fluoroscopic guidance at our institution between October 2004 and March 2009. For these 18 lesions, RF ablation was performed with gantry tilting because a rib blocked visualization of the RF ablation route even after other attempts had been made to change the relationship between the target and the rib. Results: All RF needles, with only one exception, were successfully advanced to hit the tumor. The commonest complication was a pneumothorax, which occurred in seven procedures. No serious complications occurred. The progression-free rates were 82.4% at 6 months, 62.5% at 12 months, and 30% at 24 months. Mean local progression-free duration was 17.6+-11.6 months (range 4-36 months). Conclusion: RF ablation under CT scan fluoroscopic guidance with gantry tilt is a useful and safe technique for RF ablation of lung nodules located beneath the rib

  11. Percutaneous vertebroplasty: optimizing the procedure after treatment of 250 vertebral levels under fluoroscopic guidance.

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    Pedicelli, A; Rollo, M; Piano, M; Grattacaso, G; Colosimo, C; Bonomo, L

    2009-10-01

    Percutaneous vertebroplasty (PVP) is a minimally invasive treatment for symptomatic vertebral compression fractures (VCFs). The aim of this study was to assess the effectiveness, complications and progress of results of PVP optimized in terms of technique, costs, time and strategic protocol after 3 years of procedures performed under fluoroscopic guidance alone. We treated 250 VCFs in 120 consecutive patients after assessing clinical and radiological indications. The effectiveness of the procedure was determined by statistical analysis of numerical scores for pain, mobility and drug consumption before and after treatment. No major complications and only three minor complications occurred. Clinically relevant improved mobility and reduction of pain and analgesics were observed, with overall significant results (p<0.0001) in all patients at 24 h after PVP and in 83 available patients at 6 months. A total of five asymptomatic refractures of cemented vertebrae and 14 new symptomatic vertebral fractures at different levels were observed between 1 and 10 months after the procedure. PVP is a safe, rapid, effective and costeffective therapy for VCFs, requiring only brief hospital admission and with long-lasting clinical results, when performed under good-quality radiological guidance, when correct indications are respected and when it is associated with rehabilitation therapy in the follow-up. It is a valid alternative to conservative therapy, which is burdened by high healthcare costs and often requires long-term immobilisation of frail and elderly patients at risk of clinical complications.

  12. Fine needle aspiration of focal lung lesion under CT fluoroscopic guidance

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    Jeon, Hae Jeong; Shin, Hyun Joon; Choi, Young Chil; Park, Sang Woo; Yi, Jeong Geun; Park, Jeong Hee [College of Medicine, Konkuk University, Seoul (Korea, Republic of); Jin, Yong Hyun [Sung Ae Hospital, Seoul (Korea, Republic of)

    2006-07-15

    We wanted to assess the efficacy of using CT fluoroscopy during Fine Needle Aspiration (FNA) for focal lung lesion. We retrospectively reviewed 22 patients who had undergone FNA under CT fluoroscopic guidance. The final diagnosis of focal lung lesion was based on surgery, the results of biopsy taken from another site or the clinical diagnosis with imaging follow-up. We reviewed the imaging and recorded the location of the lesion, the lesion size and the depth from the puncture site. In 24 cases of 22 patients, 16 lesions were benign and 8 were malignant. The sensitivity and specificity for malignant lesions were 100%, and 75%, respectively. The mean size of the malignant lesions was 3.75 {+-} 1.68 cm, and that of the benign lesion was 3.05 {+-} 2.98 cm. The mean depth of the lesion divided by the size was 1.85 {+-} 1.09 for 20 lesions of the correct result group and 3.13 {+-} 1.73 for 4 lesions of the incorrect result group; the difference between the two groups was statistically different ({rho} = 0.030). The complications after FNA were pneumothoraces in three cases and parenchymal hemorrhage in one case, but no significant complication was noted after the procedures. We could perform the FNA accurately and safely under CT fluoroscopy guidance, so this technique can be used for FNA of focal lung lesion for obtaining a correct result with fewer complications.

  13. Placement of central venous access via subclavian vein under fluoroscopic guidance with intravenous contrast injection

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    Choo, Sung Wook; Choo, In Wook; Do, Young Soo; Kim, Seung Hoon; Yoh, Kyu Tong; Ro, Duk Woo; Kim, Bo Kyung [Samsung Medical Center, Seoul (Korea, Republic of)

    1997-01-01

    To evaluate the safety and efficacy of Hickman catheter placement via the subclavian vein under fluoroscopic guidance with intravenous contrast injection. During an eleven-month period, 187 Hickman catheters were percutaneously placed in 167 consecutive patients in an interventional radiology suite. Subclavian venous puncture was made with injection of contrast medium into the peripheral venous line. After subclavian venous access had been obtained, a subcutaneous tunnel was created using a peel-away sheath or a tunneler. The Hickman catheters were inserted through a peel-away sheath, the distal tip of which was as the junction of the right atrium and the superior vena cava. One hundred and eighty-six Hickman catheters were successfully placed ; the one failure was due to anatomical tortuosity of the vein (0.53%). Complications included one case of subclavian vein occlusion (0.53%) ; three of line occlusion by thrombus (1.6%) ; one of oozing at the suture site (0.53%) ; six of infection or inflammation (3.2%) ; eight of natural removal (4.2%) ; one case of air embolism (0.53%) and two of malposition (0.1%). Major complications such as pneumothorax or arterial puncture leading to mediastinal hemorrhage did not, however, occur. The authors concluded that radiologic Hickman catheter placement offers advantages over traditional approaches in terms of safety, convenience, and time and cost savings.

  14. Technical and imaging report: fluoroscopic guidance for diagnosis and treatment of lumbar synovial cyst.

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    Rauchwerger, Jacob J; Candido, Kenneth D; Zoarski, Gregg H

    2011-01-01

    Lumbar synovial cysts can be a source of low back pain with or without radiculopathy depending upon the size and location of the mass. Options for treatment range from analgesics to surgery, depending upon the degree of nerve root or spinal cord impingement. Attempts at minimally invasive treatment such as computed tomography-assisted aspiration and cyst rupture are documented in the radiology literature with varying degrees of reported success. This case report is the first to document the fluoroscopically-guided management of a lumbar synovial cyst in the pain medicine literature and highlights the knowledge and technical skills required when treating such cases. © 2010 World Institute of Pain.

  15. Placement of subcutaneous ureteral bypasses without fluoroscopic guidance in cats with ureteral obstruction: 19 cases (2014-2016).

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    Livet, Véronique; Pillard, Paul; Goy-Thollot, Isabelle; Maleca, David; Cabon, Quentin; Remy, Denise; Fau, Didier; Viguier, Éric; Pouzot, Céline; Carozzo, Claude; Cachon, Thibaut

    2016-09-30

    The purpose of this study was to describe the perioperative and postoperative complications as well as short-term and long-term outcomes in cats with ureteral obstructions treated by placement of a subcutaneous ureteral bypass (SUB) device without imaging control. The second objective of this study was to compare cats treated by SUB device with cats treated by traditional surgical intervention. Data were obtained retrospectively from the medical records (2014-2016) of cats that underwent SUB placement (SUB cats) and cats that underwent traditional ureteral surgery (C cats). Nineteen SUB devices were placed without fluoroscopic, radiographic or ultrasonographic guidance in 13 cats. Fifteen traditional interventions (ureterotomy and neoureterocystostomy) were performed in 11 cats. Successful placement of the SUB device was achieved in all cats with only one major intraoperative complication (kinking of the kidney catheter) and one minor intraoperative complication (misplacement of the kidney catheter). Eleven SUB cats recovered from the surgical procedure; two SUB cats and three C cats died during the anaesthesia recovery period. Postoperative SUB complications included anaemia (n = 2), urinary tract infection (UTI) (n = 4), non-infectious cystitis (n = 5) and SUB device obstruction (n = 1). Postoperative traditional surgery complications included anaemia (n = 7), UTIs (n = 6), non-infectious cystitis (n = 1), re-obstruction (n = 4) and ureteral stricture (n = 1). Median postoperative duration of hospitalisation (3 days) was significantly shorter for SUB cats than for C cats (P = 0.013). Ten SUB cats (76.9%) and four C cats (40%) were still alive at a median follow-up of 225 days and 260 days, respectively. Owners were completely (90%) or mostly (10%) satisfied with the SUB device placement. SUB device placement appears to be an effective and safe option for treating ureteral obstruction in cats, and this study has shown that fluoroscopic guidance is not essential in

  16. Diagnostic performance of percutaneous lung biopsy using automated biopsy needles under CT-fluoroscopic guidance for ground-glass opacity lesions

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    Yoshimatsu, R; Miura, H; Yamada, K; Takahata, A; Matsumoto, T; Hasebe, T

    2013-01-01

    Objective: The goal of our study was to evaluate the diagnostic performance of percutaneous lung biopsy under CT-fluoroscopic guidance for ground-glass opacity (GGO) lesions. Methods: 85 percutaneous needle lung biopsies were performed in 73 patients. Specimens were obtained by core biopsy utilising an automated cutting needle and were evaluated histologically. Final diagnosis was confirmed by independent surgical pathology, independent culture results or clinical follow-up. Results: Rates of adequate specimens obtained and of precise diagnosis by needle biopsy were 92.9% (79/85) and 90.6% (77/85) of evaluated lung lesions, respectively. Precise diagnosis was achieved in 87.1% (27/31) of lesions ≤10 mm in diameter, 90.0% (36/40) of lesions >10 mm to ≤20 mm and 100.0% (14/14) of lesions >20 mm. Precision in diagnosing GGO lesions according to the GGO component was 73.9% (17/23) for pure GGO lesions and 96.8% (60/62) for part-solid GGO lesions. Obtaining a precise diagnosis did not differ significantly according to the lesion size (p=0.3840), but differences were significant according to the GGO component (p=0.0047). Malignancy was accurately diagnosed in 35 of 36 malignant lesions for which surgery was later performed. The specific cell type determined from specimens obtained by needle biopsy was exactly the same as the final histological diagnosis obtained after surgery in 20 lesions. Conclusion: Tissue-core lung biopsy under CT-fluoroscopic guidance for a GGO lesion provides a high degree of diagnostic accuracy but is less reliable for determining the specific cell type. Advances in knowledge: Percutaneous lung biopsy under CT-fluoroscopic guidance for GGO is useful in differentiating malignancy. PMID:23385998

  17. Transcutaneous aortic valve replacement with the Edwards SAPIEN XT and Medtronic CoreValve prosthesis under fluoroscopic guidance and local anaesthesia only.

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    Greif, Martin; Lange, Philipp; Näbauer, Michael; Schwarz, Florian; Becker, Christoph; Schmitz, Christoph; Pohl, Tilmann; D'Anastasi, Melvin; Boekstegers, Peter; Massberg, Steffen; Kupatt, Christian

    2014-05-01

    To assess the feasibility of transcatheter aortic valve implantation (TAVI; Medtronic CoreValve and Edwards SAPIEN XT) under local anaesthesia with only mild analgesic medication and fluoroscopic guidance. 461 patients underwent TAVI under local anaesthesia with lidocaine. The procedure was performed successfully in 459 of the cases. All patients were also treated with piritramide, metoclopramide hydrochloride and 62 mg dimenhydrinate. Monitoring consisted of a six-electrode, virtual 12-lead ECG, pulse oximetry, and invasive arterial pressure measurement. There was no continuous surveillance by an anaesthesiologist. There was no need for conversion to general anaesthesia except in four patients who required cardiopulmonary resuscitation. Conscious sedation with intravenous administration of midazolam for agitation or inotropic medication for prolonged hypotension was necessary in only seven of the 461 patients. The combined safety end point according to the Valve Academic Research Consortium consensus document was reached in 12.6%. Our results show that TAVI performed under local anaesthesia with only mild analgesic medication and under fluoroscopic guidance is feasible, with good outcome comparable to published data.

  18. The need for using fluoroscopic guidance to obtain gastric biopsies when in search of Helicobacter pylori with a nonendoscopic method

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    Bender, Greg N.; Mullins, Daniel J.; Makuch, Richard S

    1999-12-01

    Purpose: Nonendoscopic, fluoroscopic biopsy of the gastric mucosa, following barium examination of the stomach, has gained attention with its ease of performance and cost savings potential over endoscopy. Endoscopic research concerning the efficacy of biopsy sites has revealed an increased sensitivity of antral biopsies over greater curvature biopsies for the detection of Helicobacter pylori. Fluoroscopically guided biopsies of the gastric mucosal are studied to determine whether such a difference between site sensitivity held true. If not, blind biopsy through a nasogastric tube, which traditionally samples only the greater curvature, might prove an even less expensive alternative. Materials and methods: Seventy-two patients underwent nonendoscopic, fluoroscopically guided, mucosal biopsy of both the gastric antrum and the greater curvature of the stomach. Pathologic reports from both sites, using each patient as their own control, are compared to assess site sensitivity in the diagnosis of H. pylori gastritis. Results: The sensitivity for the detection of H. pylori gastritis by antral biopsy is 89% whereas the sensitivity of greater curvature biopsy is 62%. The difference is considered clinically significant at P{<=}0.05. Conclusions: This study confirms the need for antral biopsies when desiring a nonendoscopic approach to gastric mucosal sampling, in order to obtain a reasonable yield of data in dyspeptic patients with H. pylori gastritis. Blind techniques cannot reliably reach the antrum. Fluoroscopy can, and remains a less expensive alternative to endoscopy.

  19. Direct percutaneous transorbital puncture under fluoroscopic guidance with a 3D skull reconstruction overlay for embolisation of intraorbital and cavernous sinus dural arteriovenous fistulas.

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    Lv, Ming; Jiang, Chuhan; Liu, Dong; Ning, Zhiguang; Yang, Jun; Wu, Zhongxue

    2015-06-01

    To describe the direct percutaneous transorbital puncture technique for embolisation of the selected intraorbital and cavernous sinus dural arteriovenous fistula, which failed to be treated by conventional endovascular techniques. One case of intraorbital and five cases of cavernous sinus dural arteriovenous fistula were embolised through direct percutaneous transorbital puncture in 2012, and the clinical data were reviewed. Under fluoroscopic guidance with a three-dimensional (3D) skull reconstruction overlay, the cavernous sinus or ophthalmic vein was punctured via the superior orbital fissure. Then a microcatheter was inserted via the needle, and Onyx was injected to embolise the fistula with or without a combination of coils. Complete obliteration of the fistula was achieved in all six patients. After operation all the patients experienced transient swelling of the punctured orbit persisting for three to five days. No other complications occurred. Follow-up of six patients at three to six months showed resolution of their initial neuro-ophthalmological symptoms in five and left visual loss in one did not recover. Six months follow-up angiogram showed no recurrence of these fistulas. Direct percutaneous transorbital puncture provides an option for the intraorbital and cavernous sinus dural arteriovenous fistulas, particularly when the conventional transvenous routes are inaccessible. Overlay of the 3D skull reconstruction can facilitate the precise puncture of the superior orbital fissure. © The Author(s) 2015.

  20. Practical guidance on undertaking a service evaluation.

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    Moule, Pam; Armoogum, Julie; Dodd, Emily; Donskoy, Anne-Laure; Douglass, Emma; Taylor, Julie; Turton, Pat

    2016-07-06

    This article describes the basic principles of evaluation, focusing on the evaluation of healthcare services. It emphasises the importance of evaluation in the current healthcare environment and the requirement for nurses to understand the essential principles of evaluation. Evaluation is defined in contrast to audit and research, and the main theoretical approaches to evaluation are outlined, providing insights into the different types of evaluation that may be undertaken. The essential features of preparing for an evaluation are considered, and guidance provided on working ethically in the NHS. It is important to involve patients and the public in evaluation activity, offering essential guidance and principles of best practice. The authors discuss the main challenges of undertaking evaluations and offer recommendations to address these, drawing on their experience as evaluators.

  1. Practical guidance for charting ethics consultations.

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    Bruce, Courtenay R; Smith, Martin L; Tawose, Olubukunola Mary; Sharp, Richard R

    2014-03-01

    It is generally accepted that appropriate documentation of activities and recommendations of ethics consultants in patients' medical records is critical. Despite this acceptance, the bioethics literature is largely devoid of guidance on key elements of an ethics chart note, the degree of specificity that it should contain, and its stylistic tenor. We aim to provide guidance for a variety of persons engaged in clinical ethics consultation: new and seasoned ethics committee members who are new to ethics consultation, students and trainees in clinical ethics, and those who have significant experience with ethics consultation so that they can reflect on their practice. Toward the goal of promoting quality charting practices in ethics consultations, we propose recommendations on a broad array of questions concerning clinical ethics consultation chart notes, including whether and when to write a chart note, and practical considerations for the tenor, purpose, and content of a chart note. Our broader aim is to promote discussion about good charting practices in clinical ethics, with the hope of contributing to clear standards of excellence in clinical ethics consultation.

  2. Some Practical Remedies for Providing Vocational Guidance for Everyone.

    Science.gov (United States)

    Holland, John L.

    After describing some current problems in vocational guidance and summarizing relevant knowledge and theory in the field, this paper presents some practical plans, materials, and ideas for providing more useful vocational assistance to people of all ages. The paper reviews such prominent vocational guidance approaches as vocational information and…

  3. Rethinking Careers Education and Guidance: Theory, Policy and Practice.

    Science.gov (United States)

    Watts, A. G.; Law, Bill; Killeen, John; Kidd, Jennifer M.; Hawthorn, Ruth

    This book contains 21 papers on the theory, context, provision, practice, and development of career counseling and guidance in Great Britain. The following papers are included: "Preface" (Tony Watts et al.); "The Social Context of Guidance" (John Killeen); "Career Theory" (John Killeen); "A Career-Learning…

  4. Fluoroscopic image-guided intervention system for transbronchial localization

    Science.gov (United States)

    Rai, Lav; Keast, Thomas M.; Wibowo, Henky; Yu, Kun-Chang; Draper, Jeffrey W.; Gibbs, Jason D.

    2012-02-01

    Reliable transbronchial access of peripheral lung lesions is desirable for the diagnosis and potential treatment of lung cancer. This procedure can be difficult, however, because accessory devices (e.g., needle or forceps) cannot be reliably localized while deployed. We present a fluoroscopic image-guided intervention (IGI) system for tracking such bronchoscopic accessories. Fluoroscopy, an imaging technology currently utilized by many bronchoscopists, has a fundamental shortcoming - many lung lesions are invisible in its images. Our IGI system aligns a digitally reconstructed radiograph (DRR) defined from a pre-operative computed tomography (CT) scan with live fluoroscopic images. Radiopaque accessory devices are readily apparent in fluoroscopic video, while lesions lacking a fluoroscopic signature but identifiable in the CT scan are superimposed in the scene. The IGI system processing steps consist of: (1) calibrating the fluoroscopic imaging system; (2) registering the CT anatomy with its depiction in the fluoroscopic scene; (3) optical tracking to continually update the DRR and target positions as the fluoroscope is moved about the patient. The end result is a continuous correlation of the DRR and projected targets with the anatomy depicted in the live fluoroscopic video feed. Because both targets and bronchoscopic devices are readily apparent in arbitrary fluoroscopic orientations, multiplane guidance is straightforward. The system tracks in real-time with no computational lag. We have measured a mean projected tracking accuracy of 1.0 mm in a phantom and present results from an in vivo animal study.

  5. Unfinished Business with Feminist Thinking and Counselling and Guidance Practice

    Science.gov (United States)

    Wright, Jeannie

    2009-01-01

    This article provides a personal view of the influence of feminist theories on counselling and guidance practice over a 30-year period. It is not intended to be a scoping review of the vast literature on feminist theory and practice in relation to the talking therapies. Based on the subjective experience of one researcher/practitioner, its…

  6. Determinants of nutrition guidance practices of primary-care physicians.

    NARCIS (Netherlands)

    Hiddink, G.J.

    1996-01-01

    The aim of the studies described in this thesis was to analyze nutrition guidance practices of primary-care physicians (PCPs), their nutritional attitudes and knowledge and their interest in the role of nutrition in health and disease. A second objective was to identify the determinants of nutrition

  7. Research Circles - a method for developing guidance practices

    DEFF Research Database (Denmark)

    2012-01-01

    This video reports on our work with using research circles to improve our understanding of how to provide guidance and counseling to help young people in danger of dropping out of school. The video is based on the paper: Research Circles -- a method for developing guidance practices......, and was presented at the Conference for Social Justice, Prosperity and Sustainable Employment 2012 by assistant professor Helle Merete Nordentoft from DPU (http://edu.au.dk/). The film communicating the research paper was created by Mie Nørgaard...

  8. New Jersey's Thomas Edison and the fluoroscope.

    Science.gov (United States)

    Tselos, G D

    1995-11-01

    Thomas Edison played a major role in the development of early x-ray technology in 1896, notably increasing tube power and reliability and making the fluoroscope a practical instrument. Eventually, Edison would move x-ray technology from the laboratory to the marketplace.

  9. Multiple imputation using chained equations: Issues and guidance for practice.

    Science.gov (United States)

    White, Ian R; Royston, Patrick; Wood, Angela M

    2011-02-20

    Multiple imputation by chained equations is a flexible and practical approach to handling missing data. We describe the principles of the method and show how to impute categorical and quantitative variables, including skewed variables. We give guidance on how to specify the imputation model and how many imputations are needed. We describe the practical analysis of multiply imputed data, including model building and model checking. We stress the limitations of the method and discuss the possible pitfalls. We illustrate the ideas using a data set in mental health, giving Stata code fragments.

  10. Percutaneous needle placement using laser guidance: a practical solution

    Science.gov (United States)

    Xu, Sheng; Kapoor, Ankur; Abi-Jaoudeh, Nadine; Imbesi, Kimberly; Hong, Cheng William; Mazilu, Dumitru; Sharma, Karun; Venkatesan, Aradhana M.; Levy, Elliot; Wood, Bradford J.

    2013-03-01

    In interventional radiology, various navigation technologies have emerged aiming to improve the accuracy of device deployment and potentially the clinical outcomes of minimally invasive procedures. While these technologies' performance has been explored extensively, their impact on daily clinical practice remains undetermined due to the additional cost and complexity, modification of standard devices (e.g. electromagnetic tracking), and different levels of experience among physicians. Taking these factors into consideration, a robotic laser guidance system for percutaneous needle placement is developed. The laser guidance system projects a laser guide line onto the skin entry point of the patient, helping the physician to align the needle with the planned path of the preoperative CT scan. To minimize changes to the standard workflow, the robot is integrated with the CT scanner via optical tracking. As a result, no registration between the robot and CT is needed. The robot can compensate for the motion of the equipment and keep the laser guide line aligned with the biopsy path in real-time. Phantom experiments showed that the guidance system can benefit physicians at different skill levels, while clinical studies showed improved accuracy over conventional freehand needle insertion. The technology is safe, easy to use, and does not involve additional disposable costs. It is our expectation that this technology can be accepted by interventional radiologists for CT guided needle placement procedures.

  11. 76 FR 47593 - Guidance for Small Business Entities on Current Good Manufacturing Practice for Positron Emission...

    Science.gov (United States)

    2011-08-05

    ... a guidance for small business entities entitled ``PET Drugs--Current Good Manufacturing Practice... entitled ``PET Drugs--Current Good Manufacturing Practice (CGMP); Small Entity Compliance Guide.'' This... Manufacturing Practice for Positron Emission Tomography Drugs; Availability AGENCY: Food and Drug...

  12. International Conference on Harmonisation; guidance on good manufacturing practice for active pharmaceutical ingredients; availability. Notice.

    Science.gov (United States)

    2001-09-25

    The Food and Drug Administration (FDA) is announcing the availability of a guidance entitled "Q7A Good Manufacturing Practice Guidance for Active Pharmaceutical Ingredients." The guidance was prepared under the auspices of the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH). The guidance describes current good manufacturing practice (CGMP) for manufacturing of active pharmaceutical ingredients (APIs). The guidance is intended to help ensure that all APIs meet the standards for quality and purity they purport or are represented to possess.

  13. Guidance for updating clinical practice guidelines: a systematic review of methodological handbooks

    OpenAIRE

    Vernooij, Robin WM; Sanabria, Andrea Juliana; Solà, Ivan; Alonso-Coello, Pablo; Martínez García, Laura

    2014-01-01

    Background Updating clinical practice guidelines (CPGs) is a crucial process for maintaining the validity of recommendations. Methodological handbooks should provide guidance on both developing and updating CPGs. However, little is known about the updating guidance provided by these handbooks. Methods We conducted a systematic review to identify and describe the updating guidance provided by CPG methodological handbooks and included handbooks that provide updating guidance for CPGs. We search...

  14. Pediatricians' Role and Practices regarding Provision of Guidance about Sexual Risk Reduction to Parents

    Science.gov (United States)

    Miller, Kim S.; Wyckoff, Sarah C.; Lin, Carol Y.; Whitaker, Daniel J.; Sukalac, Thomas; Fowler, Mary Glenn

    2008-01-01

    A randomly selected nationally representative sample of 508 practicing pediatricians was surveyed in order to identify factors associated with physician delivery of primary prevention to parents about sexual risk reduction (SRR). A full 86% (n=435) reported that provision of SRR guidance is equally or more important than other guidance provided to…

  15. Guidance Manual: Asbestos Operations & Maintenance Work Practices. Second Edition.

    Science.gov (United States)

    National Inst. of Building Sciences, Washington, DC.

    This technical manual provides detailed guidance to building owners, asbestos program managers, and operations and maintenance (O&M) workers for managing asbestos-containing materials (ACM) in buildings. The manual addresses four different types of ACM found in buildings and three different levels of precaution which may be warranted by…

  16. 21 CFR 10.115 - Good guidance practices.

    Science.gov (United States)

    2010-04-01

    ... current and new FDA employees involved in the development, issuance, or application of guidance documents will be trained regarding the agency's GGP's. (2) FDA centers and offices will monitor the development..., journal articles and editorials, media interviews, press materials, warning letters, memoranda...

  17. Supervision to Enhance Educational and Vocational Guidance Practice: A Review

    Science.gov (United States)

    Reid, Hazel L.

    2010-01-01

    Supervision to support the work of career practitioners is evident in many countries, but is not universal. This author presents a literature review, intending to emphasise the prime importance of developing supervision for guidance work. The author also considers the issues facing those training to develop the role of supervisors in southeast…

  18. Minimizing radiation dose to patient and staff during fluoroscopic, nasoenteral tube insertions

    Energy Technology Data Exchange (ETDEWEB)

    Rudin, S.; Bednarek, D.R. (New York Univ., NY (United States). School of Medicine)

    1992-02-01

    Since the fluoroscopic image during nasoenteral tube placements is used for guidance and not for diagnosis, a lower contrast image with increased quantum mottle can be easily tolerated. The three methods to reduce the radiation dose rate investigated consisted of removing camera from the image intensifier output phosphor, and setting the fluoroscopic mA to the minimum value so that the kVp could be maximized. Fluoroscopic frozen video frames of a clinical tube insertion comparing the images with and without the dose-saving techniques are presented. Measurements of the radiation dose rates using a Plexiglas phantom show that the dose for patient and staff during fluoroscopic-guided nasoenteral tube placements can be reduced by over a factor of 10 without significantly adversely affecting the actual placement procedure. (author).

  19. Hunger strike among detainees: guidance for good medical practice.

    Science.gov (United States)

    Gétaz, Laurent; Rieder, Jean-Pierre; Nyffenegger, Laurent; Eytan, Ariel; Gaspoz, Jean-Michel; Wolff, Hans

    2012-09-17

    Hunger strike is a regularly reported problem in prison. Although clinical situations are rarely severe, hospitalisation is often considered. In consequence, it is not only physicians working in prisons, but also hospital medical teams who face challenges related to hunger strike, involving somatic, psychological, legal and human rights aspects. Furthermore, deontological rules must be strictly respected when delivering care, particularly in prison setting. Starvation involves metabolic changes and can cause severe, and sometimes even irreversible or fatal complications. Moreover, the phase of re-alimentation should not be trivialised, as re-feeding syndrome is a potentially fatal phenomenon. This article provides guidance for monitoring and management of patients on hunger strike.

  20. Guidance for updating clinical practice guidelines: a systematic review of methodological handbooks.

    Science.gov (United States)

    Vernooij, Robin W M; Sanabria, Andrea Juliana; Solà, Ivan; Alonso-Coello, Pablo; Martínez García, Laura

    2014-01-02

    Updating clinical practice guidelines (CPGs) is a crucial process for maintaining the validity of recommendations. Methodological handbooks should provide guidance on both developing and updating CPGs. However, little is known about the updating guidance provided by these handbooks. We conducted a systematic review to identify and describe the updating guidance provided by CPG methodological handbooks and included handbooks that provide updating guidance for CPGs. We searched in the Guidelines International Network library, US National Guidelines Clearinghouse and MEDLINE (PubMed) from 1966 to September 2013. Two authors independently selected the handbooks and extracted the data. We used descriptive statistics to analyze the extracted data and conducted a narrative synthesis. We included 35 handbooks. Most handbooks (97.1%) focus mainly on developing CPGs, including variable degrees of information about updating. Guidance on identifying new evidence and the methodology of assessing the need for an update is described in 11 (31.4%) and eight handbooks (22.8%), respectively. The period of time between two updates is described in 25 handbooks (71.4%), two to three years being the most frequent (40.0%). The majority of handbooks do not provide guidance for the literature search, evidence selection, assessment, synthesis, and external review of the updating process. Guidance for updating CPGs is poorly described in methodological handbooks. This guidance should be more rigorous and explicit. This could lead to a more optimal updating process, and, ultimately to valid trustworthy guidelines.

  1. X线透视联合超声引导行经皮肝穿胆道引流术治疗梗阻性黄疸的临床应用%Percutaneous transhepatic biliary drainage under fluoroscopic and ultrasound guidance for the treatment of obstructive jaundice: its clinical application

    Institute of Scientific and Technical Information of China (English)

    王建雄; 刘维; 窦晓霞; 王健; 宋莉; 佟小强; 邹英华

    2012-01-01

    Objective To investigate the technical and clinical value of percutaneous transhepatic biliary drainage (PTBD) in treating patients of obstructive jaundice with the help of fluoroscopic and realtime ultrasound monitoring. Methods A total of 78 patients with obstructive jaundice were enrolled in this study. The primary lesions included malignant diseases (n = 70) and benign diseases (n = 8). PTBD was carried out in all patients. Under fluoroscopic and real-time ultrasonography guidance, the biliary duct of the right hepatic lobe (n = 52) or the biliary duct of the left hepatic lobe was punctured and the cholangiography was routinely performed. the drainage procedure was carried out. Results PTBD was successfully accomplished in all patients. No severe complications, such as massive bleeding or biliary peritonitis, occurred. After the treatment the symptoms and signs of obstructive jaundice were gradually improved. The serum levels of both bitirubin and transaminase determined 1-2 weeks after the treatment were decreased, and the reductions were statistically significant when compared with the preoperative data (P < 0.01). Conclusion For the obstructive jaundice, PTBD under the guidance of fluoroscopy and realtime ultrasonography is an effective, safe, simple and economical treatment with fewer complications. (J Intervent Radiol, 2012, 21: 309-313)%目的 分析X线透视联合超声实时引导下经皮肝穿胆道引流术(PTBD)治疗阻塞性黄疸的操作技术及其应用价值.方法 78例阻塞性黄疸患者,其中70例为恶性阻塞性病变,8例为良性阻塞性病变,在超声实时引导结合X线透视下行PTBD术,穿刺右叶胆管52例,穿刺左叶胆管26例,并常规造影.结果所有患者手术均获得成功,未出现大出血及胆汁性腹膜炎等并发症,术后梗阻性黄疸症状逐渐改善,术后1~2周血清胆红素及转氨酶水平较术前明显下降(P<0.01).结论 X线透视结合超声实时引导下PTBD是一种治疗阻

  2. Practical Intersubjectivity and Normative Guidance: Bratman on Shared Agency

    Directory of Open Access Journals (Sweden)

    Roth Abraham Sesshu

    2015-01-01

    Full Text Available In an important new book on shared agency, Michael Bratman develops an account of the normative demand for the coordination of intentions amongst participants in shared agency. Bratman seeks to understand this form of normative guidance in terms of that associated with individual planning intentions. I give reasons to resist his form of reductionism. In addition, I note how Bratman’s discussion raises the interesting issue of the function or purpose of shared intention and of shared agency more generally. According to Bratman, the function of shared intention is to promote interpersonal coordination of intention and action. I suggest that power sharing amongst participants must also be included as a function of shared intention.

  3. Analysis of tuberculosis prevalence surveys: new guidance on best-practice methods

    OpenAIRE

    2013-01-01

    BACKGROUND An unprecedented number of nationwide tuberculosis (TB) prevalence surveys will be implemented between 2010 and 2015, to better estimate the burden of disease caused by TB and assess whether global targets for TB control set for 2015 are achieved. It is crucial that results are analysed using best-practice methods. OBJECTIVE To provide new theoretical and practical guidance on best-practice methods for the analysis of TB prevalence surveys, including analyses at the individual as w...

  4. Nursing research ethics, guidance and application in practice.

    Science.gov (United States)

    Doody, Owen; Noonan, Maria

    2016-07-28

    Ethics is fundamental to good research practice and the protection of society. From a historical point of view, research ethics has had a chequered past and without due cognisance there is always the potential for research to do harm. Research ethics is fundamental to research practice, nurse education and the development of evidence. In conducting research, it is important to plan for and anticipate any potential or actual risks. To engage in research, researchers need to develop an understanding and knowledge of research ethics and carefully plan how to address ethics within their research. This article aims to enhance students' and novice researchers' research ethics understanding and its application to nursing research.

  5. Development of fluoroscopic registration in spinal neuronavigation

    Science.gov (United States)

    Abbasi, Hamid R.; Grzeszczuk, Robert; Chin, Shao; Holz, H.; Hariri, Sanaz; Badr, Rana; Kim, Daniel; Adler, John R.; Shahidi, Ramin

    2001-05-01

    We present a system involving a computer-instrumented fluoroscope for the purpose of 3D navigation and guidance using pre-operative diagnostic scans as a reference. The goal of the project is to devise a computer-assisted tool that will improve the accuracy, reduce risk, minimize the invasiveness, and shorten the time it takes to perform a variety of neurosurgical and orthopedic procedures of the spine. For this purpose we propose an apparatus that will track surgical tools and localize them with respect to the patient's 3D anatomy and pre-operative 3D diagnostic scans using intraoperative fluoroscopy for in situ registration and localization of embedded fiducials. Preliminary studies have found a fiducial registration error (FRE) of 1.41 mm and a Target Localization Error (TLE) of 0.48 mm. The resulting system leverages equipment already commonly available in the operating room (OR), providing an important new functionality that is free of many current limitations, such as the inadequacy of skin fiducials for spinal neuronavigation, while keeping costs contained.

  6. Stenosis in laparoscopic gastric bypass: management by endoscopic dilation without fluoroscopic guidance Estenosis tras derivación gástrica laparoscópica: tratamiento mediante dilataciones endoscópicas sin control radiológico

    Directory of Open Access Journals (Sweden)

    Jesús Espinel

    2011-10-01

    Full Text Available Objectives: gastric bypass is the surgical procedure that is carried out most frequently in the treatment of morbid obesity. Stenosis of the gastro-jejunal anastomosis is a relatively frequent complication that requires endoscopic management. However, the optimal dilation technique is yet to be determined. The purpose of this study was to evaluate the safety and efficacy of dilation with a hydrostatic balloon (CRE without radioscopic guidance in morbidly obese patients treated by laparoscopic bypass. Material and methods: retrospective review of the data elicited from 525 patients treated against morbid obesity with laparoscopic gastric bypass from January, 2006 to November, 2010. Results: a total of 22/525 patients (4.1% developed stenosis of the anastomosis [20 women (91%, 2 men (9%]. In four patients (18.2%, there was an associated anastomotic ulcer, and in one case, there was a history of bleeding of an ulcer treated with sclerosis one month earlier. The diagnosis of stenosis was done in most patients during the first 90 days after the bypass. All cases were resolved by means of endoscopic dilation without radioscopic guidance, 15 cases (68.1% required a single session, 6 cases (27.2% two sessions, and 1 case (4.5% required four sessions. This last case had an associated anastomotic ulcer. The diameter of the balloons ranged from 12 to 20 mm, generally using diameters of 12-15 mm in the first session, and increasing them in the following sessions according to the previous result. One patient treated with a 20 mm balloon presented with a small tear, without showing any evidence of leak of contrast medium in the radioscopic guidance, and was thus managed conservatively. In the follow-up, no re-stenoses were detected. Conclusions: in our experience, stenosis of the anastomosis in the laparoscopic gastric bypass is an infrequent complication. When it happens, dilation with a hydrostatic balloon is an effective and safe treatment. Radioscopic

  7. Guidance for using mixed methods design in nursing practice research.

    Science.gov (United States)

    Chiang-Hanisko, Lenny; Newman, David; Dyess, Susan; Piyakong, Duangporn; Liehr, Patricia

    2016-08-01

    The mixed methods approach purposefully combines both quantitative and qualitative techniques, enabling a multi-faceted understanding of nursing phenomena. The purpose of this article is to introduce three mixed methods designs (parallel; sequential; conversion) and highlight interpretive processes that occur with the synthesis of qualitative and quantitative findings. Real world examples of research studies conducted by the authors will demonstrate the processes leading to the merger of data. The examples include: research questions; data collection procedures and analysis with a focus on synthesizing findings. Based on experience with mixed methods studied, the authors introduce two synthesis patterns (complementary; contrasting), considering application for practice and implications for research.

  8. Upholding Equality and Social Justice: A Social Constructivist Perspective on Emancipatory Career Guidance Practice

    Science.gov (United States)

    Bassot, Barbara

    2012-01-01

    After several years of political agendas focused on social inclusion, career guidance practice needs to return to its roots of promoting equality and social justice. This conceptual article argues that for many years there has been an overreliance on theories focused on the individual, and examines the relationship between social structures and…

  9. Sampling in forests for radionuclide analysis. General and practical guidance

    Energy Technology Data Exchange (ETDEWEB)

    Aro, Lasse (Finnish Forest Research Inst. (METLA) (Finland)); Plamboeck, Agneta H. (Swedish Defence Research Agency (FOI) (Sweden)); Rantavaara, Aino; Vetikko, Virve (Radiation and Nuclear Safety Authority (STUK) (Finland)); Straalberg, Elisabeth (Inst. Energy Technology (IFE) (Norway))

    2009-01-15

    The NKS project FOREST was established to prepare a guide for sampling in forest ecosystems for radionuclide analysis. The aim of this guide is to improve the reliability of datasets generated in future studies by promoting the use of consistent, recommended practices, thorough documentation of field sampling regimes and robust preparation of samples from the forest ecosystem. The guide covers general aims of sampling, the description of major compartments of the forest ecosystem and outlines key factors to consider when planning sampling campaigns for radioecological field studies in forests. Recommended and known sampling methods for various sample types are also compiled and presented. The guide focuses on sampling practices that are applicable in various types of boreal forests, robust descriptions of sampling sites, and documentation of the origin and details of individual samples. The guide is intended for scientists, students, forestry experts and technicians who appreciate the need to use sound sampling procedures in forest radioecological projects. The guide will hopefully encourage readers to participate in field studies and sampling campaigns, using robust techniques, thereby fostering competence in sampling. (au)

  10. Practical guidance for defining a smart grid modernization strategy the case of distribution

    CERN Document Server

    Madrigal, Marcelino

    2015-01-01

    This document provides some practical guidance on how utilities can define their own smart grid vision, identify priorities, and structure investment plans. While most of these strategic aspects apply to any area of the electricity grid, the document focuses on the segment of distribution. The guidance includes key building blocks that are needed to modernize the distribution grid and provides examples of grid modernization projects. Potential benefits that can be achieved (in monetary terms) for a given investment range are also discussed.The concept of the smart grid is relevant to any grid

  11. Evaluation of intracranial aneurysm coil embolization in phantoms and patients using a high resolution microangiographic fluoroscope (MAF)

    Science.gov (United States)

    Ionita, Ciprian N.; Jain, Amit; Loughran, Brendan; Swetadri Vasan, S. N.; Bednarek, Daniel R.; Levy, Elad; Siddiqui, Adnan H.; Snyder, Kenneth V.; Hopkins, L. N.; Rudin, Stephen

    2012-03-01

    Intracranial aneurysm (IA) embolization using Gugliemi Detachable Coils (GDC) under x-ray fluoroscopic guidance is one of the most important neuro-vascular interventions. Coil deposition accuracy is key and could benefit substantially from higher resolution imagers such as the micro-angiographic fluoroscope (MAF). The effect of MAF guidance improvement over the use of standard Flat Panels (FP) is challenging to assess for such a complex procedure. We propose and investigate a new metric, inter-frame cross-correlation sensitivity (CCS), to compare detector performance for such procedures. Pixel (P) and histogram (H) CCS's were calculated as one minus the cross-correlation coefficients between pixel values and histograms for the region of interest at successive procedure steps. IA treatment using GDC's was simulated using an anthropomorphic head phantom which includes an aneurysm. GDC's were deposited in steps of 3 cm and the procedure was imaged with a FP and the MAF. To measure sensitivity to detect progress of the procedure by change in images of successive steps, an ROI was selected over the aneurysm location and pixel-value and histogram changes were calculated after each step. For the FP, after 4 steps, the H and P CCSs between successive steps were practically zero, indicating that there were no significant changes in the observed images. For the MAF, H and P CCSs were greater than zero even after 10 steps (30 cm GDC), indicating observable changes. Further, the proposed quantification method was applied for evaluation of seven patients imaged using the MAF, yielding similar results (H and P CCSs greater than zero after the last GDC deposition). The proposed metric indicates that the MAF can offer better guidance during such procedures.

  12. 无X线监视内镜下置入幽门支架治疗胃出口恶性梗阻36例%Treatment of malignant gastric outlet obstruction by endoscopically implanting pyloric stents without fluoroscopic guidance: an analysis of 36 cases

    Institute of Scientific and Technical Information of China (English)

    吴齐; 李士杰; 曹长琦; 张集昌

    2011-01-01

    AIM: To evaluate the feasibility, efficacy, and complications of endoscopic placement of pyloric stents without fluoroscopic guidance in patients with malignant gastric outlet obstruction.METHODS: The clinical data for 36 patients with malignant gastric outlet obstruction who underwent endoscopic placement of pyloric stents between January 2007 and December 2009 were analyzed retrospectively.RESULTS: Thirty-six patients received a total of 39 stents, one stent each in 33 patients and two stents each in three patients.In seven patients with high-grade stenosis, endoscopic balloon dilatation was performed before stent insertion.Successful stent implantation was achieved in all patients.The gastric outlet obstruction score system (GOOSS) score was significantly increased within 1 and 4 weeks after stent placement (P = 0.000).The mean duration was increased 101.3 days (7-380 days).The mean survival time was 123.3 days (10-380 days).Device-related adverse events included stent migration (n = 2, day 20 and day 65), stent occlusion caused by tumor infiltration (n = 2), and acute cholangitis (n = 1,day 7).No hemorrhage or perforation occurred.CONCLUSION: Endoscopic implantation of pyloric stents without fluoroscopic guidance is a simple, safe and effective method for malignant gastric outlet obstruction.%目的:评价无X线监视内镜下置入幽门支架治疗胃出口恶性梗阻的操作技术、临床疗效及并发症.方法:对2007-01/2009-12接受无X线监视内镜下幽门支架置入治疗的36例胃出口恶性梗阻患者的临床资料进行回顾性分析.结果:36例患者共置入39枚支架,其中3例患者为双支架.7例患者因病变狭窄程度高,先行内镜下球囊扩张,再行支架置入.支架置入成功率100%.患者术后1 wk及4 wk的GOOSS评分高于术前,且差异具有统计学意义(P=0.000).患者GOOSS评分高于术前时间平均为101.3(7-380)d.患者平均生存期123.3(10-380)d.2例患者发生术后支架移位(20 d及65 d).2

  13. MR cone-beam CT fusion image overlay for fluoroscopically guided percutaneous biopsies in pediatric patients.

    Science.gov (United States)

    Thakor, Avnesh S; Patel, Premal A; Gu, Richard; Rea, Vanessa; Amaral, Joao; Connolly, Bairbre L

    2016-03-01

    Lesions only visible on magnetic resonance (MR) imaging cannot easily be targeted for image-guided biopsy using ultrasound or X-rays but instead require MR guidance with MR-compatible needles and long procedure times (acquisition of multiple MR sequences). We developed an alternative method for performing these difficult biopsies in a standard interventional suite, by fusing MR with cone-beam CT images. The MR cone-beam CT fusion image is then used as an overlay to guide a biopsy needle to the target area under live fluoroscopic guidance. Advantages of this technique include (i) the ability for it to be performed in a conventional interventional suite, (ii) three-dimensional planning of the needle trajectory using cross-sectional imaging, (iii) real-time fluoroscopic guidance for needle trajectory correction and (iv) targeting within heterogeneous lesions based on MR signal characteristics to maximize the potential biopsy yield.

  14. Strategic Environmental Assessment as catalyst of healthier spatial planning: The Danish guidance and practice

    DEFF Research Database (Denmark)

    Kørnøv, Lone

    2009-01-01

    and guidance. This paper examines the inclusion of health as a formal component in impact assessment of spatial plans. Based upon a documentary study of 100 environmental reports, the paper analyses and discusses how health impact considerations are incorporated in SEA practice. It is found that health impacts......A wide range of factors within spatial planning can affect health. There is therefore an important scope for Strategic Environmental Assessment (SEA) of spatial plans to protect and improve human health. Due to the EU Directive 2001/42/EC on SEA, health has been made explicit in Danish legislation...... are included in SEA practice and are being interpreted in a broader sense than what the national guidance exemplifies. The frequent included health aspects are noise, drinking water, air pollution, recreation/outdoor life and traffic safety. The primary determinant for health is transport...

  15. A prospective evaluation of complications of 10,000 fluoroscopically directed epidural injections.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Malla, Yogesh; Wargo, Bradley W; Cash, Kimberly A; Pampati, Vidyasagar; Fellows, Bert

    2012-01-01

    Among the multiple modalities of treatments available in managing chronic spinal pain, including surgery and multiple interventional techniques, epidural injections by various routes, such as interlaminar epidural injections, caudal epidural injections, transforaminal epidural injections, and percutaneous adhesiolysis are common. Even though the complications of fluoroscopically directed epidural injections are fewer than blind epidural injections, and have better effectiveness, multiple complications have been reported in scattered case reports, with only minor complications in randomized or non-randomized studies and systematic reviews. Thus, prospective studies with large patient series are essential to determine the types and incidences of complications. A prospective, non-randomized study of patients undergoing interventional techniques from May 2008 to December 2009. A private interventional pain management practice, a specialty referral center in the United States. To assess the complication rate of fluoroscopically directed epidural injections. This study was carried out over a period of 20 months and included over 10,000 procedures: 39% caudal epidurals, 23% cervical interlaminar epidurals, 14% lumbar interlaminar epidurals, 13% lumbar transforaminal epidurals, 8% percutaneous adhesiolysis, and 3% thoracic interlaminar epidural procedures. All of the interventions were performed under fluoroscopic guidance in an ambulatory surgery center by one of 3 physicians. The complications encountered during the procedure and postoperatively were prospectively evaluated. Measurable outcomes employed were intravascular entry of the needle, profuse bleeding, local hematoma, bruising, dural puncture and headache, nerve root or spinal cord irritation with resultant injury, infectious complications, vasovagal reactions, and facial flushing. Intravascular entry was higher for adhesiolysis (11.6%) and lumbar transforaminal (7.9%) procedures compared to other epidurals which

  16. Withdrawal of ventilatory support outside the intensive care unit: guidance for practice

    OpenAIRE

    Laddie, Joanna; Craig, Finella; Brierley, Joe; Kelly, Paula; Bluebond-Langner, Myra

    2014-01-01

    Objective To review the work of one tertiary paediatric palliative care service in facilitating planned withdrawal of ventilatory support outside the intensive care setting, with the purpose of developing local guidance for practice. Methods Retrospective 10-year (2003–2012) case note review of intensive care patients whose parents elected to withdraw ventilation in another setting. Demographic and clinical data revealed common themes and specific incidents relevant to local guideline develop...

  17. Guidance for the practical management of the heparin anticoagulants in the treatment of venous thromboembolism.

    Science.gov (United States)

    Smythe, Maureen A; Priziola, Jennifer; Dobesh, Paul P; Wirth, Diane; Cuker, Adam; Wittkowsky, Ann K

    2016-01-01

    Venous thromboembolism (VTE) is a serious and often fatal medical condition with an increasing incidence. Despite the changing landscape of VTE treatment with the introduction of the new direct oral anticoagulants many uncertainties remain regarding the optimal use of traditional parenteral agents. This manuscript, initiated by the Anticoagulation Forum, provides clinical guidance based on existing guidelines and consensus expert opinion where guidelines are lacking. This specific chapter addresses the practical management of heparins including low molecular weight heparins and fondaparinux. For each anticoagulant a list of the most common practice related questions were created. Each question was addressed using a brief focused literature review followed by a multidisciplinary consensus guidance recommendation. Issues addressed included initial anticoagulant dosing recommendations, recommended baseline laboratory monitoring, managing dose adjustments, evidence to support a relationship between laboratory tests and meaningful clinical outcomes, special patient populations including extremes of weight and renal impairment, duration of necessary parenteral therapy during the transition to oral therapy, candidates for outpatient treatment where appropriate and management of over-anticoagulation and adverse effects including bleeding and heparin induced thrombocytopenia. This article concludes with a concise table of clinical management questions and guidance recommendations to provide a quick reference for the practical management of heparin, low molecular weight heparin and fondaparinux.

  18. Research-Based Knowledge: Researchers' Contribution to Evidence-Based Practice and Policy Making in Career Guidance

    Science.gov (United States)

    Haug, Erik Hagaseth; Plant, Peter

    2016-01-01

    To present evidence for the outcomes of career guidance is increasingly seen as pivotal for a further professionalization of policy making and service provision. This paper puts an emphasis on researchers' contribution to evidence-based practice and policy making in career guidance. We argue for a broader and more pluralistic research strategy to…

  19. Producing guidance for the management of patients with chronic periodontal disease in general dental practice.

    Science.gov (United States)

    Allen, G

    2015-04-24

    The vast majority of patients will experience gingival-related disease at some point in their life, and up to a quarter of those are susceptible to advanced periodontal disease. This makes its effective management an important part of general dental practice. This paper provides guidance on management which incorporates periodontal assessment, management and recall according to patient's oral hygiene and modifiable risk factors. This has been produced in flow diagram format to aid non-surgical management of chronic gingival and periodontal disease in general dental practice.

  20. Make Change Happen at the Program or Institutional Scale: Converting Community Expertise into Practical Guidance

    Science.gov (United States)

    McDaris, J. R.; Manduca, C. A.; Orr, C. H.

    2016-12-01

    As geoscience and STEM programs address common challenges like increasing the diversity of graduates or implementing active learning pedagogies, it is important to learn from the experiences of others in the community. Individual faculty members embody a wealth of experience on these topics but distilling that experience into practical guidance that has value for a broad audience is not as simple as knowing exactly what one person did. Context is important, not only because activities used in similar contexts are easier to adapt, but also because activities that work across multiple contexts are more robust. The development of any best practices guidance benefits from the engagement of a community. Synthesizing across multiple viewpoints leads to a consensus that builds on the diversity of individual experiences. The Science Education Resource Center (SERC) at Carleton College has had success generating such resources in geoscience and STEM education. Working with different groups of educators, we have helped develop content around making change happen at the program or institutional levels, increasing the diversity of students graduating in geoscience and STEM, fostering interdisciplinary learning, translating the results of education research into practice, and several others. These resources draw out common practices, situate them in the education research base, and highlight examples of their use in the real world but also communicate the different ways individuals or institutions have adapted these practices for their particular situation. These resources were developed through a group synthesis process involving the contribution of individual or group expertise, a face-to-face meeting of teams working on themes drawn from the contributed work, and asynchronous group revision and review following the meeting. The materials developed via this process provide reliable and adaptable guidance firmly rooted in the community's experience. This presentation will

  1. 76 FR 9027 - Draft Guidance for Industry and Food and Drug Administration Staff on Best Practices for...

    Science.gov (United States)

    2011-02-16

    ... HUMAN SERVICES Food and Drug Administration Draft Guidance for Industry and Food and Drug Administration Staff on Best Practices for Conducting and Reporting Pharmacoepidemiologic Safety Studies Using Electronic Healthcare Data Sets; Availability AGENCY: Food and Drug Administration, HHS. ACTION:...

  2. 78 FR 28228 - Guidance for Industry and Food and Drug Administration Staff on Best Practices for Conducting and...

    Science.gov (United States)

    2013-05-14

    ... HUMAN SERVICES Food and Drug Administration Guidance for Industry and Food and Drug Administration Staff on Best Practices for Conducting and Reporting Pharmacoepidemiologic Safety Studies Using Electronic Healthcare Data; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The...

  3. Torsional dynamics of steerable needles: modeling and fluoroscopic guidance.

    Science.gov (United States)

    Swensen, John P; Lin, MingDe; Okamura, Allison M; Cowan, Noah J

    2014-11-01

    Needle insertions underlie a diversity of medical interventions. Steerable needles provide a means by which to enhance existing needle-based interventions and facilitate new ones. Tip-steerable needles follow a curved path and can be steered by twisting the needle base during insertion, but this twisting excites torsional dynamics that introduce a discrepancy between the base and tip twist angles. Here, we model the torsional dynamics of a flexible rod-such as a tip-steerable needle-during subsurface insertion and develop a new controller based on the model. The torsional model incorporates time-varying mode shapes to capture the changing boundary conditions inherent during insertion. Numerical simulations and physical experiments using two distinct setups-stereo camera feedback in semitransparent artificial tissue and feedback control with real-time X-ray imaging in optically opaque artificial tissue-demonstrate the need to account for torsional dynamics in control of the needle tip.

  4. Prevention and management of foot problems in diabetes: A Summary Guidance for Daily Practice 2015, based on the IWGDF guidance documents.

    Science.gov (United States)

    Schaper, N C; Van Netten, J J; Apelqvist, J; Lipsky, B A; Bakker, K

    2017-02-01

    Foot problems complicating diabetes are a source of major patient suffering and societal costs. To prevent, or at least reduce, the adverse effects of foot problems in diabetes, the International Working Group on the Diabetic Foot (IWGDF; www.iwgdf.org) was founded in 1996, consisting of experts from almost all the disciplines involved in the care of patients with diabetes and foot problems. An important output of the IWGDF is the international consensus guidance, continuously updated since 1999. To date, the publications have been translated into 26 languages, and more than 100,000 copies have been distributed globally. The "Summary Guidance for Daily Practice" summarises the essentials of prevention and management of foot problems in persons with diabetes for clinicians who work with these patients on a daily basis. This guidance is the result of a long and careful process that started with the empaneling in 2013 of five working groups consisting of 49 international experts. These experts performed seven targeted systematic reviews to provide the evidence supporting the five chapters of the IWGDF Guidance on prevention; footwear and offloading; diagnosis, prognosis and management of peripheral artery disease; diagnosis and management of foot infections; interventions to enhance healing. In total almost 80,000 studies were detected by our literature review. After review of the title and abstract the reviewers of the different working groups selected only studies that fulfilled a minimal set of quality criteria and ended up with 429 articles for complete quality analysis. The GRADE system was used to translate the evidence from the studies into recommendations for daily clinical practice. The rating of each recommendation takes into account both the strength and the quality of the evidence. The IWGDF Guidance 2015 makes a total of 77 recommendations on prevention and management of foot problems in diabetes. These recommendations were condensed by the editorial

  5. Percutaneous Drainage of Postoperative Pelvic Abscess: Fluoroscopic and US-Guided Transgluteal Approach

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Hyo Jin; Hong, Hyun Pyo; Lee, Hyung Geun; Choi, Yoon Jung; Lee, Young Rae; Lee, Ji Young; Park, Hae Won [Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, Sam Soo [Kangwon National University College of Medicine, Chuncheon (Korea, Republic of)

    2010-08-15

    To retrospectively review the effectiveness and safety of fluoroscopic and US-guided percutaneous transgluteal drainage of postoperative pelvic abscesses. From January 2002 to December 2007, 594 patients underwent surgery at our institution due to rectosigmoid cancer. A retrospective analysis revealed that percutaneous drainage of a postoperative pelvic abscess was performed in 19 out of the 594 patients (3.19%) that underwent surgery (13 male, 6 female; mean age, 57.9 years; age range, 40-82 years). The transgluteal and other methods were used for percutaneous drainage and the success rate, duration of therapy, and complication rate were evaluated. The transgluteal approach was performed with fluoroscopic and US-guidance in 10 patients (52.6%). A catheter was inserted through a preexisting surgical drain in 5 patients (26.3%). The transabdominal approach was performed under US-guidance in 4 patients (21.0%). Technical success was achieved in all patients. The catheter was removed after a mean of 14 days. In 2 patients, who were treated by the transgluteal approach, subsequent surgery was performed due to incomplete resolution of the abscess (10.5%). The mean duration of catheter drainage using the transgluteal approach (16.5 days) was longer than other methods (11.2 days). Furthermore, no procedure-related major complications or mortality was observed in all methods. The percutaneous transgluteal approach to a postoperative pelvic abscess with US and fluoroscopic guidance is relatively safe and effective.

  6. Guidance for researchers developing and conducting clinical trials in practice-based research networks (PBRNs).

    Science.gov (United States)

    Dolor, Rowena J; Schmit, Kristine M; Graham, Deborah G; Fox, Chester H; Baldwin, Laura Mae

    2014-01-01

    There is increased interest nationally in multicenter clinical trials to answer questions about clinical effectiveness, comparative effectiveness, and safety in real-world community settings. Primary care practice-based research networks (PBRNs), comprising community- and/or academically affiliated practices committed to improving medical care for a range of health problems, offer ideal settings for these trials, especially pragmatic clinical trials. However, many researchers are not familiar with working with PBRNs. Experts in practice-based research identified solutions to challenges that researchers and PBRN personnel experience when collaborating on clinical trials in PBRNs. These were organized as frequently asked questions in a draft document presented at a 2013 Agency for Health care Research and Quality PBRN conference workshop, revised based on participant feedback, then shared with additional experts from the DARTNet Institute, Clinical Translational Science Award PBRN, and North American Primary Care Research Group PBRN workgroups for further input and modification. The "Toolkit for Developing and Conducting Multi-site Clinical Trials in Practice-Based Research Networks" offers guidance in the areas of recruiting and engaging practices, budgeting, project management, and communication, as well as templates and examples of tools important in developing and conducting clinical trials. Ensuring the successful development and conduct of clinical trials in PBRNs requires a highly collaborative approach between academic research and PBRN teams. © Copyright 2014 by the American Board of Family Medicine.

  7. Practical guidance for using rivaroxaban in patients with atrial fibrillation: balancing benefit and risk

    Directory of Open Access Journals (Sweden)

    Haas S

    2014-03-01

    Full Text Available Sylvia Haas,1 Christoph Bode,2 Bo Norrving,3 Alexander GG Turpie4 1Technical University Munich, Munich, Germany; 2Department of Cardiology and Angiology, University of Freiburg, Freiburg, Germany; 3Department of Clinical Neuroscience, Lund University Hospital, Lund, Sweden; 4Department of Medicine, McMaster University, Hamilton, Ontario, Canada Abstract: Rivaroxaban is a direct factor Xa inhibitor that is widely available to reduce the risk of stroke or systemic embolism in patients with nonvalvular atrial fibrillation and one or more risk factors for stroke. Rivaroxaban provides practical advantages compared with warfarin and other vitamin K antagonists, including a rapid onset of action, few drug interactions, no dietary interactions, a predictable anticoagulant effect, and no requirement for routine coagulation monitoring. However, questions have emerged relating to the responsible use of rivaroxaban in day-to-day clinical practice, including patient selection, dosing, treatment of patients with renal impairment, conversion from use of vitamin K antagonists to rivaroxaban and vice versa, coagulation tests, and management of patients requiring invasive procedures or experiencing bleeding or an ischemic event. This article provides practical recommendations relating to the use of rivaroxaban in patients with nonvalvular atrial fibrillation, based on clinical trial evidence, relevant guidelines, prescribing information, and the authors' clinical experience. Keywords: novel oral anticoagulants, direct factor Xa inhibitor, peri-interventional management, practical guidance, rivaroxaban, stroke prevention

  8. Long term safety of fluoroscopically guided selective salpingography and tubal catheterization.

    Science.gov (United States)

    Papaioannou, S; Afnan, M; Coomarasamy, A; Ola, B; Hammadieh, N; Temperton, D H; McHugo, J M; Sharif, K

    2002-02-01

    The irradiation of the ovaries of reproductive age women during fluoroscopically guided selective salpingography and tubal catheterization has raised concern about the safety of the procedure. In addition to the risk of cancer induction, which exists with the irradiation of all tissues, with the gonads, the induction of hereditary disorders is possible. The objective of this study was to estimate these risks and present them in a clinically meaningful way. Retrospective analysis was undertaken of 366 consecutive cases of selective salpingography and tubal catheterization performed at the Birmingham Women's Hospital, UK. The radiation doses of different types of procedure were compared with the background annual radiation dose. The risks of cancer and genetic disorders induction were calculated using conversion coefficients published by the International Commission on Radiological Protection. The radiation dose women were exposed to during selective salpingography and tubal catheterization under fluoroscopic guidance was a fraction of the background annual radiation dose. The excess lifetime risks of cancer and hereditary disorders were in the order of four to 13 and two to six per million procedures respectively. The long term risks of selective salpingography and tubal catheterization under fluoroscopic guidance are low.

  9. A Pathophysiological Model-Driven Communication for Dynamic Distributed Medical Best Practice Guidance Systems.

    Science.gov (United States)

    Hosseini, Mohammad; Jiang, Yu; Wu, Poliang; Berlin, Richard B; Ren, Shangping; Sha, Lui

    2016-11-01

    There is a great divide between rural and urban areas, particularly in medical emergency care. Although medical best practice guidelines exist and are in hospital handbooks, they are often lengthy and difficult to apply clinically. The challenges are exaggerated for doctors in rural areas and emergency medical technicians (EMT) during patient transport. In this paper, we propose the concept of distributed executable medical best practice guidance systems to assist adherence to best practice from the time that a patient first presents at a rural hospital, through diagnosis and ambulance transfer to arrival and treatment at a regional tertiary hospital center. We codify complex medical knowledge in the form of simplified distributed executable disease automata, from the thin automata at rural hospitals to the rich automata in the regional center hospitals. However, a main challenge is how to efficiently and safely synchronize distributed best practice models as the communication among medical facilities, devices, and professionals generates a large number of messages. This complex problem of patient diagnosis and transport from rural to center facility is also fraught with many uncertainties and changes resulting in a high degree of dynamism. A critically ill patient's medical conditions can change abruptly in addition to changes in the wireless bandwidth during the ambulance transfer. Such dynamics have yet to be addressed in existing literature on telemedicine. To address this situation, we propose a pathophysiological model-driven message exchange communication architecture that ensures the real-time and dynamic requirements of synchronization among distributed emergency best practice models are met in a reliable and safe manner. Taking the signs, symptoms, and progress of stroke patients transported across a geographically distributed healthcare network as the motivating use case, we implement our communication system and apply it to our developed best practice

  10. Pre-procedural scout radiographs are unnecessary for routine pediatric fluoroscopic examinations

    Energy Technology Data Exchange (ETDEWEB)

    Creeden, Sean G.; Rao, Anil G.; Eklund, Meryle J.; Hill, Jeanne G.; Thacker, Paul G. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States)

    2017-03-15

    Although practice patterns vary, scout radiographs are often routinely performed with pediatric fluoroscopic studies. However few studies have evaluated their utility in routine pediatric fluoroscopy. To evaluate the value of scout abdomen radiographs in routine barium or water-soluble enema, upper gastrointestinal (GI) series, and voiding cystourethrogram pediatric fluoroscopic procedures. We retrospectively evaluated 723 barium or water-soluble enema, upper GI series, and voiding cystourethrogram fluoroscopic procedures performed at our institution. We assessed patient history and demographics, clinical indication for the examination, prior imaging findings and impressions, scout radiograph findings, additional findings provided by the scout radiograph that were previously unknown, and whether the scout radiograph contributed any findings that significantly changed management. We retrospectively evaluated 723 fluoroscopic studies (368 males and 355 females) in pediatric patients. Of these, 700 (96.8%) had a preliminary scout radiograph. Twenty-three (3.2%) had a same-day radiograph substituted as a scout radiograph. Preliminary scout abdomen radiographs/same-day radiographs showed no new significant findings in 719 (99.4%) studies. New but clinically insignificant findings were seen in 4 (0.6%) studies and included umbilical hernia, inguinal hernia and hip dysplasia. No findings were found on the scout radiographs that would either alter the examination performed or change management with regard to the exam. Pre-procedural scout abdomen radiographs are unnecessary in routine barium and water-soluble enema, upper GI series, and voiding cystourethrogram pediatric fluoroscopic procedures and can be substituted with a spot fluoroscopic last-image hold. (orig.)

  11. A Best Practices Notebook for Disaster Risk Reduction and Climate Change Adaptation: Guidance and Insights for Policy and Practice from the CATALYST Project

    NARCIS (Netherlands)

    Hare, M.; Bers, van C.; Mysiak, J.; Calliari, E.; Haque, A.; Warner, K.; Yuzva, K.; Zissener, M.; Jaspers, A.M.J.; Timmerman, J.G.

    2014-01-01

    This publication, A Best Practices Notebook for Disaster Risk Reduction and Climate Change Adaptation: Guidance and Insights for Policy and Practice from the CATALYST Project is one of two main CATALYST knowledge products that focus on the transformative approaches and measures that can support Disa

  12. A Best Practices Notebook for Disaster Risk Reduction and Climate Change Adaptation: Guidance and Insights for Policy and Practice from the CATALYST Project

    NARCIS (Netherlands)

    Hare, M.; Bers, van C.; Mysiak, J.; Calliari, E.; Haque, A.; Warner, K.; Yuzva, K.; Zissener, M.; Jaspers, A.M.J.; Timmerman, J.G.

    2014-01-01

    This publication, A Best Practices Notebook for Disaster Risk Reduction and Climate Change Adaptation: Guidance and Insights for Policy and Practice from the CATALYST Project is one of two main CATALYST knowledge products that focus on the transformative approaches and measures that can support Disa

  13. Fluoroscopic-guided covered metallic stent placement for gastric outlet obstruction and post-operative gastroenterostomy anastomotic stricture

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Min; Han, Young Min; Kim, Chong Soo; Lee, Sang Young; Lee, Soo Teik; Yang, Doo Hyun

    2001-07-01

    AIM: To evaluate the feasibility and safety of fluoroscopic-guided covered metallic stent placements in providing palliative care for patients with inoperable malignant gastric outlet obstruction. MATERIALS AND METHODS: Under fluoroscopic guidance, placement of self-expandable, covered stents was attempted in 20 patients with inoperable or recurrent gastric cancer (age range 36-79 years). All patients had inoperable gastric outlet obstruction, 13 with native anatomy and seven with post-operative anatomy (gastrointestinal anastomotic sites). All patients had intolerance to oral alimentation and/or vomiting after ingestion. Success was defined both technically and clinically. RESULTS: The placement of the stent was technically successful in 18 patients and failed in two patients (technical success: 90%). The cause of the technical failures was an inability to negotiate the guide wire through the obstruction sites in spite of the use of both fluoroscopic and endoscopic guidance. After stent placement, 15 patients were able to ingest at least liquids and had a markedly decreased incidence of vomiting (clinical success: 75%). During the mean follow-up of 6 weeks, there have been no stent reocclusion and no life-threatening complications except migration of two stents in one patient. CONCLUSION: Fluoroscopically guided covered metallic stent placement appears to be valuable for the palliative treatment of malignant obstruction of gastric outlet and post-operative gastrointestinal anastomoses. Lee, J.M. et al. (2001)

  14. Adaptation Guidance for Evidence-Based Teen Pregnancy and STI/HIV Prevention Curricula: From Development to Practice

    Science.gov (United States)

    Rolleri, Lori A.; Fuller, Taleria R.; Firpo-Triplett, Regina; Lesesne, Catherine A.; Moore, Claire; Leeks, Kimberly D.

    2014-01-01

    Evidence-based interventions (EBIs) are effective in preventing adolescent pregnancy and sexually transmitted infections; however, prevention practitioners are challenged when selecting and adapting the most appropriate programs. While there are existing adaptation frameworks, there is little practical guidance in applying research in the field.…

  15. Adaptation Guidance for Evidence-Based Teen Pregnancy and STI/HIV Prevention Curricula: From Development to Practice

    Science.gov (United States)

    Rolleri, Lori A.; Fuller, Taleria R.; Firpo-Triplett, Regina; Lesesne, Catherine A.; Moore, Claire; Leeks, Kimberly D.

    2014-01-01

    Evidence-based interventions (EBIs) are effective in preventing adolescent pregnancy and sexually transmitted infections; however, prevention practitioners are challenged when selecting and adapting the most appropriate programs. While there are existing adaptation frameworks, there is little practical guidance in applying research in the field.…

  16. Psycho-Educational Assessment of Specific Learning Disabilities: Views and Practices of Australian Psychologists and Guidance Counsellors

    Science.gov (United States)

    Meteyard, John D.; Gilmore, Linda

    2015-01-01

    This article reports an investigation of the views and practices of 203 Australian psychologists and guidance counsellors with respect to psycho-educational assessment of students with specific learning disabilities (SLDs). Results from an online survey indicated that practitioners draw upon a wide range of theoretical perspectives when…

  17. The Consideration of a Constructivist Evaluation Framework in Adult Guidance Practice

    Science.gov (United States)

    Hearne, Lucy

    2011-01-01

    This article explores the findings of a doctoral study that examined the measurement of individual progression in the Irish Adult Education Guidance Initiative. The critical constructivist stance of the study challenges the prevalence of the positivist paradigm to evaluate long-term outcomes in adult guidance. The research highlights the…

  18. Use of a fluoroscopic overlay to assist arthroscopic anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Moloney, Gele; Araujo, Paulo; Rabuck, Stephen; Carey, Robert; Rincon, Gustavo; Zhang, Xudong; Harner, Christopher

    2013-08-01

    A growing body of evidence supports the importance of anatomic tunnel positioning in the success of anterior cruciate ligament (ACL) reconstruction, which stimulates the need for technologies to aid surgeons in achieving accurate anatomic tunnel placement. Intraoperative fluoroscopy is potentially one such technology, while its efficacy and usability have yet to be established. To investigate the performance of an intraoperative fluoroscopic overlay in guiding tunnel placement during ACL reconstruction. Controlled laboratory study. Twenty cadaveric knees underwent computed tomography (CT) scans and arthroscopic digitization of ACL insertion sites. The outlines of the digitized insertion sites were mapped to the corresponding CT-acquired bone models through a co-registration procedure. Twenty orthopaedic surgeons performed simulated ACL reconstructions, each on a randomly assigned cadaveric knee, first without and then with the aid of a fluoroscopic overlay system. The overlay system displayed on a lateral fluoroscopic image targets points representing the locations of the ACL insertion sites estimated from the literature data. Surgeons were allowed to adjust their tunnel positions under the guidance of the fluoroscopic image. Their initial, intermediate, and final positions were documented and compared with the target points as well as the native insertion sites. Surgeons demonstrated significant (P < .01) improvements in femoral and tibial tunnel placements relative to the target points from an average distance of 3.9 mm to 1.6 mm on the femur and 2.1 mm to 0.9 mm on the tibia. The improvements toward the knee-specific actual insertion sites were significant on the tibial side but not on the femoral side. Surgeons can be successfully guided with fluoroscopy to create more consistent femoral and tibial tunnels during ACL reconstruction. More research is warranted to develop better population representations of the locations of natural insertion sites

  19. Accelerating progress at contaminated sediment sites: moving from guidance to practice.

    Science.gov (United States)

    Bridges, Todd S; Nadeau, Steven C; McCulloch, Megan C

    2012-04-01

    ) pursuit of sediment remediation projects as a public-private collaborative enterprise. These 5 actions provide a clear path for connecting current US regulatory guidance to improved practices that produce better applications of science and risk management and more effective and efficient solutions at contaminated sediment sites.

  20. Developing guidance for pregnancy testing of adolescents participating in research: ethical, legal and practical considerations.

    Science.gov (United States)

    Larcher, Vic; Brierley, Joe

    2016-10-01

    Adolescents need safe effective drugs that have undergone ethically approved testing in clinical trials; such studies often require pregnancy testing in 'women of childbearing age' which includes children/adolescents. There is a lack of consistent standard operating procedures for pregnancy testing in these individuals, in either research or clinical (ie, both preprocedure and clinical emergency) settings. Some harmonisation between a selective or universal testing approach based on a risk analysis of the trial drug or procedure would seem sensible. The need for pregnancy testing and the reasons for the method chosen (universal or selective) should be clearly defined in the research protocol. Research ethics committees (RECs) need to satisfy themselves that the selection of subjects to be tested, the procedures for obtaining consent and the respecting of the young person's confidentiality are appropriate and that management of any positive tests are in accord with local safeguarding policies and procedures. Researchers should have core competencies necessary to manage sensitive questioning and child safeguarding training. Clinical trials of medicinal product (CTIMP) pregnancy testing in females 13-15 years of age requires parental consent and the child's active involvement in the decision-making process ('assent') the implications of a positive test should be discussed in advance Children under 13 years should not normally be subject to pregnancy testing in CTIMPs, unless there are exceptional circumstances, for example, a trial of contraceptive agents of a high teratogenicity risk, as reviewed by a specialist paediatric REC. We analyse the ethical, legal and practical aspects of this issues and supply guidance to support those involved.

  1. Normalization in EDIP97 and EDIP2003: updated European inventory for 2004 and guidance towards a consistent use in practice

    DEFF Research Database (Denmark)

    Laurent, Alexis; Olsen, Stig Irving; Hauschild, Michael Zwicky

    2011-01-01

    regular updates. The study presents updated sets of normalization inventories, normalization references for the EDIP97/EDIP2003 methodology and guidance on their consistent use in practice. Materials and methods: The base year of the inventory is 2004; the geographical scope for the non-global impacts...... developed. The resulting inventory was combined with the most updated sets of characterization factors for each impact category in the EDIP methodologies. Results and discussion: Normalization references are provided for global and non-global impact categories for the year 2004, and causes of variations....... Differentiation of substance groups into individual substance emissions is an important source, which leads to identification of inconsistencies in the current practice and guidance to ensure compatibility between LCI and LCIA. Uncertainties are not quantified but are mainly expected to lie in the toxic substance...

  2. Image-guided transapical aortic valve implantation: sensorless tracking of stenotic valve landmarks in live fluoroscopic images.

    Science.gov (United States)

    Merk, Denis R; Karar, Mohamed Esmail; Chalopin, Claire; Holzhey, David; Falk, Volkmar; Mohr, Friedrich W; Burgert, Oliver

    2011-07-01

    Aortic valve stenosis is one of the most frequently acquired valvular heart diseases, accounting for almost 70% of valvular cardiac surgery. Transapical transcatheter aortic valve implantation has recently become a suitable minimally invasive technique for high-risk and elderly patients with severe aortic stenosis. In this article, we aim to automatically define a target area of valve implantation, namely, the area between the coronary ostia and the lowest points of two aortic valve cusps. Therefore, we present a new image-based tracking method of these aortic landmarks to assist in the placement of aortic valve prosthesis under live 2D fluoroscopy guidance. We propose a rigid intensity-based image registration technique for tracking valve landmarks in 2D fluoroscopic image sequences, based on a real-time alignment of a contrast image including the initialized manual valve landmarks to each image of sequence. The contrast image is automatically detected to visualize aortic valve features when the aortic root is filled with a contrast agent. Our registration-based tracking method has been retrospectively applied to 10 fluoroscopic image sequences from routine transapical aortic valve implantation procedures. Most of all tested fluoroscopic images showed a successful tracking of valve landmarks, especially for the images without contrast agent injections. A new intraoperative image-based method has been developed for tracking aortic valve landmarks in live 2D fluoroscopic images to assist transapical aortic valve implantations and to increase the overall safety of surgery as well.

  3. Climate Risk Informed Decision Analysis (CRIDA): A novel practical guidance for Climate Resilient Investments and Planning

    Science.gov (United States)

    Jeuken, Ad; Mendoza, Guillermo; Matthews, John; Ray, Patrick; Haasnoot, Marjolijn; Gilroy, Kristin; Olsen, Rolf; Kucharski, John; Stakhiv, Gene; Cushing, Janet; Brown, Casey

    2016-04-01

    over time. They are part of the Dutch adaptive planning approach Adaptive Delta Management, executed and develop by the Dutch Delta program. Both decision scaling and adaptation pathways have been piloted in studies worldwide. The objective of CRIDA is to mainstream effective climate adaptation for professional water managers. The CRIDA publication, due in april 2016, follows the generic water design planning design cycle. At each step, CRIDA describes stepwise guidance for incorporating climate robustness: problem definition, stress test, alternatives formulation and recommendation, evaluation and selection. In the presentation the origin, goal, steps and practical tools available at each step of CRIDA will be explained. In two other abstracts ("Climate Risk Informed Decision Analysis: A Hypothetical Application to the Waas Region" by Gilroy et al., "The Application of Climate Risk Informed Decision Analysis to the Ioland Water Treatment Plant in Lusaka, Zambia, by Kucharski et al.), the application of CRIDA to cases is explained

  4. C-arm cone beam computed tomography needle path overlay for fluoroscopic guided vertebroplasty.

    Science.gov (United States)

    Tam, Alda L; Mohamed, Ashraf; Pfister, Marcus; Chinndurai, Ponraj; Rohm, Esther; Hall, Andrew F; Wallace, Michael J

    2010-05-01

    Retrospective review. To report our early clinical experience using C-arm cone beam computed tomography (C-arm CBCT) with fluoroscopic overlay for needle guidance during vertebroplasty. C-arm CBCT is advanced three-dimensional (3-D) imaging technology that is currently available on state-of-the-art flat panel based angiography systems. The imaging information provided by C-arm CBCT allows for the acquisition and reconstruction of "CT-like" images in flat panel based angiography/interventional suites. As part of the evolution of this technology, enhancements allowing the overlay of cross-sectional imaging information can now be integrated with real time fluoroscopy. We report our early clinical experience with C-arm CBCT with fluoroscopic overlay for needle guidance during vertebroplasty. This is a retrospective review of 10 consecutive oncology patients who underwent vertebroplasty of 13 vertebral levels using C-arm CBCT with fluoroscopic overlay for needle guidance from November 2007 to December 2008. Procedural data including vertebral level, approach (transpedicular vs. extrapedicular), access (bilateral vs. unilateral) and complications were recorded. Technical success with the overlay technology was assessed based on accuracy which consisted of 4 measured parameters: distance from target to needle tip, distance from planned path to needle tip, distance from midline to needle tip, and distance from the anterior 1/3 of the vertebral body to needle tip. Success within each parameter required that the distance between the needle tip and parameter being evaluated be no more than 5 mm on multiplanar CBCT or fluoroscopy. Imaging data for 12 vertebral levels was available for review. All vertebral levels were treated using unilateral access and 9 levels were treated with an extrapedicular approach. Technical success rates were 92% for both distance from planned path and distance from midline to final needle tip, 100% when distance from needle tip to the anterior 1

  5. Practical Maintenance of Digital Systems: Guidance to Maximize the Benefits of Digital Technology for the Maintenance of Digital Systems and Plant Equipment

    Energy Technology Data Exchange (ETDEWEB)

    Hill, D; Scarola, K

    2004-10-30

    This report presents detailed guidance for the maintenance and testing of modern digital systems. The guidance provides practical means for plants to take advantage of the increased diagnostic and self-test capabilities of these systems. It helps plants avoid mistakes in design and installation that could lead to increased maintenance burden and decreased system reliability and availability.

  6. Fluoroscopic-guided primary single-step percutaneous gastrostomy. Initial results using the Freka {sup registered} GastroTube; Primaere einzeitige durchleuchtungsgesteuerte perkutane Gastrostomie (PG). Erste Ergebnisse mit dem Freka {sup registered} GastroTube

    Energy Technology Data Exchange (ETDEWEB)

    Hahne, J.D.; Schoennagel, B.P.; Arndt, C.; Bannas, P.; Koops, A.; Adam, G.; Habermann, C.R. [Universitaetsklinikum Hamburg-Eppendorf (Germany). Zentrum fuer Radiologie; Herrmann, J. [Universitaetsklinikum Hamburg-Eppendorf (Germany). Zentrum fuer Radiologie; Universitaetsklinikum Hamburg-Eppendorf (Germany). Abt. Paediatrische Radiologie

    2011-07-15

    Purpose: To determine the practicability and outcome of fluoroscopic-guided primary one-step treatment of percutaneous gastrostomy (PG) with the system Freka {sup registered} Gastro Tube (Fresenius Kabi, Germany). Materials and Methods: In 39 patients (mean age 62.7 {+-} 12.0 years), primary PG was performed based on clinical indication from August 2009 to April 2010. The intervention was performed by an experienced radiologist under aseptic conditions by direct puncture with Freka {sup registered} Gastro Tube under fluoroscopic guidance. The clinical data and outcome as well as any complications originated from the electronic archive of the University Medical Center Hamburg-Eppendorf. Results: The intervention was technically successful in all 39 patients. Within the mean follow-up time of 155.3 {+-} 73.6 days, 29 patients (74.4 %) did not experience complications. 10 patients (25.6 %) had to be revised. Complications manifested after a mean of 135.6 {+-} 61.2 days and mainly corresponded to accidental dislocation (50 %). One patient had to be surgically revised under suspicion of a malpositioned tube and suspected intestinal perforation. Clinically relevant wound infections were not detected. The total costs per patient were 553.17 Euro for our single-step treatment (OPS 5 - 431.x) vs. 963.69 Euro (OPS 5 - 431.x and OPS 8 - 123.0) for the recommended two-step treatment. Conclusion: Fluoroscopic-guided primary single-step treatment with Freka {sup registered} Gastro Tube system is feasible and not associated with an increased complication rate when compared to published literature applying a two-step treatment approach. Material costs as well as human and time resources could be significantly reduced using the single-step treatment. (orig.)

  7. A Guide to the Self-Directed Career Program: A Practical and Inexpensive Vocational Guidance System.

    Science.gov (United States)

    Holland, John L.; And Others

    This report presents the Self-Directed Career program, an inexpensive program designed to provide vocational guidance to all high school students, college students, and adults who desire it. The report discusses the need for such a program, the costs involved, the materials required, and how to use them. Appendix A provides some of the basic and…

  8. Engagement and guidance: The effects of maternal parenting practices on children's development

    NARCIS (Netherlands)

    Tramonte, L.; Gauthier, A.H.; Willms, D.

    2015-01-01

    Problems with inattention, physical aggression, and poor cognitive skills when children enter school can have long-term negative effects on their development. In this study, we address the issues of whether and how parental engagement and guidance are related to children’s behavioral and cognitive p

  9. 76 FR 4360 - Guidance for Industry on Process Validation: General Principles and Practices; Availability

    Science.gov (United States)

    2011-01-25

    ... the pharmaceutical industry on the elements of process validation for the manufacture of human and... pharmaceutical industry on the elements of process validation for the manufacture of human and animal drug and... HUMAN SERVICES Food and Drug Administration Guidance for Industry on Process Validation:...

  10. Engagement and guidance: The effects of maternal parenting practices on children's development

    NARCIS (Netherlands)

    Tramonte, L.; Gauthier, A.H.; Willms, D.

    2015-01-01

    Problems with inattention, physical aggression, and poor cognitive skills when children enter school can have long-term negative effects on their development. In this study, we address the issues of whether and how parental engagement and guidance are related to children’s behavioral and cognitive p

  11. Validation procedures for quantitative gluten ELISA methods: AOAC allergen community guidance and best practices.

    Science.gov (United States)

    Koerner, Terry B; Abbott, Michael; Godefroy, Samuel Benrejeb; Popping, Bert; Yeung, Jupiter M; Diaz-Amigo, Carmen; Roberts, James; Taylor, Steve L; Baumert, Joseph L; Ulberth, Franz; Wehling, Paul; Koehler, Peter

    2013-01-01

    The food allergen analytical community is endeavoring to create harmonized guidelines for the validation of food allergen ELISA methodologies to help protect food-sensitive individuals and promote consumer confidence. This document provides additional guidance to existing method validation publications for quantitative food allergen ELISA methods. The gluten-specific criterion provided in this document is divided into sections for information required by the method developer about the assay and information for the implementation of the multilaboratory validation study. Many of these recommendations and guidance are built upon the widely accepted Codex Alimentarius definitions and recommendations for gluten-free foods. The information in this document can be used as the basis of a harmonized validation protocol for any ELISA method for gluten, whether proprietary or nonproprietary, that will be submitted to AOAC andlor regulatory authorities or other bodies for status recognition. Future work is planned for the implementation of this guidance document for the validation of gluten methods and the creation of gluten reference materials.

  12. Targeted genome engineering using designer nucleases: State of the art and practical guidance for application in human pluripotent stem cells

    Directory of Open Access Journals (Sweden)

    Sylvia Merkert

    2016-03-01

    Full Text Available Within the last years numerous publications successfully applied sequence specific designer nucleases for genome editing in human PSCs. However, despite this abundance of reports together with the rapid development and improvement accomplished with the technology, it is still difficult to choose the optimal methodology for a specific application of interest. With focus on the most suitable approach for specific applications, we present a practical guidance for successful gene editing in human PSCs using designer nucleases. We discuss experimental considerations, limitations and critical aspects which will guide the investigator for successful implementation of this technology.

  13. An Examination of Preschool Teachers' Shared Book Reading Practices in Spanish: Before and after Instructional Guidance

    Science.gov (United States)

    Pollard-Durodola, Sharolyn D.; Gonzalez, Jorge E.; Simmons, Deborah C.; Taylor, Aaron B.; Davis, Matthew J.; Simmons, Leslie; Nava-Walichowski, Miranda

    2012-01-01

    Shared book reading is a prominent practice in preschools; however, limited research has examined this practice in classrooms with English language learners (ELLs). This study investigated the shared book reading practices of seven preschool teachers of Spanish-speaking ELLs to describe their vocabulary instructional practices before and after…

  14. An Examination of Preschool Teachers' Shared Book Reading Practices in Spanish: Before and after Instructional Guidance

    Science.gov (United States)

    Pollard-Durodola, Sharolyn D.; Gonzalez, Jorge E.; Simmons, Deborah C.; Taylor, Aaron B.; Davis, Matthew J.; Simmons, Leslie; Nava-Walichowski, Miranda

    2012-01-01

    Shared book reading is a prominent practice in preschools; however, limited research has examined this practice in classrooms with English language learners (ELLs). This study investigated the shared book reading practices of seven preschool teachers of Spanish-speaking ELLs to describe their vocabulary instructional practices before and after…

  15. Reporting guidelines for survey research: an analysis of published guidance and reporting practices.

    Science.gov (United States)

    Bennett, Carol; Khangura, Sara; Brehaut, Jamie C; Graham, Ian D; Moher, David; Potter, Beth K; Grimshaw, Jeremy M

    2010-08-01

    Research needs to be reported transparently so readers can critically assess the strengths and weaknesses of the design, conduct, and analysis of studies. Reporting guidelines have been developed to inform reporting for a variety of study designs. The objective of this study was to identify whether there is a need to develop a reporting guideline for survey research. We conducted a three-part project: (1) a systematic review of the literature (including "Instructions to Authors" from the top five journals of 33 medical specialties and top 15 general and internal medicine journals) to identify guidance for reporting survey research; (2) a systematic review of evidence on the quality of reporting of surveys; and (3) a review of reporting of key quality criteria for survey research in 117 recently published reports of self-administered surveys. Fewer than 7% of medical journals (n = 165) provided guidance to authors on survey research despite a majority having published survey-based studies in recent years. We identified four published checklists for conducting or reporting survey research, none of which were validated. We identified eight previous reviews of survey reporting quality, which focused on issues of non-response and accessibility of questionnaires. Our own review of 117 published survey studies revealed that many items were poorly reported: few studies provided the survey or core questions (35%), reported the validity or reliability of the instrument (19%), defined the response rate (25%), discussed the representativeness of the sample (11%), or identified how missing data were handled (11%). There is limited guidance and no consensus regarding the optimal reporting of survey research. The majority of key reporting criteria are poorly reported in peer-reviewed survey research articles. Our findings highlight the need for clear and consistent reporting guidelines specific to survey research.

  16. Reporting Guidelines for Survey Research: An Analysis of Published Guidance and Reporting Practices

    Science.gov (United States)

    Bennett, Carol; Khangura, Sara; Brehaut, Jamie C.; Graham, Ian D.; Moher, David; Potter, Beth K.; M. Grimshaw, Jeremy

    2011-01-01

    Background Research needs to be reported transparently so readers can critically assess the strengths and weaknesses of the design, conduct, and analysis of studies. Reporting guidelines have been developed to inform reporting for a variety of study designs. The objective of this study was to identify whether there is a need to develop a reporting guideline for survey research. Methods and Findings We conducted a three-part project: (1) a systematic review of the literature (including “Instructions to Authors” from the top five journals of 33 medical specialties and top 15 general and internal medicine journals) to identify guidance for reporting survey research; (2) a systematic review of evidence on the quality of reporting of surveys; and (3) a review of reporting of key quality criteria for survey research in 117 recently published reports of self-administered surveys. Fewer than 7% of medical journals (n = 165) provided guidance to authors on survey research despite a majority having published survey-based studies in recent years. We identified four published checklists for conducting or reporting survey research, none of which were validated. We identified eight previous reviews of survey reporting quality, which focused on issues of non-response and accessibility of questionnaires. Our own review of 117 published survey studies revealed that many items were poorly reported: few studies provided the survey or core questions (35%), reported the validity or reliability of the instrument (19%), defined the response rate (25%), discussed the representativeness of the sample (11%), or identified how missing data were handled (11%). Conclusions There is limited guidance and no consensus regarding the optimal reporting of survey research. The majority of key reporting criteria are poorly reported in peer-reviewed survey research articles. Our findings highlight the need for clear and consistent reporting guidelines specific to survey research. Please see

  17. 75 FR 18514 - Developing Guidance on Naming, Labeling, and Packaging Practices to Reduce Medication Errors...

    Science.gov (United States)

    2010-04-12

    ... Practices to Reduce Medication Errors; Public Workshop; Request for Comments AGENCY: Food and Drug... Packaging Practices to Reduce Medication Errors.'' The purpose of the public workshop is to initiate... practices to develop proprietary names to reduce medication errors. The input from this workshop will...

  18. 75 FR 33629 - Developing Guidance on Naming, Labeling, and Packaging Practices to Reduce Medication Errors...

    Science.gov (United States)

    2010-06-14

    ... Practices to Reduce Medication Errors; Public Workshop; Change of Meeting Location AGENCY: Food and Drug... Practices to Reduce Medication Errors.'' A new address is given for those attending the workshop. DATES: The... on describing practices for naming, labeling, and packaging drugs and biologics to reduce...

  19. Ultrasound and fluoroscopic images fusion by autonomous ultrasound probe detection.

    Science.gov (United States)

    Mountney, Peter; Ionasec, Razvan; Kaizer, Markus; Mamaghani, Sina; Wu, Wen; Chen, Terrence; John, Matthias; Boese, Jan; Comaniciu, Dorin

    2012-01-01

    New minimal-invasive interventions such as transcatheter valve procedures exploit multiple imaging modalities to guide tools (fluoroscopy) and visualize soft tissue (transesophageal echocardiography (TEE)). Currently, these complementary modalities are visualized in separate coordinate systems and on separate monitors creating a challenging clinical workflow. This paper proposes a novel framework for fusing TEE and fluoroscopy by detecting the pose of the TEE probe in the fluoroscopic image. Probe pose detection is challenging in fluoroscopy and conventional computer vision techniques are not well suited. Current research requires manual initialization or the addition of fiducials. The main contribution of this paper is autonomous six DoF pose detection by combining discriminative learning techniques with a fast binary template library. The pose estimation problem is reformulated to incrementally detect pose parameters by exploiting natural invariances in the image. The theoretical contribution of this paper is validated on synthetic, phantom and in vivo data. The practical application of this technique is supported by accurate results (< 5 mm in-plane error) and computation time of 0.5s.

  20. Fluoroscopically Guided Three-Tube Insertion for the Treatment of Postoperative Gastroesophageal Anastomotic Leakage

    Energy Technology Data Exchange (ETDEWEB)

    Yin, Guowen; Xu, Qingyu; Chen, Shixi; Bai, Xiangjun; Jiang, Feng; Zhang, Qin; Xu, Lin; Xu, Weidong [Cancer Hospital of Jiangsu Province, Nanjing (Korea, Republic of)

    2012-03-15

    To retrospectively evaluate the feasibility and effectiveness of three-tube insertion for the treatment of postoperative gastroesophageal anastomotic leakage (GEAL). From January 2007 to January 2011, 28 cases of postoperative GEAL after an esophagectomy with intrathoracic esophagogastric anastomotic procedures for esophageal and cardiac carcinoma were treated by the insertion of three tubes under fluoroscopic guidance. The three tubes consisted of a drainage tube through the leak, a nasogastric decompression tube, and a nasojejunum feeding tube. The study population consisted of 28 patients (18 males, 10 females) ranging in their ages from 36 to 72 years (mean: 59 years). We evaluated the feasibility of three-tube insertion to facilitate leakage site closure, and the patients' nutritional benefit by checking their serum albumin levels between pre- and post-enteral feeding via the feeding tube. The three tubes were successfully placed under fluoroscopic guidance in all twenty-eight patients (100%). The procedure times for the three tube insertion ranged from 30 to 70 minutes (mean time: 45 minutes). In 27 of 28 patients (96%), leakage site closure after three-tube insertion was achieved, while it was not attained in one patient who received stent implantation as a substitute. All patients showed good tolerance of the three-tube insertion in the nasal cavity. The mean time needed for leakage treatment was 21 {+-} 3.5 days. The serum albumin level change was significant, increasing from pre-enteral feeding (2.5 {+-} 0.40 g/dL) to post-enteral feeding (3.7 {+-} 0.51 g/dL) via the feeding tube (p < 0.001). The duration of follow-up ranged from 7 to 60 months (mean: 28 months). Based on the results of this study, the insertion of three tubes under fluoroscopic guidance is safe, and also provides effective relief from postesophagectomy GEAL. Moreover, our findings suggest that three-tube insertion may be used as the primary procedure to treat postoperative GEAL.

  1. Career guidance on the move

    DEFF Research Database (Denmark)

    Thomsen, Rie

    2013-01-01

    This article is about how the notion of place can be used in an analysis of career guidance practices and their development. It is about how a focus on the context of career guidance can develop an awareness of the place where guidance is practiced and support the development of career guidance...... in new places. In this article I introduce an analytical perspective on place; I give the example of the guidance café a practice development that took place into serious consideration because it was an attempt to develop career guidance practice through relocating it....

  2. Applying the intention-to-treat principle in practice: Guidance on handling randomisation errors.

    Science.gov (United States)

    Yelland, Lisa N; Sullivan, Thomas R; Voysey, Merryn; Lee, Katherine J; Cook, Jonathan A; Forbes, Andrew B

    2015-08-01

    The intention-to-treat principle states that all randomised participants should be analysed in their randomised group. The implications of this principle are widely discussed in relation to the analysis, but have received limited attention in the context of handling errors that occur during the randomisation process. The aims of this article are to (1) demonstrate the potential pitfalls of attempting to correct randomisation errors and (2) provide guidance on handling common randomisation errors when they are discovered that maintains the goals of the intention-to-treat principle. The potential pitfalls of attempting to correct randomisation errors are demonstrated and guidance on handling common errors is provided, using examples from our own experiences. We illustrate the problems that can occur when attempts are made to correct randomisation errors and argue that documenting, rather than correcting these errors, is most consistent with the intention-to-treat principle. When a participant is randomised using incorrect baseline information, we recommend accepting the randomisation but recording the correct baseline data. If ineligible participants are inadvertently randomised, we advocate keeping them in the trial and collecting all relevant data but seeking clinical input to determine their appropriate course of management, unless they can be excluded in an objective and unbiased manner. When multiple randomisations are performed in error for the same participant, we suggest retaining the initial randomisation and either disregarding the second randomisation if only one set of data will be obtained for the participant, or retaining the second randomisation otherwise. When participants are issued the incorrect treatment at the time of randomisation, we propose documenting the treatment received and seeking clinical input regarding the ongoing treatment of the participant. Randomisation errors are almost inevitable and should be reported in trial publications. The

  3. Effectiveness of Fluoroscopic and US - Guided Percutaneous Catheter Drainage for Iliopsoas Abscess through the Anterolateral Transabdominal Approach

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Ho Cheol; Shin, Tae Beom; Park, Mee Jung; Kim, Ji Eun; Choi, Hye Young; Bae, Kyung Soo; Choi, Dae Seob; Na, Jae Boem; Jeong, Seong Hoon [Gyeongsang National University Hospital, College of Medicine, Jinju (Korea, Republic of)

    2011-02-15

    We evaluated the effectiveness of performing fluoroscopic and ultrasonography guided percutaneous catheter drainage (PCD) through the anterolateral transabdominal approach for treating iliopsoas abscess. From January 2008 to December 2009, fluoroscopic and US-guided PCD through the anterolateral transabdominal approach was performed on sixteen iliopsoas abscesses of fourteen patients (7 males and 7 females; mean age: 63 years; age range: 30-87 years). Six abscesses were on the right side and ten abscesses were on the left side. The location of the abscesses were the psoas muscle (n=7), the iliacus muscle (n=7) and the iliopsoas muscle (n=2). All the procedures were performed under fluoroscopy and US guidance in the angiography room. The clinical findings before and after the procedure, the duration of catheter insertion and the procedure-related complications were evaluated. 15 out of the 16 iliopsoas abscesses were effectively treated. The duration of catheter insertion was 5- 27 days (mean: 14.6) days. No patient had significant complications during or after drainage. One patient died of uncontrolled diabetes complications and shock on the 9th day after percutaneous catheter drainage. One recurrence was noted 5 months after removal of the catheter. This patient underwent aspiration and antibiotic treatment for this lesion and the patient improved. Fluoroscopic and US-guided PCD for iliopsoas abscess through the anterolateral transabdominal approach is an effective and safe procedure

  4. Multiplanar reformat and volume rendering of a multidetector CT scan for path planning a fluoroscopic procedure on Gasserian ganglion block - a preliminary report

    Energy Technology Data Exchange (ETDEWEB)

    Horiguchi, Jun; Ishifuro, Minoru; Fukuda, Hiroshi; Akiyama, Yuji; Ito, Katsuhide

    2005-02-01

    In the treatment of trigeminal neuralgia, Gasserian block under fluoroscopical guidance may be difficult because of anatomic variability, and difficulty in identification of the foramen ovale. We introduce how to use three-dimensional CT in the preprocedural planning. We determine the skull-rotation angle in which the foramen ovale is best visualized, the relationship (distance, angle) between the virtual puncture point and anatomical landmarks, and the distance between the virtual puncture point and the foramen.

  5. Prepared to practice? Perception of career preparation and guidance of recent medical graduates at two campuses of a transnational medical school: a cross-sectional study.

    Science.gov (United States)

    Kassim, Sameer S; McGowan, Yvonne; McGee, Hannah; Whitford, David L

    2016-02-09

    Graduating medical students enter the workforce with substantial medical knowledge and experience, yet little is known about how well they are prepared for the transition to medical practice in diverse settings. We set out to compare perceptions of medical school graduates' career guidance with their perceptions of preparedness to practice as interns. We also set out to compare perceptions of preparedness for hospital practice between graduates from two transnational medical schools. This was a cross-sectional study. A Preparedness for Hospital Practice (PHPQ) survey and career guidance questionnaire was sent to recent medical graduates, incorporating additional free text responses on career preparation. Data was analyzed using descriptive statistics and tests of association including Chi-square, Mann-Whitney U and Kruskal-Wallis H tests. Forty three percent (240/555) of graduates responded to the survey: 39 % of respondents were domestic (Dublin, Ireland or Manama, Kingdom of Bahrain) and interning locally; 15 % were overseas students interning locally; 42 % were overseas students interning internationally and 4 % had not started internship. Two variables explained 13 % of the variation in preparedness for hospital practice score: having planned postgraduate education prior to entering medical school and having helpful career guidance in medical school. Overseas graduates interning internationally were more likely to have planned their postgraduate career path prior to entering medical school. Dublin graduates found their career guidance more helpful than Bahrain counterparts. The most cited shortcomings were lack of structured career advice and lack of advice on the Irish and Bahraini postgraduate systems. This study has demonstrated that early consideration of postgraduate career preparation and helpful medical school career guidance has a strong association with perceptions of preparedness of medical graduates for hospital practice. In an era of increasing

  6. t4 report*: Toward Good Read-Across Practice (GRAP) Guidance

    Science.gov (United States)

    Ball, Nicholas; Cronin, Mark T. D.; Shen, Jie; Blackburn, Karen; Booth, Ewan D.; Bouhifd, Mounir; Donley, Elizabeth; Egnash, Laura; Hastings, Charles; Juberg, Daland R.; Kleensang, Andre; Kleinstreuer, Nicole; Kroese, E. Dinant; Lee, Adam C.; Luechtefeld, Thomas; Maertens, Alexandra; Marty, Sue; Naciff, Jorge M.; Palmer, Jessica; Pamies, David; Penman, Mike; Richarz, Andrea-Nicole; Russo, Daniel P.; Stuard, Sharon B.; Patlewicz, Grace; van Ravenzwaay, Bennard; Wu, Shengde; Zhu, Hao; Hartung, Thomas

    2017-01-01

    Summary Grouping of substances and utilizing read-across of data within those groups represents an important data gap filling technique for chemical safety assessments. Categories/analogue groups are typically developed based on structural similarity and, increasingly often, also on mechanistic (biological) similarity. While read-across can play a key role in complying with legislation such as the European REACH regulation, the lack of consensus regarding the extent and type of evidence necessary to support it often hampers its successful application and acceptance by regulatory authorities. Despite a potentially broad user community, expertise is still concentrated across a handful of organizations and individuals. In order to facilitate the effective use of read-across, this document presents the state of the art, summarizes insights learned from reviewing ECHA published decisions regarding the relative successes/pitfalls surrounding read-across under REACH, and compiles the relevant activities and guidance documents. Special emphasis is given to the available existing tools and approaches, an analysis of ECHA's published final decisions associated with all levels of compliance checks and testing proposals, the consideration and expression of uncertainty, the use of biological support data, and the impact of the ECHA Read-Across Assessment Framework (RAAF) published in 2015. PMID:26863606

  7. Preventable Medical Errors Driven Modeling of Medical Best Practice Guidance Systems.

    Science.gov (United States)

    Ou, Andrew Y-Z; Jiang, Yu; Wu, Po-Liang; Sha, Lui; Berlin, Richard B

    2017-01-01

    In a medical environment such as Intensive Care Unit, there are many possible reasons to cause errors, and one important reason is the effect of human intellectual tasks. When designing an interactive healthcare system such as medical Cyber-Physical-Human Systems (CPHSystems), it is important to consider whether the system design can mitigate the errors caused by these tasks or not. In this paper, we first introduce five categories of generic intellectual tasks of humans, where tasks among each category may lead to potential medical errors. Then, we present an integrated modeling framework to model a medical CPHSystem and use UPPAAL as the foundation to integrate and verify the whole medical CPHSystem design models. With a verified and comprehensive model capturing the human intellectual tasks effects, we can design a more accurate and acceptable system. We use a cardiac arrest resuscitation guidance and navigation system (CAR-GNSystem) for such medical CPHSystem modeling. Experimental results show that the CPHSystem models help determine system design flaws and can mitigate the potential medical errors caused by the human intellectual tasks.

  8. Guidance, Navigation and Control (GN&C): Best Practices for Human-Rated Spacecraft Systems

    Science.gov (United States)

    Lebsock, Ken; West, John

    2008-01-01

    In 2007 the NESC completed an in-depth assessment to identify, define and document engineering considerations for the Design Development Test and Evaluation (DDT&E) of human-rated spacecraft systems. This study had been requested by the Astronaut Office at JSC to help them to better understand what is required to ensure safe, robust, and reliable human-rated spacecraft systems. The 22 GN&C engineering Best Practices described in this paper are a condensed version of what appears in the NESC Technical Report. These Best Practices cover a broad range from fundamental system architectural considerations to more specific aspects (e.g., stability margin recommendations) of GN&C system design and development. 15 of the Best Practices address the early phases of a GN&C System development project and the remaining 7 deal with the later phases. Some of these Best Practices will cross-over between both phases. We recognize that this set of GN&C Best Practices will not be universally applicable to all projects and mission applications.

  9. 78 FR 22887 - Guidance for Industry on Non-Penicillin Beta-Lactam Drugs: A Current Good Manufacturing Practices...

    Science.gov (United States)

    2013-04-17

    ... HUMAN SERVICES Food and Drug Administration Guidance for Industry on Non-Penicillin Beta-Lactam Drugs: A... announcing the availability of a guidance for industry entitled ``Non-Penicillin Beta- Lactam Drugs: A CGMP... (APIs) with non-penicillin beta-lactams. This guidance also provides information regarding the relative...

  10. Guidance towards Best Practice in Psychophysical Procedures Used when Measuring Relative Spatial Brightness

    DEFF Research Database (Denmark)

    Fotios, Steve; Chan, A; Engelke, U

    This report reviews evidence for the procedures and other factors of experiments carried out to investigate relative spatial brightness, making recommendations of those aspects that ought to be considered as essential, or at least desirable, for best practice. These factors include the size...... and complexity of the visual field employed in trials, evaluation mode (separate, simultaneous, sequential or successive) and experimental biases associated with selection of stimulus range and response mode. Some of the issues raised will be considered, by some, to be obvious and already standard practice...

  11. Guidance towards Best Practice in Psychophysical Procedures Used when Measuring Relative Spatial Brightness

    DEFF Research Database (Denmark)

    Fotios, Steve; Chan, A; Engelke, U

    This report reviews evidence for the procedures and other factors of experiments carried out to investigate relative spatial brightness, making recommendations of those aspects that ought to be considered as essential, or at least desirable, for best practice. These factors include the size...... and complexity of the visual field employed in trials, evaluation mode (separate, simultaneous, sequential or successive) and experimental biases associated with selection of stimulus range and response mode. Some of the issues raised will be considered, by some, to be obvious and already standard practice...

  12. Fluoroscopic studies of the upper gastrointestinal tract: techniques and indications.

    Science.gov (United States)

    Sánchez-Carpintero de la Vega, M; García Villar, C

    Fluoroscopic studies of the gastrointestinal tract are becoming increasing less common due to the introduction of other imaging techniques such as computed tomography and magnetic resonance imaging and to the increased availability of endoscopy. Nevertheless, fluoroscopic studies of the gastrointestinal tract continue to appear in clinical guidelines and some of their indications are still valid. These studies are dynamic, operator-dependent examinations that require training to obtain the maximum diagnostic performance. This review aims to describe the technique and bring the indications for this imaging modality up to date. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Good Clinical Practice Guidance and Pragmatic Clinical Trials: Balancing the Best of Both Worlds.

    Science.gov (United States)

    Mentz, Robert J; Hernandez, Adrian F; Berdan, Lisa G; Rorick, Tyrus; O'Brien, Emily C; Ibarra, Jenny C; Curtis, Lesley H; Peterson, Eric D

    2016-03-01

    Randomized, clinical trials are commonly regarded as the highest level of evidence to support clinical decisions. Good Clinical Practice guidelines have been constructed to provide an ethical and scientific quality standard for trials that involve human subjects in a manner aligned with the Declaration of Helsinki. Originally designed to provide a unified standard of trial data to support submission to regulatory authorities, the principles may also be applied to other studies of human subjects. Although the application of Good Clinical Practice principles generally led to improvements in the quality and consistency of trial operations, these principles have also contributed to increasing trial complexity and costs. Alternatively, the growing availability of electronic health record data has facilitated the possibility for streamlined pragmatic clinical trials. The central tenets of Good Clinical Practice and pragmatic clinical trials represent potential tensions in trial design (stringent quality and highly efficient operations). In the present article, we highlight potential areas of discordance between Good Clinical Practice guidelines and the principles of pragmatic clinical trials and suggest strategies to streamline study conduct in an ethical manner to optimally perform clinical trials in the electronic age.

  14. Technology Guidance and Counselling: Implementation Theory in Practice, Development and Experience

    Science.gov (United States)

    Susanto, Eko; Novitasari, Yuni

    2014-01-01

    This article is a testimony of the results of practical experience and literacy studies on group counseling and group counseling. Since 1905 as the beginning of develop the group acknowledged that the approach is often effective to create an atmosphere that therapy can help people solve problems. Not only that certain groups are also often used…

  15. Best Practices for Young Children's Music Education: Guidance from Brain Research

    Science.gov (United States)

    Flohr, John W.

    2010-01-01

    This article reviews best practices for young children's music experiences in light of developments in brain research. The first section reviews research music and brain topics including neuromyths, effect of music on structural brain changes and general intelligence, plasticity, critical and optimal periods, and at-risk student populations. The…

  16. Best Practices for Young Children's Music Education: Guidance from Brain Research

    Science.gov (United States)

    Flohr, John W.

    2010-01-01

    This article reviews best practices for young children's music experiences in light of developments in brain research. The first section reviews research music and brain topics including neuromyths, effect of music on structural brain changes and general intelligence, plasticity, critical and optimal periods, and at-risk student populations. The…

  17. Case sampling for psychotherapy practice, theory, and policy guidance: Qualities and quantities.

    Science.gov (United States)

    Krause, Merton S

    2016-09-01

    Random sampling of cases is usually infeasible for psychotherapy research, so opportunistic and purposive sampling must be used instead. Such sampling does not justify generalizations from sample to population-distribution statistics, but does justify reporting what independent-variable value configurations are associated with what dependent-variable value configurations. This allows only the generalization that these associations occur at least that frequently in the population sampled from, which is enough for suggesting and testing some psychotherapy theories and informing some psychotherapy practice. Although psychotherapy practice is a longitudinal process, formal psychotherapy outcome research is so far most feasible and most widely done in the form of two-phase cross-sectional input-outcome studies. Thus, the analysis of sampling for psychotherapy research here will be in terms of the independent- and dependent-variable value configurations produced in such two-phase studies.

  18. Best clinical practice guidance for management of early caries lesions in children and young adults

    DEFF Research Database (Denmark)

    Kühnisch, J; Ekstrand, K R; Pretty, I

    2016-01-01

    statements were agreed upon and, furthermore, gaps in our knowledge were identified. RESULTS: Following the systematic reviews and outcomes of the seminars, it was concluded that visual and radiographic caries detection should be utilised as a basic diagnostic approach to locate, assess and monitor non...... is an essential aspect of preventive dentistry. Therefore, the EAPD encourages oral health care providers and caregivers to implement preventive practices that can arrest early caries and improve individual and public dental health....

  19. Current practices in cancer spatial data analysis: a call for guidance

    Directory of Open Access Journals (Sweden)

    Lawson Andrew B

    2005-01-01

    Full Text Available Abstract There has long been a recognition that place matters in health, from recognition of clusters of yellow fever and cholera in the 1800s to modern day analyses of regional and neighborhood effects on cancer patterns. Here we provide a summary of discussions about current practices in the spatial analysis of georeferenced cancer data by a panel of experts recently convened at the National Cancer Institute.

  20. The use of statins in people at risk of developing diabetes mellitus: evidence and guidance for clinical practice.

    Science.gov (United States)

    Sattar, Naveed A; Ginsberg, Henry; Ray, Kausik; Chapman, M John; Arca, Marcello; Averna, Maurizio; Betteridge, D John; Bhatnagar, Deepak; Bilianou, Elena; Carmena, Rafael; Ceška, Richard; Corsini, Alberto; Erbel, Raimund; Flynn, Paul D; Garcia-Moll, Xavier; Gumprecht, Janusz; Ishibashi, Shun; Jambart, Selim; Kastelein, John J P; Maher, Vincent; da Silva, Pedro Marques; Masana, Luis; Odawara, Masato; Pedersen, Terje R; Rotella, Carlo Maria; Salti, Ibrahim; Teramoto, Tamio; Tokgozoglu, Lale; Toth, Peter P; Valensi, Paul; Vergès, Bruno

    2014-06-01

    Reducing low-density lipoprotein cholesterol (LDL-C) levels using statins is associated with significant reductions in cardiovascular (CV) events in a wide range of patient populations. Although statins are generally considered to be safe, recent studies suggest they are associated with an increased risk of developing Type 2 diabetes (T2D). This led the US Food and Drug Administration (FDA) to change their labelling requirements for statins to include a warning about the possibility of increased blood sugar and HbA1c levels and the European Medicines Agency (EMA) to issue guidance on a small increased risk of T2D with the statin class. This review examines the evidence leading to these claims and provides practical guidance for primary care physicians on the use of statins in people with or at risk of developing T2D. Overall, evidence suggests that the benefits of statins for the reduction of CV risk far outweigh the risk of developing T2D, especially in individuals with higher CV risk. To reduce the risk of developing T2D, physicians should assess all patients for T2D risk prior to starting statin therapy, educate patients about their risks, and encourage risk-reduction through lifestyle changes. Whether some statins are more diabetogenic than others requires further study. Statin-treated patients at high risk of developing T2D should regularly be monitored for changes in blood glucose or HbA1c levels, and the risk of conversion from pre-diabetes to T2D should be reduced by intensifying lifestyle changes. Should a patient develop T2D during statin treatment, physicians should continue with statin therapy and manage T2D in accordance with relevant national guidelines.

  1. Practical guidance for the use of a pattern-matching technique in case-study research: a case presentation.

    Science.gov (United States)

    Almutairi, Adel F; Gardner, Glenn E; McCarthy, Alexandra

    2014-06-01

    This paper reports on a study that demonstrates how to apply pattern matching as an analytical method in case-study research. Case-study design is appropriate for the investigation of highly-contextualized phenomena that occur within the social world. Case-study design is considered a pragmatic approach that permits employment of multiple methods and data sources in order to attain a rich understanding of the phenomenon under investigation. The findings from such multiple methods can be reconciled in case-study analysis, specifically through a pattern-matching technique. Although this technique is theoretically explained in the literature, there is scant guidance on how to apply the method practically when analyzing data. This paper demonstrates the steps taken during pattern matching in a completed case-study project that investigated the influence of cultural diversity in a multicultural nursing workforce on the quality and safety of patient care. The example highlighted in this paper contributes to the practical understanding of the pattern-matching process, and can also make a substantial contribution to case-study methods.

  2. Dosimetry with a fluoroscopic electronic portal imaging device

    NARCIS (Netherlands)

    K.L. Pasma (Kasper)

    1999-01-01

    textabstractechniques for dosimetric verification of radiotherapy treatments using a CCD camera based fluoroscopic electronic portal imaging device (EPID) are described. The dosimetric characteristics of the EPID were investigated and a method was developed to derive portal dose images (PDIs) from m

  3. Multimodality calibration for simultaneous fluoroscopic and nuclear imaging

    NARCIS (Netherlands)

    Beijst, Casper; Elschot, Mattijs; van der Velden, Sanda; de Jong, Hugo W A M

    2016-01-01

    BACKGROUND: Simultaneous real-time fluoroscopic and nuclear imaging could benefit image-guided (oncological) procedures. To this end, a hybrid modality is currently being developed by our group, by combining a c-arm with a gamma camera and a four-pinhole collimator. Accurate determination of the sys

  4. Venous and arterial thrombotic risks with thalidomide: evidence and practical guidance.

    Science.gov (United States)

    Palumbo, Antonio; Palladino, Carmela

    2012-10-01

    Oral immunomodulatory drugs (IMiDs), namely thalidomide, lenalidomide and pomalidomide, interfere with several pathways important for disease progression. Today they play a crucial role in the treatment of multiple myeloma patients, and have considerably improved myeloma outcomes. These agents, and thalidomide in particular, are associated with higher rates of thromboembolic events, both venous and arterial. Individual risk factors for thromboembolic events include advanced age, previous history of thromboembolism, an indwelling central venous catheter, comorbid conditions (e.g. infections, diabetes, cardiac disease, obesity), current or recent immobilization, recent surgery and inherited thrombophilic abnormalities. Cancer therapy and cancer itself also increase the risk of thromboembolic events. The aim of this review is to help clinicians to define the risk of thrombotic events in patients treated with thalidomide and thus to provide practical recommendations to manage thromboprophylaxis in these patients.

  5. Being relevant: Practical guidance for early career researchers interested in solving conservation problems

    Directory of Open Access Journals (Sweden)

    J.M. Chapman

    2015-07-01

    Full Text Available In a human-altered world where biodiversity is in decline and conservation problems abound, there is a dire need to ensure that the next generation of conservation scientists have the knowledge, skills, and training to address these problems. So called “early career researchers” (ECRs in conservation science have many challenges before them and it is clear that the status quo must change to bridge the knowledge–action divide. Here we identify thirteen practical strategies that ECRs can employ to become more relevant. In this context, “relevance” refers to the ability to contribute to solving conservation problems through engagement with practitioners, policy makers, and stakeholders. Conservation and career strategies outlined in this article include the following: thinking ‘big picture’ during conservation projects; embracing various forms of knowledge; maintaining positive relationships with locals familiar with the conservation issue; accepting failure as a viable (and potentially valuable outcome; daring to be creative; embracing citizen science; incorporating interdisciplinarity; promoting and practicing pro-environmental behaviours; understanding financial aspects of conservation; forming collaboration from the onset of a project; accepting the limits of technology; ongoing and effective networking; and finally, maintaining a positive outlook by focusing on and sharing conservation success stories. These strategies move beyond the generic and highlight the importance of continuing to have an open mind throughout the entire conservation process, from establishing one’s self as an asset to embracing collaboration and interdisciplinary work, and striving to push for professional and personal connections that strengthen personal career objectives.

  6. Solid-state fluoroscopic imager for high-resolution angiography: parallel-cascaded linear systems analysis.

    Science.gov (United States)

    Vedantham, Srinivasan; Karellas, Andrew; Suryanarayanan, Sankararaman

    2004-05-01

    Cascaded linear systems based modeling techniques have been used in the past to predict important system parameters that have a direct impact on image quality. Such models are also useful in optimizing system parameters to improve image quality. In this work, detailed analysis of a solid-state fluoroscopic imaging system intended for high-resolution angiography is presented with the use of such a model. The imaging system analyzed through this model uses four 8 x 8 cm three-side buttable interlined charge-coupled devices (CCDs) specifically designed for high-resolution angiography and tiled in a seamless fashion to achieve a field of view (FOV) of 16 x 16 cm. Larger FOVs can be achieved by tiling more CCDs in a similar manner. The system employs a CsI:Tl scintillator coupled to the CCDs by straight (nontapering) fiberoptics and can potentially be operated in 78, 156, or 234 microm pixel pitch modes. The system parameters analyzed through this model include presampling modulation transfer function, noise power spectrum, and detective quantum efficiency (DQE). The results of the simulations performed indicate that DQE(0) in excess of 0.6 is achievable, with the imager operating at 156 microm pixel pitch, 30 frames/s, and employing a 450-microm-thick CsI:Tl scintillator, even at a low fluoroscopic exposure rate of 1 microR/frame. Further, at a nominal fluoroscopic exposure rate of 2.5 microR/frame there was no noticeable degradation of the DQE even at the 78 microm pixel pitch mode suggesting that it is feasible to perform high-resolution angiography hitherto unattainable in clinical practice.

  7. Practical Guidance for Implementing Predictive Biomarkers into Early Phase Clinical Studies

    Directory of Open Access Journals (Sweden)

    Matthew J. Marton

    2013-01-01

    Full Text Available The recent U.S. Food and Drug Administration (FDA coapprovals of several therapeutic compounds and their companion diagnostic devices (FDA News Release, 2011, 2013 to identify patients who would benefit from treatment have led to considerable interest in incorporating predictive biomarkers in clinical studies. Yet, the translation of predictive biomarkers poses unique technical, logistic, and regulatory challenges that need to be addressed by a multidisciplinary team including discovery scientists, clinicians, biomarker experts, regulatory personnel, and assay developers. These issues can be placed into four broad categories: sample collection, assay validation, sample analysis, and regulatory requirements. In this paper, we provide a primer for drug development teams who are eager to implement a predictive patient segmentation marker into an early clinical trial in a way that facilitates subsequent development of a companion diagnostic. Using examples of nucleic acid-based assays, we briefly review common issues encountered when translating a biomarker to the clinic but focus primarily on key practical issues that should be considered by clinical teams when planning to use a biomarker to balance arms of a study or to determine eligibility for a clinical study.

  8. Suspended core subwavelength fibers: practical designs for the low-loss terahertz guidance

    CERN Document Server

    Rozé, Mathieu; Mazhorova, Anna; Walther, Markus; Skorobogatiy, Maksim

    2011-01-01

    In this work we report two designs of subwavelength fibers packaged for practical terahertz wave guiding. We describe fabrication, modeling and characterization of microstructured polymer fibers featuring a subwavelength-size core suspended in the middle of a large porous outer cladding. This design allows convenient handling of the subwavelength fibers without distorting their modal profile. Additionally, the air-tight porous cladding serves as a natural enclosure for the fiber core, thus avoiding the need for a bulky external enclosure for humidity-purged atmosphere. Fibers of 5 mm and 3 mm in outer diameters with a 150 \\mu m suspended solid core and a 900 \\mu m suspended porous core respectively, were obtained by utilizing a combination of drilling and stacking techniques. Characterization of the fiber optical properties and the near-field imaging of the guided modes were performed using a terahertz near-field microscopy setup. Near-field imaging of the modal profiles at the fiber output confirmed the effe...

  9. Geospatial resources for supporting data standards, guidance and best practice in health informatics

    Directory of Open Access Journals (Sweden)

    Kamel Boulos Maged N

    2011-01-01

    Full Text Available Abstract Background The 1980s marked the occasion when Geographical Information System (GIS technology was broadly introduced into the geo-spatial community through the establishment of a strong GIS industry. This technology quickly disseminated across many countries, and has now become established as an important research, planning and commercial tool for a wider community that includes organisations in the public and private health sectors. The broad acceptance of GIS technology and the nature of its functionality have meant that numerous datasets have been created over the past three decades. Most of these datasets have been created independently, and without any structured documentation systems in place. However, search and retrieval systems can only work if there is a mechanism for datasets existence to be discovered and this is where proper metadata creation and management can greatly help. This situation must be addressed through support mechanisms such as Web-based portal technologies, metadata editor tools, automation, metadata standards and guidelines and collaborative efforts with relevant individuals and organisations. Engagement with data developers or administrators should also include a strategy of identifying the benefits associated with metadata creation and publication. Findings The establishment of numerous Spatial Data Infrastructures (SDIs, and other Internet resources, is a testament to the recognition of the importance of supporting good data management and sharing practices across the geographic information community. These resources extend to health informatics in support of research, public services and teaching and learning. This paper identifies many of these resources available to the UK academic health informatics community. It also reveals the reluctance of many spatial data creators across the wider UK academic community to use these resources to create and publish metadata, or deposit their data in repositories

  10. CONFERENCE SUMMARY--FROM THEORY TO PRACTICE. THE DESCRIPTION AND DEMONSTRATION OF A GUIDANCE PROGRAM IN ONE DISTRICT K-12.

    Science.gov (United States)

    Palo Alto Unified School District, CA.

    VARIOUS ASPECTS OF THE PALO ALTO GUIDANCE PROGRAM WERE PRESENTED AT THE CONFERENCE. THE OBJECTIVES OF THE PROGRAM WERE BASED ON THE BELIEF THAT GUIDANCE SHOULD FOSTER INDIVIDUALIZATION IN THE DEVELOPMENT OF ALL CHILDREN BY PROVIDING CONDITIONS WHICH WOULD ENSURE THIS INDIVIDUALIZATION. THESE TWO THEORETICAL CONSTRUCTS, REINFORCEMENT THEORY AND…

  11. Development of recommended practices and guidance documents for upstream oil and gas flow measurement

    Energy Technology Data Exchange (ETDEWEB)

    Dahl, Eivind; Scheers, Lex; Ting, Frank; Letton, Chip

    2005-07-01

    As first stated in the Introduction, improvements in multiphase flow meters during the last 15 years have resulted in their increased usage in upstream oil and gas applications, especially in difficult offshore locations both topside and deep subsea. To address user needs for information and standardization in the area, documentation has recently been created under the auspices of the NFOGM, API, and ISO. Our intent here was to familiarize potential users with the three new documents, which should be helpful in a number of respects, e.g., (a) distribution of best knowledge and operational practices on the subject, (b) provision of a common language for discussing multiphase flow, and (c) accounting for the requirements of governing regulatory authorities. At this stage of completion of NFOGM, API, and ISO reports, a natural question arises as to what the future holds for another round of flow measurement documentation. Candidate areas include: 1) In Situ Verification of Multiphase Flow Meters. 2) Wet Gas Flow Measurement. 3) Flare Gas Meters. 4) Virtual Metering. 5) Composition and Phase Behavior Issues In Measurement. 6) Flow Measurement Uncertainty. Addressing certain of these is already being proposed in several possible venues, among which are (1) the DeepStar Consortium, (2) a JIP for investigating total system (meter + flowline + separator) uncertainty organized by a group at Tulsa University, and (3) a program for development of drilling and production capabilities in ultradeep water to be sponsored by the US Department of Energy. The creation of the three documents discussed in this paper demonstrates the benefits that strong international cooperation can achieve in producing standardization documents, ensuring their true global input and acceptance. On the other hand, it should also be questioned why two or more documents are required, which are the result of much duplication of effort. For example, although there are differences between API RP86 and the

  12. Best practice guidance for the use of strategies to improve retention in randomized trials developed from two consensus workshops.

    Science.gov (United States)

    Brueton, Valerie; Stenning, Sally P; Stevenson, Fiona; Tierney, Jayne; Rait, Greta

    2017-08-01

    To develop best practice guidance for the use of retention strategies in randomized clinical trials (RCTs). Consensus development workshops conducted at two UK Clinical Trials Units. Sixty-six statisticians, clinicians, RCT coordinators, research scientists, research assistants, and data managers associated with RCTs participated. The consensus development workshops were based on the consensus development conference method used to develop best practice for treatment of medical conditions. Workshops commenced with a presentation of the evidence for incentives, communication, questionnaire format, behavioral, case management, and methodological retention strategies identified by a Cochrane review and associated qualitative study. Three simultaneous group discussions followed focused on (1) how convinced the workshop participants were by the evidence for retention strategies, (2) barriers to the use of effective retention strategies, (3) types of RCT follow-up that retention strategies could be used for, and (4) strategies for future research. Summaries of each group discussion were fed back to the workshop. Coded content for both workshops was compared for agreement and disagreement. Agreed consensus on best practice guidance for retention was identified. Workshop participants agreed best practice guidance for the use of small financial incentives to improve response to postal questionnaires in RCTs. Use of second-class post was thought to be adequate for postal communication with RCT participants. The most relevant validated questionnaire was considered best practice for collecting RCT data. Barriers identified for the use of effective retention strategies were: the small improvements seen in questionnaire response for the addition of monetary incentives, and perceptions among trialists that some communication strategies are outdated. Furthermore, there was resistance to change existing retention practices thought to be effective. Face-to-face and electronic follow

  13. Spinal cord injury from fluoroscopically guided intercostal blocks with phenol.

    Science.gov (United States)

    Kissoon, Narayan R; Graff-Radford, Jonathan; Watson, James C; Laughin, Ruple S

    2014-01-01

    Image guided intercostal blocks are commonly performed and considered relatively safe. Chemical denervation is commonly used in clinical practice for treatment of chronic non-cancer associated pain. To report a case of spinal cord injury resulting from fluoroscopically guided intercostal blocks with phenol. Case report. Inpatient hospital service. RESULTS/CASE REPORTS: A 53 year-old women was transferred from her local facility for acute onset of lower extremity paresis beginning shortly after right intercostal nerve injections of 2 mL of preservative-free phenol at the T7, 8, 9 levels. She had previous intercostal blocks for chronic right-sided mid thoracic/abdominal pain every 3 months for at least one year without sequelae. Within 20 minutes of the injection, she developed a sensation of right leg weakness and heaviness. Over several hours she developed worsening right leg weakness, and then left leg weakness, followed by urinary retention. Admission examination revealed severe right greater than left leg weakness, right lower extremity hyperesthesia to T10, absent lower extremity reflexes, and bilateral extensor plantar responses. Magnetic resonance imaging (MRI) of the entire spine demonstrated extensive T2/DWI hyperintensity in the central spinal cord from T1 to L1 with mild cord enlargement and enhancement at T7-9 (sites of injection). Extensive serum and cerebrospinal fluid (CSF) evaluation did not show any evidence of an infectious, inflammatory, or metabolic cause to her myelopathy. Repeat MRI of the entire spine demonstrated near complete resolution of the T2 signal abnormality. One month after presentation, despite radiographic improvement, the patient showed some clinical improvement, but remained walker dependent and with neurogenic bowel and bladder. This report describes a single case report. This case offers several lessons for a pain specialist including 1) the potential for a neurologic catastrophe (spinal cord injury) from aqueous neurolytic

  14. Ulcerated Radiodermatitis Induced after Fluoroscopically Guided Stent Implantation Angioplasty

    Science.gov (United States)

    Herz-Ruelas, Maira Elizabeth; Gómez-Flores, Minerva; Moxica-del Angel, Joaquín; Miranda-Maldonado, Ivett; Gutiérrez-Villarreal, Ilse Marilú; Villarreal-Rodríguez, Adriana Orelia

    2014-01-01

    Cases of radiation-induced skin injury after fluoroscopically guided procedures have been reported since 1996, though the majority of them have been published in Radiology and Cardiology literature, less frequently in Dermatology journals. Chronic radiation dermatitis induced by fluoroscopy can be difficult to diagnose; a high grade of suspicion is required. We report a case of an obese 46-year-old man with hypertension, dyslipidemia, and severe coronary artery disease. He developed a pruritic and painful atrophic ulcerated skin plaque over his left scapula, six months after fluoroscopically guided stent implantation angioplasty. The diagnosis of radiodermatitis was confirmed histologically. We report this case to emphasize the importance of recognizing fluoroscopy as a cause of radiation dermatitis. A good clinical follow-up at regular intervals is important after long and complicated procedures, since the most prevalent factor for injury is long exposure time. PMID:25276441

  15. Ulcerated Radiodermatitis Induced after Fluoroscopically Guided Stent Implantation Angioplasty

    Directory of Open Access Journals (Sweden)

    Maira Elizabeth Herz-Ruelas

    2014-01-01

    Full Text Available Cases of radiation-induced skin injury after fluoroscopically guided procedures have been reported since 1996, though the majority of them have been published in Radiology and Cardiology literature, less frequently in Dermatology journals. Chronic radiation dermatitis induced by fluoroscopy can be difficult to diagnose; a high grade of suspicion is required. We report a case of an obese 46-year-old man with hypertension, dyslipidemia, and severe coronary artery disease. He developed a pruritic and painful atrophic ulcerated skin plaque over his left scapula, six months after fluoroscopically guided stent implantation angioplasty. The diagnosis of radiodermatitis was confirmed histologically. We report this case to emphasize the importance of recognizing fluoroscopy as a cause of radiation dermatitis. A good clinical follow-up at regular intervals is important after long and complicated procedures, since the most prevalent factor for injury is long exposure time.

  16. Cyclic voiding cystouretrography without the use of fluoroscopic monitoring

    Energy Technology Data Exchange (ETDEWEB)

    Kadioglu, Alev [ALKA Medical Imaging Center, Buyukdere Cad. Levent Apt. No: 36/16, 80200-Mecidiyekoy, Istanbul (Turkey)]. E-mail: alevkadioglu@yahoo.com; Mihmanli, Ismail [Istanbul University, Cerrahpasa Medical Faculty, Department of Radiology, 34300-Istanbul (Turkey); Kantarci, Fatih [Istanbul University, Cerrahpasa Medical Faculty, Department of Radiology, 34300-Istanbul (Turkey); Tekes, Aylin [ALKA Medical Imaging Center, Buyukdere Cad. Levent Apt. No: 36/16, 80200-Mecidiyekoy, Istanbul (Turkey); Uysal, Omer [Istanbul University, Cerrahpasa Medical Faculty, Department of Biostatistics, 34300-Istanbul (Turkey)

    2006-01-15

    Purpose: To determine whether cyclic voiding cystourethrography (VCUG) examinations can be performed without using real-time fluoroscopic monitoring. Materials and methods: VCUG examinations were performed in 209 children (133 girls and 76 boys). In each child, it was performed in a cyclic manner (three consecutive cycles) without using fluoroscopic monitoring and one radiograph was taken in each cycle of the examination. All patients were sedated by midazolam prior to examination. The degree of vesicoureteric reflux (VUR) was graded for each of the kidney ureter units (KUU) (total 418 KUU) separately. Statistical analysis included the comparison of the presence and absence of VUR and three ordinal-matched comparisons of each cycle. Results: VCUG was detected in 37.3% of the children (78/209) and 28.7% (120/418) of the KUU. The absence of or same degree of VUR in three consecutive cycles were obtained in 345 KUU and the agreement was calculated as 82.5%. The same degree and presence of reflux were found in 85 and 89 refluxing KUU, the same negative findings (absence of VUR) in 306 and 298 KUU, and discordant findings in 27 and 31 KUU (between the first and second and between first and third cycles), respectively. Therefore, the agreement was 93.5 and 92.5% between the first and second cycles (p = 0.70) and between the first and the third cycles (p = 0.15), respectively. Conclusion: Both the cyclic nature of this study and the results indicated that VCUG without real-time fluoroscopic monitoring could be used where adequate fluoroscopic examination is not possible for children in whom VUR detection is necessary and impacts treatment. However, the responsibility of pediatric radiologist always must also include the task to provide proper equipment for imaging children with suspected VUR.

  17. Automated quantification of lumbar vertebral kinematics from dynamic fluoroscopic sequences

    Science.gov (United States)

    Camp, Jon; Zhao, Kristin; Morel, Etienne; White, Dan; Magnuson, Dixon; Gay, Ralph; An, Kai-Nan; Robb, Richard

    2009-02-01

    We hypothesize that the vertebra-to-vertebra patterns of spinal flexion and extension motion of persons with lower back pain will differ from those of persons who are pain-free. Thus, it is our goal to measure the motion of individual lumbar vertebrae noninvasively from dynamic fluoroscopic sequences. Two-dimensional normalized mutual information-based image registration was used to track frame-to-frame motion. Software was developed that required the operator to identify each vertebra on the first frame of the sequence using a four-point "caliper" placed at the posterior and anterior edges of the inferior and superior end plates of the target vertebrae. The program then resolved the individual motions of each vertebra independently throughout the entire sequence. To validate the technique, 6 cadaveric lumbar spine specimens were potted in polymethylmethacrylate and instrumented with optoelectric sensors. The specimens were then placed in a custom dynamic spine simulator and moved through flexion-extension cycles while kinematic data and fluoroscopic sequences were simultaneously acquired. We found strong correlation between the absolute flexionextension range of motion of each vertebra as recorded by the optoelectric system and as determined from the fluoroscopic sequence via registration. We conclude that this method is a viable way of noninvasively assessing twodimensional vertebral motion.

  18. Intraoperative fluoroscopic dose assessment in prostate brachytherapy patients.

    Science.gov (United States)

    Reed, Daniel R; Wallner, Kent E; Narayanan, Sreeram; Sutlief, Steve G; Ford, Eric C; Cho, Paul S

    2005-09-01

    To evaluate a fluoroscopy-based intraoperative dosimetry system to guide placement of additional sources to underdosed areas, and perform computed tomography (CT) verification. Twenty-six patients with prostate carcinoma treated with either I-125 or Pd-103 brachytherapy at the Puget Sound VA using intraoperative postimplant dosimetry were analyzed. Implants were performed by standard techniques. After completion of the initial planned brachytherapy procedure, the initial fluoroscopic intraoperative dose reconstruction analysis (I-FL) was performed with three fluoroscopic images acquired at 0 (AP), +15, and -15 degrees. Automatic seed identification was performed and the three-dimensional (3D) seed coordinates were computed and imported into VariSeed for dose visualization. Based on a 3D assessment of the isodose patterns additional seeds were implanted, and the final fluoroscopic intraoperative dose reconstruction was performed (FL). A postimplant computed tomography (CT) scan was obtained after the procedure and dosimetric parameters and isodose patterns were analyzed and compared. An average of 4.7 additional seeds were implanted after intraoperative analysis of the dose coverage (I-FL), and a median of 5 seeds. After implantation of additional seeds the mean V100 increased from 89% (I-FL) to 92% (FL) (p sources to supplement inadequately dosed areas within the prostate gland. Additionally, guided implantation of additional source, can significantly improve V100s and D90s, without significantly increasing rectal doses.

  19. Patient Doses in Paediatric Fluoroscopic Examinations in Finland

    Energy Technology Data Exchange (ETDEWEB)

    Servomaa, A.; Komppa, T.; Heikkila, M.; Parviainen, T

    2000-07-01

    Dose-area products (DAP) in paediatric fluoroscopic examinations were measured at paediatric clinics in three university hospitals. The purpose was to provide supplementary data for development of reference doses, and for determination of relations between patient size and dose, in examinations involving both radiography and fluoroscopy for paediatric patients of various ages. The number of paediatric patients was 217. The most common fluoroscopic examinations were: micturating cystourethrography (MCU), 103 patients; barium enema (anography), 39 patients; barium meal and follow, 20 patients; and oesophagus, nine patients. Data on the patients and examination techniques, and the dose-area products are reported for various examinations and age groups. In the MCU examinations the mean DAP values were 560 mGy.cm{sup 2} for the age group of 0 years: 910 mGy.cm{sup 2} for the age group of 1-4 years; 880 mGy.cm{sup 2} for the age group of 5-9 years; and 4600 mGy.cm{sup 2} for the age group of 10-15 years. The radiation doses to which paediatric patients are exposed in fluoroscopic examinations vary over a large scale, even within narrow age bands, and comparisons between the doses are difficult because of wide ranges in patient size. This indicates the need for developing a method for taking account of the effects of patients size before deriving reference doses. (author)

  20. Technique of Peritoneal Catheter Placement under Fluroscopic Guidance

    Directory of Open Access Journals (Sweden)

    Ahmed Kamel Abdel-Aal

    2011-01-01

    Full Text Available Peritoneal catheters are mainly used for peritoneal dialysis in patients with end-stage renal disease. Other uses of this catheter include intraperitoneal chemotherapy and gene therapy for ovarian cancer and draining of uncontrolled refractory ascites in patients with liver cirrhosis. Traditionally, surgeons place most of these peritoneal catheters either by laparoscopy or open laparotomy. We detail our percutaneous approach to placing peritoneal catheters using fluoroscopic guidance. We emphasize the use of additional ultrasound guidance, including gray scale and color Doppler ultrasound, to determine the safest puncture site and to guide the initial needle puncture in order to avoid bowel perforation and injury to epigastric artery. We present our experience in placing peritoneal catheters using this technique in 95 patients with various indications. Fluoroscopic guided percutaneous placement of peritoneal catheters is a safe, minimally invasive, and effective alternative to open surgical or laparoscopic placement.

  1. Heavy Metal Pad Shielding during Fluoroscopic Interventions

    OpenAIRE

    Dromi, Sergio; Wood, Bradford J.; Oberoi, Jay; Neeman, Ziv

    2006-01-01

    Significant direct and scatter radiation doses to patient and physician may result from routine interventional radiology practice. A lead-free disposable tungsten antimony shielding pad was tested in phantom patients during simulated diagnostic angiography procedures. Although the exact risk of low doses of ionizing radiation is unknown, dramatic dose reductions can be seen with routine use of this simple, sterile pad made from lightweighttungsten antimony material.

  2. Fluoroscopically guided fallopian tube recanalization with a simplified set of instruments; Durchleuchtungsgesteuerte Eileiter-Rekanalisation mit vereinfachtem Instrumentarium

    Energy Technology Data Exchange (ETDEWEB)

    Schmitz-Rode, T.; Guenther, R.W. [Technische Hochschule Aachen (Germany). Klinik fuer Radiologische Diagnostik; Neulen, J. [Technische Hochschule Aachen (Germany). Frauenklinik fuer gynaekologische Endokrinologie und Reproduktionsmedizin

    2004-10-01

    Purpose: Fluoroscopically guided transcervical fallopian tube recanalization is recognized as an important step in the workup of female infertility. In the present study, a simplified set of recanalization instruments was tested. Materials and Methods: Forty-two women with infertility and sonographically confirmed or suspected uni- or bilateral tubal occlusion were examined. After vaginal placement of a plastic speculum and fixation of a tenaculum, a 4F glide catheter with a 0.89 mm glidewire was advanced transcervically. After documentation of tubal occlusion by hysterosalpingography, the uterotubal junction was catheterized with the same instruments. Under fluoroscopic guidance, the glidewire was negotiated beyond the intramural portion of the tube. Selective salpingography documented the outcome of the recanalization. Results: Hysterosalpingography confirmed tubal occlusions in 26 of 42 patients (in 12 cases unilateral and in 14 cases bilateral). Fallopian tube recanalization was successful in 23 of 26 patients (technical success rate of 88%). The resulting fertility rate was 30% (7/23), without any ectopic pregnancy. Complications such as tubal perforation, infection, or bleeding did not occur. Tubal catheterization was straightforward and smooth in 17/23 cases. For a hyperflexed uterus (6/23), a curved tip of the catheter was helpful in tubal probing. (orig.)

  3. Technologies of image guidance and the development of advanced linear accelerator systems for radiotherapy.

    Science.gov (United States)

    Wu, Vincent W C; Law, Maria Y Y; Star-Lack, Josh; Cheung, Fion W K; Ling, C Clifton

    2011-01-01

    As advanced radiotherapy approaches for targeting the tumor and sparing the normal tissues have been developed, the image guidance of therapy has become essential to directing and confirming treatment accuracy. To approach these goals, image guidance devices now include kV on-board imagers, kV/MV cone-beam CT systems, CT-on-rails, and mobile and in-room radiographic/fluoroscopic systems. Nonionizing sources, such as ultrasound and optical systems, and electromagnetic devices have been introduced to monitor or track the patient and/or tumor positions during treatment. In addition, devices have been designed specifically for monitoring and/or controlling respiratory motion. Optimally, image-guided radiation therapy systems should possess 3 essential elements: (1) 3D imaging of soft tissues and tumors, (2) efficient acquisition and comparison of the 3D images, and (3) an efficacious process for clinically meaningful intervention. Understanding and using these tools effectively is central to current radiotherapy practice. The implementation and integration of these devices continue to carry practical challenges, which emphasize the need for further development of the technologies and their clinical applications.

  4. Guidance on a better integration of aquaculture, fisheries, and other activities in the coastal zone: from tools to practical examples

    NARCIS (Netherlands)

    Stelzenmüller, V.; Schulze, T.; Gimpel, A.; Bartelings, H.; Bello, E.; Bergh, O.; Bolman, B.; Caetano, M.; Davaasuren, N.; Fabi, G.; Ferreira, J.G.; Gault, J.; Gramolini, R.; Grati, F.; Hamon, K.G.; Jak, R.G.; Kopke, K.; Laurans, M.; Mäkinen, T.; O’Donnell, V.; O’Hagan, A.M.; O’Mahony, C.; Oostenbrugge, van H.; Ramos, J.; Saurel, C.; Sell, A.L.; Silvo, K.; Sinschek, K.; Soma, K.; Stenberg, C.; Taylor, N.; Vale, C.; Vasquez, F.; Verner-Jeffreys, D.W.

    2013-01-01

    This guidance document provides a comprehensive assessment of the conflicts and synergies between fisheries, aquaculture and other activities in the coastal zone in six COEXIST case study areas. It forms deliverable D5.2 of the COEXIST project and synthesises deliverable D5.1, which provides a more

  5. Guidance on a better integration of aquaculture, fisheries, and other activities in the coastal zone: from tools to practical examples

    NARCIS (Netherlands)

    Stelzenmüller, V.; Schulze, T.; Gimpel, A.; Bartelings, H.; Bello, E.; Bergh, O.; Bolman, B.; Caetano, M.; Davaasuren, N.; Fabi, G.; Ferreira, J.G.; Gault, J.; Gramolini, R.; Grati, F.; Hamon, K.G.; Jak, R.G.; Kopke, K.; Laurans, M.; Mäkinen, T.; O’Donnell, V.; O’Hagan, A.M.; O’Mahony, C.; Oostenbrugge, van H.; Ramos, J.; Saurel, C.; Sell, A.L.; Silvo, K.; Sinschek, K.; Soma, K.; Stenberg, C.; Taylor, N.; Vale, C.; Vasquez, F.; Verner-Jeffreys, D.W.

    2013-01-01

    This guidance document provides a comprehensive assessment of the conflicts and synergies between fisheries, aquaculture and other activities in the coastal zone in six COEXIST case study areas. It forms deliverable D5.2 of the COEXIST project and synthesises deliverable D5.1, which provides a more

  6. Intrapelvic obturator internus muscle injections: a novel fluoroscopic technique.

    Science.gov (United States)

    Valovska, Assia; Zaccagnino, Michael P; Weaver, Michael J; Valovski, Ivan; Kaye, Alan David; Urman, Richard D

    2015-01-01

    The obturator internus (OI) muscle is important in adult chronic noninfectious pelvic, perineal, gluteal, and retrotrochanteric pain syndromes. Evaluation and management of these patients' pain can be challenging because of the complex anatomy of this region, broad differential diagnosis, and lack of specific physical examination findings. Consequently, several clinicians have advocated the use of image guided injections to assist in the accurate diagnosis of OI-related symptoms and provide symptomatic relief to affected patients. We present 2 case series describing a novel fluoroscopically guided contrast controlled transpectineal approach to intrapelvic OI injections. Unlike prior fluoroscopically guided OI injection techniques, the approach described in the present 2 cases utilized multiple standard pelvic views, thus facilitating optimal needle positioning in three-dimensional space. This technique utilized standard fluoroscopic pelvic views to accurately measure needle depth within the pelvic cavity permitting the bulk of the OI to be injected in a controlled and safe fashion. The first patient underwent a left intrapelvic OI muscle injection with bupivacaine 0.25% and 40 mg methylprednisolone. The average pre- and postprocedural visual analog pain scale scores were 5 out of 10 and 2 out of 10, respectively, with a self-reported 75% pain reduction. The second patient underwent a right intrapelvic OI muscle injection with bupivacaine 0.25% and 40 mg methylprednisolone. The average pre- and postprocedural visual analog scale scores were 8 out of 10 and 1 out of 10, respectively, with a self-reported 90% pain reduction. Larger scale studies should be undertaken to evaluate the therapeutic efficacy and generalized accuracy of this technique.

  7. Multimodality calibration for simultaneous fluoroscopic and nuclear imaging

    OpenAIRE

    Beijst, Casper; Elschot, Mattijs; van der Velden, Sandra; de Jong, Hugo W A M

    2016-01-01

    Background Simultaneous real-time fluoroscopic and nuclear imaging could benefit image-guided (oncological) procedures. To this end, a hybrid modality is currently being developed by our group, by combining a c-arm with a gamma camera and a four-pinhole collimator. Accurate determination of the system parameters that describe the position of the x-ray tube, x-ray detector, gamma camera, and collimators is crucial to optimize image quality. The purpose of this study was to develop a calibratio...

  8. PFO closure with only fluoroscopic guidance: 7 years real-world single centre experience.

    Science.gov (United States)

    Mangieri, Antonio; Godino, Cosmo; Montorfano, Matteo; Arioli, Francesco; Rosa, Isabella; Ajello, Silvia; Piraino, Daniela; Monello, Alberto; Pavon, Anna Giulia; Viani, Giacomo; Magni, Valeria; Cappelletti, Alberto; Margonato, Alberto; Colombo, Antonio

    2015-07-01

    To evaluate the safety and the efficacy of fluoroscopy-guided only (Fluo-G) and of echocardiography-guided (Echo-G; trans-esophageal echocardiography-TEE-or intracardiac echocardiography-ICE) percutaneous closure of patent foramen ovale (PFO). Single center retrospective registry enrolling 368 consecutive patients (mean age 50.5 years) who underwent PFO closure between June 2004 and December 2011. Most patients had prior cryptogenic stroke (n = 126; 34.2%), TIA (n = 218; 51.1%); some of these had recurrent neurological events [multiple strokes n = 28 (7.8%); multiple TIAs n = 72 (18.6%)]. All the patients underwent a preprocedure TEE. PFO closure was performed with Echo-G in 187 patients (50.8%) (TEE n = 69, 36.8% and ICE n = 124, 66.3%). In Fluo-G cases, PFO with atrial septal aneurysm (ASA) was significantly less present (P Fluo-G group (P Fluo-G vs. 98.3% Echo-G) and RtL-shunt at follow-up (11.7% Fluo-G vs. 7.6% Echo-G). The rate of conversion from Fluoro-G to Echo-G procedure was 4.4% (n = 8). At a median follow-up of 4 years, freedom from recurrent embolic events rate was similar between the two groups (Echo-G 94.5 vs. Fluo-G 95.7%). In our experience Fluoro-G PFO closure was performed mainly in cases of simple anatomy, with similar results in terms of safety and efficacy compared to Echo-G cases. Both fluoroscopy and total procedural times were lower in the Fluo-G cases. © 2015 Wiley Periodicals, Inc.

  9. Percutaneous retrieval of malpositioned, kinked and unraveled guide wire under fluoroscopic guidance during central venous cannulation

    Directory of Open Access Journals (Sweden)

    Gopal Krishan Jalwal

    2014-01-01

    Full Text Available The placement of central venous catheter using Seldinger′s technique, remains a commonly performed procedure with its own risks and benefits. Various complications have been reported with the use of guide wire as well as catheter. We report a unique problem during subclavian vein cannulation due to guidewire malposition which led to its kinking and difficult retrieval requiring removal in fluoroscopy suit. The probable mechanism of guide wire entrapment and possible bedside management of similar problems is described.

  10. The fluoroscopic barium enema in colonic polyp detection.

    Science.gov (United States)

    Teefey, S A; Carlson, H C

    1983-12-01

    The results of 1,500 barium enema studies done by vigorous manual palpation under fluoroscopy were reviewed to determine the adequacy of this technique in detecting polyps above the proctoscopic level. Of the 1,500 patients examined, 103 (7%) were diagnosed radiographically as having a total of 149 polyps. Polyps were found at proctoscopy in about 10% of the 1,500 patients. Colonoscopy or surgery was performed on 35 of the 103 patients. Of the 52 polyps discovered during these procedures, only three were missed at fluoroscopic barium enema study, a false-negative rate of 6%. Fourteen patients whose barium enemas initially were reported as negative for polyps or neoplasia had colonoscopy. Two of the 14 patients had positive findings, for a true-negative rate of 86%. If the detection rate of 7% found at barium enema, taking into account an overlap of 10%, is combined with the rate of 7.5% found at proctoscopy, a frequency of about 14% emerges in detecting polyps in the rectum and in the colon. Thus, the fluoroscopic barium enema when combined with proctoscopy is a sensitive method in the detection of colorectal polyps. In addition, it has the advantage of rapid execution and relatively low cost.

  11. Feasibility of differential quantification of 3D temporomandibular kinematics during various oral activities using a cone-beam computed tomography-based 3D fluoroscopic method

    Directory of Open Access Journals (Sweden)

    Chien-Chih Chen

    2013-06-01

    Conclusion: A new CBCT-based 3D fluoroscopic method was proposed and shown to be capable of quantitatively differentiating TMJ movement patterns among complicated functional activities. It also enabled a complete description of the rigid-body mandibular motion and descriptions of as many reference points as needed for future clinical applications. It will be helpful for dental practice and for a better understanding of the functions of the TMJ.

  12. Lifelong Guidance

    National Research Council Canada - National Science Library

    Noworol, Czesław

    2011-01-01

    .... Career guidance refers to services and activities intended to assist individuals, of any age and at any point throughout their lives, to make educational, training and occupational choices and to manage their careers...

  13. MR guidance and thermometry of percutaneous laser disc decompression in open MRI: an initial clinical investigation

    Energy Technology Data Exchange (ETDEWEB)

    Streitparth, Florian; Walter, Thula; Bucourt, Maximilian de; Freyhardt, Patrick; Maurer, Martin; Renz, Diane; Gebauer, Bernhard; Hamm, Bernd; Teichgraeber, Ulf K.M. [Charite, Humboldt-University Medical School, Department of Radiology, Berlin (Germany); Hartwig, Tony; Putzier, Michael; Strube, Patrick [Charite, Humboldt-University, Center for Musculoskeletal Surgery, Berlin (Germany); Bretschneider, Tina [University of Magdeburg, Department of Radiology, Magdeburg (Germany)

    2013-10-15

    To assess the feasibility, safety and efficacy of real-time MR guidance and thermometry of percutaneous laser disc decompression (PLDD). Twenty-four discs in 22 patients with chronic low-back and radicular pain were treated by PLDD using open 1.0-T magnetic-resonance imaging (MRI). A fluoroscopic proton-density-weighted turbo spin-echo (PDw TSE) sequence was used to position the laser fibre. Non-spoiled gradient-echo (GRE) sequences were employed for real-time thermal monitoring based on proton resonance frequency (PRF). Radicular pain was assessed over 6 months with a numerical rating scale (NRS). PLDD was technically successful in all cases, with adequate image quality for laser positioning. The PRF-based real-time temperature monitoring was found to be feasible in practice. After 6 months, 21 % reported complete remission of radicular pain, 63 % at least great pain relief and 74 % at least mild relief. We found a significant decrease in the NRS score between the pre-intervention and the 6-month follow-up assessment (P < 0.001). No major complications occurred; the single adverse event recorded, moderate motor impairment, resolved. Real-time MR guidance and PRF-based thermometry of PLDD in the lumbar spine under open 1.0-T MRI appears feasible, safe and effective and may pave the way to more precise operating procedures. (orig.)

  14. Current Trends in Tactical Missile Guidance

    Directory of Open Access Journals (Sweden)

    S. Vathsal

    2005-07-01

    Full Text Available The problem of tactical missile guidance is very challenging and has been treated using several basic metlfodologies in the past four decades. Major techniques can be grouped underclassical guidance laws, modern guidance laws, l'aws for manoeuvring targets, predictive guidance for endgame scenario, and guidance laws based on intelligent control methods. Each technique has some advantages and disadvantages while implementing in a practical system. Guidance law selection is dictated by nature of flight profile like boost, midcourse, terminal homing, etc, and also miss-distance and a single-shot kill probability. This paper presents a brief survey of the existing techniques and current trends in tactical missile guidance.

  15. Reflection on the Guidance of Teaching Practice of Normal University Against the Background of the New Curriculum Reform%新课改视野下高师教育实习指导反思

    Institute of Scientific and Technical Information of China (English)

    张惠强

    2014-01-01

    Normal practice guidance for educational practice tasks efficiently, successfully completed, plays a key role in normal practice guidance currently there is a low degree of specialization, practice guidance formality and other issues, Nor-mal practice guidance to new ideas, in-depth reflection, understand the spirit of the new curriculum to the concept of the new curriculum reform to lead normal practice guidance, training to adapt to the new curriculum standards of new teachers to meet the needs of basic education reform and development and future personnel training.%高师实习指导对教育实习任务高效、顺利完成,起着关键作用,目前高师实习指导存在专业化程度低、实习指导流于形式等问题,高师实习指导要更新观念,深入反思,吃透新课改精神,以新课程改革的理念引领高师实习指导工作,培养适应新课程标准的新型师资,适应基础教育改革发展及未来人才培养的需要。

  16. Vocational Guidance for Everyone

    Science.gov (United States)

    Holland, John L.

    1974-01-01

    Describes some of the current problems of vocational guidance, summarizes relevant knowledge and theory in the field, and offers some practical plans for a coordinated, theoretically compatible group of vocational programs, services, and experiences for a high school. (Author/JM)

  17. Auto-shape lossless compression of pharynx and esophagus fluoroscopic images.

    Science.gov (United States)

    Arif, Arif Sameh; Mansor, Sarina; Logeswaran, Rajasvaran; Karim, Hezerul Abdul

    2015-02-01

    The massive number of medical images produced by fluoroscopic and other conventional diagnostic imaging devices demand a considerable amount of space for data storage. This paper proposes an effective method for lossless compression of fluoroscopic images. The main contribution in this paper is the extraction of the regions of interest (ROI) in fluoroscopic images using appropriate shapes. The extracted ROI is then effectively compressed using customized correlation and the combination of Run Length and Huffman coding, to increase compression ratio. The experimental results achieved show that the proposed method is able to improve the compression ratio by 400 % as compared to that of traditional methods.

  18. 17 CFR Appendix B to Part 38 - Guidance on, and Acceptable Practices in, Compliance With Core Principles

    Science.gov (United States)

    2010-04-01

    ... acceptable program for monitoring markets will generally involve the collection of various market data... market and the analysis of data collected. Trade practice surveillance programs may be carried out by the... acceptable trade practice surveillance program generally would include: (1) Maintenance of data...

  19. Fluoroscope Study of Lesser Snow Geese at Sabine National Wildlife Refuge, Louisiana

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This dataset contains the results of a fluoroscope study of Lesser Snow Geese wintering at Sabine National Wildlife Refuge in November of 1974.

  20. The AAPM/RSNA physics tutorial for residents: general overview of fluoroscopic imaging.

    Science.gov (United States)

    Schueler, B A

    2000-01-01

    Fluoroscopy is used to visualize the motion of internal fluids, structures, and devices. During a fluoroscopic examination, the operator controls activation of the x-ray tube for real-time imaging of the patient. The article provides a general overview of fluoroscopic imaging from its initial development to modern use. Early fluoroscopes produced a dim image on a fluorescent screen that required dark adaptation of the physician's eyes to optimize viewing conditions. Image intensifiers were later developed to replace the fluorescent screen and increase image brightness. Modern fluoroscopy systems include an image intensifier with television image display and a choice of several different types of image recording devices. Fluoroscopic equipment is available in many different configurations for use in a wide variety of clinical applications.

  1. Evaluation of low-dose limits in 3D-2D rigid registration for surgical guidance

    Science.gov (United States)

    Uneri, A.; Wang, A. S.; Otake, Y.; Kleinszig, G.; Vogt, S.; Khanna, A. J.; Gallia, G. L.; Gokaslan, Z. L.; Siewerdsen, J. H.

    2014-09-01

    An algorithm for intensity-based 3D-2D registration of CT and C-arm fluoroscopy is evaluated for use in surgical guidance, specifically considering the low-dose limits of the fluoroscopic x-ray projections. The registration method is based on a framework using the covariance matrix adaptation evolution strategy (CMA-ES) to identify the 3D patient pose that maximizes the gradient information similarity metric. Registration performance was evaluated in an anthropomorphic head phantom emulating intracranial neurosurgery, using target registration error (TRE) to characterize accuracy and robustness in terms of 95% confidence upper bound in comparison to that of an infrared surgical tracking system. Three clinical scenarios were considered: (1) single-view image + guidance, wherein a single x-ray projection is used for visualization and 3D-2D guidance; (2) dual-view image + guidance, wherein one projection is acquired for visualization, combined with a second (lower-dose) projection acquired at a different C-arm angle for 3D-2D guidance; and (3) dual-view guidance, wherein both projections are acquired at low dose for the purpose of 3D-2D guidance alone (not visualization). In each case, registration accuracy was evaluated as a function of the entrance surface dose associated with the projection view(s). Results indicate that images acquired at a dose as low as 4 μGy (approximately one-tenth the dose of a typical fluoroscopic frame) were sufficient to provide TRE comparable or superior to that of conventional surgical tracking, allowing 3D-2D guidance at a level of dose that is at most 10% greater than conventional fluoroscopy (scenario #2) and potentially reducing the dose to approximately 20% of the level in a conventional fluoroscopically guided procedure (scenario #3).

  2. Estimates of diagnostic reference levels for pediatric peripheral and abdominal fluoroscopically guided procedures.

    Science.gov (United States)

    Strauss, Keith J; Racadio, John M; Johnson, Neil; Patel, Manish; Nachabe, Rami A

    2015-06-01

    The objective of our study was to survey radiation dose indexes of pediatric peripheral and abdominal fluoroscopically guided procedures from which estimates of diagnostic reference levels (DRLs) can be proposed for both a standard fluoroscope and a novel fluoroscope with advanced image processing and lower radiation dose rates. Radiation dose structured reports were retrospectively collected for 408 clinical pediatric cases: Half of the procedures were performed with a standard imaging technology and half with a novel x-ray technology. Dose-area product (DAP), air Kerma (AK), fluoroscopy time, number of digital subtraction angiography images, and patient mass were collected to calculate and normalize radiation dose indexes for procedures completed with the standard and novel fluoroscopes. The study population was composed of 180 and 175 patients who underwent procedures with the standard and novel technology, respectively. The 21 different types of pediatric peripheral and abdominal interventional procedures produced 408 total studies. Median ages, mass and body mass index, fluoroscopy time per procedure, and total number of recorded images for the standard and novel technologies were not statistically different. The area of the x-ray beams was square at the level of the patient with a dimension of 10-13 cm. The dose reduction achieved with the novel fluoroscope ranged from 18% to 51% of the dose required with the standard fluoroscope. The median DAP and AK patient dose indexes were 0.38 Gy · cm(2) and 4.00 mGy, respectively, for the novel fluoroscope. Estimates of dose indexes of pediatric peripheral and abdominal fluoroscopically guided, clinical procedures should assist in the development of DRLs to foster management of radiation doses of pediatric patients.

  3. The Self in Guidance: Assumptions and Challenges.

    Science.gov (United States)

    Edwards, Richard; Payne, John

    1997-01-01

    Examines the assumptions of "self" made in the professional and managerial discourses of guidance. Suggests that these assumptions obstruct the capacity of guidance workers to explain their own practices. Drawing on contemporary debates over identity, modernity, and postmodernity, argues for a more explicit debate about the self in guidance. (RJM)

  4. Silent aspiration: results of 2,000 video fluoroscopic evaluations.

    Science.gov (United States)

    Garon, Bernard R; Sierzant, Tess; Ormiston, Charles

    2009-08-01

    The purpose of this retrospective study of aspiration and the lack of a protective cough reflex at the vocal folds (silent aspiration) was to increase the awareness of nursing staffs of the diagnostic pathology groups associated with silent aspiration. Of the 2,000 patients evaluated in this study, 51% aspirated on the video fluoroscopic evaluation. Of the patients who aspirated, 55% had no protective cough reflex (silent aspiration). The diagnostic pathology groups with the highest rates of silent aspiration were brain cancer, brainstem stroke, head-neck cancer, pneumonia, dementia/Alzheimer, chronic obstructive lung disease, seizures, myocardial infarcts, neurodegenerative pathologies, right hemisphere stroke, closed head injury, and left hemisphere stroke. It is of high concern that the diagnostic groups identified in this research as having the highest risk of silent aspiration be viewed as "red-flag" patients by the nursing staff caring for them. Early nursing dysphagia screens, with close attention to the clinical symptoms associated with silent aspiration, and early referral for formal dysphagia evaluation are stressed.

  5. Dose reduction during fluoroscopic placement of feeding tubes

    Energy Technology Data Exchange (ETDEWEB)

    Rudin, S.; Bednarek, D.R.; Miller, J.A. (State Univ. of New York, Buffalo (USA))

    1991-03-01

    By both increasing the optical iris of the video camera and removing the grid in fluoroscopic procedures involved in placement of a Dubbhoff feeding tube, the radiation dose to patients and staff was reduced by five to seven times. An average expected dose to a patient of about 300 mGy per procedure was reduced by two to three times when the grid was removed and by an additional three times when an iris of increased diameter was used. Because Dobbhoff procedures do not involve obtaining a diagnosis, the image degradation was acceptable and did not affect the total exposure times or ability to conduct the procedure. With the grid out, the difference between the mean exposure times of 5.1 minutes in 96 patient studies done with a normal iris opening and 4.0 minutes in 52 studies done with an enlarged iris was not statistically significant. The importance of reducing patient dose is reinforced by the finding that one-third of the patients underwent repeated procedures, accounting for almost 60% of the total.

  6. Measuring radiation dose to patients undergoing fluoroscopically-guided interventions

    Science.gov (United States)

    Lubis, L. E.; Badawy, M. K.

    2016-03-01

    The increasing prevalence and complexity of fluoroscopically guided interventions (FGI) raises concern regarding radiation dose to patients subjected to the procedure. Despite current evidence showing the risk to patients from the deterministic effects of radiation (e.g. skin burns), radiation induced injuries remain commonplace. This review aims to increase the awareness surrounding radiation dose measurement for patients undergoing FGI. A review of the literature was conducted alongside previous researches from the authors’ department. Studies pertaining to patient dose measurement, its formalism along with current advances and present challenges were reviewed. Current patient monitoring techniques (using available radiation dosimeters), as well as the inadequacy of accepting displayed dose as patient radiation dose is discussed. Furthermore, advances in real-time patient radiation dose estimation during FGI are considered. Patient dosimetry in FGI, particularly in real time, remains an ongoing challenge. The increasing occurrence and sophistication of these procedures calls for further advances in the field of patient radiation dose monitoring. Improved measuring techniques will aid clinicians in better predicting and managing radiation induced injury following FGI, thus improving patient care.

  7. Practice guidance on the management of acute and chronic gastrointestinal problems arising as a result of treatment for cancer

    Science.gov (United States)

    Davidson, Susan E; Gillespie, Catherine; Allum, William H; Swarbrick, Edwin

    2011-01-01

    Backgound The number of patients with chronic gastrointestinal (GI) symptoms after cancer therapies which have a moderate or severe impact on quality of life is similar to the number diagnosed with inflammatory bowel disease annually. However, in contrast to patients with inflammatory bowel disease, most of these patients are not referred for gastroenterological assessment. Clinicians who do see these patients are often unaware of the benefits of targeted investigation (which differ from those required to exclude recurrent cancer), the range of available treatments and how the pathological processes underlying side effects of cancer treatment differ from those in benign GI disorders. This paper aims to help clinicians become aware of the problem and suggests ways in which the panoply of syndromes can be managed. Methods A multidisciplinary literature review was performed to develop guidance to facilitate clinical management of GI side effects of cancer treatments. Results Different pathological processes within the GI tract may produce identical symptoms. Optimal management requires appropriate investigations and coordinated multidisciplinary working. Lactose intolerance, small bowel bacterial overgrowth and bile acid malabsorption frequently develop during or after chemotherapy. Toxin-negative Clostridium difficile and cytomegalovirus infection may be fulminant in immunosuppressed patients and require rapid diagnosis and treatment. Hepatic side effects include reactivation of viral hepatitis, sinusoidal obstruction syndrome, steatosis and steatohepatitis. Anticancer biological agents have multiple interactions with conventional drugs. Colonoscopy is contraindicated in neutropenic enterocolitis but endoscopy may be life-saving in other patients with GI bleeding. After cancer treatment, simple questions can identify patients who need referral for specialist management of GI symptoms. Other troublesome pelvic problems (eg, urinary, sexual, nutritional) are frequent

  8. MODARIA WG5: Towards a practical guidance for including uncertainties in the results of dose assessment of routine releases

    Energy Technology Data Exchange (ETDEWEB)

    Mora, Juan C. [Centro de Investigaciones Energeticas, Medioambientales y Tecnologicas - CIEMAT (Spain); Telleria, Diego [International Atomic Energy Agency - IAEA (Austria); Al Neaimi, Ahmed [Emirates Nuclear Energy Corporation - ENEC (United Arab Emirates); Blixt Buhr, Anna Ma [Vattenfall AB (Sweden); Bonchuk, Iurii [Radiation Protection Institute - RPI (Ukraine); Chouhan, Sohan [Atomic Energy of Canada Limited - AECL (Canada); Chyly, Pavol [SE-VYZ (Slovakia); Curti, Adriana R. [Autoridad Regulatoria Nuclear - ARN (Argentina); Da Costa, Dejanira [Instituto de Radioprotecao e Dosimetria - IRD (Brazil); Duran, Juraj [VUJE Inc (Slovakia); Galeriu, Dan [Horia Hulubei National Institute of Physics and Nuclear Engineering - IFIN-HH (Romania); Haegg, Ann- Christin; Lager, Charlotte [Swedish Radiation Safety Authority - SSM (Sweden); Heling, Rudie [Nuclear Research and Consultancy Group - NRG (Netherlands); Ivanis, Goran; Shen, Jige [Ecometrix Incorporated (Canada); Iosjpe, Mikhail [Norwegian Radiation Protection Authority - NRPA (Norway); Krajewski, Pawel M. [Central Laboratory for Radiological Protection - CLOR (Poland); Marang, Laura; Vermorel, Fabien [Electricite de France - EdF (France); Mourlon, Christophe [Institut de Radioprotection et de Surete Nucleaire - IRSN (France); Perez, Fabricio F. [Belgian Nuclear Research Centre - SCK (Belgium); Woodruffe, Andrew [Federal Authority for Nuclear Regulation - FANR (United Arab Emirates); Zorko, Benjamin [Jozef Stefan Institute (Slovenia)

    2014-07-01

    MODARIA (Modelling and Data for Radiological Impact Assessments) project was launched in 2012 with the aim of improving the capabilities in radiation dose assessment by means of acquisition of improved data for model testing, model testing and comparison, reaching consensus on modelling philosophies, approaches and parameter values, development of improved methods and exchange of information. The project focuses on areas where uncertainties remain in the predictive capability of environmental models, emphasizing in reducing associated uncertainties or developing new approaches to strengthen the evaluation of the radiological impact. Within MODARIA, four main areas were defined, one of them devoted to Uncertainty and Variability. In this area four working groups were included, Working Group 5 dealing with the 'uncertainty and variability analysis for assessments of radiological impacts arising from routine discharges of radionuclides'. Whether doses are estimated by using measurement data, by applying models, or through a combination of measurements and calculations, the variability and uncertainty contribute to a distribution of possible values. The degree of variability and uncertainty is represented by the shape and extent of that distribution. The main objective of WG5 is to explore how to consider uncertainties and variabilities in the results of assessment of doses in planned situations for controlling the impact of routine releases from radioactive and nuclear installations to the environment. The final aim is to produce guidance for the calculation of uncertainties in these exposure situations and for the presentation of such results to the different stakeholders. To achieve that objective the main tasks identified were: to find tools and methods for uncertainty and variability analysis applicable to dose assessments in routine radioactive discharges, to define scenarios where information on uncertainty and variability of parameters is available

  9. The independent living donor advocate: a guidance document from the American Society of Transplantation's Living Donor Community of Practice (AST LDCOP).

    Science.gov (United States)

    Hays, R E; LaPointe Rudow, D; Dew, M A; Taler, S J; Spicer, H; Mandelbrot, D A

    2015-02-01

    The independent living donor advocate (ILDA) serves a mandated and supportive role in the care of the living organ donor, yet qualifications and role requirements are not clearly defined. Guidance comes from Centers for Medicare and Medicaid Services (CMS) Conditions for Transplant Center Participation and interpretive guidelines, Organ Procurement and Transplantation Network (OPTN) Policy and CMS and OPTN site surveys, yet interpretation of regulations varies. Herein, the AST Living Donor Community of Practice (LDCOP) offers seven recommendations to clarify and optimize the ILDA role: (a) the ILDA must have a certain skill set rather than a specific profession, (b) the ILDA must be educated and demonstrate competence in core knowledge components, (c) the ILDA's primary role is to assess components of informed consent, (d) centers must develop a transparent system to define ILDA independence, (e) the ILDA should have a reporting structure outside the transplant center, (f) the ILDA's role should be integrated throughout the donor care continuum, (g) the ILDA role should include a narrow "veto power." We address controversies in ILDA implementation, and offer pathways to maximize benefits and minimize limitations of approaches that may each meet regulatory requirements but confer different practice benefits. We propose a research agenda to explore the impact of the ILDA. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

  10. Review of LCA studies of solid waste management systems--part II: methodological guidance for a better practice.

    Science.gov (United States)

    Laurent, Alexis; Clavreul, Julie; Bernstad, Anna; Bakas, Ioannis; Niero, Monia; Gentil, Emmanuel; Christensen, Thomas H; Hauschild, Michael Z

    2014-03-01

    Life cycle assessment (LCA) is increasingly used in waste management to identify strategies that prevent or minimise negative impacts on ecosystems, human health or natural resources. However, the quality of the provided support to decision- and policy-makers is strongly dependent on a proper conduct of the LCA. How has LCA been applied until now? Are there any inconsistencies in the past practice? To answer these questions, we draw on a critical review of 222 published LCA studies of solid waste management systems. We analyse the past practice against the ISO standard requirements and the ILCD Handbook guidelines for each major step within the goal definition, scope definition, inventory analysis, impact assessment, and interpretation phases of the methodology. Results show that malpractices exist in several aspects of the LCA with large differences across studies. Examples are a frequent neglect of the goal definition, a frequent lack of transparency and precision in the definition of the scope of the study, e.g. an unclear delimitation of the system boundaries, a truncated impact coverage, difficulties in capturing influential local specificities such as representative waste compositions into the inventory, and a frequent lack of essential sensitivity and uncertainty analyses. Many of these aspects are important for the reliability of the results. For each of them, we therefore provide detailed recommendations to practitioners of waste management LCAs.

  11. Safeguards Guidance Document for Designers of Commercial Nuclear Facilities: International Nuclear Safeguards Requirements and Practices For Uranium Enrichment Plants

    Energy Technology Data Exchange (ETDEWEB)

    Robert Bean; Casey Durst

    2009-10-01

    This report is the second in a series of guidelines on international safeguards requirements and practices, prepared expressly for the designers of nuclear facilities. The first document in this series is the description of generic international nuclear safeguards requirements pertaining to all types of facilities. These requirements should be understood and considered at the earliest stages of facility design as part of a new process called “Safeguards-by-Design.” This will help eliminate the costly retrofit of facilities that has occurred in the past to accommodate nuclear safeguards verification activities. The following summarizes the requirements for international nuclear safeguards implementation at enrichment plants, prepared under the Safeguards by Design project, and funded by the U.S. Department of Energy (DOE) National Nuclear Security Administration (NNSA), Office of NA-243. The purpose of this is to provide designers of nuclear facilities around the world with a simplified set of design requirements and the most common practices for meeting them. The foundation for these requirements is the international safeguards agreement between the country and the International Atomic Energy Agency (IAEA), pursuant to the Treaty on the Non-proliferation of Nuclear Weapons (NPT). Relevant safeguards requirements are also cited from the Safeguards Criteria for inspecting enrichment plants, found in the IAEA Safeguards Manual, Part SMC-8. IAEA definitions and terms are based on the IAEA Safeguards Glossary, published in 2002. The most current specification for safeguards measurement accuracy is found in the IAEA document STR-327, “International Target Values 2000 for Measurement Uncertainties in Safeguarding Nuclear Materials,” published in 2001. For this guide to be easier for the designer to use, the requirements have been restated in plainer language per expert interpretation using the source documents noted. The safeguards agreement is fundamentally a

  12. Patient doses from fluoroscopically guided cardiac procedures in pediatrics

    Science.gov (United States)

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

    2007-08-01

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

  13. The Diagnosis and Management of Nonalcoholic Fatty Liver Disease: Practice Guidance from the American Association for the Study of Liver Diseases.

    Science.gov (United States)

    Chalasani, Naga; Younossi, Zobair; Lavine, Joel E; Charlton, Michael; Cusi, Kenneth; Rinella, Mary; Harrison, Stephen A; Brunt, Elizabeth M; Sanyal, Arun J

    2017-07-17

    This guidance provides a data-supported approach to the diagnostic, therapeutic, and preventive aspects of NAFLD care. A "Guidance" document is different from a "Guideline." Guidelines are developed by a multidisciplinary panel of experts and rate the quality (level) of the evidence and the strength of each recommendation using the Grading of Recommendations, Assessment Development, and Evaluation (GRADE) system. A guidance document is developed by a panel of experts in the topic, and guidance statements, not recommendations, are put forward to help clinicians understand and implement the most recent evidence. This article is protected by copyright. All rights reserved. © 2017 by the American Association for the Study of Liver Diseases.

  14. Constituent Aspects of Workplace Guidance in Secondary VET

    Science.gov (United States)

    Swager, Robert; Klarus, Ruud; van Merriënboer, Jeroen J. G.; Nieuwenhuis, Loek F. M.

    2015-01-01

    Purpose: This paper aims to present an integrated model of workplace guidance to enhance awareness of what constitutes good guidance, to improve workplace guidance practices in vocational education and training. Design/methodology/approach: To identify constituent aspects of workplace guidance, a systematic search of Web of Science was conducted,…

  15. Optimum PN Guidance Law for Maneuvering Target

    Institute of Scientific and Technical Information of China (English)

    SUN Bao-cai; QI Zai-kang

    2007-01-01

    An optimum PN guidance law for maneuvering target is developed using optimal control theory. By estimating the target position and setting the cost function, the guidance law can be deduced even without knowing the missile lateral acceleration. Since the quadratic cost function can make a compromise between the miss distance andthe control constraint, the optimum guidance law obtained is more general. Also, introduced line of sight rate as the input, a practical form of this guidance law is derived. The simulation results show the effectiveness of the guidance laws.

  16. Inferring 3D kinematics of carpal bones from single view fluoroscopic sequences.

    Science.gov (United States)

    Chen, Xin; Graham, Jim; Hutchinson, Charles; Muir, Lindsay

    2011-01-01

    We present a novel framework for inferring 3D carpal bone kinematics and bone shapes from a single view fluoroscopic sequence. A hybrid statistical model representing both the kinematics and shape variation of the carpal bones is built, based on a number of 3D CT data sets obtained from different subjects at different poses. Given a fluoroscopic sequence, the wrist pose, carpal bone kinematics and bone shapes are estimated iteratively by matching the statistical model with the 2D images. A specially designed cost function enables smoothed parameter estimation across frames. We have evaluated the proposed method on both simulated data and real fluoroscopic sequences. It was found that the relative positions between carpal bones can be accurately estimated, which is potentially useful for detection of conditions such as scapholunate dissociation.

  17. A feasibility study of markerless fluoroscopic gating for lung cancer radiotherapy using 4DCT templates

    Energy Technology Data Exchange (ETDEWEB)

    Li Ruijiang; Lewis, John H; Cervino, Laura I; Jiang, Steve B [Department of Radiation Oncology, University of California San Diego, 3855 Health Sciences Dr, La Jolla, CA 92037-0843 (United States)], E-mail: sbjiang@ucsd.edu

    2009-10-21

    A major difficulty in conformal lung cancer radiotherapy is respiratory organ motion, which may cause clinically significant targeting errors. Respiratory-gated radiotherapy allows for more precise delivery of prescribed radiation dose to the tumor, while minimizing normal tissue complications. Gating based on external surrogates is limited by its lack of accuracy, while gating based on implanted fiducial markers is limited primarily by the risk of pneumothorax due to marker implantation. Techniques for fluoroscopic gating without implanted fiducial markers (markerless gating) have been developed. These techniques usually require a training fluoroscopic image dataset with marked tumor positions in the images, which limits their clinical implementation. To remove this requirement, this study presents a markerless fluoroscopic gating algorithm based on 4DCT templates. To generate gating signals, we explored the application of three similarity measures or scores between fluoroscopic images and the reference 4DCT template: un-normalized cross-correlation (CC), normalized cross-correlation (NCC) and normalized mutual information (NMI), as well as average intensity (AI) of the region of interest (ROI) in the fluoroscopic images. Performance was evaluated using fluoroscopic and 4DCT data from three lung cancer patients. On average, gating based on CC achieves the highest treatment accuracy given the same efficiency, with a high target coverage (average between 91.9% and 98.6%) for a wide range of nominal duty cycles (20-50%). AI works well for two patients out of three, but failed for the third patient due to interference from the heart. Gating based on NCC and NMI usually failed below 50% nominal duty cycle. Based on this preliminary study with three patients, we found that the proposed CC-based gating algorithm can generate accurate and robust gating signals when using 4DCT reference template. However, this observation is based on results obtained from a very limited

  18. Feature-based respiratory motion tracking in native fluoroscopic sequences for dynamic roadmaps during minimally invasive procedures in the thorax and abdomen

    Science.gov (United States)

    Wagner, Martin G.; Laeseke, Paul F.; Schubert, Tilman; Slagowski, Jordan M.; Speidel, Michael A.; Mistretta, Charles A.

    2017-03-01

    Fluoroscopic image guidance for minimally invasive procedures in the thorax and abdomen suffers from respiratory and cardiac motion, which can cause severe subtraction artifacts and inaccurate image guidance. This work proposes novel techniques for respiratory motion tracking in native fluoroscopic images as well as a model based estimation of vessel deformation. This would allow compensation for respiratory motion during the procedure and therefore simplify the workflow for minimally invasive procedures such as liver embolization. The method first establishes dynamic motion models for both the contrast-enhanced vasculature and curvilinear background features based on a native (non-contrast) and a contrast-enhanced image sequence acquired prior to device manipulation, under free breathing conditions. The model of vascular motion is generated by applying the diffeomorphic demons algorithm to an automatic segmentation of the subtraction sequence. The model of curvilinear background features is based on feature tracking in the native sequence. The two models establish the relationship between the respiratory state, which is inferred from curvilinear background features, and the vascular morphology during that same respiratory state. During subsequent fluoroscopy, curvilinear feature detection is applied to determine the appropriate vessel mask to display. The result is a dynamic motioncompensated vessel mask superimposed on the fluoroscopic image. Quantitative evaluation of the proposed methods was performed using a digital 4D CT-phantom (XCAT), which provides realistic human anatomy including sophisticated respiratory and cardiac motion models. Four groups of datasets were generated, where different parameters (cycle length, maximum diaphragm motion and maximum chest expansion) were modified within each image sequence. Each group contains 4 datasets consisting of the initial native and contrast enhanced sequences as well as a sequence, where the respiratory motion is

  19. RADCOM: a computerized translation device for use during fluoroscopic examination of non-English-speaking patients.

    Science.gov (United States)

    Cohn, M J; Cohen, A J

    1994-02-01

    We developed and have implemented RADCOM (RADiology COMmunicator), a computerized speech-based language translator for use during fluoroscopic examination of non-English-speaking patients. It is controlled completely by voice commands issued into a headset microphone. The system output is digital audio via a small speaker, in the native language of the patient. RADCOM currently supports more than 40 commands in more than a dozen languages. The language data base is easily expandable. We have performed more than 20 fluoroscopic examinations with the RADCOM system. The non-English-speaking patients respond well, following the selected instructions appropriately.

  20. Technique for Percutaneous Fluoroscopically Guided G-Tube Placement in a High-BMI Patient

    Directory of Open Access Journals (Sweden)

    Irwin M. Best

    2012-01-01

    Full Text Available Enteral feeding is still the preferred method of nutritional support even in patients with excessive body mass index. Often, this mass poses a hindrance in performing routine procedures. We present a case describing the technique used to safely place a fluoroscopically guided G-tube in a patient with a significant nutritional deficit after repair of a ruptured thoracic aneurysm. Her admission weight was in excess of 180 Kg. However, protracted respiratory insufficiency and mechanical ventilation prolonged her hospital course. The G-tube was successfully placed using a fluoroscopically guided technique. The advantages of such an approach are discussed.

  1. Technique for Percutaneous Fluoroscopically Guided G-Tube Placement in a High-BMI Patient.

    Science.gov (United States)

    Best, Irwin M

    2012-01-01

    Enteral feeding is still the preferred method of nutritional support even in patients with excessive body mass index. Often, this mass poses a hindrance in performing routine procedures. We present a case describing the technique used to safely place a fluoroscopically guided G-tube in a patient with a significant nutritional deficit after repair of a ruptured thoracic aneurysm. Her admission weight was in excess of 180 Kg. However, protracted respiratory insufficiency and mechanical ventilation prolonged her hospital course. The G-tube was successfully placed using a fluoroscopically guided technique. The advantages of such an approach are discussed.

  2. A Study of Occupational Radiation Dosimetry During Fluoroscopically Guided Simulated Urological Surgery in the Lithotomy Position.

    Science.gov (United States)

    Horsburgh, Ben A; Higgins, Mike

    2016-12-01

    To quantify through environmental audit the radiation dose that urologists receive during surgery in the lithotomy position, and to quantify the dose reduction achieved by altering exposure techniques and personal protective equipment use. Simulated surgery in the lithotomy position using an anthropomorphic phantom as a patient and a SimMan(®) mannequin as the surgeon. Pulsed fluoroscopy, focus-to-skin distance (FSD), collimation, and addition of a lead shield at the table end were individually and collectively introduced after a control study. Scattered X-ray dose rates to the simulated surgeon's eye, thyroid, trunk, external genitalia, and leg were measured with each of the technique adjustments. The absorbed dose in air at the phantom skin was measured throughout. Results were compared to discover surgeon dose rates with technique alteration. Increasing FSD leads to a rise in surgeon eye dose, and table end lead protection increases the patient skin dose. Use of all the dose-reduction techniques together reduces the dose to the patient, and a surgeon's trunk dose is decreased by 95%, external genitalia dose by 99%, and leg dose by 97%. Sitting to perform fluoroscopically guided surgery in the lithotomy position increases surgeon dose by a median value of 17%, with the external genitalia dose increased by 78% compared with the standing position. This study describes effective methods of dose reduction that are easy to instigate. The resulting reduction in radiation dose during urology procedures meets the requirements of international guidelines and legislation. This change in practice improves patient care and reduces risk to urologists from occupational exposure to radiation. By combining all of the dose-reduction techniques, urologists should never reach the threshold for deterministic radiation effects to their eyes during their career, and they will have a significantly lower chance of stochastic risks such as cancer.

  3. Imaging Guidance Improves the Results of Viscosupplementation with HANOX-M-XL in Patients with Ankle Osteoarthritis: Results of a Clinical Survey in 50 Patients Treated in Daily Practice

    Science.gov (United States)

    Bossert, Marie; Boublil, Daniel; Parisaux, Jean-Marc; Bozgan, Ana-Maria; Richelme, Emmanuel; Conrozier, Thierry

    2016-01-01

    BACKGROUND The objective of this survey was to assess retrospectively the interest of performing viscosupplementation using imaging guidance in patients suffering from ankle osteoarthritis (OA). PATIENTS AND METHODS This is a multicenter retrospective survey using a standardized questionnaire. Fifty patients suffering from ankle OA and treated, in daily clinical practice, with a single intra-articular injection of a novel viscosupplement made of a combination of a non-animal cross-linked hyaluronan and mannitol, HANOX M-XL, were included in the survey. The injection procedure (imaging or landmark guidance), demographic data, patient’s self-evaluation of pain, satisfaction, treatment efficacy, and tolerability were collected. Predictive factors of both efficacy and patient’s satisfaction were investigated. RESULTS The percentages of patients very satisfied/satisfied and not really satisfied/dissatisfied with the treatment were 68% and 32%, respectively. Efficacy was rated as very good, good, moderate, and poor by 38%, 30%, 12%, and 20% of the cases, respectively. Efficacy was unrelated to gender and age and was highly correlated with pain score (P steroidal anti-inflammatory drugs was >75% in 64% of the cases. Efficacy was significantly different with regard to imaging guidance. There was a statistically significant difference in efficacy and satisfaction between landmark-guided and imaging-guided injections (P = 0.02). The success rate was 2.3 times higher in the imaging-guided group than in the landmark-guided group. No significant difference was found between patients injected under fluoroscopy or ultrasound guidance, despite a trend favoring ultrasound (P = 0.09). Tolerability was rated as very good/good in 47 patients, moderate in two, and poor in one and was unrelated to the type of guidance. CONCLUSION This preliminary study suggests that the use of imaging guidance significantly optimizes the success rate of ankle viscosupplementation. No safety concern

  4. An image-guidance system for dynamic dose calculation in prostate brachytherapy using ultrasound and fluoroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Kuo, Nathanael, E-mail: nkuo8@jhmi.edu; Prince, Jerry L. [Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland 21218 (United States); Dehghan, Ehsan [Philips Research North America, Briarcliff Manor, New York 10510 (United States); Deguet, Anton [Department of Computer Science, Johns Hopkins University, Baltimore, Maryland 21218 (United States); Mian, Omar Y.; Le, Yi; Song, Danny Y. [Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland 21231 (United States); Burdette, E. Clif [Acoustic MedSystems Inc., Savoy, Illinois 61974 (United States); Fichtinger, Gabor [School of Computing, Queen' s University, Kingston, Ontario K7L3N6 (Canada); Lee, Junghoon [Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland 21218 and Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland 21231 (United States)

    2014-09-15

    Purpose: Brachytherapy is a standard option of care for prostate cancer patients but may be improved by dynamic dose calculation based on localized seed positions. The American Brachytherapy Society states that the major current limitation of intraoperative treatment planning is the inability to localize the seeds in relation to the prostate. An image-guidance system was therefore developed to localize seeds for dynamic dose calculation. Methods: The proposed system is based on transrectal ultrasound (TRUS) and mobile C-arm fluoroscopy, while using a simple fiducial with seed-like markers to compute pose from the nonencoded C-arm. Three or more fluoroscopic images and an ultrasound volume are acquired and processed by a pipeline of algorithms: (1) seed segmentation, (2) fiducial detection with pose estimation, (3) seed matching with reconstruction, and (4) fluoroscopy-to-TRUS registration. Results: The system was evaluated on ten phantom cases, resulting in an overall mean error of 1.3 mm. The system was also tested on 37 patients and each algorithm was evaluated. Seed segmentation resulted in a 1% false negative rate and 2% false positive rate. Fiducial detection with pose estimation resulted in a 98% detection rate. Seed matching with reconstruction had a mean error of 0.4 mm. Fluoroscopy-to-TRUS registration had a mean error of 1.3 mm. Moreover, a comparison of dose calculations between the authors’ intraoperative method and an independent postoperative method shows a small difference of 7% and 2% forD{sub 90} and V{sub 100}, respectively. Finally, the system demonstrated the ability to detect cold spots and required a total processing time of approximately 1 min. Conclusions: The proposed image-guidance system is the first practical approach to dynamic dose calculation, outperforming earlier solutions in terms of robustness, ease of use, and functional completeness.

  5. 28 CFR 552.13 - X-ray, major instrument, fluoroscope, or surgical intrusion.

    Science.gov (United States)

    2010-07-01

    ... INSTITUTIONAL MANAGEMENT CUSTODY Searches of Housing Units, Inmates, and Inmate Work Areas § 552.13 X-ray, major... 28 Judicial Administration 2 2010-07-01 2010-07-01 false X-ray, major instrument, fluoroscope, or... reasons only, with the inmate's consent. (b) The institution physician may authorize use of an X-ray...

  6. Information architecture. Volume 3: Guidance

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-04-01

    The purpose of this document, as presented in Volume 1, The Foundations, is to assist the Department of Energy (DOE) in developing and promulgating information architecture guidance. This guidance is aimed at increasing the development of information architecture as a Departmentwide management best practice. This document describes departmental information architecture principles and minimum design characteristics for systems and infrastructures within the DOE Information Architecture Conceptual Model, and establishes a Departmentwide standards-based architecture program. The publication of this document fulfills the commitment to address guiding principles, promote standard architectural practices, and provide technical guidance. This document guides the transition from the baseline or defacto Departmental architecture through approved information management program plans and budgets to the future vision architecture. This document also represents another major step toward establishing a well-organized, logical foundation for the DOE information architecture.

  7. Abortion Information: A Guidance Viewpoint

    Science.gov (United States)

    Wolleat, Patricia L.

    1975-01-01

    A number of questions relating to providing abortion information to teenagers can be raised from legal, ethical and philosophical standpoints. The purpose of this article is to examine abortion information-giving from the perspective of counseling and guidance theory and practice. (Author)

  8. Transcatheter Mitral Paravalvular Leak Closure Facilitated by Preprocedural Cardiac CT for Simulation of Fluoroscopic Anatomy and Paravalvular Defect Localization.

    Science.gov (United States)

    Korsholm, Kasper; Mortensen, Ulrik; Jensen, Jesper Møller; Piazza, Nicolo; Thériault-Lauzier, Pascal; Nielsen-Kudsk, Jens Erik

    2017-02-01

    Paravalvular leakage (PVL) occurs in 6%-15% of cases after surgical heart valve replacement. A percutaneous approach is increasingly used to close PVLs as an alternative to repeat surgery. Computed tomography (CT) can be used for simulation of fluoroscopic cardiac anatomy. This technique allows preprocedural definition of optimal C-arm angulations and PVL localization in reference to fluoroscopic views. It is very helpful for guidewire crossing of the PVL and positioning of the closure device. We report a case with the first use of dedicated software for fluoroscopic simulation (FluoroCT) in transcatheter mitral PVL closure.

  9. 75 FR 53023 - Sound Incentive Compensation Guidance

    Science.gov (United States)

    2010-08-30

    ... principles and the guidance are consistent with the Principles for Sound Compensation Practices adopted by... of Management and Budget (OMB) for review, as required by the Paperwork Reduction Act. Today, OTS is.... Description: The guidance is based on three key principles that are designed to ensure that incentive...

  10. Routine Use of Fluoroscopic-Guided Femoral Arterial Puncture to Minimise Vascular Complication Rates in CTO Intervention: Multi-centre UK Experience.

    Science.gov (United States)

    Fairley, Sarah L; Lucking, Andrew J; McEntegart, Margaret; Shaukat, Aadil; Smith, David; Chase, Alexander; Hanratty, Colm G; Spratt, James C; Walsh, Simon J

    2016-12-01

    Chronic total occlusion (CTO) revascularisation has a crucial role in contemporary percutaneous coronary intervention (PCI). Procedural success is influenced by disease complexity, calcific burden and patient characteristics but has substantially improved with the implementation of novel hybrid strategies. However, vascular-access related complications remain a cause of morbidity and mortality. This study aimed to assess the effectiveness of fluoroscopic-guided femoral arterial puncture to minimise this risk during CTO PCI. Standardised data were retrospectively collected from four high-volume UK CTO centres between September 2011 and November 2013. Demographic, clinical and procedural data (vascular access site, sheath size, anticoagulation use) was collated. The anatomical location of the femoral puncture in relation to the femoral bifurcation, femoral head position and inferior epigastric artery were recorded. Adverse events related to vascular access were documented. A total of 528 patients were included (676 femoral punctures) with the majority being male (n=432, 81.8%). Large sheaths (8F) were used in 81.2% of cases. Fluoroscopy-enabled punctures were made in the 'safe zone' in over > 93% of cases. Vascular closure devices (VCD) were used in 88.3% of cases. The adverse event rate per puncture was 0.89%. This study demonstrates an extremely low incidence of vascular-access complications in CTO PCI when fluoroscopic guidance is used to obtain femoral arterial access by default radial operators. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  11. Agent Based Individual Traffic guidance

    DEFF Research Database (Denmark)

    Wanscher, Jørgen Bundgaard

    2004-01-01

    When working with traffic planning or guidance it is common practice to view the vehicles as a combined mass. >From this models are employed to specify the vehicle supply and demand for each region. As the models are complex and the calculations are equally demanding the regions and the detail...... can be obtained through cellular phone tracking or GPS systems. This information can then be used to provide individual traffic guidance as opposed to the mass information systems of today -- dynamic roadsigns and trafficradio. The goal is to achieve better usage of road and time. The main topic...

  12. 论现代教学论对教学实践的“作为”与“难为”%The Guidance and Problems of Modern Teaching Theory on Teaching Practice

    Institute of Scientific and Technical Information of China (English)

    李玉文

    2012-01-01

    Teaching theory plays an researchers' involvement with ideal, active role in the teaching practice innovation because of the passion and sense of responsibility, which provides teaching practice innovation with the sight of theoretical knowledge and observation, showing its continuous concern, involvement, and guidance for the practice. However, the guidance of theory is questioned because of the differences between the ontological values of teaching theory and practice, their "interpenetration", and the biased attribution of the problems in teaching practice, etc. In order to give full play to the guidance of teaching theory in practice, we should stick to its academic and theoretical traits, to strengthen the construction of "practical teaching theory" with understanding and empathy, and devote to the focus turning of teaching theory to practice so as to promote the teaching practice innovation in a scientific and effective way.%现代教学论学者具有参与教学实践变革的理想愿望与自觉意识,通过对教学实践变革的理论阐释和行动研究,为教学实践提供相应的科学知识和观察视角,发挥教学论对教学实践变革的指导作用。但由于理论与实践各自的本体价值不同、“相互纠缠”及人们对教学实践“问题”归因的偏颇,也由于教学论自身的一些问题与不足,使得人们质疑教学论的实践指导作用。为真正发挥出教学论的实践指导作用,我们应当继续坚持教学论的理论学科品质,加强“实践教学论”的建设,努力建设理解的、移情性的教学论,并致力于教学论的实践转化,给教学实践变革以科学有效的指导。

  13. Tests and Guidance: What Students Need.

    Science.gov (United States)

    Krumboltz, John D.

    1982-01-01

    Innovations in testing and guidance which can integrate assessment to facilitate learning, help develop practical wisdom in behavior, and correct students' faulty cognitions in career decisions are described. (CM)

  14. Region-of-interest micro-angiographic fluoroscope detector used in aneurysm and artery stenosis diagnoses and treatment

    Science.gov (United States)

    Wang, Weiyuan; Ionita, Ciprian; Huang, Ying; Qu, Bin; Panse, Ashish; Jain, Amit; Bednarek, Daniel R.; Rudin, Stephen

    2012-03-01

    Due to the need for high-resolution angiographic and interventional vascular imaging, a Micro-Angiographic Fluoroscope (MAF) detector with a Control, Acquisition, Processing, and Image Display System (CAPIDS) was installed on a detector changer, which was attached to the C-arm of a clinical angiographic unit at a local hospital. The MAF detector provides high-resolution, high-sensitivity, and real-time imaging capabilities and consists of a 300 μm thick CsI phosphor, a dual stage micro-channel plate light image intensifier (LII) coupled to a fiber optic taper (FOT), and a scientific grade frame-transfer CCD camera, providing an image matrix of 1024×1024 35 μm effective square pixels with 12 bit depth. The changer allows the MAF region-of-interest (ROI) detector to be inserted in front of the Image Intensifier (II) when higher resolution is needed during angiographic or interventional vascular imaging procedures, e.g. endovascular stent deployment. The CAPIDS was developed and implemented using Laboratory Virtual Instrumentation Engineering Workbench (LabVIEW) software and provides a user-friendly interface that enables control of several clinical radiographic imaging modes of the MAF including: fluoroscopy, roadmapping, radiography, and digital-subtraction-angiography (DSA). The total system has been used for image guidance during endovascular image-guided interventions (EIGI) for diagnosing and treating artery stenoses and aneurysms using self-expanding endovascular stents and coils in fifteen patient cases, which have demonstrated benefits of using the ROI detector. The visualization of the fine detail of the endovascular devices and the vessels generally gave the clinicians confidence on performing neurovascular interventions and in some instances contributed to improved interventions.

  15. Aid to Percutaneous Renal Access by Virtual Projection of the Ultrasound Puncture Tract onto Fluoroscopic Images

    CERN Document Server

    Mozer, Pierre; Leroy, Antoine; Baumann, Michael; Payan, Yohan; Troccaz, Jocelyne; Chartier-Kastler, Emmanuel; Richard, François

    2007-01-01

    Background and Purpose: Percutaneous renal access in the context of percutaneous nephrolithotomy (PCNL) is a difficult technique, requiring rapid and precise access to a particular calix. We present a computerized system designed to improve percutaneous renal access by projecting the ultrasound puncture tract onto fluoroscopic images. Materials and Methods: The system consists of a computer and a localizer allowing spatial localization of the position of the various instruments. Without any human intervention, the ultrasound nephrostomy tract is superimposed in real time onto fluoroscopic images acquired in various views. Results: We tested our approach by laboratory experiments on a phantom. Also, after approval by our institution's Ethics Committee, we validated this technique in the operating room during PCNL in one patient. Conclusion: Our system is reliable, and the absence of image-processing procedures makes it robust. We have initiated a prospective study to validate this technique both for PCNL speci...

  16. Video-fluoroscopic study of swallowing in children with neurodevelopmental disorders.

    Science.gov (United States)

    Fung, Cheuk-Wing; Khong, Pek-Lan; To, Raymond; Goh, Winnie; Wong, Virginia

    2004-02-01

    Children with neurodevelopmental disorders can have feeding problems. Malnutrition and recurrent aspiration pneumonia can increase the risk of morbidity and mortality. Video-fluoroscopic study of swallowing (VFSS) is essential in understanding the pathological mechanisms involved during swallowing. The aim of the present study was to assess the role of VFSS in assessment and management of four children with various neurodevelopmental disorders in a multidisciplinary feeding team. We describe the team approach, with the participation of child neurologist, radiologist with the rehabilitation team including the speech therapist, occupational therapist and dietician, in the assessment and plan of management. Video-fluoroscopic study of swallowing had been useful in assessing the type of swallowing problems with treatment goals targeted to the basic underlying pathophysiological mechanism. A child neurologist should be involved in the multidisciplinary oromotor rehabilitation program for neurologically impaired children with feeding problems.

  17. R&D of the Fluoroscopes of 100 MeV Cyclotron Beam Lines

    Institute of Scientific and Technical Information of China (English)

    YIN; Meng; GUAN; Feng-ping; XIE; Huai-dong; ZHENG; Xia; XING; Jian-sheng; LV; Yin-long

    2013-01-01

    Beijing Radioactive Ion-beam Facility(BRIF)consists of a 100 MeV H-cyclotron CYCIAE-100and nine beam lines.All the beam lines provide the channels of the proton beam or the neutron beam to the terminal of physics experiment.There are many beam diagnosis monitors distributing along the beam lines,including,Faraday cups,beam position monitors,fluoroscopes,collimators,emittance measurement

  18. On guidance and volatility

    NARCIS (Netherlands)

    Billings, M.B.; Jennings, R.; Lev, B.

    2013-01-01

    Survey evidence suggests that managers voluntarily disclose information, particularly earnings guidance, with an aim toward dampening share price volatility. Yet, consultants and influential institutions advise against providing guidance — citing fears of litigation and market penalties associated w

  19. Graphic Turbulence Guidance

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Forecast turbulence hazards identified by the Graphical Turbulence Guidance algorithm. The Graphical Turbulence Guidance product depicts mid-level and upper-level...

  20. Graphical Turbulence Guidance - Composite

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Forecast turbulence hazards identified by the Graphical Turbulence Guidance algorithm. The Graphical Turbulence Guidance product depicts mid-level and upper-level...

  1. X-ray tomographic intervention guidance: Towards real-time 4D imaging

    CERN Document Server

    Bartling, Sönke

    2016-01-01

    Implementation of real-time, continuous, and three-dimensional imaging (4D intervention guidance) would be a quantum leap for minimally-invasive medicine. It allows guidance during interventions by assessing the spatial position of instruments continuously in respect to their surroundings. Recent research showed that it is feasible using X-ray and novel tomographic reconstruction approaches. Radiation dose stays within reasonable limits. This article provides abstractions and background information together with an outlook on these prospects. There are explanations of how situational awareness during interventions is generated today and how they will be in future. The differences between fluoroscopically and CT-guided interventions are eluted to within the context of these developments. The exploration of uncharted terrain between these current methods is worth pursuing. Necessary image quality of 4D intervention guidance varies relevantly from that of standard computed tomography. Means to analyze the risk-b...

  2. A spatio-temporal detective quantum efficiency and its application to fluoroscopic systems

    Energy Technology Data Exchange (ETDEWEB)

    Friedman, S. N.; Cunningham, I. A. [Sackler School of Medicine, Faculty of Medicine, Tel Aviv University, Ramat Aviv 69978 (Israel); Imaging Research Laboratories, Robarts Research Institute and Lawson Health Research Institute, 100 Perth Drive, London, Ontario N6A 5K8 (Canada) and Department of Medical Biophysics, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 5B8 (Canada)

    2010-11-15

    Purpose: Fluoroscopic x-ray imaging systems are used extensively in spatio-temporal detection tasks and require a spatio-temporal description of system performance. No accepted metric exists that describes spatio-temporal fluoroscopic performance. The detective quantum efficiency (DQE) is a metric widely used in radiography to quantify system performance and as a surrogate measure of patient ''dose efficiency.'' It has been applied previously to fluoroscopic systems with the introduction of a temporal correction factor. However, the use of a temporally-corrected DQE does not provide system temporal information and it is only valid under specific conditions, many of which are not likely to be satisfied by suboptimal systems. The authors propose a spatio-temporal DQE that describes performance in both space and time and is applicable to all spatio-temporal quantum-based imaging systems. Methods: The authors define a spatio-temporal DQE (two spatial-frequency axes and one temporal-frequency axis) in terms of a small-signal spatio-temporal modulation transfer function (MTF) and spatio-temporal noise power spectrum (NPS). Measurements were made on an x-ray image intensifier-based bench-top system using continuous fluoroscopy with an RQA-5 beam at 3.9 {mu}R/frame and hardened 50 kVp beam (0.8 mm Cu filtration added) at 1.9 {mu}R/frame. Results: A zero-frequency DQE value of 0.64 was measured under both conditions. Nonideal performance was noted at both larger spatial and temporal frequencies; DQE values decreased by {approx}50% at the cutoff temporal frequency of 15 Hz. Conclusions: The spatio-temporal DQE enables measurements of decreased temporal system performance at larger temporal frequencies analogous to previous measurements of decreased (spatial) performance. This marks the first time that system performance and dose efficiency in both space and time have been measured on a fluoroscopic system using DQE and is the first step toward the

  3. A spatio-temporal detective quantum efficiency and its application to fluoroscopic systems.

    Science.gov (United States)

    Friedman, S N; Cunningham, I A

    2010-11-01

    Fluoroscopic x-ray imaging systems are used extensively in spatio-temporal detection tasks and require a spatio-temporal description of system performance. No accepted metric exists that describes spatio-temporal fluoroscopic performance. The detective quantum efficiency (DQE) is a metric widely used in radiography to quantify system performance and as a surrogate measure of patient "dose efficiency". It has been applied previously to fluoroscopic systems with the introduction of a temporal correction factor. However, the use of a temporally-corrected DQE does not provide system temporal information and it is only valid under specific conditions, many of which are not likely to be satisfied by suboptimal systems. The authors propose a spatio-temporal DQE that describes performance in both space and time and is applicable to all spatio-temporal quantum-based imaging systems. The authors define a spatio-temporal DQE (two spatial-frequency axes and one temporal-frequency axis) in terms of a small-signal spatio-temporal modulation transfer function (MTF) and spatio-temporal noise power spectrum (NPS). Measurements were made on an x-ray image intensifier-based bench-top system using continuous fluoroscopy with an RQA-5 beam at 3.9 microR/frame and hardened 50 kVp beam (0.8 mm Cu filtration added) at 1.9 microR/frame. A zero-frequency DQE value of 0.64 was measured under both conditions. Nonideal performance was noted at both larger spatial and temporal frequencies; DQE values decreased by approximately 50% at the cutoff temporal frequency of 15 Hz. The spatio-temporal DQE enables measurements of decreased temporal system performance at larger temporal frequencies analogous to previous measurements of decreased (spatial) performance. This marks the first time that system performance and dose efficiency in both space and time have been measured on a fluoroscopic system using DQE and is the first step toward the generalized use of DQE on clinical fluoroscopic systems.

  4. Academic Libraries and Learning Support in Collaboration. Library Based Guidance for Peer Assisted Learning Leaders at Bournemouth University: Theory and Practice.

    OpenAIRE

    Parton, Steve; Fleming, Hugh

    2008-01-01

    This article begins with an overview of the University’s pioneering Peer Assisted Learning Scheme (PAL) and describes how in 2005/6, the Library became involved, collaborating with the PAL Coordinator to develop materials for use by PAL Leaders. PAL is intended to foster cross-year support between students on the same course. It encourages students to support each other and learn co-operatively under the guidance of trained students from the year above - called PAL Leaders. Two documents were...

  5. Assessing validation of dual fluoroscopic image matching method for measurement of in vivo spine kinematics

    Institute of Scientific and Technical Information of China (English)

    BAI Jian-qiang; HU Yong-cheng; DU Li-qing; HE Jing-liang; LIU Kai; LIU Zhong-jun; XIA Qun

    2011-01-01

    Background Accurate knowledge of the spinal structural functions is critical to understand the biomechanical factors that affect spinal pathology. Many studies have investigated the human vertebral motion both in vitro and in vivo.However, determination of in vivo motion of the vertebrae under physiologic loading conditions remains a challenge in biomedical engineering because of the limitations of current technology and the complicated anatomy of the spine.Methods For in vitro validation, a human lumbar specimen was imbedded with steel beads and moved to a known distance by an universal testing machine (UTM). The dual fluoroscopic system was used to capture the spine motion and reproduce the moving distance. For in vivo validation, a living subject moved the spine in various positions while bearing weight. The fluoroscopes were used to reproduce the in vivo spine positions 5 times. The standard deviations in translation and orientation of the five measurements were used to evaluate the repeatability of technique. The accuracy of vertebral outline matching with metallic marks matching technology was compared.Results The translation positions of the human lumbar specimen could be determined with a mean accuracy less than 0.35 mm and a mean repeatability 0.36 mm for the image matching technique. The repeatability of the method in reproducing in vivo human spine six degrees of freedom (6DOF) kinematics was less than 0.43 mm in translation and less than 0.65° in rotation. The accuracy of metallic marks and vertebral outline matching did not show significant difference.Conclusions Combining a dual fluoroscopic and computerized tomography imaging technique was accurate and reproduceable for noninvasive measurement of spine vertebral motion. The vertebral outline matching technique could be a useful technique for matching of vertebral positions and orientations which can evaluate and improve the efficacy of the various surgical treatments.

  6. Fluoroscopically-guided micropuncture femoral artery access for large-caliber sheath insertion.

    Science.gov (United States)

    Cilingiroglu, Mehmet; Feldman, Ted; Salinger, Michael H; Levisay, Justin; Turi, Zoltan G

    2011-04-01

    Over the last decade, significant developments have been made in the treatment of structural heart disease. Some of these techniques require placement of large arterial sheaths for device delivery. Optimal vascular access is essential for successful large-vessel sheath insertion as well as to avoid vascular complications. The critical step for ideal percutaneous vessel entry is single anterior wall-only puncture of the common femoral artery in a location above the femoral bifurcation and below the inguinal ligament. We describe a fluoroscopically-guided micropuncture technique for accurate placement of large-caliber arterial sheaths.

  7. A Theory-Ridden, Computerless, Impersonal Vocational Guidance System.

    Science.gov (United States)

    Holland, John L.

    Beginning with a brief summary of the need for practical vocational guidance systems, the author explains his Self Directed Search for Educational and Vocational Planning (SDS), which was developed to provide a cheap, practical, vocational guidance system having a high degree of scientific validty and client effectiveness. The SDS is a…

  8. Short-term outcome of fluoroscopic-guided steroid injection therapy of lumber facet cyst-induced radicular pain

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Mi Ri; Kwon, Jong Won; Lee, Jong Seo; Kim, Eu Sang [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2015-04-15

    To determine the short-term effect of fluoroscopic-guided steroid injection therapy of lumbar facet cyst-induced radicular pain. Seventeen patients with radiculopathy due to lumbar synovial cysts, who were treated with fluoroscopically guided injection, were retrospectively evaluated. All plain radiographic images and MR images before the therapy were reviewed. Five patients underwent only the facet joint injection, whereas twelve patients underwent the facet joint injection with perineural injection therapy. The clinical course of pain was evaluated on the first follow-up after therapy. Effective pain relief was achieved in 11 (64.7%) of the 17 patients. Among 12 patients who underwent facet joint injection with perineural injection, 9 patients (75%) had an effective pain relief. Of 5 patients, 2 (40%) patients only took the facet joint injection and had an effective pain relief. Fluoroscopic-guided steroid injection therapy shows a good short-term effect in patients with symptomatic lumbar facet joint synovial cysts.

  9. Fluoroscopic bone fragment tracking for surgical navigation in femur fracture reduction by incorporating optical tracking of hip joint rotation center.

    Science.gov (United States)

    Nakajima, Yoshikazu; Tashiro, Takahito; Sugano, Nobuhiko; Yonenobu, Kazuo; Koyama, Tsuyoshi; Maeda, Yuki; Tamura, Yuichi; Saito, Masanobu; Tamura, Shin'ichi; Mitsuishi, Mamoru; Sugita, Naohiko; Sakuma, Ichiro; Ochi, Takahiro; Matsumoto, Yoichiro

    2007-09-01

    A new method for fluoroscopic tracking of a proximal bone fragment in femoral fracture reduction is presented. The proposed method combines 2-D and 3-D image registration from single-view fluoroscopy with tracking of the head center position of the proximal femoral fragment to improve the accuracy of fluoroscopic registration without the need for repeated manual adjustment of the C-arm as required in stereo-view registrations. Kinematic knowledge of the hip joint, which has a positional correspondence with the femoral head center and the pelvis acetabular center, allows the position of the femoral fragment to be determined from pelvis tracking. The stability of the proposed method with respect to fluoroscopic image noise and the desired continuity of the fracture reduction operation is demonstrated, and the accuracy of tracking is shown to be superior to that achievable by single-view image registration, particularly in depth translation.

  10. Computed tomography guidance for spinal intervention: basics of technique, pearls, and avoiding pitfalls.

    Science.gov (United States)

    Timpone, Vincent M; Hirsch, Joshua A; Gilligan, Christopher J; Chandra, Ronil V

    2013-01-01

    The utilization of spinal interventional pain techniques has grown rapidly over the last decade. However, practitioners use widely different techniques in these procedures, particularly in the use of image guidance. The importance of image guidance was highlighted by the fact that in recent systematic reviews on therapeutic effectiveness of epidural steroid injections and facet joint interventions, only studies that used image guidance were included. The choice of image guidance remains a matter of physician preference with conventional fluoroscopic or Computed Tomography (CT) guidance most common. There are many advantages to CT guidance for certain spinal interventional pain procedures, mainly due to increased needle tip positioning accuracy. CT guidance provides greater anatomical detail that facilitates accurate needle trajectory planning, monitoring and final placement. Unlike conventional fluoroscopy that may be hindered by tissue overlap and lack of surrounding anatomical detail CT guidance offers direct visualization of the entire needle trajectory and the surrounding soft tissue and bone structures. Large osteophytes and adjacent vascular structures can be identified and safely avoided. The goals of this narrative review are to provide a basic overview of CT techniques available for spinal interventional pain procedures, to discuss the potential advantages and disadvantages of CT guidance, to provide a simple step-by-step approach to use of CT guidance, to share technical pearls, and to discuss methods to avoid potential pitfalls. This review will provide interventional pain physicians with knowledge of relevant CT image acquisition techniques and appropriate radiation dose reduction strategies. This will contribute to increased technical success rates while reducing radiation dose to the patient and staff.

  11. Risk of whole body radiation exposure and protective measures in fluoroscopically guided interventional techniques: a prospective evaluation

    Directory of Open Access Journals (Sweden)

    Rivera Jose

    2003-08-01

    Full Text Available Abstract Background Fluoroscopic guidance is frequently utilized in interventional pain management. The major purpose of fluoroscopy is correct needle placement to ensure target specificity and accurate delivery of the injectate. Radiation exposure may be associated with risks to physician, patient and personnel. While there have been many studies evaluating the risk of radiation exposure and techniques to reduce this risk in the upper part of the body, the literature is scant in evaluating the risk of radiation exposure in the lower part of the body. Methods Radiation exposure risk to the physician was evaluated in 1156 patients undergoing interventional procedures under fluoroscopy by 3 physicians. Monitoring of scattered radiation exposure in the upper and lower body, inside and outside the lead apron was carried out. Results The average exposure per procedure was 12.0 ± 9.8 seconds, 9.0 ± 0.37 seconds, and 7.5 ± 1.27 seconds in Groups I, II, and III respectively. Scatter radiation exposure ranged from a low of 3.7 ± 0.29 seconds for caudal/interlaminar epidurals to 61.0 ± 9.0 seconds for discography. Inside the apron, over the thyroid collar on the neck, the scatter radiation exposure was 68 mREM in Group I consisting of 201 patients who had a total of 330 procedures with an average of 0.2060 mREM per procedure and 25 mREM in Group II consisting of 446 patients who had a total of 662 procedures with average of 0.0378 mREM per procedure. The scatter radiation exposure was 0 mREM in Group III consisting of 509 patients who had a total 827 procedures. Increased levels of exposures were observed in Groups I and II compared to Group III, and Group I compared to Group II. Groin exposure showed 0 mREM exposure in Groups I and II and 15 mREM in Group III. Scatter radiation exposure for groin outside the apron in Group I was 1260 mREM and per procedure was 3.8182 mREM. In Group II the scatter radiation exposure was 400 mREM and with 0.6042 m

  12. Best practices consensus protocol for peritoneal dialysis catheter placement by interventional radiologists.

    Science.gov (United States)

    Abdel-Aal, Ahmed K; Dybbro, Paul; Hathaway, Peter; Guest, Steven; Neuwirth, Michael; Krishnamurthy, Venkat

    2014-01-01

    Peritoneal dialysis (PD) catheters can be placed by interventional radiologists, an approach that might offer scheduling efficiencies, cost-effectiveness, and a minimally invasive procedure. In the United States, changes in the dialysis reimbursement structure by the Centers for Medicare and Medicaid Services are expected to result in the increased use of PD, a less costly dialysis modality that offers patients the opportunity to receive dialysis in the home setting and to have more independence for travel and work schedules, and that preserves vascular access for future dialysis options. Placement of PD catheters by interventional radiologists might therefore be increasingly requested by nephrology practices, given that recent publications have demonstrated the favorable impact on PD practices of an interventional radiology PD placement capability. Earlier reports of interventional radiology PD catheter placement came from single-center practices with smaller reported experiences. The need for a larger consensus document that attempts to establish best demonstrated practices for radiologists is evident. The radiologists submitting this consensus document represent a combined experience of more than 1000 PD catheter placements. The authors submit these consensus-proposed best demonstrated practices for placement of PD catheters by interventional radiologists under ultrasonographic and fluoroscopic guidance. This technique might allow for expeditious placement of permanent PD catheters in late-referred patients with end-stage renal disease, thus facilitating urgent-start PD and avoiding the need for temporary vascular access catheters. Copyright © 2014 International Society for Peritoneal Dialysis.

  13. Best Practices Consensus Protocol for Peritoneal Dialysis Catheter Placement by Interventional Radiologists

    Science.gov (United States)

    Abdel-Aal, Ahmed K.; Dybbro, Paul; Hathaway, Peter; Guest, Steven; Neuwirth, Michael; Krishnamurthy, Venkat

    2014-01-01

    Peritoneal dialysis (PD) catheters can be placed by interventional radiologists, an approach that might offer scheduling efficiencies, cost-effectiveness, and a minimally invasive procedure. In the United States, changes in the dialysis reimbursement structure by the Centers for Medicare and Medicaid Services are expected to result in the increased use of PD, a less costly dialysis modality that offers patients the opportunity to receive dialysis in the home setting and to have more independence for travel and work schedules, and that preserves vascular access for future dialysis options. Placement of PD catheters by interventional radiologists might therefore be increasingly requested by nephrology practices, given that recent publications have demonstrated the favorable impact on PD practices of an interventional radiology PD placement capability. Earlier reports of interventional radiology PD catheter placement came from single-center practices with smaller reported experiences. The need for a larger consensus document that attempts to establish best demonstrated practices for radiologists is evident. The radiologists submitting this consensus document represent a combined experience of more than 1000 PD catheter placements. The authors submit these consensus-proposed best demonstrated practices for placement of PD catheters by interventional radiologists under ultrasonographic and fluoroscopic guidance. This technique might allow for expeditious placement of permanent PD catheters in late-referred patients with end-stage renal disease, thus facilitating urgent-start PD and avoiding the need for temporary vascular access catheters. PMID:24584622

  14. Percutaneous Bone Biopsies: Comparison between Flat-Panel Cone-Beam CT and CT-Scan Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Tselikas, Lambros, E-mail: lambros.tselikas@gmail.com; Joskin, Julien, E-mail: j.joskin@gmail.com [Gustave Roussy, Interventional Radiology Department (France); Roquet, Florian, E-mail: florianroquet@hotmail.com [Gustave Roussy, Biostatistics Department (France); Farouil, Geoffroy, E-mail: g.farouil@gmail.com [Gustave Roussy, Interventional Radiology Department (France); Dreuil, Serge, E-mail: serge.dreuil@gustaveroussy.fr [Gustave Roussy, Medical Physics Department (France); Hakimé, Antoine, E-mail: thakime@yahoo.com; Teriitehau, Christophe, E-mail: cteriitehau@me.com [Gustave Roussy, Interventional Radiology Department (France); Auperin, Anne, E-mail: anne.auperin@gustaveroussy.fr [Gustave Roussy, Biostatistics Department (France); Baere, Thierry de, E-mail: thierry.debaere@gustaveroussy.fr; Deschamps, Frederic, E-mail: frederic.deschamps@gustaveroussy.fr [Gustave Roussy, Interventional Radiology Department (France)

    2015-02-15

    PurposeThis study was designed to compare the accuracy of targeting and the radiation dose of bone biopsies performed either under fluoroscopic guidance using a cone-beam CT with real-time 3D image fusion software (FP-CBCT-guidance) or under conventional computed tomography guidance (CT-guidance).MethodsSixty-eight consecutive patients with a bone lesion were prospectively included. The bone biopsies were scheduled under FP-CBCT-guidance or under CT-guidance according to operating room availability. Thirty-four patients underwent a bone biopsy under FP-CBCT and 34 under CT-guidance. We prospectively compared the two guidance modalities for their technical success, accuracy, puncture time, and pathological success rate. Patient and physician radiation doses also were compared.ResultsAll biopsies were technically successful, with both guidance modalities. Accuracy was significantly better using FP-CBCT-guidance (3 and 5 mm respectively: p = 0.003). There was no significant difference in puncture time (32 and 31 min respectively, p = 0.51) nor in pathological results (88 and 88 % of pathological success respectively, p = 1). Patient radiation doses were significantly lower with FP-CBCT (45 vs. 136 mSv, p < 0.0001). The percentage of operators who received a dose higher than 0.001 mSv (dosimeter detection dose threshold) was lower with FP-CBCT than CT-guidance (27 vs. 59 %, p = 0.01).ConclusionsFP-CBCT-guidance for bone biopsy is accurate and reduces patient and operator radiation doses compared with CT-guidance.

  15. A C-arm calibration method with application to fluoroscopic image-guided procedures

    Science.gov (United States)

    Rai, Lav; Gibbs, Jason D.; Wibowo, Henky

    2012-02-01

    C-arm fluoroscopy units provide continuously updating X-ray video images during surgical procedure. The modality is widely adopted for its low cost, real-time imaging capabilities, and its ability to display radio-opaque tools in the anatomy. It is, however, important to correct for fluoroscopic image distortion and estimate camera parameters, such as focal length and camera center, for registration with 3D CT scans in fluoroscopic imageguided procedures. This paper describes a method for C-arm calibration and evaluates its accuracy in multiple C-arm units and in different viewing orientations. The proposed calibration method employs a commerciallyavailable unit to track the C-arm and a calibration plate. The method estimates both the internal calibration parameters and the transformation between the coordinate systems of tracker and C-arm. The method was successfully tested on two C-arm units (GE OEC 9800 and GE OEC 9800 Plus) of different image intensifier sizes and verified with a rigid airway phantom model. The mean distortion-model error was found to be 0.14 mm and 0.17 mm for the respective C-arms. The mean overall system reprojection error (which measures the accuracy of predicting an image using tracker coordinates) was found to be 0.63 mm for the GE OEC 9800.

  16. Career guidance in communities

    DEFF Research Database (Denmark)

    Thomsen, Rie

    The aim of this paper is to inspire practitioners and professionals to leave their offices to bring career guidance into communities that might not identify with career guidance in the first instance. By making the effort to engage with communities, practitioners may bring about a critical change...

  17. Corporate information management guidance

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-08-01

    At the request of the Department of Energy`s (DOE) Information Management (IM) Council, IM representatives from nearly all Headquarters (HQ) organizations have been meeting over the past year as the Corporate Guidance Group (CGG) to develop useful and sound corporate information management (IM) guidance. The ability of the Department`s IM community to develop such unified guidance continues to be critical to the success of future Departmental IM planning processes and the establishment of a well-coordinated IM environment between Headquarters and field organizations. This report, with 26 specific corporate IM guidance items documented and unanimously agreed to, as well as 12 items recommended for further development and 3 items deferred for future consideration, represents a highly successful effort by the IM community. The effort has proven that the diverse DOE organizations can put aside individual preferences and work together towards a common and mutually beneficial goal. In examining most areas and issues associated with information management in the Department, they have developed specific, far-reaching, and useful guidance. The IM representatives recommend that the documented guidance items provided in this report and approved by the DOE IM Council be followed by all IM organizations. The representatives also strongly recommend that the guidance process developed by the CGG be the single process for developing corporate IM guidance.

  18. The disabled college career planning and employment guidance education practice significance%残疾人高校职业生涯规划与就业指导教育的实践意义

    Institute of Scientific and Technical Information of China (English)

    连婷; 王婷婷

    2014-01-01

    This article discusses the practical significance of the university career planning and employment guidance education for the disabled from three aspects, which are beneficial to promote social harmony and stability, to improve the quality of education of colleges for the disabled, and to deepen these schools’ ideological and political education work.%本文从有利于促进社会和谐稳定发展、有利于提升残疾人高校的教育质量、有利于深化残疾人学校的思想政治教育工作三方面,论述了残疾人高校职业生涯规划与就业指导教育的实践意义。

  19. Shuttle entry guidance

    Science.gov (United States)

    Harpold, J. C.; Graves, C. A., Jr.

    1978-01-01

    This paper describes the design of the entry guidance for the Space Shuttle Orbiter. This guidance provides the steering commands for trajectory control from initial penetration of the earth's atmosphere until the terminal area guidance is activated at an earth-relative speed of 2500 fps. At this point, the Orbiter is at a distance of about 50 nmi from the runway threshold, and at an altitude of about 80,000 ft. The entry guidance design is based on an analytic solution of the equations of motion defining the drag acceleration profile that meets the terminal criteria of the entry flight while maintaining the flight within systems and operational constraints. Guidance commands, which are based on a control law that ensures damping of oscillatory type trajectory motion, are computed to steer the Orbiter to this drag acceleration profile.

  20. Shuttle entry guidance revisited

    Science.gov (United States)

    Mease, Kenneth D.; Kremer, Jean-Paul

    1992-08-01

    The Shuttle entry guidance concept is reviewed which is aimed at tracking a reference drag trajectory that leads to the specified range and velocity for the initiation of the terminal energy management phase. An approximate method of constructing the domain of attraction is proposed, and its validity is ascertained by simulation. An alternative guidance law yielding global exponential tracking in the absence of control saturation is derived using a feedback linearization method. It is noted that the alternative guidance law does not improve on the stability and performance of the current guidance law, for the operating domain and control capability of the Shuttle. It is suggested that the new guidance law with a larger operating domain and increased lift-to-drag capability would be superior.

  1. Shuttle entry guidance revisited

    Science.gov (United States)

    Mease, Kenneth D.; Kremer, Jean-Paul

    1992-01-01

    The Shuttle entry guidance concept is reviewed which is aimed at tracking a reference drag trajectory that leads to the specified range and velocity for the initiation of the terminal energy management phase. An approximate method of constructing the domain of attraction is proposed, and its validity is ascertained by simulation. An alternative guidance law yielding global exponential tracking in the absence of control saturation is derived using a feedback linearization method. It is noted that the alternative guidance law does not improve on the stability and performance of the current guidance law, for the operating domain and control capability of the Shuttle. It is suggested that the new guidance law with a larger operating domain and increased lift-to-drag capability would be superior.

  2. SU-E-I-26: Estimation of Micro-Angiographic Fluoroscope (MAF) Gain Settings for Digital Subtraction Angiography (DSA) Based on the Fluoroscopic Exposure.

    Science.gov (United States)

    Ionita, C; Loughran, B; Nagesh, S Setlur; Jain, A; Bednarek, D; Rudin, S

    2012-06-01

    The MAF is a new high-resolution detector which is being clinically evaluated in neuro-vascular procedures. The detector contains a large-dynamic-range, high-sensitivity light image intensifier with variable gain. Since the MAF is a research prototype only partially integrated with the clinical system, x-ray technique parameters must be set manually. To improve workflow we developed an automatic method to estimate and set the proper LII voltage (MAF gain) for DSA acquisition based on the fluoroscopic parameters. The detector entrance exposure (XD) can be written as the x-ray tube output exposure (Xo) times an object attenuation factor and an inverse-square correction. If the object attenuation, scatter and distances are unchanged and the effect of x-ray kVp changes are neglected, then the DSA XD can be expressed as the ratio of Xo(DSA)/Xo(Fluoroscopy) multiplied with XD(fluoroscopy). We measured Xo for fluoroscopy and DSA for mAs and kVp ranges appropriate to neuro- vascular interventions and fit the data with a 2D function. To estimate the XD(Fluoroscopy) we derived a curve of XD versus LII-voltage for a mid- dynamic-range average pixel gray-level. Since the MAF system during clinical fluoroscopy automatically adjusts the LII voltage until the desired gray-level value is achieved, by reading that voltage we can estimate the XD(Fluoroscopy). Using the 2D-fit function, Xo(DSA) is automatically calculated for the kVp and mA values set and XD(DSA) can be estimated using the relation above. Using the inverse LII calibration curve, the proper LII-voltage can be determined for the desired average gray-level. The algorithm was implemented and evaluated in thirty-two in-vivo DSA runs on rabbits. The proper LII voltage was selected in all cases with no failures. Using the fluoroscopic LII gain setting to determine the appropriate DSA setting can greatly improve the workflow in clinical evaluations of the MAF. NIH Grants R01-EB008425, R01-EB002873 and an equipment grant from

  3. The European Society of Therapeutic Radiology and Oncology-European Institute of Radiotherapy (ESTRO-EIR) report on 3D CT-based in-room image guidance systems: a practical and technical review and guide.

    Science.gov (United States)

    Korreman, Stine; Rasch, Coen; McNair, Helen; Verellen, Dirk; Oelfke, Uwe; Maingon, Philippe; Mijnheer, Ben; Khoo, Vincent

    2010-02-01

    The past decade has provided many technological advances in radiotherapy. The European Institute of Radiotherapy (EIR) was established by the European Society of Therapeutic Radiology and Oncology (ESTRO) to provide current consensus statement with evidence-based and pragmatic guidelines on topics of practical relevance for radiation oncology. This report focuses primarily on 3D CT-based in-room image guidance (3DCT-IGRT) systems. It will provide an overview and current standing of 3DCT-IGRT systems addressing the rationale, objectives, principles, applications, and process pathways, both clinical and technical for treatment delivery and quality assurance. These are reviewed for four categories of solutions; kV CT and kV CBCT (cone-beam CT) as well as MV CT and MV CBCT. It will also provide a framework and checklist to consider the capability and functionality of these systems as well as the resources needed for implementation. Two different but typical clinical cases (tonsillar and prostate cancer) using 3DCT-IGRT are illustrated with workflow processes via feedback questionnaires from several large clinical centres currently utilizing these systems. The feedback from these clinical centres demonstrates a wide variability based on local practices. This report whilst comprehensive is not exhaustive as this area of development remains a very active field for research and development. However, it should serve as a practical guide and framework for all professional groups within the field, focussed on clinicians, physicists and radiation therapy technologists interested in IGRT.

  4. The Entropy Module and Bispectral Index as guidance for propofol-remifentanil anaesthesia in combination with regional anaesthesia compared with a standard clinical practice group.

    NARCIS (Netherlands)

    Ellerkmann, R.K.; Soehle, M.; Riese, G.; Zinserling, J.; Wirz, S.; Hoeft, A.; Bruhn, J.

    2010-01-01

    This study was designed to investigate the impact of the Entropy Module and Bispectral Index (BIS) monitoring on drug consumption and recovery times compared with standard anaesthetic practice in patients undergoing orthopaedic surgery using a combination of regional and general anaesthesia as perfo

  5. The Entropy Module and Bispectral Index as guidance for propofol-remifentanil anaesthesia in combination with regional anaesthesia compared with a standard clinical practice group.

    NARCIS (Netherlands)

    Ellerkmann, R.K.; Soehle, M.; Riese, G.; Zinserling, J.; Wirz, S.; Hoeft, A.; Bruhn, J.

    2010-01-01

    This study was designed to investigate the impact of the Entropy Module and Bispectral Index (BIS) monitoring on drug consumption and recovery times compared with standard anaesthetic practice in patients undergoing orthopaedic surgery using a combination of regional and general anaesthesia as perfo

  6. Discrepancy between fluoroscopic arthrography and magnetic resonance arthrography in patients with arthroscopically confirmed supraspinatus tendon tears: The additional benefit of cine fluoroscopic arthrography images

    Energy Technology Data Exchange (ETDEWEB)

    Hahn, Seok; Lee, Young Han; Suh, Jin Suck [Dept. Radiology, Research Institute of Radiological Science, Medical Convergence Research Institute, and Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2016-12-15

    To determine the additional diagnostic benefits of fluoroscopic arthrography (FA) in patients with full-thickness supraspinatus tendon (SST) tears by comparing FA images with magnetic resonance arthrography (MRA) images. This study included FA and MRA images of 53 patients who were confirmed to have full-thickness SST tears by arthroscopy. In the FA analysis, the presence of contrast leakage into the subacromial-subdeltoid bursa was recorded. In the MRA analysis, contrast leakage, retraction of a torn tendon, width and length of the tear, and supraspinatus atrophy were evaluated. Patients were divided into the concordant group or the discordant group based on the presence of contrast leakage to compare the characteristics of SST tears. We used Fisher's exact test and two-sample t-test for the comparison. Of the 53 patients, 34 were included in the concordant group and 19 were included in the discordant group. In the concordant group, the grades of retraction were higher than those in the discordant group; the width and length of the tears were larger. Muscle atrophy was more severe in the concordant group. A full-thickness SST tear did not always exhibit contrast leakage on FA, particularly small SST tears or tears with low-grade retraction. FA can provide diagnostic information regarding the severity of full-thickness SST tears by itself.

  7. MO-F-CAMPUS-I-02: Occupational Conceptus Doses From Fluoroscopically-Guided Interventional Procedures

    Energy Technology Data Exchange (ETDEWEB)

    Damilakis, J; Perisinakis, K; Solomou, G [University of Crete (Greece); Stratakis, J [University of Crete, Heraklion, Crete (Greece)

    2015-06-15

    Purpose: The aim of this method was to provide dosimetric data on conceptus dose for the pregnant employee who participates in fluoroscopically-guided interventional procedures. Methods: Scattered air-kerma dose rates were obtained for 17 fluoroscopic projections involved in interventional procedures. These projections were simulated on an anthropomorphic phantom placed on the examination table supine. The operating theater was divided into two grids relative to the long table sides. Each grid consisted of 33 cells spaced 0.50 m apart. During the simulated exposures, at each cell, scatter air-kerma rate was measured at 110 cm from the floor i.e. at the height of the waist of the pregnant worker. Air-kerma rates were divided by the dose area product (DAP) rate of each exposure to obtain normalized data. For each projection, measurements were performed for 3 kVp and 3 filtration values i.e. for 9 different x-ray spectra. All measurements were performed by using a modern C-arm angiographic system (Siemens Axiom Artis, Siemens, Germany) and a radiation meter equipped with an ionization chamber. Results: The results consist of 153 iso-dose maps, which show the spatial distribution of DAP-normalized scattered air-kerma doses at the waist level of a pregnant worker. Conceptus dose estimation is possible using air-kerma to embryo/fetal dose conversion coefficients published in a previous study (J Cardiovasc Electrophysiol, Vol. 16, pp. 1–8, July 2005). Using these maps, occupationally exposed pregnant personnel may select a working position for a certain projection that keeps abdominal dose as low as reasonably achievable. Taking into consideration the regulatory conceptus dose limit for occupational exposure, determination of the maximum workload allowed for the pregnant personnel is also possible. Conclusion: Data produced in this work allow for the anticipation of conceptus dose and the determination of the maximum workload for a pregnant worker from any

  8. Laser Guidance Analysis Facility

    Data.gov (United States)

    Federal Laboratory Consortium — This facility, which provides for real time, closed loop evaluation of semi-active laser guidance hardware, has and continues to be instrumental in the development...

  9. Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients: A Guidance Report and Clinical Checklist by the Consensus on Managing Modifiable Risk in Transplantation (COMMIT) Group.

    Science.gov (United States)

    Neuberger, James M; Bechstein, Wolf O; Kuypers, Dirk R J; Burra, Patrizia; Citterio, Franco; De Geest, Sabina; Duvoux, Christophe; Jardine, Alan G; Kamar, Nassim; Krämer, Bernhard K; Metselaar, Herold J; Nevens, Frederik; Pirenne, Jacques; Rodríguez-Perálvarez, Manuel L; Samuel, Didier; Schneeberger, Stefan; Serón, Daniel; Trunečka, Pavel; Tisone, Giuseppe; van Gelder, Teun

    2017-04-01

    Short-term patient and graft outcomes continue to improve after kidney and liver transplantation, with 1-year survival rates over 80%; however, improving longer-term outcomes remains a challenge. Improving the function of grafts and health of recipients would not only enhance quality and length of life, but would also reduce the need for retransplantation, and thus increase the number of organs available for transplant. The clinical transplant community needs to identify and manage those patient modifiable factors, to decrease the risk of graft failure, and improve longer-term outcomes.COMMIT was formed in 2015 and is composed of 20 leading kidney and liver transplant specialists from 9 countries across Europe. The group's remit is to provide expert guidance for the long-term management of kidney and liver transplant patients, with the aim of improving outcomes by minimizing modifiable risks associated with poor graft and patient survival posttransplant.The objective of this supplement is to provide specific, practical recommendations, through the discussion of current evidence and best practice, for the management of modifiable risks in those kidney and liver transplant patients who have survived the first postoperative year. In addition, the provision of a checklist increases the clinical utility and accessibility of these recommendations, by offering a systematic and efficient way to implement screening and monitoring of modifiable risks in the clinical setting.

  10. Radiation Dose Reduction Methods For Use With Fluoroscopic Imaging, Computers And Implications For Image Quality

    Science.gov (United States)

    Edmonds, E. W.; Hynes, D. M.; Rowlands, J. A.; Toth, B. D.; Porter, A. J.

    1988-06-01

    The use of a beam splitting device for medical gastro-intestinal fluoroscopy has demonstrated that clinical images obtained with a 100mm photofluorographic camera, and a 1024 X 1024 digital matrix with pulsed progressive readout acquisition techniques, are identical. In addition, it has been found that clinical images can be obtained with digital systems at dose levels lower than those possible with film. The use of pulsed fluoroscopy with intermittent storage of the fluoroscopic image has also been demonstrated to reduce the fluoroscopy part of the examination to very low dose levels, particularly when low repetition rates of about 2 frames per second (fps) are used. The use of digital methods reduces the amount of radiation required and also the heat generated by the x-ray tube. Images can therefore be produced using a very small focal spot on the x-ray tube, which can produce further improvement in the resolution of the clinical images.

  11. Systematic review and meta-analysis of studies evaluating diagnostic test accuracy: A practical review for clinical researchers-Part I. general guidance and tips

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kyung Won; Choi, Sang Hyun; Huh, Jimi; Park, Seong Ho [Dept. of Radiology, and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of); Lee, June Young [Dept. of Biostatistics, Korea University College of Medicine, Seoul (Korea, Republic of)

    2015-12-15

    In the field of diagnostic test accuracy (DTA), the use of systematic review and meta-analyses is steadily increasing. By means of objective evaluation of all available primary studies, these two processes generate an evidence-based systematic summary regarding a specific research topic. The methodology for systematic review and meta-analysis in DTA studies differs from that in therapeutic/interventional studies, and its content is still evolving. Here we review the overall process from a practical standpoint, which may serve as a reference for those who implement these methods.

  12. Use of a fluoroscopic overlay to guide femoral tunnel placement during posterior cruciate ligament reconstruction.

    Science.gov (United States)

    Araujo, Paulo H; Moloney, Gele; Rincon, Gustavo; Carey, Robert; Zhang, Xudong; Harner, Christopher

    2014-11-01

    Intraoperative recognition of the local anatomy of the posterior cruciate ligament (PCL) is difficult for many surgeons, and correct positioning of the graft can be challenging. To investigate the efficacy of an overlay system based on fluoroscopic landmarks in guiding femoral tunnel placement during PCL reconstruction. Controlled laboratory study. Twenty cadaveric knees were arthroscopically prepared, and their PCL femoral insertion sites were digitized. The digitized images were co-registered to computed tomography-acquired 3-dimensional bone models. Twenty surgeons with diverse backgrounds performed simulated arthroscopic reconstruction of the anterolateral (AL) and posteromedial (PM) bundles of the PCL, first without and then with the aid of a lateral fluoroscopic image on which the position of a target insertion site based on literature data was displayed as an overlay. The surgeons were allowed to adjust tunnel placement in accordance with the displayed target position. A 3-way comparison was made of the tunnel positions placed by the surgeons, the native insertion site positions, and the literature-based positions. The overlay system was effective in helping surgeons to improve femoral tunnel placement toward the target and toward the anatomic insertion site (P 5 mm from the native insertion site. With the use of the overlay, 70% of the surgeons were overlay to guide intraoperative placement of the femoral tunnel(s) during PCL reconstruction can result in more anatomic reconstructions and therefore assist in re-creating native knee kinematics after PCL reconstruction. Intraoperative fluoroscopy is an effective, easy, and safe method for improving femoral tunnel positioning during PCL reconstruction. © 2014 The Author(s).

  13. Accurate 3D kinematic measurement of temporomandibular joint using X-ray fluoroscopic images

    Science.gov (United States)

    Yamazaki, Takaharu; Matsumoto, Akiko; Sugamoto, Kazuomi; Matsumoto, Ken; Kakimoto, Naoya; Yura, Yoshiaki

    2014-04-01

    Accurate measurement and analysis of 3D kinematics of temporomandibular joint (TMJ) is very important for assisting clinical diagnosis and treatment of prosthodontics and orthodontics, and oral surgery. This study presents a new 3D kinematic measurement technique of the TMJ using X-ray fluoroscopic images, which can easily obtain the TMJ kinematic data in natural motion. In vivo kinematics of the TMJ (maxilla and mandibular bone) is determined using a feature-based 2D/3D registration, which uses beads silhouette on fluoroscopic images and 3D surface bone models with beads. The 3D surface models of maxilla and mandibular bone with beads were created from CT scans data of the subject using the mouthpiece with the seven strategically placed beads. In order to validate the accuracy of pose estimation for the maxilla and mandibular bone, computer simulation test was performed using five patterns of synthetic tantalum beads silhouette images. In the clinical applications, dynamic movement during jaw opening and closing was conducted, and the relative pose of the mandibular bone with respect to the maxilla bone was determined. The results of computer simulation test showed that the root mean square errors were sufficiently smaller than 1.0 mm and 1.0 degree. In the results of clinical application, during jaw opening from 0.0 to 36.8 degree of rotation, mandibular condyle exhibited 19.8 mm of anterior sliding relative to maxillary articular fossa, and these measurement values were clinically similar to the previous reports. Consequently, present technique was thought to be suitable for the 3D TMJ kinematic analysis.

  14. Non-fluoroscopic navigation systems for radiofrequency catheter ablation for supraventricular tachycardia reduce ionising radiation exposure.

    Science.gov (United States)

    See, Jason; Amora, Jonah L; Lee, Sheldon; Lim, Paul; Teo, Wee Siong; Tan, Boon Yew; Ho, Kah Leng; Lee, Chee Wan; Ching, Chi-Keong

    2016-07-01

    The use of non-fluoroscopic systems (NFS) to guide radiofrequency catheter ablation (RFCA) for the treatment of supraventricular tachycardia (SVT) is associated with lower radiation exposure. This study aimed to determine if NFS reduces fluoroscopy time, radiation dose and procedure time. We prospectively enrolled patients undergoing RFCA for SVT. NFS included EnSiteTM NavXTM or CARTO® mapping. We compared procedure and fluoroscopy times, and radiation exposure between NFS and conventional fluoroscopy (CF) cohorts. Procedural success, complications and one-year success rates were reported. A total of 200 patients over 27 months were included and RFCA was guided by NFS for 79 patients; those with atrioventricular nodal reentrant tachycardia (AVNRT), left-sided atrioventricular reentrant tachycardia (AVRT) and right-sided AVRT were included (n = 101, 63 and 36, respectively). Fluoroscopy times were significantly lower with NFS than with CF (10.8 ± 11.1 minutes vs. 32.0 ± 27.5 minutes; p < 0.001). The mean fluoroscopic dose area product was also significantly reduced with NFS (NSF: 5,382 ± 5,768 mGy*cm2 vs. CF: 21,070 ± 23,311 mGy*cm2; p < 0.001); for all SVT subtypes. There was no significant reduction in procedure time, except for left-sided AVRT ablation (NFS: 79.2 minutes vs. CF: 116.4 minutes; p = 0.001). Procedural success rates were comparable (NFS: 97.5% vs. CF: 98.3%) and at one-year follow-up, there was no significant difference in the recurrence rates (NFS: 5.2% vs. CF: 4.2%). No clinically significant complications were observed in both groups. The use of NFS for RFCA for SVT is safe, with significantly reduced radiation dose and fluoroscopy time. Copyright © Singapore Medical Association.

  15. Efficient segmentation of 3D fluoroscopic datasets from mobile C-arm

    Science.gov (United States)

    Styner, Martin A.; Talib, Haydar; Singh, Digvijay; Nolte, Lutz-Peter

    2004-05-01

    The emerging mobile fluoroscopic 3D technology linked with a navigation system combines the advantages of CT-based and C-arm-based navigation. The intra-operative, automatic segmentation of 3D fluoroscopy datasets enables the combined visualization of surgical instruments and anatomical structures for enhanced planning, surgical eye-navigation and landmark digitization. We performed a thorough evaluation of several segmentation algorithms using a large set of data from different anatomical regions and man-made phantom objects. The analyzed segmentation methods include automatic thresholding, morphological operations, an adapted region growing method and an implicit 3D geodesic snake method. In regard to computational efficiency, all methods performed within acceptable limits on a standard Desktop PC (30sec-5min). In general, the best results were obtained with datasets from long bones, followed by extremities. The segmentations of spine, pelvis and shoulder datasets were generally of poorer quality. As expected, the threshold-based methods produced the worst results. The combined thresholding and morphological operations methods were considered appropriate for a smaller set of clean images. The region growing method performed generally much better in regard to computational efficiency and segmentation correctness, especially for datasets of joints, and lumbar and cervical spine regions. The less efficient implicit snake method was able to additionally remove wrongly segmented skin tissue regions. This study presents a step towards efficient intra-operative segmentation of 3D fluoroscopy datasets, but there is room for improvement. Next, we plan to study model-based approaches for datasets from the knee and hip joint region, which would be thenceforth applied to all anatomical regions in our continuing development of an ideal segmentation procedure for 3D fluoroscopic images.

  16. Untangling the web of European regulations for the preparation of unlicensed radiopharmaceuticals: a concise overview and practical guidance for a risk-based approach.

    Science.gov (United States)

    Lange, Rogier; ter Heine, Rob; Decristoforo, Clemens; Peñuelas, Iván; Elsinga, Philip H; van der Westerlaken, Monique M L; Hendrikse, N Harry

    2015-05-01

    Radiopharmaceuticals are highly regulated, because they are controlled both as regular medicinal products and as radioactive substances. This can pose a hurdle for their development and clinical use. Radiopharmaceuticals are fundamentally different from other medicinal products and these regulations are not always adequate for their production. Strict compliance may have a huge resource impact, without further improving product quality. In this paper we give an overview of the applicable legislation and guidelines and propose a risk-based approach for their implementation. We focus on a few controversial Good Manufacturing Practice topics: cleanroom classification, air pressure regime, cleanroom qualification and microbiological monitoring. We have developed an algorithm to assess the combined risk of microbiological contamination of a radiopharmaceutical preparation process and propose corresponding Good Manufacturing Practice classification levels. In our opinion, the risk of carry-over of radiopharmaceuticals by individuals cannot be contained by pressure differences, and complicated regimes with underpressured rooms are not necessary in most situations. We propose a sterility assurance level of 10 for radiopharmaceuticals that are administered within a working day, irrespective of their use. We suggest the adoption of limits for environmental monitoring of microbial contamination, as proposed by Bruel and colleagues, on behalf of the French Society of Radiopharmacy. Recently launched regulatory documents seem to breathe a more liberal spirit than current legislation and recognize the need for the use of risk assessment. We argue that future legislation be further harmonized and state risk assessment as the gold standard for implementation of drug quality regulations for the preparation of unlicensed radiopharmaceuticals.

  17. My view on occupation guidance

    Institute of Scientific and Technical Information of China (English)

    2012-01-01

    Occupation instruction needs to the support of theories,in the case of the occupation guidance theory is not very developed in our country,It has very important sense that absorbing and drawing lessons from the advanced occupation guidance theory,and targeting guidance to occupation guidance work,.

  18. Making Connections: Guidance and Career Education in the Middle Years.

    Science.gov (United States)

    Levi, Marion; Ziegler, Suzanne

    This report is an examination of recommended and actual school-based guidance policies, programs, and practices for young adolescents. The information is drawn from Canadian and international publications, and from a survey of guidance and career education programs for grades 7-8 in Ontario boards of education and schools, called The 1990 Ontario…

  19. Thinking Differently about Guidance: Power, Children's Autonomy and Democratic Environments

    Science.gov (United States)

    Millei, Zsuzsa

    2012-01-01

    This article critiques guidance approaches to discipline, that are employed in early childhood environments with an aim to create democratic environments for children, and as part of "good" practices. Advocates of guidance claim that this is a more humane or democratic approach to discipline that empowers children, and therefore, power in the…

  20. CAREER GUIDANCE EXPERIENCE ABROAD

    Directory of Open Access Journals (Sweden)

    Sergey N. Tolstoguzov

    2015-01-01

    Full Text Available The aim of this paper is to describe the experience of careeroriented activities carried out with students of schools in developed and developing countries. Career Guidance in Russia, despite the vast experience of its implementation, is experiencing serious difficulties. In this regard, it is important to take into account the international experience career-oriented activities, such as in the developed countries of North America and the European Union as well as in several Asian countries with rapidly growing economies and a large demographic potential, taking into account the best variants for the Russian education system. Methods. The experience of career-oriented work undertaken with pupils of the USA, Canada, Israel, France, UK, Germany, Denmark, Sweden, Japan, Singapore, China and India is shown on the basis of the comparative analysis of different publications and information sources. The author has made an attempt to generalize the principles of psycho-pedagogical and administrative assistance in professional self-determination of senior pupils abroad. Scientific novelty. The approaches to career-oriented activities in countries with different levels of economic development are compared for the first time. Some principles are revealed. Firstly, the higher the income level per capita in the country, the greater attention is given to vocational guidance. The politics in the developed countries is based on interests of the individual: children’s acquaintance with the world of professions begins already at younger school and the moment of definitive selfdetermination is postponed till the end of their senior stage of education; the possibility of direction change of professional preparation in case of detection of discrepancy of qualities of the pupil to originally selected profile is provided. Career-oriented activity in developing countries, on the contrary, is rigidly coordinated to requirements of economy and a labour market

  1. Anticipatory guidance through DVD.

    Science.gov (United States)

    Franz, Sandra; McMahon, Pamela M; Calongne, Laurinda; Steele-Moses, Susan K

    2014-03-01

    The major purpose of the study was to determine if a 5-minute DVD is an effective method for communicating anticipatory guidance to parents at their child's 4-month well-child visit. A total of 84 caregivers were randomly assigned to receive anticipatory guidance through standard care (written anticipatory guidance handout and free talk) or DVD (DVD format + standard care). Participants completed a brief questionnaire immediately before and after their visit. As anticipated, knowledge scores improved significantly from pre-test to post-test. There was also a significant interaction between format used for anticipatory guidance and time. Specifically, there was greater improvement in knowledge over time for parents in the DVD group as compared with the standard care group. Additionally, the mean knowledge level of those in the DVD group as compared with those in the standard care group trended toward significance. Finally, visit length was shortened by nearly 3 minutes in the DVD group, and close to 100% of all respondents, regardless of anticipatory guidance format, indicated that they were very satisfied with their visit and amount of information learned.

  2. To feed or not to feed? Case presentation and best practice guidance for human milk feeding and group B streptococcus in developed countries.

    Science.gov (United States)

    Davanzo, Riccardo; De Cunto, Angela; Travan, Laura; Bacolla, Gianfranco; Creti, Roberta; Demarini, Sergio

    2013-11-01

    Group B Streptococcus (GBS) is the most frequent cause of neonatal invasive disease. Two forms of GBS are recognized: early-onset and late-onset disease. The average incidence of late-onset disease is 0.24 per 1000, a figure that has remained substantially unchanged over time. Exposure to breast milk represents a potential source of infection, especially in late-onset and/or recurrent GBS disease. As a result, both breastfeeding and the use of breast milk have been questioned. We report for the first time the case of both simultaneous and recurrent infection in newborn preterm twins, born 3 weeks apart, resulting from ingestion of GBS positive breast milk. A genetically identical strain was found in both breast milk and her newborn infants. Transmission of GBS through breast milk should be considered in late-onset GBS sepsis. An eradicating antibiotic treatment of GBS positive mothers with ampicillin plus rifampin and temporary discontinuation of breastfeeding and/or the use of heat processed breast milk may represent preventive measures, although outcomes are inconsistent, for recurrent GBS disease. Guidelines on breastfeeding and prevention of recurrent neonatal GBS disease are needed. It is unfortunate that existing scientific literature is scarce and there is no general consensus. As a consequence, we propose a best practice approach on the topic.

  3. 社会体育指导与管理专业学生实践能力探析%Analysis on the Practice Ability of Students Majoring in Guidance and Management of Social Sports

    Institute of Scientific and Technical Information of China (English)

    李克建; 王伟

    2014-01-01

    Practice ability training is a systematic and complicat-ed process,while students' learning process during their school time is the process to obtain professional knowledge,skills and practice ability. This paper proposes the strengthening of the cul-tivation of students' practice ability based on the basic attributes of experience,skill and education.By improving the quality of classroom teaching,the effect of extracurricular activities and the strength of social practice guidance,the training of students' prac-tice ability is realized. In the process of cultivating students' spe-cialized practice ability, great importance should be attached to the quality of such three links as curriculum learning, profession-al practice and graduation thesis.The aim is to make students truly master special knowledge and special skills through cur-riculum learning; professional practice is aimed to improve the practice ability of students and realize the goal of talent cultiva-tion; graduation thesis writing styles are aimed to train and exam-ine students' abilities of combining theory with practice, discover-ing problems, analyzing problems and solving specific problems.%实践能力培养是一项系统而复杂的过程,学生在校期间的学习过程,是其获取专业知识、技能和实践能力的过程。本文提出依据体验性、技能性和师范性的基本属性,加强学生实践能力的培养力度。通过提高课堂教学质量、课外活动效果和社会实践指导力度,实现对学生实践能力的培养。在对学生专项实践能力培养过程中要高度重视课程学习、专业实习和毕业论文三个环节的质量,让学生能够通过课程学习真正掌握专项知识和专项能力;通过专业实习提高学生实践能力,实现人才培养目标;通过毕业论文写作的方式培养和检验学生理论联系实际,发现问题、分析问题和解决具体问题的能力。

  4. Movement Strategy Discovery during Training via Haptic Guidance.

    Science.gov (United States)

    Gibo, Tricia L; Abbink, David A

    2016-01-01

    Haptic guidance has previously been investigated to facilitate motor skill training, whereupon a robotic device assists a trainee in executing the desired movement. However, many studies have reported a null or even detrimental effect of haptic guidance on training compared to unassisted practice. While prior studies have focused on using haptic guidance to refine a movement strategy, our study explores its effect on the discovery of a new strategy. Subjects learned to manipulate a virtual under-actuated system via a haptic device either with or without haptic guidance (and without haptic feedback of system dynamics). The guidance enabled subjects to experience a range of successful movements, rather than strictly enforcing one trajectory. Subjects who trained with guidance adopted a strategy that involved faster reaches, required greater control of the system's degrees of freedom, and increased the potential for faster task completion. However, overall improvement of task performance was limited with the new strategy.

  5. Trajectory reshaping based guidance with impact time and angle constraints

    Directory of Open Access Journals (Sweden)

    Zhao Yao

    2016-08-01

    Full Text Available This study presents a novel impact time and angle constrained guidance law for homing missiles. The guidance law is first developed with the prior-assumption of a stationary target, which is followed by the practical extension to a maneuvering target scenario. To derive the closed-form guidance law, the trajectory reshaping technique is utilized and it results in defining a specific polynomial function with two unknown coefficients. These coefficients are determined to satisfy the impact time and angle constraints as well as the zero miss distance. Furthermore, the proposed guidance law has three additional guidance gains as design parameters which make it possible to adjust the guided trajectory according to the operational conditions and missile’s capability. Numerical simulations are presented to validate the effectiveness of the proposed guidance law.

  6. Ultrasound Guidance for Renal Tract Access and Dilation Reduces Radiation Exposure during Percutaneous Nephrolithotomy

    Directory of Open Access Journals (Sweden)

    Thomas Chi

    2016-01-01

    Full Text Available Purposes. To present our series of 38 prone percutaneous nephrolithotomy procedures performed with renal access and tract dilation purely under ultrasound guidance and describe the benefits and challenges accompanying this approach. Methods. Thirty-eight consecutive patients presenting for percutaneous nephrolithotomy for renal stone removal were included in this prospective cohort study. Ultrasonographic imaging in the prone position was used to obtain percutaneous renal access and guide tract dilation. Fluoroscopic screening was used only for nephrostomy tube placement. Preoperative, intraoperative, and postoperative procedural and patient data were collected for analysis. Results. Mean age of patients was 52.7±17.2 years. Forty-five percent of patients were male with mean BMI of 26.1±7.3 and mean stone size of 27.2±17.6 millimeters. Renal puncture was performed successfully with ultrasonographic guidance in all cases with mean puncture time of 135.4±132.5 seconds. Mean dilation time was 11.5±3.8 min and mean stone fragmentation time was 37.5±29.0 min. Mean total operative time was 129.3±41.1. No patients experienced any significant immediate postoperative complication. All patients were rendered stone-free and no additional secondary procedures were required. Conclusions. Ultrasound guidance for renal access and tract dilation in prone percutaneous nephrolithotomy is a feasible and effective technique. It can be performed safely with significantly reduced fluoroscopic radiation exposure to the patient, surgeon, and intraoperative personnel.

  7. Swot分析理论视野下以专业为导向的大学生就业指导课的教学实践探索%Teaching Practice Exploration of Professional-oriented College Students' Career Guidance Course in Swot Analysis Theory Perspective

    Institute of Scientific and Technical Information of China (English)

    柳海萍

    2014-01-01

    大学生就业指导课地位重要且意义重大,但其作为一门新兴课程,在教学中存在教学形式单一和教学内容专业针对性弱等问题。文章对就业指导课教学进行了Swot分析,以专业为导向对就业指导课的教学实践进行了探索。%Employment guidance is important and significant position in college, but as a new course, there is a single form of teaching content and teaching professional targeted and weak in teaching. This paper made Swot analysis on career guid-ance teaching, explored on professional practice-oriented teaching career guidance lessons.

  8. Magnetic Resonance Enterography Findings in Crohn′s disease in the Pediatric Population and Correlation with Fluoroscopic and Multidetector Computed Tomographic Techniques

    OpenAIRE

    Parul Patel; Margaret Ormanoski; Hoadley, Kim M.

    2011-01-01

    Traditionally, fluoroscopic examinations such as enteroclysis, upper GI studies, and small bowel follow through exams have been the procedures of choice in evaluating inflammatory bowel disease (IBD) in pediatric populations. With the advent of multidetector computed tomography (MDCT), it has subsequently become a complementary examination in imaging inflammatory bowel disease. A major advantage of MDCT over fluoroscopic examination is its ability to directly visualize bowel mucosa, as well a...

  9. pedagogical guidance for consumer studies reflected in the south ...

    African Journals Online (AJOL)

    user

    ISSN 0378-5254 Journal of Family Ecology and Consumer Sciences, Vol 43, 2015. Pedagogical guidance .... recommendations in the Ministerial Task Team report (DoE, 2009:62) .... the method and practice/ activities of teaching – specifically ...

  10. PIV Logon Configuration Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Glen Alan [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-03-04

    This document details the configurations and enhancements implemented to support the usage of federal Personal Identity Verification (PIV) Card for logon on unclassified networks. The guidance is a reference implementation of the configurations and enhancements deployed at the Los Alamos National Laboratory (LANL) by Network and Infrastructure Engineering – Core Services (NIE-CS).

  11. Regulatory guidance document

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1994-05-01

    The Office of Civilian Radioactive Waste Management (OCRWM) Program Management System Manual requires preparation of the OCRWM Regulatory Guidance Document (RGD) that addresses licensing, environmental compliance, and safety and health compliance. The document provides: regulatory compliance policy; guidance to OCRWM organizational elements to ensure a consistent approach when complying with regulatory requirements; strategies to achieve policy objectives; organizational responsibilities for regulatory compliance; guidance with regard to Program compliance oversight; and guidance on the contents of a project-level Regulatory Compliance Plan. The scope of the RGD includes site suitability evaluation, licensing, environmental compliance, and safety and health compliance, in accordance with the direction provided by Section 4.6.3 of the PMS Manual. Site suitability evaluation and regulatory compliance during site characterization are significant activities, particularly with regard to the YW MSA. OCRWM`s evaluation of whether the Yucca Mountain site is suitable for repository development must precede its submittal of a license application to the Nuclear Regulatory Commission (NRC). Accordingly, site suitability evaluation is discussed in Chapter 4, and the general statements of policy regarding site suitability evaluation are discussed in Section 2.1. Although much of the data and analyses may initially be similar, the licensing process is discussed separately in Chapter 5. Environmental compliance is discussed in Chapter 6. Safety and Health compliance is discussed in Chapter 7.

  12. Robust fluoroscopic respiratory gating for lung cancer radiotherapy without implanted fiducial markers

    Science.gov (United States)

    Cui, Ying; Dy, Jennifer G.; Sharp, Greg C.; Alexander, Brian; Jiang, Steve B.

    2007-02-01

    For gated lung cancer radiotherapy, it is difficult to generate accurate gating signals due to the large uncertainties when using external surrogates and the risk of pneumothorax when using implanted fiducial markers. We have previously investigated and demonstrated the feasibility of generating gating signals using the correlation scores between the reference template image and the fluoroscopic images acquired during the treatment. In this paper, we present an in-depth study, aiming at the improvement of robustness of the algorithm and its validation using multiple sets of patient data. Three different template generating and matching methods have been developed and evaluated: (1) single template method, (2) multiple template method, and (3) template clustering method. Using the fluoroscopic data acquired during patient setup before each fraction of treatment, reference templates are built that represent the tumour position and shape in the gating window, which is assumed to be at the end-of-exhale phase. For the single template method, all the setup images within the gating window are averaged to generate a composite template. For the multiple template method, each setup image in the gating window is considered as a reference template and used to generate an ensemble of correlation scores. All the scores are then combined to generate the gating signal. For the template clustering method, clustering (grouping of similar objects together) is performed to reduce the large number of reference templates into a few representative ones. Each of these methods has been evaluated against the reference gating signal as manually determined by a radiation oncologist. Five patient datasets were used for evaluation. In each case, gated treatments were simulated at both 35% and 50% duty cycles. False positive, negative and total error rates were computed. Experiments show that the single template method is sensitive to noise; the multiple template and clustering methods are more

  13. 高职导游专业课程教学改革与实践探析--以浙江旅游职业学院《英语导游讲解》为例%Teaching reform and practice of the tourism guidance specialty in higher vocational education--Taking"English guidance"in Zhejiang Tourism College as an example

    Institute of Scientific and Technical Information of China (English)

    陈建新

    2014-01-01

    专业课程建设是高职教学质量与教学改革工程的重要组成部分。受行业性质决定,高职导游专业属于应用型、实操型、技能型专业,是为各类旅行社培养导游、接待等服务型人才的专业。以高职导游专业主干核心课程--《英语导游讲解》课程为例,从课程教学、学生实践、课程考核三方面提出课程建设的改革思路,以实现专业建设与社会行业需求的对接。%Professional courses construction is an important part of teaching quality and teaching reform project. By the nature of the industry, tour guidance major of higher vocational education belongs to the application type, operation type, professional skills, for all types of travel agency training guide, reception services of professional personnel. The tour guide major of higher vocational education as the core curriculum--"English guide"course as an example, put forward the reform thinking of course construction from the examination course teaching, students' practice, curriculum three aspects, in order to achieve docking professional construction and social needs of the industry.

  14. The Role of the Regular Teacher in a Whole School Approach to Guidance Counselling in Ireland

    Science.gov (United States)

    Hearne, Lucy; Galvin, James

    2015-01-01

    A whole school approach to guidance counselling has been promulgated by Irish policy-makers as a model of good practice in the delivery of guidance counselling in the post-primary sector since the 1998 Education Act (DES, 2005a, 2009, 2012). This approach to guidance counselling provision is viewed as a whole school responsibility where schools…

  15. [Percutaneous fluoroscopic and arthroscopic controlled screw fixation of posterior facet fractures of the calcaneus].

    Science.gov (United States)

    Nehme, A; Chaminade, B; Chiron, P; Fabie, F; Tricoire, J-L; Puget, J

    2004-05-01

    We describe a new technique for reduction and percutaneous osteosynthesis of displaced posterior facet fractures of the calcaneus which appears to overcome the problems encountered with other percutaneous methods described for this type of surgery. The method relies on the use of traction which allows automatic reduction of the greater tubersosity. The patient is installed on an orthopedic traction table. Pin traction provides anatomic reduction of the posterior articular surface and restitution of Böhler's angle under fluoroscopic and arthroscopic control. We used this technique in thirteen patients with fifteen displaced posterior facet fractures of the calcaneum. Mean patient age was 50.4 Years. Mean follow-up was twenty Months. We did not have any cutaneous or infectious complications in this short series. In the majority of the cases, the overall functional and physical results were excellent or good. The mean Böhler's angle was 27 degrees, corresponding to 83% correction compared with the healthy side. These preliminary results are encouraging. We were able to restitute calcaneum anatomy, shorten hospital stay, and avoid all skin complications. Indications for this percutaneous technique could be widened. It is a valid alternative to open treatment of posterior facet fractures of the calcaneum.

  16. Basal cell carcinoma and breast carcinoma following repeated fluoroscopic examinations of the chest.

    Science.gov (United States)

    Myskowski, P L; Gumpertz, E; Safai, B

    1985-03-01

    A 69-year-old white Italian woman was first seen at Memorial Sloan-Kettering Cancer Center in 1981 concerning several skin growths on her back. The patient had had several basal cell carcinomas surgically removed from her back during the preceding 5 years. There was no history of arsenic ingestion or prolonged sun exposure and her family history was negative for skin cancer. The patient had developed pulmonary tuberculosis in 1938 and was treated with pneumothorax therapy. She had had more than 50 fluoroscopic examinations of the chest following this therapy, as well as multiple diagnostic x-ray films since that time. She recalled that she had faced the fluoroscopy beam during the procedure. In 1959, she had a transabdominal hysterectomy for fibroid tumors. In 1980 she underwent a right modified radical mastectomy for adenoid cystic carcinoma of the breast; biopsies of lymph nodes were negative. Physical examination revealed a thin, white woman with a right mastectomy scar. On the back, clustered in the interscapular region, were multiple scars and nine erythematous nodules with pearly borders, telangiectasia, and translucent surfaces. Within several nodules there were areas of light and dark brown pigmentation. There were no other suspicious lesions on the head, chest, or extremities, nor did the patient show any evidence of the basal cell nevus syndrome. Biopsy of all lesions revealed basal cell carcinoma, some of which were pigmented, without evidence of chronic radiodermatitis. All lesions were treated with curettage and electrodesiccation three times with good cosmetic results (Fig. 1).

  17. Treatment of degenerative chronic low back pain with fluoroscopically guided epidural procaine-corticosteroid injection

    Directory of Open Access Journals (Sweden)

    Ćulafić Slobodan

    2008-01-01

    Full Text Available Background/Aim. Low back pain is one of the most common painful conditions in the modern age. Therefore, it is very important to establish the most effective protocol for the treatment of this condition. The aim of this study was to find out if fluoroscopically, guided epidural procainecorticosteroid injection is effective in the treatment of degenerative chronic low back pain. Methods. This prospective cohort study was performed in the Military Medical Academy from September 2005 to June 2006 and included 60 patients of both sexes, 34-85 years of age. Degenerative changes of lumbosacral spine were determined by magnetic resonance imaging. The intensity of low back pain was evaluated by subjective (Roland's scale and objective parameter (Lazarevic sign. Epidural procaine-corticosteroid injection was applied in the patients with low back pain not responding to conservative therapy. After the application of injection, effects of the therapy were followed up. Results. In 92% of the patients there was a reduction of pain intensity for three months, in 4.8% a reduction for a month, but after another injection they felt pain reduction for the next three months. One patient (2.3% had pain reduction for one month. Conclusion. In the treatment of degenerative chronic low back pain, not responding to conservative therapy with nonsteroidal anti-inflammatory drugs, epidural procaine-corticosteroid injection have a satisfactory short-term as well as a long-term analgesic effect.

  18. A novel fluoroscopic-assisted balloon thrombectomy technique for thrombosed hemodialysis prosthetic grafts [corrected].

    Science.gov (United States)

    Kakkos, Stavros K; Haddad, Joseph A; Haddad, Georges K

    2010-01-01

    Previous studies have shown that stenosis of the arterial anastomosis of thrombosed hemodialysis (HD) grafts, unmasked after conventional thrombectomy, very often necessitate subsequent arterial angioplasty. The aim of this study was to describe a novel fluoroscopic-assisted balloon thrombectomy technique which permits simultaneous arterial angioplasty (should this is required) for thrombosed HD grafts. Thirty patients with 36 thrombotic episodes of their prosthetic HD grafts participated in this study. A balloon angioplasty catheter is placed beyond the arterial anastomosis, over a guidewire; the balloon is inflated with contrast solution under fluoroscopy and pulled back to remove the arterial thrombus from the anastomosis. Any coexisting stenosis revealed by balloon indentation is completely dilated at that time, rather than after the thrombectomy. Mechanical thrombolysis of the graft and venous outflow is then performed with the AngioJet catheter (Possis Medical, Inc). Technical and clinical success rates (the latter defined as one subsequent HD session) of the procedure were 100% and 94%, respectively. No complications, including arterial embolism, vessel rupture or pulmonary embolism, were encountered. Primary assisted patency at 3 and 6 months was 51% and 32%, respectively, while functional secondary patency at the same follow-up points was 78%. Our technique is safe and also effective in both short- and long-term follow-up. Because it offers convenience, since the treatment of arterial anastomotic stenoses is accomplished in one (rather than two) steps, this method deserves further investigation.

  19. Pediatric patient and staff dose measurements in barium meal fluoroscopic procedures

    Science.gov (United States)

    Filipov, D.; Schelin, H. R.; Denyak, V.; Paschuk, S. A.; Porto, L. E.; Ledesma, J. A.; Nascimento, E. X.; Legnani, A.; Andrade, M. E. A.; Khoury, H. J.

    2015-11-01

    This study investigates patient and staff dose measurements in pediatric barium meal series fluoroscopic procedures. It aims to analyze radiographic techniques, measure the air kerma-area product (PKA), and estimate the staff's eye lens, thyroid and hands equivalent doses. The procedures of 41 patients were studied, and PKA values were calculated using LiF:Mg,Ti thermoluminescent dosimeters (TLDs) positioned at the center of the patient's upper chest. Furthermore, LiF:Mg,Cu,P TLDs were used to estimate the equivalent doses. The results showed a discrepancy in the radiographic techniques when compared to the European Commission recommendations. Half of the results of the analyzed literature presented lower PKA and dose reference level values than the present study. The staff's equivalent doses strongly depends on the distance from the beam. A 55-cm distance can be considered satisfactory. However, a distance decrease of ~20% leads to, at least, two times higher equivalent doses. For eye lenses this dose is significantly greater than the annual limit set by the International Commission on Radiological Protection. In addition, the occupational doses were found to be much higher than in the literature. Changing the used radiographic techniques to the ones recommended by the European Communities, it is expected to achieve lower PKA values ​​and occupational doses.

  20. X-ray characterization of CMOS imaging detector with high resolution for fluoroscopic imaging application

    Science.gov (United States)

    Cha, Bo Kyung; Kim, Cho Rong; Jeon, Seongchae; Kim, Ryun Kyung; Seo, Chang-Woo; Yang, Keedong; Heo, Duchang; Lee, Tae-Bum; Shin, Min-Seok; Kim, Jong-Boo; Kwon, Oh-Kyung

    2013-12-01

    This paper introduces complementary metal-oxide semiconductor (CMOS) active pixel sensor (APS)-based X-ray imaging detectors with high spatial resolution for medical imaging application. In this study, our proposed X-ray CMOS imaging sensor has been fabricated by using a 0.35 μm 1 Poly 4 Metal CMOS process. The pixel size is 100 μm×100 μm and the pixel array format is 24×96 pixels, which provide a field-of-view (FOV) of 9.6 mm×2.4 mm. The 14.3-bit extend counting analog-to digital converter (ADC) with built-in binning mode was used to reduce the area and simultaneously improve the image resolution. Both thallium-doped CsI (CsI:Tl) and Gd2O2S:Tb scintillator screens were used as converters for incident X-rays to visible light photons. The optical property and X-ray imaging characterization such as X-ray to light response as a function of incident X-ray exposure dose, spatial resolution and X-ray images of objects were measured under different X-ray energy conditions. The measured results suggest that our developed CMOS-based X-ray imaging detector has the potential for fluoroscopic imaging and cone-beam computed tomography (CBCT) imaging applications.

  1. Transbronchial lung biopsy without fluoroscopic guide in Tehran Imam Khomeini’s Hospital (1999

    Directory of Open Access Journals (Sweden)

    "Firoozbakhsh S

    2002-08-01

    Full Text Available Background: Transbronchial lung biopsy (TBLB is an attractive alternative to open lung biopsy as an initial diagnostic procedure for patients with diffuse parenchymal disease or localized densities beyond direct endoscopic vision. TBLB can be carried out safely without fluoroscopy in patients with diffuse lung disease. Since in our bronchoscopic department fluoroscopy is not available, we planned to evaluate the blind (without fluoroscopic guide TBLB being performed in our department to determine the success rate in obtaining lung tissue, the sensitivity of the procedure and the risk of complications. Materials and Methods: Sixty-Four TBLB were done in our department during a 6 month period (March-September 1999. Results: Lung tissue wasn’t detected in two (3.1 percent samples. Pathological results were helpful in 46 (71.9 percent cases. No evidence of hemoptysis was found after the procedure. Three (4.68 percent cases of pneumothorax was detected. Only one of them required chest tube (1.51 percent. Conclusion: We concluded that blind TBLB was successful in our department with rates of complications comparable to other approved centers.

  2. Fluoroscopically-Guided Posterior Approach for Shoulder Magnetic Resonance Arthrography: Comparison with Conventional Anterior Approach

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Koun J.; Ha, Doo Hoe; Lee, Sang Min [Dept. of Radiology, CHA Budang Medical Center, CHA University College of Medicine, Seongnam (Korea, Republic of)

    2011-10-15

    To prospectively evaluate the usefulness of the fluoroscopically-guided posterior approach compared with the anterior approach for shoulder magnetic resonance(MR) arthrography. Institutional review board approval and informed consent were obtained. Among 60 shoulder MR arthrographies performed on 59 patients with symptomatic shoulders, an intra-articular injection was performed (30 cases using the anterior approach and 30 using the posterior approach). Procedure-related pain was assessed by using a 5 score visual analogue scale (VAS). Depth of the puncture and standardized depth of puncture by body mass index (BMI) were recorded. The contrast leakage along the course of the puncture was evaluated by reviewing the MR. The statistical analyses included the Mann-Whitney U and Kruskal-Wallis test. There was no significant difference in VAS scores between the anterior and posterior groups (1.77 {+-} 1.10 vs. 1.80 {+-} 0.96). Depth of puncture and standardized depth of puncture by BMI were significantly shorter in the posterior group than those in the anterior group (4.4 {+-} 0.8 cm and 1.8 {+-} 0.3 cm vs. 6.6 {+-} 0.9 cm and 2.8 {+-} 0.4 cm, p < 0.001), respectively. The incidence of contrast leakage was more frequent in the posterior group (p = 0.003). The posterior approach will be useful in shoulder MR arthrography with a suspected anterior pathology, a postoperative follow-up study or obese patient.

  3. Role Guided Intraperitoneal Port-A-Cath Insertion in The Managment of Cancer Ovary of Fluoroscopic

    Directory of Open Access Journals (Sweden)

    Ahmed H Soliman *, Saad Ali Abd-Rabou *, Maged Abou Seada *,

    2013-07-01

    Full Text Available Introduction : The use of intraperitoneal (IP chemotherapy as a treatment for ovarian cancer has been demonstrated to result in improved survival. Aim of the work: The aim of this work is to evaluate the applicability and efficacy of fluoroscopic placed intraperitoneal port-A-cath and to assess the response rate to intraperitoneal chemotherapy in cases of ovarian carcinoma .Methods: The studied group included ,22 female patients with malignant ovarian cancer whom referred from gynecological surgery and gynecological oncology units to the Vascular and Interventional Radiology Unit, Ain Shams University Hospitals, for peritoneal port-A-cath application. All the patients were known cases of either primary or recurrent ovarian cancer , underwent cytoreductive surgery and referred to us .Results: Intraperitoneal port-A-cath with the aid of fluoroscopy showed highest technical success ( 91.9% and lowest complication rate on the long run compared to other methods of peritoneal access . Patients with cancer ovary showed significant improvement of the disease process denoted by changes in the degree of ascites , peritoneal nodules and tumor marker level after receiving combined IV/ IP chemotherapy. Conclusion: Port catheters proved to be the most safe method of long term access to the peritoneal cavity with the lowest complication rate compared to other methods of access to the peritoneal cavity

  4. Islamic Guidance for Drug Addiction

    Directory of Open Access Journals (Sweden)

    Agus Supriyanto

    2016-10-01

    Full Text Available Islamic Guidance is social rehabilitation program for Drug Addiction (resident. The goal of this research to know the Islamic guidance for resident at the Center for Rehabilitation of the National Narcotics Agency Lido Bogor. The methodology in this research is qualitative descriptive, with a sample two religious counselor. Can be concluded that Islamic guidance is implemented with the classical format, group format, and individual formats. The goal of the Islamic Guidance to develop religious mentally.

  5. Islamic Guidance for Drug Addiction

    OpenAIRE

    Agus Supriyanto

    2016-01-01

    Islamic Guidance is social rehabilitation program for Drug Addiction (resident). The goal of this research to know the Islamic guidance for resident at the Center for Rehabilitation of the National Narcotics Agency Lido Bogor. The methodology in this research is qualitative descriptive, with a sample two religious counselor. Can be concluded that Islamic guidance is implemented with the classical format, group format, and individual formats. The goal of the Islamic Guidance to develop religio...

  6. PROFESSIONAL GUIDANCE: EXPERIENCE REPORT

    Directory of Open Access Journals (Sweden)

    Fabiana Pinto de Almeida Bizarria

    2014-05-01

    Full Text Available This article presents an account of a career guidance with a group of five teenagers ( 16 and 19 , students of pre-university preparatory course offered by a public university in the state of Ceará . The work group dynamics was from a privileged form of performance by allowing a greater enrichment of the discussions , considering the heterogeneity and diversity of the group . To address relevant issues in career guidance based on the theory Socio-Historical , a roadmap of action process was constructed from three axes . Each axis has worked in two sessions that match a date. The first axis called " meaning of choice," worked on thematic choice process . With regard to the axis " World of Work " was discussed idealizations and representations about the professions , the labor market and the vestibular / ESMS . Emotional links with the professions , skills and ideas on skills and information professions : Finally , the " self " axis, which contains the themes was developed .

  7. College English teaching and practice under the guidance of the theory of applied linguistics%探究应用语言学理论指导下大学英语教学与实践

    Institute of Scientific and Technical Information of China (English)

    张远扬

    2015-01-01

    Improve the quality of English teaching is not only is the goal of education workers, also is the need of social development, social development need highly qualified English talents, this puts forward new requirements for college English teaching. In the process of social development, the theory of applied linguistics has been continuously completed, plays out in the teaching practice of English more and more important role. How to applied linguistics theory under the guidance of find a suitable for Chinese college students' English teaching method, improve students' English learning ability and enthusiasm, is a new challenge to teachers of English to the university.%英语教学质量的提高不仅是教育工作者的愿望,也是社会发展的需要,社会发展需要高素质的英语人才,这就为高校英语的教学提出了新的要求。在社会发展过程中,应用语言学的理论得到了不断的完善,在英语的教学实践中发挥出了越来越重要的作用。如何在应用语言学的理论指导下探索出一条适合中国高校学生的英语教学方法,提高大学生的英语学习能力和热情,是给广大大学英语教师提出的新挑战。

  8. A Formal Investigation of the Organization of Guidance Behavior: Implications for Humans and Autonomous Guidance

    Science.gov (United States)

    Kong, Zhaodan

    Guidance behavior generated either by artificial agents or humans has been actively studied in the fields of both robotics and cognitive science. The goals of these two fields are different. The former is the automatic generation of appropriate or even optimal behavior, while the latter is the understanding of the underlying mechanism. Their challenges, though, are closely related, the most important one being the lack of a unified, formal and grounded framework where the guidance behavior can be modeled and studied. This dissertation presents such a framework. In this framework, guidance behavior is analyzed as the closed-loop dynamics of the whole agent-environment system. The resulting dynamics give rise to interaction patterns. The central points of this dissertation are that: first of all, these patterns, which can be explained in terms of symmetries that are inherent to the guidance behavior, provide building blocks for the organization of behavior; second, the existence of these patterns and humans' organization of their guidance behavior based on these patterns are the reasons that humans can generate successful behavior in spite of all the complexities involved in the planning and control. This dissertation first gives an overview of the challenges existing in both scientific endeavors, such as human and animal spatial behavior study, and engineering endeavors, such as autonomous guidance system design. It then lays out the foundation for our formal framework, which states that guidance behavior should be interpreted as the collection of the closed-loop dynamics resulting from the agent's interaction with the environment. The following, illustrated by examples of three different UAVs, shows that the study of the closed-loop dynamics should not be done without the consideration of vehicle dynamics, as is the common practice in some of the studies in both autonomous guidance and human behavior analysis. The framework, the core concepts of which are

  9. Comparison measurements of DQE for two flat panel detectors: fluoroscopic detector vs. cone beam CT detector

    Science.gov (United States)

    Betancourt Benítez, Ricardo; Ning, Ruola; Conover, David

    2006-03-01

    The physical performance of two flat panel detectors (FPD) has been evaluated using a standard x-ray beam quality set by IEC, namely RQA5. The FPDs evaluated in this study are based on an amorphous silicon photodiode array that is coupled to a thallium-doped Cesium Iodide scintillator and to a thin film transistor (TFT) array. One detector is the PaxScan 2520 that is designed for fluoro imaging, and has a small dynamic range and a large image lag. The other detector is the PaxScan 4030CB that is designed for cone beam CT, and has a large dynamic range (>16-bit), a reduced image lag and many imaging modes. Varian Medical Systems manufactured both detectors. The linearity of the FPDs was investigated by using an ionization chamber and aluminum filtration in order to obtain the beam quality. Since the FPDs are used in fluoroscopic mode, image lag of the FPD was measured in order to investigate its effect on this study, especially its effect on DQE. The spatial resolution of the FPDs was determined by obtaining the pre-sampling modulation transfer function for each detector. A sharp edge was used in accordance to IEC 62220-1. Next, the Normalized Noise Power Spectrum (NNPS) was calculated for various exposures levels at RQA5 radiation quality. Finally, the DQE of each FPD was obtained with a modified version of the international standard set by IEC 62220-1. The results show that the physical performance in DQE and MTF of the PaxScan 4030CB is superior to that of PaxScan2520.

  10. Fluoroscopic and CT enteroclysis in children: initial experience, technical feasibility, and utility

    Energy Technology Data Exchange (ETDEWEB)

    Brown, Shanaree [Indiana University School of Medicine, Indianapolis, IN (United States); University of Missouri, Department of Radiology, Columbia, MO (United States); Applegate, Kimberly E. [Riley Hospital for Children, Section of Pediatric Radiology, Indianapolis, IN (United States); Riley Hospital for Children, Department of Radiology, Indiana University School of Medicine, Indianapolis, IN (United States); Sandrasegaran, Kumar; Jennings, S.G.; Garrett, Joshua; Maglinte, Dean T. [Riley Hospital for Children, Department of Radiology, Indiana University School of Medicine, Indianapolis, IN (United States); Skantharajah, Arunan [Indiana University, Indianapolis, IN (United States)

    2008-05-15

    Partial small-bowel obstruction can be difficult to diagnose on clinical examination. These obstructions might not be detected on routine abdominal/pelvic CT. To evaluate the feasibility, safety, and techniques of fluoroscopic enteroclysis (FE) and CT enteroclysis (CTE), and to review their indications and findings in children. We retrospectively reviewed all enteroclysis studies in children younger than 18 years performed between January 2002 and March 2007. We correlated the results with other abdominal imaging and surgical and pathological findings. The review revealed 112 FE and 74 CTE studies performed in 175 children (mean age 14 years, range 3-18 years). FE and CTE studies were performed most commonly for evaluation of known Crohn disease (FE 38%, CTE 29%) and abdominal pain (FE 26%, CTE 26%). One FE study was terminated because of patient anxiety, and one CTE study was terminated because of patient discomfort. No complications of FE or CTE were reported. The findings were normal in 54% of the FE studies and 46% of the CTE studies. The most common small bowel diagnoses were Crohn disease (FE 34%, CTE 28%) and partial small bowel obstruction (FE 3%, CTE 10%). Two FE studies (2%) and 14 CTE studies (19%) showed abnormalities outside the small bowel. In 54 patients with inflammatory bowel disease, 11 FE studies and 25 CTE studies showed additional bowel abnormalities. Overall, 14 and 21 patients had surgery as a result of the findings of FE and CTE, respectively. FE and CTE are safe, feasible, and accurate in depicting small-bowel pathology in children. These techniques can be particularly useful in children with Crohn disease involving the small bowel. (orig.)

  11. Improved-resolution real-time skin-dose mapping for interventional fluoroscopic procedures

    Science.gov (United States)

    Rana, Vijay K.; Rudin, Stephen; Bednarek, Daniel R.

    2014-03-01

    We have developed a dose-tracking system (DTS) that provides a real-time display of the skin-dose distribution on a 3D patient graphic during fluoroscopic procedures. Radiation dose to individual points on the skin is calculated using exposure and geometry parameters from the digital bus on a Toshiba C-arm unit. To accurately define the distribution of dose, it is necessary to use a high-resolution patient graphic consisting of a large number of elements. In the original DTS version, the patient graphics were obtained from a library of population body scans which consisted of larger-sized triangular elements resulting in poor congruence between the graphic points and the x-ray beam boundary. To improve the resolution without impacting real-time performance, the number of calculations must be reduced and so we created software-designed human models and modified the DTS to read the graphic as a list of vertices of the triangular elements such that common vertices of adjacent triangles are listed once. Dose is calculated for each vertex point once instead of the number of times that a given vertex appears in multiple triangles. By reformatting the graphic file, we were able to subdivide the triangular elements by a factor of 64 times with an increase in the file size of only 1.3 times. This allows a much greater number of smaller triangular elements and improves resolution of the patient graphic without compromising the real-time performance of the DTS and also gives a smoother graphic display for better visualization of the dose distribution.

  12. PSD Increment Consumption Guidance

    Science.gov (United States)

    This document may be of assistance in applying the New Source Review (NSR) air permitting regulations including the Prevention of Significant Deterioration (PSD) requirements. This document is part of the NSR Policy and Guidance Database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

  13. Benefit of fluoroscopically guided intraarticular, long-acting corticosteroid injection for subtalar arthritis in juvenile idiopathic arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Cahill, Anne M.; Cho, Sandy S. [Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Baskin, Kevin M. [Children' s Hospital of Philadelphia, Department of Pediatrics, Division of Rheumatology, Philadelphia, PA (United States); Beukelman, Timothy; Cron, Randy Q. [Children' s Hospital of Pittsburgh, Department of Radiology, Pittsburgh, PA (United States); Kaye, Robin D. [Children' s Hospital of Wisconsin, Department of Radiology, Milwaukee, WI (United States); Towbin, Richard B.

    2007-06-15

    Children with arthritis may endure a lifetime of disfigurement, dysfunction, and pain if acute inflammation progresses to chronic changes in the joint cartilage and underlying bone. Intraarticular steroids have become an integral component of treatment, but at times are difficult to deliver to joints, such as the subtalar joint, that have complex anatomies. We describe our technique and outcomes using fluoroscopically guided intraarticular subtalar steroid injection in patients with active symptoms of juvenile idiopathic arthritis (JIA). Fluoroscopically guided subtalar joint injections were performed in 38 children (mean age 6.7 years). Medical records were reviewed retrospectively and improvement was evaluated clinically by the degree of foot movement in eversion and inversion. Subtalar joint injection was technically successful in 100% of the JIA patients with improvement in physical symptoms in 34/38 (89%). Of the 38 children, 32 were followed up within 13 weeks of the initial injection and, therefore, satisfied the eligibility criteria for resolution of arthritis. Of these 32 children, 14 showed clinical resolution (44%). The mean duration of improvement was 1.2 {+-} 0.9 years. Children with a longer interval (>1 year) from diagnosis to treatment had significantly less resolution (P = 0.04). Local subcutaneous atrophy or hypopigmentation were observed in 53% of the children after steroid injection (20/38). These minor complications were associated with a greater volume of steroid injected into the site per child (P = 0.02). Fluoroscopically guided subtalar joint injection is an effective treatment for subtalar arthropathy. Prompt referral for intraarticular steroid treatment in the acute phase improves response. Skin changes often occur at the injection site, and specific precautions should be employed to reduce this risk. Prospective study is indicated to determine the most effective treatment strategy to prevent long-term pain and disability. (orig.)

  14. Avoiding plagiarism: guidance for nursing students.

    Science.gov (United States)

    Price, Bob

    The pressures of study, diversity of source materials, past assumptions relating to good writing practice, ambiguous writing guidance on best practice and students' insecurity about their reasoning ability, can lead to plagiarism. With the use of source checking software, there is an increased chance that plagiarised work will be identified and investigated, and penalties given. In extreme cases, plagiarised work may be reported to the Nursing and Midwifery Council and professional as well as academic penalties may apply. This article provides information on how students can avoid plagiarism when preparing their coursework for submission.

  15. The Practice and Probe into the Guidance on English Writing of Grade Nine%九年级英语写作指导的实践与探索

    Institute of Scientific and Technical Information of China (English)

    金巧英

    2011-01-01

    This paper discusses the guidance on English writing of grade nine and teachers should accomplish the following work: the guidance on writing skills; guidance on key points of writing; promoting writing with effective correction; guiding students to get i%本文讨论了九年级英语写作的指导,认为教师应当做好如下几个方面:写作技巧的指导;写作要点的指导;以有效批改促进写作;指导学生沉浸阅读文本,促使写作辅导日常化;教师自身的写作水平是提高英语写作教学的根本。

  16. European guidance: a project of the European Psychiatric Association.

    Science.gov (United States)

    Gaebel, W; Möller, H-J

    2012-02-01

    Evidence based medicine is a cornerstone of modern medicine including psychiatry. Treatment practice guidelines are nowadays available for guiding mental health care mainly with a focus on specific disorders. Many important clinical situations or problems beyond treatment, however, are lacking proper guidance. It is in this scope that a European Psychiatry Association (EPA) has developed its own program, the European Guidance Project. The present special issue presents six topics out of these series of guidance documents. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  17. Guidance of Nonlinear Systems

    Science.gov (United States)

    Meyer, George

    1997-01-01

    The paper describes a method for guiding a dynamic system through a given set of points. The paradigm is a fully automatic aircraft subject to air traffic control (ATC). The ATC provides a sequence of way points through which the aircraft trajectory must pass. The way points typically specify time, position, and velocity. The guidance problem is to synthesize a system state trajectory which satisfies both the ATC and aircraft constraints. Complications arise because the controlled process is multi-dimensional, multi-axis, nonlinear, highly coupled, and the state space is not flat. In addition, there is a multitude of possible operating modes, which may number in the hundreds. Each such mode defines a distinct state space model of the process by specifying the state space coordinatization, the partition of the controls into active controls and configuration controls, and the output map. Furthermore, mode transitions must be smooth. The guidance algorithm is based on the inversion of the pure feedback approximations, which is followed by iterative corrections for the effects of zero dynamics. The paper describes the structure and modules of the algorithm, and the performance is illustrated by several example aircraft maneuvers.

  18. Saudi dental students’ perceptions of pediatric behavior guidance techniques

    OpenAIRE

    Al-Jobair, Asma M; Al-Mutairi, Manal A.

    2015-01-01

    Background Dental students receive theoretical and clinical training in pediatric behavioral guidance techniques at university. Therefore, the content of the educational course and the degree of training in behavioral techniques may have an impact on the students’ perceptions and practice of such techniques. The purpose of this study was to evaluate Saudi dental students’ perceptions of behavior guidance techniques used in pediatric dentistry, and to assess the changes in their perceptions af...

  19. SU-E-J-126: Generation of Fluoroscopic 3D Images Using Single X-Ray Projections on Realistic Modified XCAT Phantom Data.

    Science.gov (United States)

    Mishra, P; Li, R; St James, S; Yue, Y; Mak, R; Berbeco, R; Lewis, J

    2012-06-01

    To simulate the process of generating fluoroscopic 3D treatment images from 4DCT and measured 2D x-ray projections using a realistic modified XCAT phantom based on measured patient 3D tumor trajectories. First, the existing XCAT phantom is adapted to incorporate measured patient lung tumor trajectories. Realistic diaphragm and chest wall motion are automatically generated based on input tumor motion and position, producing synchronized, realistic motion in the phantom. Based on 4DCT generated with the XCAT phantom, we derive patient-specific motion models that are used to generate 3D fluoroscopic images. Patient-specific models are created in two steps: first, the displacement vector fields (DVFs) are obtained through deformable image registration of each phase of 4DCT with respect to a reference image (typically peak-exhale). Each phase is registered to the reference image to obtain (n-1) DVFs. Second, the most salient characteristics in the DVFs are captured in a compact representation through principal component analysis (PCA). Since PCA is a linear decomposition method, all the DVFs can be represented as linear combinations of eigenvectors. Fluoroscopic 3D images are obtained using the projection image to determine optimal weights for the eigenvectors. These weights are determined through iterative optimization of a cost function relating the projection image to the 3D image via the PCA lung motion model and a projection operator. Constructing fluoroscopic 3D images is thus reduced to finding optimal weights for the eigenvectors. Fluoroscopic 3D treatment images were generated using the modified XCAT phantom. The average relative error of the reconstructed image over 30 sec is 0.0457 HU and the standard deviation is 0.0063. The XCAT phantom was modified to produce realistic images by incorporating patient tumor trajectories. The modified XCAT phantom can be used to simulate the process of generating fluoroscopic 3D treatment images from 4DCT and 2D x

  20. Comparison of anatomic landmarks and ultrasound guidance for intercostal nerve injections in cadavers.

    Science.gov (United States)

    Bhatia, Anuj; Gofeld, Michael; Ganapathy, Sugantha; Hanlon, John; Johnson, Marjorie

    2013-01-01

    Intercostal nerve (ICN) injections are routinely performed under anatomic landmark or fluoroscopic guidance for acute and chronic pain indications. Ultrasound (US) is being used increasingly to perform ICN injections, but there is lack of evidence to support categorically the benefits of US over conventional techniques. We compared guidance with US versus anatomic landmarks for accuracy and safety of ICN injections in cadavers in a 2-phase study that included evaluation of deposition of injected dye by dissection and spread of contrast on fluoroscopy. A cadaver experiment was performed to validate US as an imaging modality for ICN blocks. In the first phase of the study, 12 ICN injections with 2 different volumes of dye were performed in 1 cadaver using anatomic landmarks on one side and US-guidance on the other (6 injections on each side). The cadaver was then dissected to evaluate spread of the dye. The second phase of the study consisted of 74 ICN injections (37 US-guided and 37 using anatomic landmarks) of contrast dye in 6 non-embalmed cadavers followed by fluoroscopy to evaluate spread of the contrast dye. In the first phase of the study, the intercostal space was identified with US at all levels. Injection of 2 mL of dye was sufficient to ensure compete staining of the ICN for 5 of 6 US-guided injections but anatomic landmark guidance resulted in correct injection at only 2 of 6 intercostal spaces. No intravascular injection was found on dissection with either of the guidance techniques. In the second phase of the study, US-guidance was associated with a higher rate of intercostal spread of 1 mL of contrast dye on fluoroscopy compared with anatomic landmarks guidance (97% vs 70%; P = 0.017). Ultrasound confers higher accuracy and allows use of lower volumes of injectate compared with anatomic landmarks as a guidance method for ICN injections in cadavers. Ultrasound may be a viable alternative to anatomic landmarks as a guidance method for ICN injections.

  1. 医护人员性健康指导知信行状况及其影响因素%Investigation of current status of the knowledge, attitude and practice of medical staff on sexual health guidance and analysis of influence factors

    Institute of Scientific and Technical Information of China (English)

    何平; 张安琴; 张蒙

    2012-01-01

    Objective To investigate the current status of knowledge, attitude and practice (KAP) of medical staff among different clinic unit on sexual health guidance,and analyze the influence factors. Methods A self-devetoped KAP questionnaire for medical staff was used, and 460 medical personnel in Chengdu city were investigated. The data were statistically analyzed. Results The scores of KAP of sexual health guidance were tow. There was a significant difference in KAP among different clinic units ( F = l. 063 , 6.746,7.618 for knowledge,attitude and practice,respectively;all P<0. 001) with the best in the department of gynaecotogy. The primary influence factor for guidance behavior was that the patients lacked consulting knowledge. The secondary factor was that medical staff lacked sexual knowledge. Conclusion The most clinical medical staff lack knowledge of sexual health guidance and ignore patients' sexual health problems. The guidance behavior is also limited. Therefore,it will be a tong way for sexual health guidance.%目的 了解医护人员对患者性健康指导现状,分析性健康指导知信行的影响因素.方法 自行设计问卷调查表,调查460名临床医护人员的性健康指导知信情况,并对数据进行分析统计.结果 医护人员对患者性健康指导的知信行分值均偏低;不同科室医护人员在性健康指导知识、态度和行为方面存在差异(F值分别为7.063、6.746和7.618,均P<0.001),妇科在性健康指导方面做得最好(P<0.01);影响健康指导行为的首要因素是没有患者咨询性知识,其次为医护人员性知识缺乏.结论 临床科室医护人员普遍存在性健康指导知识缺乏、忽视患者性健康问题、健康行为受限的诸多问题.性健康教育任重道远.

  2. Evaluation of the microangiographic fluoroscope (MAF) using generalized system performance metrics

    Energy Technology Data Exchange (ETDEWEB)

    Jain, Amit [Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York 14214 (United States); Bednarek, Daniel R. [Toshiba Stroke and Vascular Research Center, Department of Radiology, Department of Neurosurgery, and Department of Physiology and Biophysics, University at Buffalo, State University of New York, Buffalo, New York 14214 (United States); Rudin, Stephen [Toshiba Stroke and Vascular Research Center, Department of Radiology, Department of Neurosurgery, Department of Physiology and Biophysics, Department of Mechanical and Aerospace Engineering, Department of Electrical Engineering, and Department of Biomedical Engineering, University at Buffalo, State University of New York, Buffalo, New York 14214 (United States)

    2013-03-15

    Purpose: The performance of a newly developed, high resolution, microangiographic fluoroscope (MAF) (35 {mu}m pixel pitch and 300 {mu}m thick CsI phosphor) was evaluated using a generalized linear system analysis and compared with that of a standard amorphous Si thin film transistor flat panel detector (FPD) (194 {mu}m pixel pitch and 600 {mu}m thick CsI phosphor). The linear system metrics such as modulation transfer function (MTF), noise power spectrum, and detection quantum efficiency (DQE) are commonly used to gauge the intrinsic detector performance in the detector plane. However, these linear system metrics do not provide information about the image receptor performance in a real system since they do not include the effects of other parameters such as focal spot distribution, scatter radiation, and geometric unsharpness, which may compromise detector performance characteristics. Use of generalized linear system metrics [generalized modulation transfer function (GMTF), generalized normalized noise power spectrum (GNNPS), and generalized detection quantum efficiency (GDQE)] that include these effects gives a more meaningful, complete, and appropriate evaluation of detector performance as part of the imaging system. Methods: A uniform head equivalent phantom was used to simulate realistic clinical parameters and x-ray spectra. The detector MTFs were measured using the slanted edge method and the focal spot MTFs were measured using a pinhole assembly. The scatter MTF was simulated and the scatter fraction was measured for a head-equivalent phantom. The generalized system metrics were calculated for different combinations of three choices of focal spots and three different magnifications with two different air-gaps. The performance of the MAF was also illustrated using stent images obtained with different focal spots under similar conditions. Results: Results for the generalized metrics provide a quantitative description of the performance of the imaging system

  3. International Conference on Harmonisation; guidance on Q10 Pharmaceutical Quality System; availability. Notice.

    Science.gov (United States)

    2009-04-08

    The Food and Drug Administration (FDA) is announcing the availability of a guidance entitled "Q10 Pharmaceutical Quality System." The guidance was prepared under the auspices of the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH). The guidance describes a model for an effective quality management system for the pharmaceutical industry, referred to as the Pharmaceutical Quality System. The guidance is intended to provide a comprehensive approach to an effective pharmaceutical quality system that is based on International Organization for Standardization (ISO) concepts, includes applicable good manufacturing practice (GMP) regulations and complements ICH guidances on "Q8 Pharmaceutical Development" and "Q9 Quality Risk Management."

  4. GUIDANCE DOCUMENT ON IMPLEMENTATION OF THE ...

    Science.gov (United States)

    The Agreement in Principle for the Stage 2 M-DBP Federal Advisory Committee contains a list of treatment processes and management practices for water systems to use in meeting additional Cryptosporidium treatment requirements under the LT2ESWTR. This list, termed the microbial toolbox, includes watershed control programs, alternative intake locations, pretreatment processes, additional filtration barriers, inactivation technologies, and enhanced plant performance. The intent of the microbial toolbox is to provide water systems with broad flexibility in selecting cost-effective LT2ESWTR compliance strategies. Moreover, the toolbox allows systems that currently provide additional pathogen barriers or that can demonstrate enhanced performance to receive additional Cryptosporidium treatment credit. Provide guidance to utilities with surface water supplies and to state drinking water programs on the use of different treatment technologies to reduce the level of Cryptosporidium in drinking water. Technologies included in the guidance manual may be used to achieve compliance with the requirements of the LT2ESWTR.

  5. Magnetic Resonance Enterography Findings in Crohn's disease in the Pediatric Population and Correlation with Fluoroscopic and Multidetector Computed Tomographic Techniques.

    Science.gov (United States)

    Patel, Parul; Ormanoski, Margaret; Hoadley, Kim M

    2011-01-01

    Traditionally, fluoroscopic examinations such as enteroclysis, upper GI studies, and small bowel follow through exams have been the procedures of choice in evaluating inflammatory bowel disease (IBD) in pediatric populations. With the advent of multidetector computed tomography (MDCT), it has subsequently become a complementary examination in imaging inflammatory bowel disease. A major advantage of MDCT over fluoroscopic examination is its ability to directly visualize bowel mucosa, as well as demonstrate extra-enteric complications of IBD such as abscesses, fistulae, and sinus tracts. The major disadvantage of CT however is exposure to ionizing radiation, especially in IBD patients of the pediatric age group who maybe repeatedly imaged due to exacerbations. As a result, magnetic resonance enterography (MRE) is becoming increasingly important in the evaluation and follow-up of pediatric patients with IBD. This pictorial essay will summarize the multi-modality imaging findings of IBD with emphasis on MRE including the imaging protocol and procedure. For the purposes of this article, patients less than 17 years of age have been considered to represent the pediatric population.

  6. C-arm cone-beam CT combined with a new electromagnetic navigation system for guidance of percutaneous needle biopsies. Initial clinical experience

    Energy Technology Data Exchange (ETDEWEB)

    Kickuth, R.; Reichling, C.; Bley, T.; Hahn, D.; Ritter, C. [University Hospital of Wuerzburg (Germany). Inst. of Diagnostic and Interventional Radiology

    2015-07-15

    To evaluate the feasibility and efficacy of C-arm fluoroscopic cone-beam computed tomography (CACT) in combination with a new electromagnetic tracking (EMT) system for needle guidance during percutaneous biopsies. 53 patients were referred for biopsy of thoracic (n = 19) and abdominal (n = 34) lesions. CT-like images of the anatomical region of interest (ROI) were generated using a flat panel-based angiographic system. These images were transmitted to an EMT system. A coaxial puncture needle with a sensor in its tip was connected with the navigation system and tracked into an electromagnetic field created via a field generator. Data generated within this field were merged with the CACT images. On a monitor both the anatomical ROI and needle tip position were displayed to enable precise needle insertion into the target. Through the coaxial needle, biopsy specimens for the histologic evaluation were extracted. Number of representative biopsy samples, number of core biopsies/patient, total procedure time, dose-area product, fluoroscopic time, and complications were recorded. 53 CACT/EMT-guided biopsy procedures were performed, 48 of which (91 %) yielded representative tissue samples. Four core biopsies were obtained from each patient. 40 (75 %) lesions were malignant and 13 (25 %) lesions were benign. The total procedure time was 9 ± 5 min (range, 3 - 23 min), fluoroscopic time was 0.8 ± 0.4 min (range, 0.4 - 2 min). The mean dose-area product (cGy cm{sup 2}) was 7373 (range, 895 - 26 904). The rate of complications (1 pneumothorax, 2 hemoptyses) was 6 %. CACT combined with EMT appears to be a feasible and effective technique for the guidance of percutaneous biopsies with a low rate of therapeutically relevant complications.

  7. Motor learning with fading and growing haptic guidance.

    Science.gov (United States)

    Heuer, Herbert; Lüttgen, Jenna

    2014-07-01

    Haptic guidance has been shown to have both facilitatory and interfering effects on motor learning. Interfering effects have been hypothesized to result from the particular dynamic environment, which supports a passive role of the learner, and they should be attenuated by fading guidance. Facilitatory effects, in particular for dynamic movement characteristics, have been hypothesized to result from the high-quality information provided by haptic demonstration. If haptic demonstration provides particularly precise information about target movements, the motor system's need for such information should more likely increase in the course of motor learning, in which case growing guidance should be more beneficial for learning. We contrasted fading and growing guidance in the course of learning a spatio-temporal motor pattern. To stimulate an active role of the learner, practice trials consisted of three phases, a visual demonstration of the target movement, a guided reproduction, and a reproduction without haptic guidance. Performance was assessed in terms of variable duration errors, relative-timing errors, variable path-length errors, and shape errors. Motor learning with growing and fading guidance turned out to be largely equivalent, so that the notion of an increasing optimal precision of haptic demonstrations, which matches a demand of increasingly precise information on the target movement, found no support. Duration errors declined only with fading, but not with growing guidance. Relative timing revealed a benefit of immediately preceding haptic demonstration, but learning was not different between the two practice protocols. This contrast between absolute and relative timing adds to other evidence according to which acquisition of these two aspects of motor timing involves different learning mechanisms. Whereas relative timing gained from immediately preceding haptic demonstration, but revealed no practice-related improvement in the presence of haptic guidance

  8. La Orientación Vocacional en las escuelas argentinas: Necesidad de políticas públicas y de nuevas prácticas de orientación The Vocational Guidance in argentinian schools: The need of a public policy and new guidance practices

    Directory of Open Access Journals (Sweden)

    Diana Aisenson

    2009-12-01

    Full Text Available En esta publicación se presentan por primera vez los resultados finales de una evaluación realizada a servicios de orientación de escuelas de nivel medio, a partir de los datos obtenidos de la investigación: "La Orientación Vocacional en la Argentina" (1999-2003, estudio en el que participaron equipos de nueve universidades nacionales. Los resultados finales obtenidos, que fueron procesados durante 2008, muestran que los servicios de orientación en las escuelas son precarios y adolecen de varios problemas. Estos incluyen la carencia de políticas macro institucionales en el campo; de profesionales con especialización adecuada; de recursos materiales y técnicos, e inadecuada vinculación con organismos laborales. Esta información es un insumo de interés para la investigación "Educación para la Orientación: Proyectos y construcción identitaria de jóvenes escolarizados" (P054, Programación UBACyT 2008-2010 cuyo objetivo es evaluar los dispositivos de orientación que se utilizan en dos servicios de la Universidad de Buenos Aires¹.In this paper, the final results of the evaluation of guidance services in high schools are presented for the first time, the data given obtained in research on vocational guidance in Argentina (1999-2003, involving the participation of teams from nine national universities. Results obtained, which were processed during 2008, show that guidance services in schools are precarious and have many problems. These include the lacks of macro institutional policies in the field; counselors with adequate expertise; material and technical resources, and inadequate networking among relevant organizations. These data are the basic component of the research project entitled "Education for Guidance and the Projects and Personal Identity Constructions of young people" (P054, UBACyT 2008-2010, whose objective is to evaluate the guidance strategies and methods that are used in two services of the University of Buenos Aires.

  9. Guidance at the educational marketplace

    DEFF Research Database (Denmark)

    Lystbæk, Christian Tang

    in educational policies and institutions. As educational systems have expanded and, further, have been restructured with the expansion of choice opportunities since the 1980s, guidance has become prioritized as a form of counseling or coaching, which can support students. Thus, guidance has become an important...

  10. Guidance in the Secondary School

    Science.gov (United States)

    Kumar, V. Jurist Lional

    2010-01-01

    Secondary School Students face a lot of problems in their body as well as in mind due to puberty that tends to adolescence stage. Adolescence has peculiar characters of their own. They need proper Guidance and Counselling to tackle their own problems. Guidance is described as a counselling service to assist the individual in achieving self…

  11. Innovative Approaches to Career Guidance.

    Science.gov (United States)

    Freeman, Andrew R.

    A key part of a broad-based approach to career education in Australian schools is vocational/career guidance. Various vocational guidance programs have been developed for specific groups in Australian society, including work experience, caravans, and micrographics technology for the handicapped; pre-employment courses and a family education center…

  12. Final OSWER Vapor Intrusion Guidance

    Science.gov (United States)

    EPA is preparing to finalize its guidance on assessing and addressing vapor intrusion, which is defined as migration of volatile constituents from contaminated media in the subsurface (soil or groundwater) into the indoor environment. In November 2002, EPA issued draft guidance o...

  13. Interstitial guidance of cancer invasion.

    Science.gov (United States)

    Gritsenko, Pavlo G; Ilina, Olga; Friedl, Peter

    2012-01-01

    Cancer cell invasion into healthy tissues develops preferentially along pre-existing tracks of least resistance, followed by secondary tissue remodelling and destruction. The tissue scaffolds supporting or preventing guidance of invasion vary in structure and molecular composition between organs. In the brain, the guidance is provided by myelinated axons, astrocyte processes, and blood vessels which are used as invasion routes by glioma cells. In the human breast, containing interstitial collagen-rich connective tissue, disseminating breast cancer cells preferentially invade along bundled collagen fibrils and the surface of adipocytes. In both invasion types, physical guidance prompted by interfaces and space is complemented by molecular guidance. Generic mechanisms shared by most, if not all, tissues include (i) guidance by integrins towards fibrillar interstitial collagen and/or laminins and type IV collagen in basement membranes decorating vessels and adipocytes, and, likely, CD44 engaging with hyaluronan; (ii) haptotactic guidance by chemokines and growth factors; and likely (iii) physical pushing mechanisms. Tissue-specific, resticted guidance cues include ECM proteins with restricted expression (tenascins, lecticans), cell-cell interfaces, and newly secreted matrix molecules decorating ECM fibres (laminin-332, thrombospondin-1, osteopontin, periostin). We here review physical and molecular guidance mechanisms in interstitial tissue and brain parenchyma and explore shared principles and organ-specific differences, and their implications for experimental model design and therapeutic targeting of tumour cell invasion.

  14. Restructuring Guidance and Counseling Programs.

    Science.gov (United States)

    Snyder, Beverly A.; Daly, Timothy P.

    1993-01-01

    Briefly reviews counseling profession's call for revitalization and transformation in school counseling and guidance programs. Summarizes one school system's efforts during late 1980s and early 1990s to transform its program from services and crisis orientation into a comprehensive developmental model based on Myrick's developmental guidance and…

  15. 多元化教育实习模式在产科临床带教中的创建研究%The creation and research of diverse education practice mode on clinical obstetric ' s guidance and teaching

    Institute of Scientific and Technical Information of China (English)

    尚剑; 罗清平; 章兰萍; 黄春华

    2016-01-01

    Objective To study the creation and effect of diverse education practice model in obstetric's clini-cal guidance and teaching. Methods A total of 240 obstetric practice nurses in our hospital form January 2013 to De-cember 2014 were selected as the research objects, and the intern students in the group were all women. 120 interns in the hospital in 2013 were taken as a control group, receiving traditional education during the internship and 120 interns in 2014 as the observation group, receiving diverse education during the internship. Results Practice self-assessment, evaluation from teachers and evaluation and satisfaction from patients of the students in the two groups were compared and analyzed, and it was found that the self-evaluation satisfaction of the observation group was up to 96. 67%, the clin-ical teacher gave the students (93. 47±4. 92) marks, and patient satisfaction was 95. 00%. The difference was statisti-cally significant ( P<0. 05 ) . This study analyzed and compared the assessments of the clinical teachers from the two groups of students, and found that the students in the observation group were more satisfied with the clinical teacher's re-sponsibility, service attitude, medical ethics, concern for students, theoretical knowledge, teaching level, operating a-bility, teaching methods and student satisfaction scores had a higher satisfaction than that of the control group, the differ-ence was statistically significant ( P<0. 05 ) . Conclusions Diverse educational practice mode intern can not only im-prove interns with the phenomenon of culture shock, but also help students adapt to the environment quickly and improve their theoretical knowledge and operating skills. Students, clinical teachers and patients were quite satisfied with the ap-plication of the model, for it enables interns to adapt to obstetric care, worthy of clinical reference.%目的:研究多元化教育实习模式在产科临床带教中的创建及

  16. RH Packaging Program Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Washington TRU Solutions LLC

    2008-01-12

    The purpose of this program guidance document is to provide the technical requirements for use, operation, inspection, and maintenance of the RH-TRU 72-B Waste Shipping Package (also known as the "RH-TRU 72-B cask") and directly related components. This document complies with the requirements as specified in the RH-TRU 72-B Safety Analysis Report for Packaging (SARP), and Nuclear Regulatory Commission (NRC) Certificate of Compliance (C of C) 9212. If there is a conflict between this document and the SARP and/or C of C, the C of C shall govern. The C of C states: "...each package must be prepared for shipment and operated in accordance with the procedures described in Chapter 7.0, Operating Procedures, of the application." It further states: "...each package must be tested and maintained in accordance with the procedures described in Chapter 8.0, Acceptance Tests and Maintenance Program of the Application." Chapter 9.0 of the SARP tasks the Waste Isolation Pilot Plant (WIPP) Management and Operating (M&O) Contractor with assuring the packaging is used in accordance with the requirements of the C of C. Because the packaging is NRC-approved, users need to be familiar with Title 10 Code of Federal Regulations (CFR) §71.8, "Deliberate Misconduct." Any time a user suspects or has indications that the conditions of approval in the C of C were not met, the U.S. Department of Energy (DOE) Carlsbad Field Office (CBFO) shall be notified immediately. The CBFO will evaluate the issue and notify the NRC if required.In accordance with 10 CFR Part 71, "Packaging and Transportation of Radioactive Material," certificate holders, packaging users, and contractors or subcontractors who use, design, fabricate, test, maintain, or modify the packaging shall post copies of (1) 10 CFR Part 21, "Reporting of Defects and Noncompliance," regulations, (2) Section 206 of the Energy Reorganization Act of 1974, and (3) NRC Form 3, Notice to Employees. These documents must be posted in a

  17. RH Packaging Program Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Washington TRU Solutions LLC

    2006-11-07

    The purpose of this program guidance document is to provide the technical requirements for use, operation, inspection, and maintenance of the RH-TRU 72-B Waste Shipping Package and directly related components. This document complies with the requirements as specified in the RH-TRU 72-B Safety Analysis Report for Packaging (SARP), and Nuclear Regulatory Commission (NRC) Certificate of Compliance (C of C) 9212. If there is a conflict between this document and the SARP and/or C of C, the C of C shall govern. The C of C states: "...each package must be prepared for shipment and operated in accordance with the procedures described in Chapter 7.0, Operating Procedures, of the application." It further states: "...each package must be tested and maintained in accordance with the procedures described in Chapter 8.0, Acceptance Tests and Maintenance Program of the Application." Chapter 9.0 of the SARP tasks the Waste Isolation Pilot Plant (WIPP) Management and Operating (M&O) Contractor with assuring the packaging is used in accordance with the requirements of the C of C. Because the packaging is NRC-approved, users need to be familiar with 10 Code of Federal Regulations (CFR) §71.8, "Deliberate Misconduct." Any time a user suspects or has indications that the conditions of approval in the C of C were not met, the U.S. Department of Energy (DOE) Carlsbad Field Office (CBFO) shall be notified immediately. CBFO will evaluate the issue and notify the NRC if required. In accordance with 10 CFR Part 71, "Packaging and Transportation of Radioactive Material," certificate holders, packaging users, and contractors or subcontractors who use, design, fabricate, test, maintain, or modify the packaging shall post copies of (1) 10 CFR Part 21, "Reporting of Defects and Noncompliance," regulations, (2) Section 206 of the Energy Reorganization Act of 1974, and (3) NRC Form 3, Notice to Employees. These documents must be posted in a conspicuous location where the activities subject to

  18. Practical guidance: the use of social media in oncology practice.

    Science.gov (United States)

    Dizon, Don S; Graham, David; Thompson, Michael A; Johnson, Lisa J; Johnston, Claire; Fisch, Michael J; Miller, Robert

    2012-09-01

    The penetration of social media into modern society has become a worldwide cultural phenomenon. Social media use widely accessible Web-based and mobile technologies to facilitate the creation and sharing of user-generated content in a collaborative and social manner. The uptake of social media in medicine provides new opportunities for health care professionals and institutions to interact with patients and other professionals. Oncologists may use social media as a platform for patient education and authoritative health messaging, for professional development and knowledge sharing, and for direct patient interaction, although this may be fraught with important legal and privacy concerns. In this article, a working group of the ASCO Integrated Media and Technology Committee explores how oncologists might responsibly use social media in their professional lives. Existing social media policies from hospitals, health systems, and pharmaceutical industries are examined to identify common concepts informing the development of future guidelines. Key principles identified include establishing institutional ownership of social media activities and safeguarding protected health information. Furthermore, oncologists must not confuse the roles of provider of information and provider of care, must understand regulations related to state licensure and medical records, and must recognize the importance of transparency and disclosure of potential conflicts of interest. social media may be particularly useful for raising the awareness of and recruitment to clinical trials, but compliance with federal and state regulations and areas under the purview of a local institutional review board must also be ensured. Examples of constructive use of social media in oncology with Facebook, Twitter, and YouTube are provided.

  19. Lifelong guidance: How guidance and counselling support lifelong learning in the contrasting contexts of China and Denmark

    Science.gov (United States)

    Zhang, Zhixin

    2016-10-01

    Due to the effects of globalisation and rapid technological development, traditional linear life course patterns of the past are gradually disappearing, and this affects education and learning systems as well as labour markets. Individuals are forced to develop lifestyles and survival strategies to manage job insecurity and make their skills and interests meet labour market needs. In modern attempts to develop and implement institutional provision for lifelong learning, guidance and counselling play an important role. The current Danish guidance system is well-organised, highly structured and professionalised. By contrast, Chinese guidance is still fragmented and "sectorisational". This paper explores whether elements of the highly structured and professionalised Danish guidance system and practice might be applicable to the Chinese context. The author begins by outlining international and national factors which are affecting citizens' life and career planning. She then presents and discusses the evolution of guidance and the different elements of provision in each of the two countries. Next, She compares the concepts and goals of "lifelong guidance" in Denmark and China, pointing out their similarities and differences and their respective strengths and weaknesses. The paper concludes with some suggestions for the further development of guidance in China.

  20. Lifelong guidance: How guidance and counselling support lifelong learning in the contrasting contexts of China and Denmark

    Science.gov (United States)

    Zhang, Zhixin

    2016-09-01

    Due to the effects of globalisation and rapid technological development, traditional linear life course patterns of the past are gradually disappearing, and this affects education and learning systems as well as labour markets. Individuals are forced to develop lifestyles and survival strategies to manage job insecurity and make their skills and interests meet labour market needs. In modern attempts to develop and implement institutional provision for lifelong learning, guidance and counselling play an important role. The current Danish guidance system is well-organised, highly structured and professionalised. By contrast, Chinese guidance is still fragmented and "sectorisational". This paper explores whether elements of the highly structured and professionalised Danish guidance system and practice might be applicable to the Chinese context. The author begins by outlining international and national factors which are affecting citizens' life and career planning. She then presents and discusses the evolution of guidance and the different elements of provision in each of the two countries. Next, She compares the concepts and goals of "lifelong guidance" in Denmark and China, pointing out their similarities and differences and their respective strengths and weaknesses. The paper concludes with some suggestions for the further development of guidance in China.

  1. Pandemic influenza guidance for corporations.

    Science.gov (United States)

    2011-06-01

    The purpose of this guidance document is to assist members of the American College of Occupational and Environmental Medicine (ACOEM), and the organizations for which they work, in managing the impact of a pandemic of influenza or other contagious respiratory disease on patients, employees, and business. This guidance document outlines actions to take before and during an influenza pandemic on the basis of two main strategies: (1) reducing the spread of the virus within facilities; and (2) providing medical care and medical surveillance to client/patient populations. Facilities in which ACOEM members serve include government agencies and the military, universities, and corporations, which generally have multiple locations/sites and their own medical staff, with members responsible for medical care and disease control. This guidance is for organizations with outpatient occupational medicine services, to be used as appropriate. Medical centers should also use guidance that addresses additional employee and external patient care needs.1–3 The ACOEM fully supports implementation of occupational influenza programs that conform with guidance from the Centers for Disease Control and Prevention (CDC), with other guidance from the US Department of Health and Human Services (DHHS), and Occupational Safety and Health Administration (OSHA) regulations and guidance.

  2. EPA guidance on cultural competence training.

    Science.gov (United States)

    Schouler-Ocak, Meryam; Graef-Calliess, Iris T; Tarricone, Ilaria; Qureshi, Adil; Kastrup, Marianne C; Bhugra, Dinesh

    2015-03-01

    The stress of migration as well as social factors and changes related to the receiving society may lead to the manifestation of psychiatric disorders in vulnerable individuals after migration. The diversity of cultures, ethnicities, races and reasons for migration poses a challenge for those seeking to understand how illness is experienced by immigrants whose backgrounds differ significantly from their clinicians. Cultural competence represents good clinical practice and can be defined as such that a clinician regards each patient in the context of the patient's own culture as well as from the perspective of the clinician's cultural values and prejudices. The EPA Guidance on cultural competence training outlines some of the key issues related to cultural competence and how to deal with these. It points out that cultural competence represents a comprehensive response to the mental health care needs of immigrant patients and requires knowledge, skills and attitudes which can improve the effectiveness of psychiatric treatment. To reach these aims, both individual and organizational competence are needed, as well as teaching competence in terms of educational leadership. The WPA Guidance on Mental Health and Mental Health Care for Migrants and the EPA Guidance on Mental Health Care for Migrants list a series of recommendations for policy makers, service providers and clinicians; these are aimed at improving mental health care for immigrants. The authors of this paper would like to underline these recommendations and, focusing on cultural competency and training, believe that they will be of positive value. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  3. Fluoroscopic Analysis of Tibial Translation in Anterior Cruciate Ligament Injured Knees With and Without Bracing During Forward Lunge

    Directory of Open Access Journals (Sweden)

    Jalali

    2015-07-01

    Full Text Available Background Despite several studies with different methods, the effect of functional knee braces on knee joint kinematics is not clear. Direct visualization of joint components through medical imaging modalities may provide the clinicians with more useful information. Objectives In this study, for the first time in the literature, video fluoroscopy was used to investigate the effect of knee bracing on the sagittal plane kinematics of anterior cruciate ligament (ACL injured patients. Patients and Methods For twelve male unilateral ACL deficient subjects, the anterior tibial translation was measured during lunge exercise in non-braced and braced conditions. Fluoroscopic images were acquired from the subjects using a digital fluoroscopy system with a rate of 10 fps. The image of each frame was scaled using a calibration coin and analyzed in AutoCAD environment. The angle between the two lines, tangent to the posterior cortexes of the femoral and tibial shafts was measured as the flexion angle. For the fluoroscopic images associated with 0°, 15°, 30°, 45° and 60° knee flexion angles, the relative anterior-posterior configuration of the tibiofemoral joint was assessed by measuring the position of landmarks on the tibia and femur. Results Results indicated that the overall anterior translations of the tibia during the eccentric (down and concentric (up phases of lunge exercise were 10.4 ± 1.7 mm and 9.0 ± 2.2 mm for non-braced, and 10.1 ± 3.4 mm and 7.4 ± 2.5 mm, for braced conditions, respectively. The difference of the tibial anterior-posterior translation behaviors of the braced and non-braced knees was not statistically significant. Conclusion Fluoroscopic imaging provides an effective tool to measure the dynamic behavior of the knee joint in the sagittal plane and within the limitations of this study, the pure mechanical stabilizing effect of functional knee bracing is not sufficient to control the anterior tibial translation of the ACL

  4. SU-E-J-01: 3D Fluoroscopic Image Estimation From Patient-Specific 4DCBCT-Based Motion Models

    Energy Technology Data Exchange (ETDEWEB)

    Dhou, S; Hurwitz, M; Lewis, J [Brigham and Women' s Hospital, Dana-Farber Cancer Center, Harvard Medical School, Boston, MA (United States); Mishra, P [Varian Medical Systems, Palo Alto, CA (United States)

    2014-06-01

    Purpose: 3D motion modeling derived from 4DCT images, taken days or weeks before treatment, cannot reliably represent patient anatomy on the day of treatment. We develop a method to generate motion models based on 4DCBCT acquired at the time of treatment, and apply the model to estimate 3D time-varying images (referred to as 3D fluoroscopic images). Methods: Motion models are derived through deformable registration between each 4DCBCT phase, and principal component analysis (PCA) on the resulting displacement vector fields. 3D fluoroscopic images are estimated based on cone-beam projections simulating kV treatment imaging. PCA coefficients are optimized iteratively through comparison of these cone-beam projections and projections estimated based on the motion model. Digital phantoms reproducing ten patient motion trajectories, and a physical phantom with regular and irregular motion derived from measured patient trajectories, are used to evaluate the method in terms of tumor localization, and the global voxel intensity difference compared to ground truth. Results: Experiments included: 1) assuming no anatomic or positioning changes between 4DCT and treatment time; and 2) simulating positioning and tumor baseline shifts at the time of treatment compared to 4DCT acquisition. 4DCBCT were reconstructed from the anatomy as seen at treatment time. In case 1) the tumor localization error and the intensity differences in ten patient were smaller using 4DCT-based motion model, possible due to superior image quality. In case 2) the tumor localization error and intensity differences were 2.85 and 0.15 respectively, using 4DCT-based motion models, and 1.17 and 0.10 using 4DCBCT-based models. 4DCBCT performed better due to its ability to reproduce daily anatomical changes. Conclusion: The study showed an advantage of 4DCBCT-based motion models in the context of 3D fluoroscopic images estimation. Positioning and tumor baseline shift uncertainties were mitigated by the 4DCBCT

  5. RH Packaging Program Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Washington TRU Solutions, LLC

    2003-08-25

    The purpose of this program guidance document is to provide technical requirements for use, operation, inspection, and maintenance of the RH-TRU 72-B Waste Shipping Package and directly related components. This document complies with the requirements as specified in the RH-TRU 72-B Safety Analysis Report for Packaging (SARP), and Nuclear Regulatory Commission (NRC) Certificate of Compliance (C of C) 9212. If there is a conflict between this document and the SARP and/or C of C, the SARP and/or C of C shall govern. The C of C states: ''...each package must be prepared for shipment and operated in accordance with the procedures described in Chapter 7.0, ''Operating Procedures,'' of the application.'' It further states: ''...each package must be tested and maintained in accordance with the procedures described in Chapter 8.0, ''Acceptance Tests and Maintenance Program of the Application.'' Chapter 9.0 of the SARP tasks the Waste Isolation Pilot Plant (WIPP) Management and Operating (M&O) contractor with assuring the packaging is used in accordance with the requirements of the C of C. Because the packaging is NRC approved, users need to be familiar with 10 CFR {section} 71.11, ''Deliberate Misconduct.'' Any time a user suspects or has indications that the conditions of approval in the C of C were not met, the Carlsbad Field Office (CBFO) shall be notified immediately. CBFO will evaluate the issue and notify the NRC if required. This document details the instructions to be followed to operate, maintain, and test the RH-TRU 72-B packaging. This Program Guidance standardizes instructions for all users. Users shall follow these instructions. Following these instructions assures that operations are safe and meet the requirements of the SARP. This document is available on the Internet at: ttp://www.ws/library/t2omi/t2omi.htm. Users are responsible for ensuring they are using the current

  6. X-ray fluoroscopic observation of slag foaming; Slag no awadachi gensho no x sen toshi kansatsu

    Energy Technology Data Exchange (ETDEWEB)

    Ogawa, Y.; Tokumitsu, N. [Nippon Steel Corp., Tokyo (Japan)

    2001-01-01

    Slag foaming caused by slag/metal reaction in a graphite crucible was observed with X-ray fluoroscopic apparatus in order to make clear the effect of bubble size on the foam height and the distribution of bubbles in slag. It was observed that the foam layer was formed when CO bubbles evolved at slag/metal interface became less than approximately 2mm in diameter. The foam height increased with the decrease of bubble size even in case of almost the same gas evolution rate. The size of bubbles decreased with the increase of iron oxide Content in slag and the decrease of sulphur content. It is considered that the bubbles become smaller when slag is wettable with metal. Therefore, the physical properties of slag/metal interface also affect the foam height besides the surface tension or viscosity of slag because they change the bubble size. (author)

  7. Google Glass as an Alternative to Standard Fluoroscopic Visualization for Percutaneous Fixation of Hand Fractures: A Pilot Study.

    Science.gov (United States)

    Chimenti, Peter C; Mitten, David J

    2015-08-01

    This pilot study investigated the feasibility of Google Glass to assist visualization of fluoroscopic images during percutaneous pinning of hand fractures. Cadavers were used to compare total time to pin each fracture and total number of radiographs per fracture from a mini C-arm. A FluoroScan monitor was used for radiographic visualization compared to projecting the images in the Google Glass display. All outcome measures significantly improved for proximal phalanx fractures (127 versus 86 seconds, p = 0.017; 5.3 versus 2.2 images, p = 0.003), and fewer images were obtained during fixation of metacarpal fractures using Google Glass compared with traditional techniques (6.4 versus 3.6, p Google Glass allows constant attention directed toward the operative field.

  8. CDM Convective Forecast Planning guidance

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The CDM Convective Forecast Planning (CCFP) guidance product provides a foreast of en-route aviation convective hazards. The forecasts are updated every 2 hours and...

  9. Response to work activity guidance

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This memorandum is concerning the request from the FY95 Platte-Kansas Rivers Ecosystem Work Activity Guidance for refuge managers to review the purposes of refuges...

  10. TSCA Inventory Policy and Guidance

    Science.gov (United States)

    A list of numerous policy statements and guidance documents on how to identify certain chemical substances for the purpose of assigning unique and unambiguous descriptions tor each substance listed on the Inventory.

  11. Design considerations for a new, high resolution Micro-Angiographic Fluoroscope based on a CMOS sensor (MAF-CMOS).

    Science.gov (United States)

    Loughran, Brendan; Swetadri Vasan, S N; Singh, Vivek; Ionita, Ciprian N; Jain, Amit; Bednarek, Daniel R; Titus, Albert; Rudin, Stephen

    2013-03-06

    The detectors that are used for endovascular image-guided interventions (EIGI), particularly for neurovascular interventions, do not provide clinicians with adequate visualization to ensure the best possible treatment outcomes. Developing an improved x-ray imaging detector requires the determination of estimated clinical x-ray entrance exposures to the detector. The range of exposures to the detector in clinical studies was found for the three modes of operation: fluoroscopic mode, high frame-rate digital angiographic mode (HD fluoroscopic mode), and DSA mode. Using these estimated detector exposure ranges and available CMOS detector technical specifications, design requirements were developed to pursue a quantum limited, high resolution, dynamic x-ray detector based on a CMOS sensor with 50 μm pixel size. For the proposed MAF-CMOS, the estimated charge collected within the full exposure range was found to be within the estimated full well capacity of the pixels. Expected instrumentation noise for the proposed detector was estimated to be 50-1,300 electrons. Adding a gain stage such as a light image intensifier would minimize the effect of the estimated instrumentation noise on total image noise but may not be necessary to ensure quantum limited detector operation at low exposure levels. A recursive temporal filter may decrease the effective total noise by 2 to 3 times, allowing for the improved signal to noise ratios at the lowest estimated exposures despite consequent loss in temporal resolution. This work can serve as a guide for further development of dynamic x-ray imaging prototypes or improvements for existing dynamic x-ray imaging systems.

  12. Design considerations for a new high resolution Micro-Angiographic Fluoroscope based on a CMOS sensor (MAF-CMOS)

    Science.gov (United States)

    Loughran, Brendan; Swetadri Vasan, S. N.; Singh, Vivek; Ionita, Ciprian N.; Jain, Amit; Bednarek, Daniel R.; Titus, Albert H.; Rudin, Stephen

    2013-03-01

    The detectors that are used for endovascular image-guided interventions (EIGI), particularly for neurovascular interventions, do not provide clinicians with adequate visualization to ensure the best possible treatment outcomes. Developing an improved x-ray imaging detector requires the determination of estimated clinical x-ray entrance exposures to the detector. The range of exposures to the detector in clinical studies was found for the three modes of operation: fluoroscopic mode, high frame-rate digital angiographic mode (HD fluoroscopic mode), and DSA mode. Using these estimated detector exposure ranges and available CMOS detector technical specifications, design requirements were developed to pursue a quantum limited, high resolution, dynamic x-ray detector based on a CMOS sensor with 50 μm pixel size. For the proposed MAF-CMOS, the estimated charge collected within the full exposure range was found to be within the estimated full well capacity of the pixels. Expected instrumentation noise for the proposed detector was estimated to be 50-1,300 electrons. Adding a gain stage such as a light image intensifier would minimize the effect of the estimated instrumentation noise on total image noise but may not be necessary to ensure quantum limited detector operation at low exposure levels. A recursive temporal filter may decrease the effective total noise by 2 to 3 times, allowing for the improved signal to noise ratios at the lowest estimated exposures despite consequent loss in temporal resolution. This work can serve as a guide for further development of dynamic x-ray imaging prototypes or improvements for existing dynamic x-ray imaging systems.

  13. Guidance Systems of Fighter Aircraft

    Directory of Open Access Journals (Sweden)

    K.N. Rajanikanth

    2005-07-01

    Full Text Available Mission performance of a fighter aircraft is crucial for survival and strike capabilities in todays' aerial warfare scenario. The guidance functions of such an aircraft play a vital role inmeeting the requirements and accomplishing the mission success. This paper presents the requirements of precision guidance for various missions of a fighter aircraft. The concept ofguidance system as a pilot-in-loop system is pivotal in understanding and designing such a system. Methodologies of designing such a system are described.

  14. Guidance Systems of Fighter Aircraft

    OpenAIRE

    K.N. Rajanikanth; Rao, R S; P. S. Subramanyam; Ajai Vohra

    2005-01-01

    Mission performance of a fighter aircraft is crucial for survival and strike capabilities in todays' aerial warfare scenario. The guidance functions of such an aircraft play a vital role inmeeting the requirements and accomplishing the mission success. This paper presents the requirements of precision guidance for various missions of a fighter aircraft. The concept ofguidance system as a pilot-in-loop system is pivotal in understanding and designing such a system. Methodologies of designing s...

  15. Guidance molecules in lung cancer

    OpenAIRE

    Nasarre, Patrick; Potiron, Vincent; Drabkin, Harry; Roche, Joëlle

    2010-01-01

    Guidance molecules were first described in the nervous system to control axon outgrowth direction. They are also widely expressed outside the nervous system where they control cell migration, tissue development and establishment of the vascular network. In addition, they are involved in cancer development, tumor angiogenesis and metastasis. This review is primarily focused on their functions in lung cancer and their involvement in lung development is also presented. Five guidance molecule fam...

  16. Trajectory reshaping based guidance with impact time and angle constraints

    Institute of Scientific and Technical Information of China (English)

    Zhao Yao; Sheng Yongzhi; Liu Xiangdong

    2016-01-01

    This study presents a novel impact time and angle constrained guidance law for homing missiles. The guidance law is first developed with the prior-assumption of a stationary target, which is followed by the practical extension to a maneuvering target scenario. To derive the closed-form guidance law, the trajectory reshaping technique is utilized and it results in defining a specific poly-nomial function with two unknown coefficients. These coefficients are determined to satisfy the impact time and angle constraints as well as the zero miss distance. Furthermore, the proposed guidance law has three additional guidance gains as design parameters which make it possible to adjust the guided trajectory according to the operational conditions and missile’s capability. Numerical simulations are presented to validate the effectiveness of the proposed guidance law. © 2016 Chinese Society of Aeronautics and Astronautics. Production and hosting by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

  17. Strengthening Practical Effect of Psychological Guidance upon College Students' Ideological Education%利用心理疏导增强大学生思想政治教育实效性

    Institute of Scientific and Technical Information of China (English)

    彭拴莲

    2009-01-01

    College students suffer from psychological confusion and conflict caused by stress, showing intertwines of ideological and mental problems. Ideological and political education has to show concern for these problems and conduct psychological guidance so as to nip psychological problems in the bud. This paper, taking five psychological problems of college students as the starting point, discusses the role of psychological guidance in ideological and political education and its specific procedures.%大学生因压力诱发心理困惑和冲突,表现出思想问题与心理问题的交织.思想政治教育要体现她的现代价值就必须关注这些现实问题,引入心理疏导,把心理问题消灭在萌芽状态.文章从厘清大学生五种心理问题入手,分析心理疏导对思想政治教育的意义,探讨心理疏导的有效步骤.

  18. Health Promotion Guidance Activity of Youth Sports Clubs

    Science.gov (United States)

    Kokko, Sami; Kannas, Lasse; Villberg, Jari; Ormshaw, Michael

    2011-01-01

    Purpose: This paper aims to clarify the extent to which youth sports clubs guide their coaches to recognise health promotion as a part of the coaching practice. The guidance activity of clubs is seen parallel to internal organisational communication. Design/methodology/approach: A survey of 93 (from 120, 78 per cent) youth sports clubs in Finland…

  19. Laboratory Biosafety and Biosecurity Risk Assessment Technical Guidance Document

    Energy Technology Data Exchange (ETDEWEB)

    Astuto-Gribble, Lisa M; Caskey, Susan Adele

    2014-07-01

    The purpose of this document is threefold: 1) to describe the laboratory bio safety and biosecurity risk assessment process and its conceptual framework; 2) provide detailed guidance and suggested methodologies on how to conduct a risk assessment; and 3) present some practical risk assessment process strategies using realistic laboratory scenarios.

  20. Health Promotion Guidance Activity of Youth Sports Clubs

    Science.gov (United States)

    Kokko, Sami; Kannas, Lasse; Villberg, Jari; Ormshaw, Michael

    2011-01-01

    Purpose: This paper aims to clarify the extent to which youth sports clubs guide their coaches to recognise health promotion as a part of the coaching practice. The guidance activity of clubs is seen parallel to internal organisational communication. Design/methodology/approach: A survey of 93 (from 120, 78 per cent) youth sports clubs in Finland…

  1. Social Justice and Career Guidance in the Age of Talent

    Science.gov (United States)

    Arthur, Nancy

    2014-01-01

    The practice of career guidance is heavily influenced by changes in the workplace impacted by globalization and fluctuating economies. In the current era, known as the Age of Talent, people are increasingly viewed as commodities to fulfill labor market needs. There are controversies and inequities about who has access to meaningful employment and…

  2. Career Guidance and Student Success in Dutch Higher Vocational Education

    Science.gov (United States)

    te Wierik, Mark L. J.; Beishuizen, Jos; van Os, Willem

    2015-01-01

    To enhance student success, a growing number of vocational education and training institutions in the Netherlands are nowadays implementing new career guidance practices in their competence-based approaches to learning. Based on individual-level data of undergraduate first-year full-time students from a Dutch university of applied sciences, this…

  3. Quality in career guidance: The Danish case

    DEFF Research Database (Denmark)

    Plant, Peter

    2011-01-01

    Quality assurance systems are introduced in career guidance to monitor, control and develop guidance interventions. The Danish case represents at centrally driven, top-down approach......Quality assurance systems are introduced in career guidance to monitor, control and develop guidance interventions. The Danish case represents at centrally driven, top-down approach...

  4. Children's Television Advertising: The Attitudes and Opinions of Elementary School Guidance Counselors.

    Science.gov (United States)

    Barry, Thomas E.

    1978-01-01

    Illustrates that guidance counselors from grade schools have negative attitudes about the advertising practices aimed at children. Presents additional evidence that guidance counselors are unaware of the changes being made in advertising aimed at children, such as limiting commercial time during children's television shows. (RL)

  5. The Consequences of Fading Instructional Guidance on Delayed Performance: The Case of Financial Services Training

    Science.gov (United States)

    Kissane, Mark; Kalyuga, Slava; Chandler, Paul; Sweller, John

    2008-01-01

    Empirical studies within a cognitive load framework have determined that for novice learners, worked examples provide appropriate levels of instructional guidance. As learners advance in specific subject domains, worked examples should be gradually replaced by practice problems with limited guidance. This study compared performance, both…

  6. Key Competencies and School Guidance Counselling: Learning Alongside Communities of Support

    Science.gov (United States)

    Kotzé, Elmarie; Crocket, Kathie; Burke, Alison; Graham, Judith; Hughes, Colin

    2013-01-01

    Often the work of school guidance counsellors goes on "behind the scenes" in the privacy and confidentiality of the counselling room. This article makes visible particular aspects of school counselling practice. It illustrates the potential for understanding school guidance counselling as a site of student learning, in particular of key…

  7. Towards a Model of Career Guidance and Counseling for University Students in China

    Science.gov (United States)

    Hao, Dengfeng; Sun, Vincy J.; Yuen, Mantak

    2015-01-01

    This paper examines the evolution of career guidance and counseling in Chinese universities. In particular it highlights how national and cultural influences in China have interacted with longer-term influences and practices from the West, producing a unique "Five Aspects in One" model of delivery. Current career guidance and counseling…

  8. 经皮胃造瘘术在治疗恶性肿瘤所致继发性吞咽困难中的应用%Clinical application of percutaneous fluoroscopic gastrostomy in the treatment of secondary dysphagia caused by malignancy

    Institute of Scientific and Technical Information of China (English)

    易小宇; 何伟; 余雷

    2013-01-01

    目的 分析经皮胃造瘘术在治疗恶性肿瘤所致继发性吞咽困难中的应用.方法 选择15例因头颈部恶性肿瘤导致无法进食、胃肠功能仍存在、需依赖静脉内营养患者,在局麻下行透视下经皮胃造瘘术.结果 15例均操作成功,1例术后出现严重并发症,3例出现轻微并发症,经处理后恢复正常.15例患者术后均摆脱静脉内营养,行肠内营养支持,明显提高生活质量.结论 透视下经皮胃造瘘术操作简单、易行,并发症可控可处理,特别适用于头颈部恶性肿瘤所致进食困难的患者.%Objective To summarize the clinical experience of percutaneous fluoroscopic gastrostomy (PFG) in the treatment of secondary dysphagia caused by malignancy.Methods Fifteen head and neck cancer patients with swallowing disorders (12 men,3 women; age range:48-76 years ; mean:54 years) underwent PFG.Radiopaque gastrostomy feeding catheter was placed with Seldinger technique under fluoroscopic guidance.Results All patients had technically successful placement of PFG tubes.One patient had serious complications and three patients had minor complications,which resolved after treatment.Parenteral nutrition was no longer required in all patients.Condusions PEG is a safe,effective and minimally-invasive procedure for nutrition support therapy in head and neck cancer patients with swallowing disorders.

  9. 开放教育“导学约课”实践探索研究%A Practical Exploration of“Guidance and Appointment Learning”in Open Education

    Institute of Scientific and Technical Information of China (English)

    刘文英

    2015-01-01

    “导学约课”充分发挥开放教育学习在时间、空间、形式上的灵活性,以缓和学员家庭、工学矛盾为目的,充分体现以人为本、按需服务的理念,学员乐意接受。在“导学约课”的各个环节中,倡导教师主导与学员的主体地位,强调教师的导学要以学习者为中心,以现代教育技术手段为支撑,通过多种媒体的综合运用,将教师的引导、指导、诱导、辅导、督导贯穿于学员自主学习的全过程,激发学员的学习兴趣和学习主动性,培养学员的自主学习能力,探索开放教育教学新模式,使开放教育教学达到最佳效果。%The“Guidance and Appointment Learning”gives full play to the opening education study in time,space,form of flexibil-ity,to ease students family,learning,for the purpose,fully embodies the concept of people-oriented,on-demand service,students willing to accept. In the uide to learn about class”of each link,advocating“dominant”for teachers and students“main body”,emphasis on teachers“guide learning”to learners as he center,supported by modern education technology,through the integrated use of a variety of media,to the teacher′s guidance,coaching,mentoring,guidance,induced throughout the course of students autonomous learning,stimu-late students learning interest and learning initiative,training students′ability of autonomous learning,explore the new mode of open educa-tion teaching,make the open education teaching to achieve the best effect.

  10. PRACTICE IN NIGERIA

    African Journals Online (AJOL)

    of EBP in nursing curriculum, technological infrastructure, changing practice, ... some strategies to overcome these challenges. Objectives of the paper ... establishment of organizations to develop guidance to .... professional growth in an age of information explosion. ... Technology infrastructure. Access to the ... Resistance.

  11. International Conference on Harmonisation; guidance on E2E Pharmacovigilance Planning; availability. Notice.

    Science.gov (United States)

    2005-04-01

    The Food and Drug Administration (FDA) is announcing the availability of a guidance entitled "E2E Pharmacovigilance Planning." The guidance was prepared under the auspices of the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH). The guidance describes a method for summarizing the important potential and identified risks of a drug. It proposes a structure for a pharmacovigilance plan and sets out principles of good practice for the design and conduct of observational studies. The guidance is intended to aid in planning pharmacovigilance activities, especially in preparation for the early postmarketing period of a new drug.

  12. 医学化学教学中对学生实施"学法指导"的探索与实践%Study and practice of "guidance of learning" method in the teaching of medical chemistry

    Institute of Scientific and Technical Information of China (English)

    赵华文; 刘毅敏; 赵先英; 杨旭; 李欣; 武丽萍

    2009-01-01

    It is becoming a trend for teaching reform that students' learning methods are integrated into teachers' teaching format. This paper discusses how to guide student to learn with the method of "guidance of learning" in the teaching of medical chemistry so as to improve students' learning ability.%研究学生科学的学习方法,寓学法于教法之中,是教学方法改革的发展趋势.本文就医学化学教学中实施"学法指导",引导学生学习,进而培养学生学习能力进行了探索与实践,取得了满意的效果.

  13. Guangdong Engineering Institute graduates employment guidance practice report%广东工程职业技术学院毕业生就业指导工作实践报告

    Institute of Scientific and Technical Information of China (English)

    刘文清

    2012-01-01

    广东工程职业技术学院是以工科为主的高职院校,以高就业为导向,以"三高一融合一服务"为办学理念,以"始于您的就业需求,终于您的满意就业"为就业服务宗旨,以"提高毕业生就业质量和就业满意度"为毕业生就业工作目标。近年来在毕业生就业工作上创出了特色,造出了品牌,做成了精品,毕业生都能在技术岗位高质量就业。%Guangdong Engineering Institute is engineering-based vocational college.It is high employment-oriented and takes "three high-integration-service" as educational philosophy,makes "began your employment needs,and finally achieve your satisfactory employment "as employment services aiming to improve the quality of graduate employment and job satisfaction,.In recent years it creates a brand and made a fine in the work of graduate employment.The graduates can reach a high-quality employment in technical positions and the college is highly praised by parents,society,and graduates.This paper summarized the college employment guidance experience in recent years in order to encourage each other with the same level vocational colleges career guidance workers.

  14. Autonomous Guidance, Navigation and Control

    Science.gov (United States)

    Bordano, A. J.; Mcswain, G. G.; Fernandes, S. T.

    1991-01-01

    The NASA Autonomous Guidance, Navigation and Control (GN&C) Bridging program is reviewed to demonstrate the program plan and GN&C systems for the Space Shuttle. The ascent CN&C system is described in terms of elements such as the general-purpose digital computers, sensors for the navigation subsystem, the guidance-system software, and the flight-control subsystem. Balloon-based and lidar wind soundings are used for operations assessment on the day of launch, and the guidance software is based on dedicated units for atmospheric powered flight, vacuum powered flight, and abort-specific situations. Optimization of the flight trajectories is discussed, and flight-control responses are illustrated for wavelengths of 500-6000 m. Alternate sensors are used for load relief, and adaptive GN&C systems based on alternate gain synthesis are used for systems failures.

  15. Practice and Reflection on Course Construction of Career Development and Career Guidance in Teachers College%高等师范院校职业发展与就业指导课程建设的实践与思考

    Institute of Scientific and Technical Information of China (English)

    李峰

    2015-01-01

    职业发展与就业指导课程已成为高等师范院校提升大学生就业竞争力的重要途径之一.以首批全国高校职业发展与就业指导示范课程中入围的9所高等师范院校课程为研究对象, 分析师范院校职业发展与就业指导课程的实践状况, 提出了 "显特色、 筑体系、 强师资、 重服务、 建学科" 的优化课程建设对策, 旨在推动课程朝着规范化、 特色化和学科化的方向发展.%Course construction of career development and career guidance has become one of the important ways to improve the teachers college students'employment competitiveness .The paper takes the National demonstration course of career development and career guidance in 9 teachers colleges as the research object , and analyzes the practical situation of the teachers college course construction in career development and guidance .It puts forward the countermeasures , such as highlighting the characteristics , constructing the system , strengthening the teachers , paying attention to the service , establishing the discipline .These countermeasures are aimed at promoting the development of courses in the direction of standardization , specialization and subject .

  16. Multimodality and video observation in “Collective Academic Supervision” in the Master Program in Guidance, Aarhus University, Denmark

    DEFF Research Database (Denmark)

    Nordentoft, Helle; Buhl, Mie

    2012-01-01

    How come that the practice of guidance appears to be so simple and yet so vastly complicated. What could be simpler than being and interested interviewer and listener? Still, the complexity of what is involved in professional interaction practices can be difficult to pinpoint. In this presentation...... at the Danish Master Program in Guidance....

  17. Guidance on Radiochronometry

    Energy Technology Data Exchange (ETDEWEB)

    Williams, Ross W. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Gaffney, Amy M. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Kristo, Michael J. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2016-08-21

    Radiochronometry is the measurement of radioactive materials and their decay products to determine the “age” of the material. It differs from the practice of geochronology in that the materials (samples) are man-made, and in that the timespan of interest is confined to the nuclear era, i.e., since the discovery of fission in 1939. In radiochronometry, the “age” of the material ideally records the time when the sample was manufactured, or produced in the final form that is analyzed in the laboratory. It is an important predictive signature in a nuclear forensic investigation which can help in the attribution to a source. The calculation of this “age” can only be made if a model is invoked that allows simplification of the parent radionuclide to daughter isotope decay equation. The simplification required for this model is that the parent was purified completely from all traces of its daughter product at the time of sample preparation. Then, this “age” should be described as the “model age” from which a “model date” in the past can then be calculated. For this model date to represent the date of sample preparation, two other assumptions are required to be true. The first is that the material has remained a closed system since that time (i.e., that there has been no loss or gain of either parent or daughter), and the second is that the analyses are accurate.

  18. 将门急诊病案管理融入导医岗位培训的探索与实践%Investigation and Practice on the Application of Medical Records Management of Outpatient and Emergency Departments in the Training Process of Medical Guidance Position

    Institute of Scientific and Technical Information of China (English)

    张育; 邓应梅

    2015-01-01

    The position training of medical guidance nurses in outpatient department of a comprehensive hospital need to explore training mode,content and methods continuously,so as to establish a comprehensive, systematic and standardize position training mode for the medical guidance nurses.Focused on the problems of delivery,recycle and supervision of medical records in outpatient department,our hospital absorbed the content of medical records management of outpatient and emergency departments in the training process of medical guidance position.The theory class accounted for 60% of all the learning time and practice class accounted for 40%, examinations of both theory and practice were arranged,problems would be solved at the same time.Through the position training,to promote practice by learning,make the nurses in outpatient department clearly understanding the work of medical guidance,standardize the guiding behaviors in outpatient department,enrich the knowledge field of the nurses and promote the improvement of comprehensive quality of the nurses.At the same time of the realization of no complaint,we also received the award and thanks letters of the medical guidance nurses,which promoted the high quality nursing service of outpatient department effectively.%综合医院门诊导医护士的岗位培训,需要不断探索培训的方式、内容与方法,从而建立导医护士全面、系统、规范化的岗位培训模式。鉴于门诊病案在门诊运行中的运送、回收和监管的难题,某院故此将门急诊病案服务管理融入导医培训内容中统筹安排。导医岗位培训理论授课占总学时的60%,实践课程占40%,培训后组织实践及理论考核,针对问题进行现场答疑。通过岗位培训,以点带面、以学促实践,使门诊护士既明确了导医的工作内容,又规范了门诊导医行为,拓展了导医护士的知识面,促进了护士综合素质的提高,在实现零投诉的同时,

  19. 高职院校学生职业发展与就业指导教育的实践--以宁波职业技术学院海天学院为例%Research on the Practice of Students ’ Career Development and Employment Guidance Education in Higher Vocational Colleges---Taking Ningbo Polytechnic Haitian College for Example

    Institute of Scientific and Technical Information of China (English)

    乐虞莹; 张定华

    2014-01-01

    从高职院校学生职业发展与就业指导教育的现实诉求入手,对大学生职业发展与就业指导课程模块设计、教学方法和实践平台建设等方面进行探讨,并就今后发展和完善提出建议,以提升学生就业力,提高就业质量,关注学生的职业成长和可持续发展。%Starting from the realistic aspirations of higher vocational college students’ career development and employment guidance education, this article discusses the module design, teaching methods and practical platform construction of college students’ career development and employment guidance education, also makes some recommendations for future development and improvement to enhance students’ employability, improve employment quality, pay attention to their career development and sustainable development.

  20. Guidance for evidence-informed policies about health systems: rationale for and challenges of guidance development.

    Science.gov (United States)

    Bosch-Capblanch, Xavier; Lavis, John N; Lewin, Simon; Atun, Rifat; Røttingen, John-Arne; Dröschel, Daniel; Beck, Lise; Abalos, Edgardo; El-Jardali, Fadi; Gilson, Lucy; Oliver, Sandy; Wyss, Kaspar; Tugwell, Peter; Kulier, Regina; Pang, Tikki; Haines, Andy

    2012-01-01

    In the first paper in a three-part series on health systems guidance, Xavier Bosch-Capblanch and colleagues examine how guidance is currently formulated in low- and middle-income countries, and the challenges to developing such guidance.

  1. 78 FR 56752 - Interim Staff Guidance Specific Environmental Guidance for Integral Pressurized Water Reactors...

    Science.gov (United States)

    2013-09-13

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Interim Staff Guidance Specific Environmental Guidance for Integral Pressurized Water Reactors... and operate integral pressurized water reactors (iPWR). This guidance applies to environmental reviews...

  2. Comparison of MR and fluoroscopic mucous fistulography in the pre-operative evaluation of infants with anorectal malformation: a pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Alves, Jose C.G.; Lotz, Jan W.; Pitcher, Richard D. [Stellenbosch University, Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Tygerberg Academic Hospital, Cape Town (South Africa); Sidler, Daniel [Stellenbosch University, Division of Pediatric Surgery, Department of Surgical Sciences, Tygerberg Academic Hospital, Cape Town (South Africa)

    2013-08-15

    Anorectal malformations are often associated with rectal pouch fistulas. Surgical correction requires accurate evaluation of the presence and position of such fistulas. Fluoroscopy is currently the chosen modality for the detection of fistulas. The role of MRI is unexplored. To compare the diagnostic accuracy of MR versus fluoroscopic fistulography in the pre-operative evaluation of infants with anorectal malformation. We conducted a pilot study of infants requiring defunctioning colostomy for initial management of anorectal malformation. Dynamic sagittal steady-state free-precession MRI of the pelvis was acquired during introduction of saline into the mucous fistulas. Findings were compared among MR fistulography, fluoroscopic fistulography and intraoperative inspection. Eight children were included. Median age at fistulography was 15 weeks, inter-quartile range 13-20 weeks; all were boys. There was full agreement among MR fistulography, fluoroscopic fistulography and surgical findings. The pilot data suggest that MR fistulography is promising in the pre-operative evaluation of children with anorectal malformation. (orig.)

  3. Fluoroscopic-guided supra-scapular nerve block in the management of shoulder pain in a Nigerian Teaching Hospital: Report of five cases

    Directory of Open Access Journals (Sweden)

    Zakari Aliyu Suleiman

    2015-01-01

    Full Text Available Shoulder pain complaints are common in our environment. The disorder can occur among the young active age group or in the older patients as a result of degenerative changes with its attendant limitations of the function of the affected upper limb, hindrance of the performance of activities of daily living, and reduced quality of life. The traditional oral analgesics, physiotherapy, and intra-articular corticosteroid injections are seldom ineffective at providing the desired pain relief and functional improvement at the shoulder joint. We investigated the role of fluoroscopic-guided supra-scapular nerve blocks (SSNBs in patients with shoulder pain who failed to respond to the routine conservative management. With the patient lying prone and the C-arm fluoroscope placed in anterior-posterior position, the scapula notch was visualized and a 22G spinal needle was directed toward the nerve. The mixture of local anesthetic agent and steroid was injected as close to the nerve as possible after negative aspiration. Fluoroscopic-guided SSNB can produce substantial pain relief and improved range of movement in patients with painful shoulders. The procedure is safe, well tolerated, and can be done on a day-case basis.

  4. Autonomous gliding entry guidance with

    Directory of Open Access Journals (Sweden)

    Guo Jie

    2015-10-01

    Full Text Available This paper presents a novel three-dimensional autonomous entry guidance for relatively high lift-to-drag ratio vehicles satisfying geographic constraints and other path constraints. The guidance is composed of onboard trajectory planning and robust trajectory tracking. For trajectory planning, a longitudinal sub-planner is introduced to generate a feasible drag-versus-energy profile by using the interpolation between upper boundary and lower boundary of entry corridor to get the desired trajectory length. The associated magnitude of the bank angle can be specified by drag profile, while the sign of bank angle is determined by lateral sub-planner. Two-reverse mode is utilized to satisfy waypoint constraints and dynamic heading error corridor is utilized to satisfy no-fly zone constraints. The longitudinal and lateral sub-planners are iteratively employed until all of the path constraints are satisfied. For trajectory tracking, a novel tracking law based on the active disturbance rejection control is introduced. Finally, adaptability tests and Monte Carlo simulations of the entry guidance approach are performed. Results show that the proposed entry guidance approach can adapt to different entry missions and is able to make the vehicle reach the prescribed target point precisely in spite of geographic constraints.

  5. Atmospheric guidance techniques and performance

    Science.gov (United States)

    Harpold, J. C.; Gavert, D. E.

    1982-01-01

    The Orbiter entry guidance system controls the Space Shuttle Orbiter from the initial atmospheric penetration point to the point at which an earth relative velocity of 2500 feet/second is reached. At the latter point, control of the Orbiter is transferred to the terminal area energy management system. The entry guidance system is based on the concept that the range to be flown during entry is a unique function of the drag deceleration profile flown throughout the entry. The range prediction during entry is based on analytic equations which are simple drag deceleration functions of earth relative velocity above Mach 10.5 and energy with respect to the earth below Mach 10.5. Flight through the entry corridor is accomplished by linking these simple drag deceleration functions together in series in order to define a drag deceleration reference profile. The results of the first three Space Shuttle missions have not only verified the entry guidance concept but have also demonstrated the stability of the guidance system.

  6. Teacher Guidance of Knowledge Construction

    Science.gov (United States)

    Schwarz, Baruch; Dreyfus, Tommy; Hadas, Nurit; Hershkowitz, Rina

    2004-01-01

    This paper focuses on how teachers guide construction of knowledge in classrooms. We suggest that guidance hinges on the kind of dialogue teachers choose to engage students in. We propose several classroom dialogue types relevant for the construction of knowledge and suggest that critical dialogue is particularly effective for knowledge…

  7. Guidance: Interim Municipal Settlement Policy

    Science.gov (United States)

    Interim guidance and fact sheets regarding settlements involving municipalities or municipal waste under Section 122 CERCLA as amended by SARA. Interim policy sets forth the criteria by which EPA generally determines whether to exercise enforcement discretion to pursue MSW generators and transporters as PRPs.

  8. Agent Based Individual Traffic Guidance

    DEFF Research Database (Denmark)

    Wanscher, Jørgen

    This thesis investigates the possibilities in applying Operations Research (OR) to autonomous vehicular traffic. The explicit difference to most other research today is that we presume that an agent is present in every vehicle - hence Agent Based Individual Traffic guidance (ABIT). The next...

  9. DOE Waste Treatability Group Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Kirkpatrick, T.D.

    1995-01-01

    This guidance presents a method and definitions for aggregating U.S. Department of Energy (DOE) waste into streams and treatability groups based on characteristic parameters that influence waste management technology needs. Adaptable to all DOE waste types (i.e., radioactive waste, hazardous waste, mixed waste, sanitary waste), the guidance establishes categories and definitions that reflect variations within the radiological, matrix (e.g., bulk physical/chemical form), and regulated contaminant characteristics of DOE waste. Beginning at the waste container level, the guidance presents a logical approach to implementing the characteristic parameter categories as part of the basis for defining waste streams and as the sole basis for assigning streams to treatability groups. Implementation of this guidance at each DOE site will facilitate the development of technically defined, site-specific waste stream data sets to support waste management planning and reporting activities. Consistent implementation at all of the sites will enable aggregation of the site-specific waste stream data sets into comparable national data sets to support these activities at a DOE complex-wide level.

  10. Interstitial guidance of cancer invasion.

    NARCIS (Netherlands)

    Gritsenko, P.G.; Ilina, O.; Friedl, P.H.

    2012-01-01

    Cancer cell invasion into healthy tissues develops preferentially along pre-existing tracks of least resistance, followed by secondary tissue remodelling and destruction. The tissue scaffolds supporting or preventing guidance of invasion vary in structure and molecular composition between organs. In

  11. Cooperative Guidance for Multimissile Salvo Attack

    Institute of Scientific and Technical Information of China (English)

    Zhao Shiyu; Zhou Rui

    2008-01-01

    Cooperative guidance problems of multiple missiles are considered in this article. A cooperative guidance scheme, where coordi-nation algorithms and local guidance laws are combined together, is proposed. This scheme actually builds up a hierarchical cooperative guidance architecture, which may provide a general solution to the multimissile cooperative guidance problems. In the case of salvo attacks which require missiles to hit the target simultaneously, both centralized and distributed coordination algorithms are derived based on the impact-time-control guidance (ITCG) law. Numerical simulations are performed to demonstrate the effectiveness of the proposed approaches.

  12. Thyroid, parathyroid, and salivary gland evaluations in patients exposed to multiple fluoroscopic examinations during tuberculosis therapy: a pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Kaplan, M.M.; Boice, J.D. Jr.; Ames, D.B.; Rosenstein, M.

    1988-02-01

    The prevalence of thyroid, parathyroid, and salivary abnormalities was determined in 91 women who received an average of 112 fluoroscopic chest examinations during pneumothorax treatment for tuberculosis more than 40 yr previously and in 72 women treated for tuberculosis by other modalities. Thyroid abnormalities were determined by physical examination, scintiscans, and measurements of serum free T4 index, TSH, and thyroid microsomal antibodies. Thyroid nodules were diagnosed in 7.7% of the exposed and 4.2% of the comparison group (prevalence ratio, 1.8; 90% confidence interval 0.6-5.7). Autoimmune thyroid disease was diagnosed in 15.2% of the exposed and 6.9% of the comparison group (prevalence ratio, 2.2; 95% confidence interval, 0.8-6.2). No salivary tumors were detected. Two exposed women and 1 comparison woman had primary hyperparathyroidism. Although absorbed dose to the thyroid could not be precisely determined, approximately 60 rads would be expected to yield the observed excess of thyroid nodules. While the prevalence ratios were not significantly increased in the exposed group, the results suggest that susceptibility of the thyroid to nodules from cumulative radiation doses of this magnitude could be increased even when the doses are accumulated over years and that such x-ray exposure of the thyroid gland may predispose the patient to the development of autoimmune disease.

  13. Rehabilitation after ACL Injury: A Fluoroscopic Study on the Effects of Type of Exercise on the Knee Sagittal Plane Arthrokinematics

    Directory of Open Access Journals (Sweden)

    Sadegh Norouzi

    2013-01-01

    Full Text Available A safe rehabilitation exercise for anterior cruciate ligament (ACL injuries needs to be compatible with the normal knee arthrokinematics to avoid abnormal loading on the joint structures. The objective of this study was to measure the amount of the anterior tibial translation (ATT of the ACL-deficient knees during selective open and closed kinetic chain exercises. The intact and injured knees of fourteen male subjects with unilateral ACL injury were imaged using uniplanar fluoroscopy, while the subjects performed forward lunge and unloaded/loaded open kinetic knee extension exercises. The ATTs were measured from fluoroscopic images, as the distance between the tibial and femoral reference points, at seven knee flexion angles, from 0° to 90°. No significant differences were found between the ATTs of the ACL-deficient and intact knees at all flexion angles during forward lunge and unloaded open kinetic knee extension (. During loaded open kinetic knee extension, however, the ATTs of the ACL deficient knees were significantly larger than those of the intact knees at 0° (. It was suggested that the forward lunge, as a weight-bearing closed kinetic chain exercise, provides a safer approach for developing muscle strength and functional stability in rehabilitation program of ACL-deficient knees, in comparison with open kinetic knee extension exercise.

  14. Transverse morphology of the sacroiliac joint: effect of angulation and implications for fluoroscopically guided sacroiliac joint injection

    Energy Technology Data Exchange (ETDEWEB)

    Ling, B.C.; Lee, J.W.; Man, H.S.J.; Grace, M.G.A.; Lambert, R.G.W. [Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton (Canada); Jhangri, G.S. [Department of Public Health Sciences, University of Alberta Hospital, Edmonton (Canada)

    2006-11-15

    Effects of angulation of computed tomography (CT) reconstruction plane on sacroiliac (SI) joint morphology were studied, and factors influencing the approach to fluoroscopically guided SI joint injection were assessed. CT scans of pelvises were reformatted on 41 subjects, aged 51.7 ({+-}15.1) years. Transverse images were reconstructed at the caudal 3 cm of the SI joint tilting plane of reconstruction from -30 to +30 at 15 increments. Anteroposterior diameter of joint (depth), angle from sagittal plane (orientation angle), and distance from skin were measured. Joint contour was classified, and presence of bone blocking access to the joint was recorded. Comparison between angles were analysed by t-test. Relationships between variables were assessed by a Pearson correlation test. Depth was shorter with angulation in the inferior direction (P<0.01). Orientation angle increased with superior angulation (P<0.01). Distance from skin increased (P<0.01) with angulation in either direction. Joint contour was significantly different from baseline at each angle (P<0.001) but highly variable. Inferior angulation resulted in interposition of ilium between skin and SI joint, and superior angulation caused bone block due to the lower sacrum. None of these features was identified without tilting of the reconstruction plane, and effects were more pronounced with steeper angulation.

  15. Closed reduction and fluoroscopic-assisted percutaneous pinning of 42 physeal fractures in 37 dogs and 4 cats.

    Science.gov (United States)

    Boekhout-Ta, Christina L; Kim, Stanley E; Cross, Alan R; Evans, Richard; Pozzi, Antonio

    2017-01-01

    To report complications and clinical outcome of dogs and cats that underwent fluoroscopic-assisted percutaneous pinning (FAPP) of physeal fractures. Retrospective study. Client-owned dogs (n = 37) and cats (n = 4). Records (August 2007-August 2014) of physeal fractures treated with FAPP in 3 hospitals were evaluated. Data collected included signalment, fracture characteristics (etiology, location, duration, Salter-Harris classification, preoperative and postoperative displacement), surgical information (implant size, surgical duration), and outcome assessment information (functional outcome, radiographic outcome, and complications). The majority of animals (92%) were classified as full functional outcome. No significant predictors of functional outcome were identified. The overall complication rate was 15% (n = 6). Elective pin removal rate was 41% (n = 17). Goniometry and limb circumference measurements of the affected and contralateral limbs were not significantly different in dogs for which measurements were obtained. Seventeen of 18 animals (16 dogs, 2 cats) measured had bone length changes on follow-up radiographs. FAPP is associated with an excellent functional outcome in a narrow selection of fracture configurations, specifically those with minimal displacement and for which anatomical alignment can be achieved with closed reduction. © 2016 The American College of Veterinary Surgeons.

  16. Practical Tips for Increasing Listening Practice Time

    Science.gov (United States)

    McCaughey, Kevin

    2015-01-01

    Learning a language--like learning to dance ballet, weaving carpets, or playing the saxophone--takes time and practice. In general, it is safe to say that the more practice one gets, the better one will become. This article will help teachers of English reconsider how to think about listening tasks. It will provide guidance for increasing…

  17. Career guidance and counselling for mobilities

    National Research Council Canada - National Science Library

    Zvariková, Mária

    2011-01-01

    In its first part, the article provides a basic overview on guidance and counselling for mobility issues at universities, focusing on the possibilities and role of guidance and counselling for both...

  18. Comparison of CT and PET/CT for biopsy guidance in oncological patients.

    Science.gov (United States)

    Cerci, Juliano J; Tabacchi, Elena; Bogoni, Mateos; Delbeke, Dominique; Pereira, Carlos Cunha; Cerci, Rodrigo J; Krauzer, Cassiano; Sakamoto, Danielle Giacometti; Fanti, Stefano; Vitola, João Vicente

    2017-08-01

    To compare FDG PET/CT and CT for the guidance of percutaneous biopsies with histological confirmation of lesions. We prospectively evaluated 323 patients of whom 181 underwent FDG PET/CT-guided biopsy (total 188 biopsies) and 142 underwent CT-guided biopsy (total 146 biopsies). Biopsies were performed using the same PET/CT scanner with a fluoroscopic imaging system. Technical feasibility, clinical success and complication rates in the two groups were evaluated. Of the 188 biopsies with PET/CT guidance, 182 (96.8%) were successful with conclusive tissue samples obtained and of the 146 biopsies with CT guidance, 137 (93.8%) were successful. Therefore, 6 of 188 biopsies (3.1%) with PET/CT guidance and 9 of 146 (6.1%) with CT guidance were inconclusive (p = 0.19). Due to inconclusive histological results, 4 of the 188 lesions (2.1%) were rebiopsied with PET/CT guidance and 3 of 146 lesions (2.0%) were rebiopsied with CT guidance. Histology demonstrated that 142 of 188 lesions (75.5%) were malignant, and 40 (21.2%) were benign in the PET/CT-guided group, while 89 of 146 lesions (60.9%) were malignant and 48 (32.8%) were benign in the CT-guided group (p = 0.004 and 0.01, respectively). Patients with a histological diagnosis of benign lesion had no recurrence of disease with a minimum of 6 months follow-up. Of the 188 PET/CT-guided biopsies, 6 (3.1%) were repeat biopsies due to a previous nondiagnostic CT-guided biopsy performed in a different diagnostic centre. The interval between the two biopsies was less than a month in all cases. Histology revealed five malignant lesions and one benign lesion among these. The complication rate in the PET/CT-guided biopsy group was 12.7% (24 of 188), while in the CT-guided group, was 9.5% (14 of 146, p = 0.26). Therefore, there was no significant difference in complication rates between PET/CT and CT guidance. PET/CT-guided biopsy is already known to be a feasible and accurate method in the diagnostic work-up of suspected

  19. Fluoroscopic guided fogarty embolectomy for an angio-seal embolism in the popliteal artery

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Dong; Lee, Seung Hwa; Chung, Hwan Hoon; Seo, Bo Kyoung; Cha, Sang Hoon; Lee, Kee Yeol; Ahn, Jeong Cheon [Korea University Ansan Hospital, College of Medicine, Korea University, Ansan (Korea, Republic of)

    2013-08-15

    The Angio-Seal is a widely used arterial closure device that helps achieve faster hemostasis and provide early ambulation to patients. However, it can cause various complications in clinical practice. We present the uncommon complication of popliteal artery occlusion following Angio-Seal deployment, and describe an effective interventional approach to its treatment. Because fluoroscopy-guided Fogarty embolectomy has the advantages of complete removal of the embolus without fragmentation, and clear visualization of the exact location of the embolus during the procedure, it is a suitable method for treating this complication.

  20. A guidance concept for hypersonic aerospacecrafts

    Science.gov (United States)

    Ishimoto, Shinji

    In this paper a guidance concept for hypersonic re-entry flights is presented. The method uses a closed-form guidance technique based on a drag acceleration reference profile. A guidance law for range control is developed. It employs a physical relation between vehicle energy and range instead of a prediction-correction technique used for Shuttle entry guidance. Simulation results show that the algorithm provides good performance.

  1. Quality Assurance in University Guidance Services

    Science.gov (United States)

    Simon, Alexandra

    2014-01-01

    In Europe there is no common quality assurance framework for the delivery of guidance in higher education. Using a case study approach in four university career guidance services in England, France and Spain, this article aims to study how quality is implemented in university career guidance services in terms of strategy, standards and models,…

  2. 78 FR 53792 - Draft Guidance for Reciprocity

    Science.gov (United States)

    2013-08-30

    ...The U.S. Nuclear Regulatory Commission (NRC) is revising its licensing guidance for reciprocity. The NRC is requesting public comment on draft NUREG-1556, Volume 19, Revision 1, ``Consolidated Guidance about Materials Licenses: Guidance for Agreement State Licensees about NRC Form 241 `Report of Proposed Activities in Non- Agreement States, Areas of Exclusive Federal Jurisdiction, of Offshore......

  3. Providing Career Guidance for Young Women.

    Science.gov (United States)

    Colby, Pamela G.

    This module is directed at personnel working or planning to work in the areas of guidance, counseling, placement and follow-through in junior and senior high school settings, grades 7-12. The module topic is career guidance for young women of junior and senior high school age, aand the focus will be on providing nonbiased career guidance which…

  4. Quality Assurance in University Guidance Services

    Science.gov (United States)

    Simon, Alexandra

    2014-01-01

    In Europe there is no common quality assurance framework for the delivery of guidance in higher education. Using a case study approach in four university career guidance services in England, France and Spain, this article aims to study how quality is implemented in university career guidance services in terms of strategy, standards and models,…

  5. International Conference on Harmonisation; guidance on Q8(R1) Pharmaceutical Development; addition of annex; availability. Notice.

    Science.gov (United States)

    2009-06-09

    The Food and Drug Administration (FDA) is announcing the availability of a guidance entitled "Q8(R1) Pharmaceutical Development." The guidance was prepared under the auspices of the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH). The ICH Q8(R1) guidance includes the previously published parent guidance entitled "Q8 Pharmaceutical Development" (Q8 parent guidance) (71 FR 29344; May 22, 2006) and a newly added annex. The annex provides further clarification of key concepts outlined in the Q8 parent guidance and describes the principles of quality by design (QbD). The annex is intended to show how concepts and tools (e.g., design space) outlined in the Q8 parent guidance could be put into practice by the applicant for all dosage forms.

  6. Reentry guidance for Space Shuttle

    Science.gov (United States)

    Causey, W.; Sohoni, V.

    1973-01-01

    An explicit guidance scheme is outlined which provides the appropriate energy management in order for the shuttle orbiter to reach any location within the required footprint. Considering the orbiter as entering the earth's atmosphere, expressions for the downrange, crossrange, and the time of the termination of the entry phase as functions of the control variables are developed. Performing an order-of-magnitude analysis of the terms in these expressions, only dominant terms are retained. Analytical expressions for the elements of the sensitivity matrix which represents the partial derivatives of the desired range with respect to control variables are formulated. Using the Gauss-Jordan inversion technique, the required change in guidance commands as a function of the deviations in the downrange and crossrange are explicitly computed.

  7. Reentry guidance for Space Shuttle

    Science.gov (United States)

    Causey, W.; Sohoni, V.

    1973-01-01

    An explicit guidance scheme is outlined which provides the appropriate energy management in order for the shuttle orbiter to reach any location within the required footprint. Considering the orbiter as entering the earth's atmosphere, expressions for the downrange, crossrange, and the time of the termination of the entry phase as functions of the control variables are developed. Performing an order-of-magnitude analysis of the terms in these expressions, only dominant terms are retained. Analytical expressions for the elements of the sensitivity matrix which represents the partial derivatives of the desired range with respect to control variables are formulated. Using the Gauss-Jordan inversion technique, the required change in guidance commands as a function of the deviations in the downrange and crossrange are explicitly computed.

  8. Review of soil contamination guidance

    Energy Technology Data Exchange (ETDEWEB)

    Mueller, M.A.; Kennedy, W.E. Jr.; Soldat, J.K.

    1981-08-01

    A review of existing and proposed radioactive soil contamination standards and guidance was conducted for United Nuclear Corporation (UNC), Office of Surplus Facilities Management. Information was obtained from both government agencies and other sources during a literature survey. The more applicable standards were reviewed, evaluated, and summarized. Information pertaining to soil contamination for both facility operation and facility decommissioning was obtained from a variety of sources. These sources included: the Code of Federal Regulations, regulatory guides, the Federal Register, topical reports written by various government agencies, topical reports written by national laboratories, and publications from the American National Standards Institute (ANSI). It was difficult to directly compare the standards and guidance obtained from these sources since each was intended for a specific situation and different units or bases were used. However, most of the information reviewed was consistent with the philosophy of maintaining exposures at levels as low as reasonably achievable (ALARA).

  9. Teleautonomous guidance for mobile robots

    Science.gov (United States)

    Borenstein, J.; Koren, Y.

    1990-01-01

    Teleautonomous guidance (TG), a technique for the remote guidance of fast mobile robots, has been developed and implemented. With TG, the mobile robot follows the general direction prescribed by an operator. However, if the robot encounters an obstacle, it autonomously avoids collision with that obstacle while trying to match the prescribed direction as closely as possible. This type of shared control is completely transparent and transfers control between teleoperation and autonomous obstacle avoidance gradually. TG allows the operator to steer vehicles and robots at high speeds and in cluttered environments, even without visual contact. TG is based on the virtual force field (VFF) method, which was developed earlier for autonomous obstacle avoidance. The VFF method is especially suited to the accommodation of inaccurate sensor data (such as that produced by ultrasonic sensors) and sensor fusion, and allows the mobile robot to travel quickly without stopping for obstacles.

  10. Microfluidic control of axonal guidance

    Science.gov (United States)

    Gu, Ling; Black, Bryan; Ordonez, Simon; Mondal, Argha; Jain, Ankur; Mohanty, Samarendra

    2014-10-01

    The precision of axonal pathfinding and the accurate formation of functional neural circuitry are crucial for an organism during development as well as during adult central and peripheral nerve regeneration. While chemical cues are believed to be primarily responsible for axonal pathfinding, we hypothesize that forces due to localized fluid flow may directly affect neuronal guidance during early organ development. Here, we report direct evidence of fluid flow influencing axonal migration, producing turning angles of up to 90°. Microfluidic flow simulations indicate that an axon may experience significant bending force due to cross-flow, which may contribute to the observed axonal turning. This method of flow-based guidance was successfully used to fasciculate one advancing axon onto another, showcasing the potential of this technique to be used for the formation of in vitro neuronal circuits.

  11. 2011 Army Strategic Planning Guidance

    Science.gov (United States)

    2011-03-25

    TESI ) of 22,000 Soldiers, the Army’s total force by the end of the mid-term period is programmed to be 520K (AC). We will achieve a more...dwell ratios, extending TESI authority to adequately man deploying units and sustain the All-Volunteer Force, right-sizing the generating force, and... TESI Temporary End-Strength Increase WMD Weapons of Mass Destruction 2011 ARMY STRATEGIC PLANNING GUIDANCE Page 19 2011

  12. Current materiality guidance for auditors

    OpenAIRE

    McKee, Thomas E.; Eilifsen, Aasmund

    2000-01-01

    Auditors have to make materiality judgments on every audit. This is a difficult process, as both quantitative and qualitative factors have to be evaluated. Additionally, there is no formal guidance for how to implement the materiality concepts discussed in the auditing standards. Although they are sometimes difficult to make, good materiality judgments are crucial for the conduct of a successful audit as poor judgments can result in an audit that is ineffective and/or inefficient. This report...

  13. Haptic Shared Control in Tele-Manipulation: Effects of Inaccuracies in Guidance on Task Execution.

    Science.gov (United States)

    van Oosterhout, Jeroen; Wildenbeest, Jeroen G W; Boessenkool, Henri; Heemskerk, Cock J M; de Baar, Marco R; van der Helm, Frans C T; Abbink, David A

    2015-01-01

    Haptic shared control is a promising approach to improve tele-manipulated task execution, by making safe and effective control actions tangible through guidance forces. In current research, these guidance forces are most often generated based on pre-generated, errorless models of the remote environment. Hence such guidance forces are exempt from the inaccuracies that can be expected in practical implementations. The goal of this research is to quantify the extent to which task execution is degraded by inaccuracies in the model on which haptic guidance forces are based. In a human-in-the-loop experiment, subjects (n = 14) performed a realistic tele-manipulated assembly task in a virtual environment. Operators were provided with various levels of haptic guidance, namely no haptic guidance (conventional tele-manipulation), haptic guidance without inaccuracies, and haptic guidance with translational inaccuracies (one large inaccuracy, in the order of magnitude of the task, and a second smaller inaccuracy). The quality of natural haptic feedback (i.e., haptic transparency) was varied between high and low to identify the operator's ability to detect and cope with inaccuracies in haptic guidance. The results indicate that haptic guidance is beneficial for task execution when no inaccuracies are present in the guidance. When inaccuracies are present, this may degrade task execution, depending on the magnitude and the direction of the inaccuracy. The effect of inaccuracies on overall task performance is dominated by effects found for the Constrained Translational Movement, due to its potential for jamming. No evidence was found that a higher quality of haptic transparency helps operators to detect and cope with inaccuracies in the haptic guidance.

  14. Regulatory Advocacy Update: ASPS Comments in Response to the FDA Draft Guidance Documents on Human Cell and Tissue Products.

    Science.gov (United States)

    Rubin, J Peter; D'Amico, Richard A; Rodriguez, Ricardo; Coleman, Sydney R; Cederna, Paul; Glasberg, Scot; Neumeister, Michael; Song, David H; Butler, Charles; Hume, Keith M

    2017-02-09

    The Food and Drug Administration (FDA) released draft guidance documents on Human Cells, Tissues, and Cellular and Tissue-Based Products (HCT/P) Regulations. These proposed guidance documents can impact the practice of plastic surgery in the area of tissue grafting procedures. This article describes the relevant issues in these draft guidance documents, and presents the comments provided to the FDA by the American Society of Plastic Surgeons (ASPS).

  15. Three-dimensional kinematic estimation of mobile-bearing total knee arthroplasty from x-ray fluoroscopic images

    Science.gov (United States)

    Yamazaki, Takaharu; Futai, Kazuma; Tomita, Tetsuya; Sato, Yoshinobu; Yoshikawa, Hideki; Tamura, Shinichi; Sugamoto, Kazuomi

    2011-03-01

    To achieve 3D kinematic analysis of total knee arthroplasty (TKA), 2D/3D registration techniques, which use X-ray fluoroscopic images and computer-aided design (CAD) model of the knee implant, have attracted attention in recent years. These techniques could provide information regarding the movement of radiopaque femoral and tibial components but could not provide information of radiolucent polyethylene insert, because the insert silhouette on X-ray image did not appear clearly. Therefore, it was difficult to obtain 3D kinemaitcs of polyethylene insert, particularly mobile-bearing insert that move on the tibial component. This study presents a technique and the accuracy for 3D kinematic analysis of mobile-bearing insert in TKA using X-ray fluoroscopy, and finally performs clinical applications. For a 3D pose estimation technique of the mobile-bearing insert in TKA using X-ray fluoroscopy, tantalum beads and CAD model with its beads are utilized, and the 3D pose of the insert model is estimated using a feature-based 2D/3D registration technique. In order to validate the accuracy of the present technique, experiments including computer simulation test were performed. The results showed the pose estimation accuracy was sufficient for analyzing mobile-bearing TKA kinematics (the RMS error: about 1.0 mm, 1.0 degree). In the clinical applications, seven patients with mobile-bearing TKA in deep knee bending motion were studied and analyzed. Consequently, present technique enables us to better understand mobile-bearing TKA kinematics, and this type of evaluation was thought to be helpful for improving implant design and optimizing TKA surgical techniques.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-06-15

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

  17. Changes in length of the plantar aponeurosis during the stance phase of gait--an in vivo dynamic fluoroscopic study.

    Science.gov (United States)

    Fessel, G; Jacob, H A C; Wyss, Ch; Mittlmeier, Th; Müller-Gerbl, M; Büttner, A

    2014-12-01

    In locomotion, ligaments and muscles have been recognized to support the arch of the foot. However, it remains unclear to what extent the passive and active structures of the lower extremity support the longitudinal arch of the foot during walking. In this study, the mechanical function of the plantar aponeurosis (PA) is investigated by elongation measurements in vivo during the stance phase of gait, in combination with measurements of the mechanical properties of the PA in vitro. Fluoroscopy was used to measure the dynamic changes in PA length and the angular motion of the metatarsophalangeal joint of the first ray, measured during the stance phase (StPh) in 11 feet. Simultaneously, ground forces were measured. Additionally, four cadaver feet delivered topographic information relating to the PA, and three autopsy specimens of PA served to determine the in vitro mechanical properties of PA. The present study revealed a non-significant peak average PA shortening of 0.48% at about 32.5% StPh, followed by a significant average peak elongation of 3.6% at 77.5% StPh. This average peak elongation of 3.6% corresponds to a force of 292N, as estimated by mechanical testing of the autopsy PA specimens. Considering the maximum peak elongation measured in one volunteer of 4.8% at 76% StPh, a peak PA load of 488N might be expected. Hence, with an average body weight of 751N, as allocated to the 11 investigated feet, this maximum peak force would correspond to about 0.65×body weight. As far as we are aware, this is the first report on a dynamic fluoroscopic study of the PA in gait with an appreciable number of feet (11 feet). In conclusion, muscles contribute to support of the longitudinal arch of the foot and can possibly relax the PA during gait. The 'windlass effect' for support of the arch in this context is therefore questionable.

  18. Large or small bore, push or pull: a comparison of three classes of percutaneous fluoroscopic gastrostomy catheters.

    Science.gov (United States)

    Kuo, Yuo-Chen; Shlansky-Goldberg, Richard D; Mondschein, Jeffrey I; Stavropoulos, S William; Patel, Aalpen A; Solomon, Jeffrey A; Soulen, Michael C; Kwak, Andrew; Itkin, Maxim; Chittams, Jesse L; Trerotola, Scott O

    2008-04-01

    To compare the tube performance and complication rates of small-bore, large-bore push-type, and large-bore pull-type gastrostomy catheters. A total of 160 patients (74 men, 86 women; mean age, 66.9 years, range, 22-95 y) underwent percutaneous fluoroscopic gastrostomy placement between January 2004 and March 2006. Choice of catheter was based on the preference of the attending radiologist. Data were collected retrospectively with institutional review board approval. Radiology reports provided information on the catheter, indication for gastrostomy, technical success, and immediate outcome. Chart review provided data on medical history, postprocedural complications, progress to feeding goal, and clinical outcomes. Statistical analysis was performed to compare the three classes of gastrostomy catheters. All 160 catheters were placed successfully. Patients who received small-bore catheters (14 F; n = 88) had significantly more tube complications (17% vs 5.6%) and were less likely to meet their feeding goal (P = .035) compared with patients with large-bore catheters (20 F; n = 72). No difference was observed in terms of major or minor complications. Large-bore push-type (n = 14) and pull-type catheters (n = 58) were similar in terms of complication rates. Patients who received large-bore push-type catheters achieved their feeding goals in significantly less time than those with large-bore pull-type catheters (average, 3.8 days vs 6.0 days; P = .04). Patients who received small-bore gastrostomy catheters are significantly more prone to tube dysfunction. Large-bore catheters should be preferentially used, with push-type catheters performing better with regard to the time to achieve feeding goal.

  19. Incorporating Corrections for the Head-Holder and Compensation Filter when Calculating Skin Dose during Fluoroscopically-Guided Interventions

    Science.gov (United States)

    Vijayan, Sarath; Rana, Vijay K.; Rudin, Stephen; Bednarek, Daniel R.

    2015-01-01

    The skin dose tracking system (DTS) that we developed provides a color-coded illustration of the cumulative skin dose distribution on a 3D graphic of the patient during fluoroscopic procedures for immediate feedback to the interventionist. To improve the accuracy of dose calculation, we now have incorporated two additional important corrections (1) for the holder used to immobilize the head in neuro-interventions and (2) for the built-in compensation filters used for beam equalization. Both devices have been modeled in the DTS software so that beam intensity corrections can be made. The head-holder is modeled as two concentric hemi-cylindrical surfaces such that the path length between those surfaces can be determined for rays to individual points on the skin surface. The head-holder on the imaging system we used was measured to attenuate the primary x-rays by 10 to 20% for normal incidence, and up to 40% at non-normal incidence. In addition, three compensation filters of different shape are built into the collimator apparatus and were measured to have attenuation factors ranging from 58% to 99%, depending on kVp and beam filtration. These filters can translate and rotate in the beam and their motion is tracked by the DTS using the digital signal from the imaging system. When it is determined that a ray to a given point on the skin passes through the compensation filter, the appropriate attenuation correction is applied. These corrections have been successfully incorporated in the DTS software to provide a more accurate determination of skin dose. PMID:26819488

  20. Incorporating corrections for the head-holder and compensation filter when calculating skin dose during fluoroscopically guided interventions

    Science.gov (United States)

    Vijayan, Sarath; Rana, Vijay K.; Rudin, Stephen; Bednarek, Daniel R.

    2015-03-01

    The skin dose tracking system (DTS) that we developed provides a color-coded illustration of the cumulative skin dose distribution on a 3D graphic of the patient during fluoroscopic procedures for immediate feedback to the interventionist. To improve the accuracy of dose calculation, we now have incorporated two additional important corrections (1) for the holder used to immobilize the head in neuro-interventions and (2) for the built-in compensation filters used for beam equalization. Both devices have been modeled in the DTS software so that beam intensity corrections can be made. The head-holder is modeled as two concentric hemi-cylindrical surfaces such that the path length between those surfaces can be determined for rays to individual points on the skin surface. The head-holder on the imaging system we used was measured to attenuate the primary x-rays by 10 to 20% for normal incidence, and up to 40% at non-normal incidence. In addition, three compensation filters of different shape are built into the collimator apparatus and were measured to have attenuation factors ranging from 58% to 99%, depending on kVp and beam filtration. These filters can translate and rotate in the beam and their motion is tracked by the DTS using the digital signal from the imaging system. When it is determined that a ray to a given point on the skin passes through the compensation filter, the appropriate attenuation correction is applied. These corrections have been successfully incorporated in the DTS software to provide a more accurate determination of skin dose.

  1. Incorporating Corrections for the Head-Holder and Compensation Filter when Calculating Skin Dose during Fluoroscopically-Guided Interventions.

    Science.gov (United States)

    Vijayan, Sarath; Rana, Vijay K; Rudin, Stephen; Bednarek, Daniel R

    2015-03-18

    The skin dose tracking system (DTS) that we developed provides a color-coded illustration of the cumulative skin dose distribution on a 3D graphic of the patient during fluoroscopic procedures for immediate feedback to the interventionist. To improve the accuracy of dose calculation, we now have incorporated two additional important corrections (1) for the holder used to immobilize the head in neuro-interventions and (2) for the built-in compensation filters used for beam equalization. Both devices have been modeled in the DTS software so that beam intensity corrections can be made. The head-holder is modeled as two concentric hemi-cylindrical surfaces such that the path length between those surfaces can be determined for rays to individual points on the skin surface. The head-holder on the imaging system we used was measured to attenuate the primary x-rays by 10 to 20% for normal incidence, and up to 40% at non-normal incidence. In addition, three compensation filters of different shape are built into the collimator apparatus and were measured to have attenuation factors ranging from 58% to 99%, depending on kVp and beam filtration. These filters can translate and rotate in the beam and their motion is tracked by the DTS using the digital signal from the imaging system. When it is determined that a ray to a given point on the skin passes through the compensation filter, the appropriate attenuation correction is applied. These corrections have been successfully incorporated in the DTS software to provide a more accurate determination of skin dose.

  2. Thinking and Practice on Guidance Work for the Undergraduate Thesis%“学生为主教师为辅”的反向指导模式在本科毕业论文指导工作中的运用

    Institute of Scientific and Technical Information of China (English)

    敬思群

    2013-01-01

    Graduation design(thesis)is the final and most important practical links of undergraduate teaching plan. It is a good measure to train students' abilities of using the knowledge to analyze and resolve the problem ex-tensively,and an important content of professional teaching quality evaluation. A view was pointed out in this pa-per that goal and requirement and reverse guidance models of a student-centered,teacher-subordinate method were the core work of completing graduation thesis.Main factors affecting graduation design (thesis) quality were analyzed.The importance of teaching staff was expounded. This paper could provide some reference for guidance work of the undergraduate thesis.%  毕业设计(论文)是本科教学计划的最后的和最重要的一个实践性环节,是培养学生综合运用知识、独立分析问题和解决问题能力的一项得力措施,也是专业教学质量评价的一项重要内容。该文指出“学生为主,教师为辅”的反向指导模式是做好毕业论文的核心工作,并分析了影响本科毕业论文(设计)质量的主要因素,阐述了教师队伍的重要性,为本科毕业论文指导工作提供参考。

  3. International perspectives on social media guidance for nurses: a content analysis.

    Science.gov (United States)

    Ryan, Gemma

    2016-12-01

    Aim This article reports the results of an analysis of the content of national and international professional guidance on social media for the nursing profession. The aim was to consolidate good practice examples of social media guidelines, and inform the development of comprehensive guidance. Method A scoping search of professional nursing bodies' and organisations' social media guidance documents was undertaken using google search. Results 34 guidance documents were located, and a content analysis of these was conducted. Conclusion The results, combined with a review of competency hearings and literature, indicate that guidance should cover the context of social media, and support nurses to navigate and negotiate the differences between the real and online domains to help them translate awareness into actions.

  4. Strategy guidance and memory aiding in learning a problem-solving skill.

    Science.gov (United States)

    Carlson, R A; Lundy, D H; Schneider, W

    1992-04-01

    Guidance can help learners overcome the difficulties of getting started in a novel domain, but it is often ineffective in promoting learning and transfer. This article examines two aspects of guidance--communicating solution strategies for a problem domain and providing working memory support--in learning a novel problem-solving skill. Subjects in two experiments learned to troubleshoot simulated information networks. The learning environment varied in type of guidance provided--none, variable template, fixed template, and procedural instruction--and in availability of memory aiding. Variable-template guidance was effective when memory aiding was provided, and procedural instructions produced effective learning with or without memory aiding. However, fixed-template guidance was not effective, and there was no consistent effect of memory aiding in unguided, discovery learning conditions. The results have theoretical implications for the locus of guided-learning effects and suggest practical guidelines for the design of guided-learning environments.

  5. Fluoroscopic lumbar interlaminar epidural injections in managing chronic lumbar axial or discogenic pain.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Cash, Kimberly A; McManus, Carla D; Pampati, Vidyasagar; Benyamin, Ramsin

    2012-01-01

    Among the multiple causes of chronic low back pain, axial and discogenic pain are common. Various modalities of treatments are utilized in managing discogenic and axial low back pain including epidural injections. However, there is a paucity of evidence regarding the effectiveness, indications, and medical necessity of any treatment modality utilized for managing axial or discogenic pain, including epidural injections. In an interventional pain management practice in the US, a randomized, double-blind, active control trial was conducted. The objective was to assess the effectiveness of lumbar interlaminar epidural injections of local anesthetic with or without steroids for managing chronic low back pain of discogenic origin. However, disc herniation, radiculitis, facet joint pain, or sacroiliac joint pain were excluded. Two groups of patients were studied, with 60 patients in each group receiving either local anesthetic only or local anesthetic mixed with non-particulate betamethasone. Primary outcome measures included the pain relief-assessed by numeric rating scale of pain and functional status assessed by the, Oswestry Disability Index, Secondary outcome measurements included employment status, and opioid intake. Significant improvement or success was defined as at least a 50% decrease in pain and disability. Significant improvement was seen in 77% of the patients in Group I and 67% of the patients in Group II. In the successful groups (those with at least 3 weeks of relief with the first two procedures), the improvement was 84% in Group I and 71% in Group II. For those with chronic function-limiting low back pain refractory to conservative management, it is concluded that lumbar interlaminar epidural injections of local anesthetic with or without steroids may be an effective modality for managing chronic axial or discogenic pain. This treatment appears to be effective for those who have had facet joints as well as sacroiliac joints eliminated as the pain source.

  6. 以职业活动为导向的应用文写作课程整体建设思路%Integral Construction Ideas of Practical Writing Course with the Professional Activities as the Guidance

    Institute of Scientific and Technical Information of China (English)

    邱静仪

    2012-01-01

    应用文写作课程作为职业教育课程体系中的一个组成部分,其定位不能局限于文化基础课、人文素质课,而是要成为一门职业岗位能力的训练课。重视应用文写作课程建设,不仅可以培养学生的应用写作能力,还可以增强学生职业能力和就业竞争力,为学生职业能力和职业生涯的可持续发展服务。%Practical Writing Course as an integral part of the system of vocational education programs, its location can not be confined to cultural foundation course, human quality courses, but to become a professional post ability training sessions. Great importance to the construction of the "Practical Writing Course, not only students of applied writing ability, but also can enhance students' professional ability and employability and competitiveness, and sustainable development of the stu dents' professional capabilities and career services.

  7. Analysing Interplanetary Probe Guidance Accuracy

    Directory of Open Access Journals (Sweden)

    S. V. Sukhova

    2016-01-01

    Full Text Available The paper presents a guidance accuracy analysis and estimates delta-v budget required to provide the trajectory correction maneuvers for direct interplanetary flights (without midcourse gravity assists. The analysis takes into consideration the orbital hyperbolic injection errors (depend on a selected launch vehicle and ascent trajectory and the uncertainties of midcourse correction maneuvers.The calculation algorithm is based on Monte Carlo simulation and Danby’s matrix methods (the matrizant of keplerian motion. Danby’s method establishes a link between the errors of the spacecraft state vectors at different flight times using the reference keplerian orbit matrizant. Utilizing the nominal trajectory parameters and the covariance matrix of launch vehicle injection errors the random perturbed orbits are generated and required velocity corrections are calculated. The next step is to simulate midcourse maneuver performance uncertainty using the midcourse maneuver covariance matrix. The obtained trajectory correction impulses and spacecraft position errors are statistically processed to compute required delta-v budget and dispersions ellipse parameters for different prediction intervals.As an example, a guidance accuracy analysis has been conducted for a 2022 mission to Mars and a Venus mission in 2026. The paper considers one and two midcourse correction options, as well as utilization of two different launch vehicles.The presented algorithm based on Monte Carlo simulation and Danby’s methods provides preliminary evaluation for midcourse corrections delta-v budget and spacecraft position error. The only data required for this guidance accuracy analysis are a reference keplerian trajectory and a covariance matrix of the injection errors. Danby’s matrix method allows us to take into account also the other factors affecting the trajectory thereby increasing the accuracy of analysis.

  8. Implementation of a competency check-off in diagnostic fluoroscopy for radiology trainees: impact on reducing radiation for three common fluoroscopic exams in children

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Sweta [University of Missouri-Kansas City SOM, Department of Radiology, Kansas City, MO (United States); Desouches, Stephane L. [University of Missouri-Kansas City SOM, Department of Radiology, Kansas City, MO (United States); St. Luke' s Hospital, Department of Radiology, Kansas City, MO (United States); Lowe, Lisa H.; Kasraie, Nima; Reading, Brenton [University of Missouri-Kansas City SOM, Department of Radiology, Kansas City, MO (United States); Children' s Mercy Hospitals and Clinics, Department of Radiology, Kansas City, MO (United States)

    2014-07-24

    Fluoroscopy is an important tool for diagnosis in the pediatric population, but it carries the risk of radiation exposure. Because radiology resident education and experience in the use of fluoroscopy equipment in children vary, we implemented an intervention to standardize fluoroscopy training. The purpose of this study is to determine the impact of implementing a fluoroscopy competency check-off for radiology resident trainees aimed at decreasing radiation exposure in three common pediatric fluoroscopic studies. A fluoroscopy competency check-off form was developed for radiology resident trainees performing pediatric procedures. Techniques used to limit radiation exposure for common pediatric radiologic studies were reviewed as part of the check-off process. Pediatric radiologists supervised each trainee until they demonstrated competence to independently perform three specified procedures. Radiation dose was recorded for the three procedures, upper GI (UGI), voiding cystourethrogram (VCUG) and oropharyngeal (OPM) exams, over 6 months preceding and 6 months following implementation of the competency check-off. The mean cumulative dose for each procedure was compared before and after implementation of competency check-off using a Kruskal-Wallis test. During the 12-month study period doses from 909 fluoroscopic procedures were recorded. In the 6 months preceding competency check-off implementation, procedures were performed by 24 radiology resident trainees including 171 UGI, 176 VCUG and 171 OPM exams. In the 6 months following competency check-off, 23 trainees performed 114 UGI, 145 VCUG and 132 OPM exams. After competency check-off implementation, a statistically significant reduction in average radiation dose was found for all three studies (P < 0.001). Median cumulative doses (mGy) were decreased by 33%, 36% and 13% for UGIs, VCUGs and OPMs, respectively. Implementation of a competency check-off for radiology resident trainees can reduce average radiation

  9. SU-E-I-42: Normalized Embryo/fetus Doses for Fluoroscopically Guided Pacemaker Implantation Procedures Calculated Using a Monte Carlo Technique

    Energy Technology Data Exchange (ETDEWEB)

    Damilakis, J; Stratakis, J; Solomou, G [University of Crete, Heraklion (Greece)

    2014-06-01

    Purpose: It is well known that pacemaker implantation is sometimes needed in pregnant patients with symptomatic bradycardia. To our knowledge, there is no reported experience regarding radiation doses to the unborn child resulting from fluoroscopy during pacemaker implantation. The purpose of the current study was to develop a method for estimating embryo/fetus dose from fluoroscopically guided pacemaker implantation procedures performed on pregnant patients during all trimesters of gestation. Methods: The Monte Carlo N-Particle (MCNP) radiation transport code was employed in this study. Three mathematical anthropomorphic phantoms representing the average pregnant patient at the first, second and third trimesters of gestation were generated using Bodybuilder software (White Rock science, White Rock, NM). The normalized embryo/fetus dose from the posteroanterior (PA), the 30° left-anterior oblique (LAO) and the 30° right-anterior oblique (RAO) projections were calculated for a wide range of kVp (50–120 kVp) and total filtration values (2.5–9.0 mm Al). Results: The results consist of radiation doses normalized to a) entrance skin dose (ESD) and b) dose area product (DAP) so that the dose to the unborn child from any fluoroscopic technique and x-ray device used can be calculated. ESD normalized doses ranged from 0.008 (PA, first trimester) to 2.519 μGy/mGy (RAO, third trimester). DAP normalized doses ranged from 0.051 (PA, first trimester) to 12.852 μGy/Gycm2 (RAO, third trimester). Conclusion: Embryo/fetus doses from fluoroscopically guided pacemaker implantation procedures performed on pregnant patients during all stages of gestation can be estimated using the method developed in this study. This study was supported by the Greek Ministry of Education and Religious Affairs, General Secretariat for Research and Technology, Operational Program ‘Education and Lifelong Learning’, ARISTIA (Research project: CONCERT)

  10. A small-signal approach to temporal modulation transfer functions with exposure-rate dependence and its application to fluoroscopic detective quantum efficiency.

    Science.gov (United States)

    Friedman, S N; Cunningham, I A

    2009-08-01

    The detective quantum efficiency (DQE) is a metric widely used in radiography to quantify system performance and as a surrogate measure of patient "dose efficiency." It has been applied previously to fluoroscopic systems with the introduction of a temporal correction factor. Calculation of this correction factor relies on measurements of the temporal modulation transfer function (MTF). However, the temporal MTF is often exposure-rate dependent, violating a necessary Fourier linearity requirement. The authors show that a Fourier analysis is appropriate for fluoroscopic systems if a "small-signal" approach is used. Using a semitransparent edge, a lag-corrected DQE is described and measured for an x-ray image intensifier-based fluoroscopic system under continuous (non-pulsed) exposure conditions. It was found that results were equivalent for both rising and falling-edge profiles independent of edge attenuation when effective attenuation was in the range of 0.1-0.6. This suggests that this range is appropriate for measuring the small-signal temporal MTF. In general, lag was greatest at low exposure rates. It was also found that results obtained using a falling-edge profile with a radiopaque edge were equivalent to the small-signal results for the test system. If this result is found to be true generally, it removes the need for the small-signal approach. Lag-corrected DQE values were validated by comparison with radiographic DQE values obtained using very long exposures under the same conditions. Lag was observed to inflate DQE measurements by up to 50% when ignored.

  11. Fluoroscopic lumbar interlaminar epidural injections in managing chronic lumbar axial or discogenic pain

    Directory of Open Access Journals (Sweden)

    Manchikanti L

    2012-08-01

    Full Text Available Laxmaiah Manchikanti,1,2 Kimberly A Cash,1 Carla D McManus,1 Vidyasagar Pampati,1 Ramsin Benyamin3,41Pain Management Center of Paducah, Paducah, KY; 2University of Louisville, Louisville, KY; 3Millennium Pain Center, Bloomington, IL; 4University of Illinois, Urbana-Champaign, IL, USAAbstract: Among the multiple causes of chronic low back pain, axial and discogenic pain are common. Various modalities of treatments are utilized in managing discogenic and axial low back pain including epidural injections. However, there is a paucity of evidence regarding the effectiveness, indications, and medical necessity of any treatment modality utilized for managing axial or discogenic pain, including epidural injections. In an interventional pain management practice in the US, a randomized, double-blind, active control trial was conducted. The objective was to assess the effectiveness of lumbar interlaminar epidural injections of local anesthetic with or without steroids for managing chronic low back pain of discogenic origin. However, disc herniation, radiculitis, facet joint pain, or sacroiliac joint pain were excluded. Two groups of patients were studied, with 60 patients in each group receiving either local anesthetic only or local anesthetic mixed with non-particulate betamethasone. Primary outcome measures included the pain relief-assessed by numeric rating scale of pain and functional status assessed by the, Oswestry Disability Index, Secondary outcome measurements included employment status, and opioid intake. Significant improvement or success was defined as at least a 50% decrease in pain and disability. Significant improvement was seen in 77% of the patients in Group I and 67% of the patients in Group II. In the successful groups (those with at least 3 weeks of relief with the first two procedures, the improvement was 84% in Group I and 71% in Group II. For those with chronic function-limiting low back pain refractory to conservative management

  12. Precision optical navigation guidance system

    Science.gov (United States)

    Starodubov, D.; McCormick, K.; Nolan, P.; Johnson, D.; Dellosa, M.; Volfson, L.; Fallahpour, A.; Willner, A.

    2016-05-01

    We present the new precision optical navigation guidance system approach that provides continuous, high quality range and bearing data to fixed wing aircraft during landing approach to an aircraft carrier. The system uses infrared optical communications to measure range between ship and aircraft with accuracy and precision better than 1 meter at ranges more than 7.5 km. The innovative receiver design measures bearing from aircraft to ship with accuracy and precision better than 0.5 mRad. The system provides real-time range and bearing updates to multiple aircraft at rates up to several kHz, and duplex data transmission between ship and aircraft.

  13. Quality guidance and quality formation

    DEFF Research Database (Denmark)

    Poulsen, Carsten Stig; Juhl, Hans Jørn; Kristensen, Kai

    1996-01-01

    This paper presents an extension of the quality guidance model of Steenkamp and van Trijp that includes consumer quality formation processes. Quality expectations and quality experiences are seen as antecedents of perceived overall product quality conceptual model is applied using LISREL to a data...... set on Danish butter cookies. Five plausible models of the relation between expectation, experience and perceived product quality are estimated. Finally one model is selected on the basis of three criteria: chi-square, RMSEA and AIC: The results show a model where expectations are indirectly related...... to perceived quality through experience. Udgivelsesdato: APR...

  14. Quality guidance and quality formation

    DEFF Research Database (Denmark)

    Poulsen, Carsten Stig; Juhl, Hans Jørn; Kristensen, Kai

    1996-01-01

    This paper presents an extension of the quality guidance model of Steenkamp and van Trijp that includes consumer quality formation processes. Quality expectations and quality experiences are seen as antecedents of perceived overall product quality conceptual model is applied using LISREL to a data...... set on Danish butter cookies. Five plausible models of the relation between expectation, experience and perceived product quality are estimated. Finally one model is selected on the basis of three criteria: chi-square, RMSEA and AIC: The results show a model where expectations are indirectly related...... to perceived quality through experience. Udgivelsesdato: APR...

  15. Orthobiologic Interventions Using Ultrasound Guidance.

    Science.gov (United States)

    Malanga, Gerard; Abdelshahed, Dena; Jayaram, Prathap

    2016-08-01

    The application of regenerative therapies for the treatment of musculoskeletal conditions has emerged over the last decade with recent acceleration. These include prolotherapy, platelet-rich plasma, and mesenchymal stem cell therapy. These strategies augment the body's innate physiology to heal pathologic processes. This article presents an overview of platelet-rich plasma and mesenchymal stem cell therapy for the treatment of musculoskeletal injuries. A brief literature review is included, as are techniques for the use of ultrasound guidance to assist with these procedures. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Sliding mode control based guidance law with impact angle constraint

    Institute of Scientific and Technical Information of China (English)

    Zhao Yao; Sheng Yongzhi; Liu Xiangdong

    2014-01-01

    The terminal guidance problem for an unpowered lifting reentry vehicle against a sta-tionary target is considered. In addition to attacking the target with high accuracy, the vehicle is also expected to achieve a desired impact angle. In this paper, a sliding mode control (SMC)-based guidance law is developed to satisfy the terminal angle constraint. Firstly, a specific sliding mode function is designed, and the terminal requirements can be achieved by enforcing both the sliding mode function and its derivative to zero at the end of the flight. Then, a backstepping approach is used to ensure the finite-time reaching phase of the sliding mode and the analytic expression of the control effort can be obtained. The trajectories generated by this method only depend on the initial and terminal conditions of the terminal phase and the instantaneous states of the vehicle. In order to test the performance of the proposed guidance law in practical application, numerical simulations are carried out by taking all the aerodynamic parameters into consideration. The effec-tiveness of the proposed guidance law is verified by the simulation results in various scenarios.

  17. Hands-Free System for Bronchoscopy Planning and Guidance.

    Science.gov (United States)

    Khare, Rahul; Bascom, Rebecca; Higgins, William E

    2015-12-01

    Bronchoscopy is a commonly used minimally invasive procedure for lung-cancer staging. In standard practice, however, physicians differ greatly in their levels of performance. To address this concern, image-guided intervention (IGI) systems have been devised to improve procedure success. Current IGI bronchoscopy systems based on virtual bronchoscopic navigation (VBN), however, require involvement from the attending technician. This lessens physician control and hinders the overall acceptance of such systems. We propose a hands-free VBN system for planning and guiding bronchoscopy. The system introduces two major contributions. First, it incorporates a new procedure-planning method that automatically computes airway navigation plans conforming to the physician's bronchoscopy training and manual dexterity. Second, it incorporates a guidance strategy for bronchoscope navigation that enables user-friendly system control via a foot switch, coupled with a novel position-verification mechanism. Phantom studies verified that the system enables smooth operation under physician control, while also enabling faster navigation than an existing technician-assisted VBN system. In a clinical human study, we noted a 97% bronchoscopy navigation success rate, in line with existing VBN systems, and a mean guidance time per diagnostic site = 52 s. This represents a guidance time often nearly 3 min faster per diagnostic site than guidance times reported for other technician-assisted VBN systems. Finally, an ergonomic study further asserts the system's acceptability to the physician and long-term potential.

  18. [International trend of guidance for nanomaterial risk assessment].

    Science.gov (United States)

    Hirose, Akihiko

    2013-01-01

    In the past few years, several kinds of opinions or recommendations on the nanomaterial safety assessment have been published from international or national bodies. Among the reports, the first practical guidance of risk assessment from the regulatory body was published from the European Food Safety Authorities in May 2011, which included the determination of exposure scenario and toxicity testing strategy. In October 2011, European Commission (EC) adopted the definition of "nanomaterial" for regulation. And more recently, Scientific Committee on Consumer Safety of EC released guidance for assessment of nanomaterials in cosmetics in June 2012. A series of activities in EU marks an important step towards realistic safety assessment of nanomaterials. On the other hand, the US FDA announced a draft guidance for industry in June 2011, and then published draft guidance documents for both "Cosmetic Products" and "Food Ingredients and Food Contact Substances" in April 2012. These draft documents do not restrictedly define the physical properties of nanomaterials, but when manufacturing changes alter the dimensions, properties, or effects of an FDA-regulated product, the products are treated as new products. Such international movements indicate that most of nanomaterials with any new properties would be assessed or regulated as new products by most of national authorities in near future, although the approaches are still case by case basis. We will introduce such current international activities and consideration points for regulatory risk assessment.

  19. Pediatric behavior guidance in the 21st century workshop C report - advocacy and policy.

    Science.gov (United States)

    Quinonez, Rocio B; Nelson, Travis

    2014-01-01

    This report outlines a series of recommendations derived from an advocacy and policy workshop at the 2013 American Academy of Pediatric Dentistry (AAPD) Behavior Guidance Symposium. The committee charge was to address two questions: (1) what should be done to change public and media perception of behavior guidance, if anything, and: (2) what should be done to insure that needed behavior guidance techniques will be available for practicing pediatric dentists in the future. Members of the workshop voiced a wide variety of opinions and impressions of how public perception and media promotion of behavior guidance affect the practice of pediatric dentistry. A diverse assortment of strategies to promote the availability of these techniques in the future was suggested. This report will serve to inform policy and advocacy efforts by AAPD to improve children's oral health and promote excellence in patient care.

  20. Guide to good practices for shift routines and operating practices

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-12-01

    This Guide to Good Practices is written to enhance understanding of, and provide direction for, ``Shift Routines and Operating Practices,`` Chapter 2 of Department of Energy (DOE) Order 5480.19, Conduct of Operations Requirements for DOE Facilities. The practices in this guide should be considered when planning or reviewing shift routines and operating practices. ``Shift Routines and Operating Practices`` is an element of an effective Conduct of Operations program. The complexity and array of activities performed in DOE facilities dictate the necessity for a high standard of professional conduct and sound operating practices to promote safe and efficient operations. Recently, guidance pertaining to this element has been strengthened for nuclear power reactors. This additional guidance is given in Appendix C for information purposes. Though this guidance and good practices pertain to nuclear power reactors, DOE sites may choose to use a graded approach for implementing these in nuclear facilities.

  1. Effects of physical guidance on short-term learning of walking on a narrow beam

    OpenAIRE

    Domingo, Antoinette; Ferris, Daniel P.

    2009-01-01

    Physical guidance is often used in rehabilitation when teaching patients to re-learn movements. However, the effects of guidance on motor learning of complex skills, such as walking balance, are not clear. We tested four groups of healthy subjects that practiced walking on a narrow (1.27 cm) or wide (2.5 cm) treadmill-mounted balance beam, with or without physical guidance. Assistance was given by springs attached to a hip belt that applied restoring forces towards beam center. Subjects were ...

  2. Flight Guidance System Requirements Specification

    Science.gov (United States)

    Miller, Steven P.; Tribble, Alan C.; Carlson, Timothy M.; Danielson, Eric J.

    2003-01-01

    This report describes a requirements specification written in the RSML-e language for the mode logic of a Flight Guidance System of a typical regional jet aircraft. This model was created as one of the first steps in a five-year project sponsored by the NASA Langley Research Center, Rockwell Collins Inc., and the Critical Systems Research Group of the University of Minnesota to develop new methods and tools to improve the safety of avionics designs. This model will be used to demonstrate the application of a variety of methods and techniques, including safety analysis of system and subsystem requirements, verification of key properties using theorem provers and model checkers, identification of potential sources mode confusion in system designs, partitioning of applications based on the criticality of system hazards, and autogeneration of avionics quality code. While this model is representative of the mode logic of a typical regional jet aircraft, it does not describe an actual or planned product. Several aspects of a full Flight Guidance System, such as recovery from failed sensors, have been omitted, and no claims are made regarding the accuracy or completeness of this specification.

  3. Gynecologic radiation therapy. Novel approaches to image-guidance and management

    Energy Technology Data Exchange (ETDEWEB)

    Viswanathan, Akila N. [Harvard Medical School, Boston, MA (United States). Dept. of Radiation Oncology; Kirisits, Christian; Poetter, Richard (eds.) [Vienna General Hospital Medical Univ. (Austria). Dept. of Radiotherapy; Erickson, Beth E. [Medical College of Wisconsin Clinics Froedtert Hospital, Milwaukee, WI (United States). Dept. of Radiation Oncology

    2011-07-01

    Recent advances in the treatment of gynecologic malignancies led to a new worldwide consensus to introduce image guidance to gynecologic radiation therapy, particularly to brachytherapy. The book summarizes the changed practice of management: treatment planning for cervical cancer, not modified for over 60 years, has been shifted to an image-based approach, endometrial cancer management with an increase in the use of chemotherapy and vaginal brachytherapy, and vaginal cancer therapy including image guidance and high-dose delivery with IMRT. (orig.)

  4. Optimal terminal guidance for exoatmospheric interception

    Directory of Open Access Journals (Sweden)

    Yu Wenbin

    2016-08-01

    Full Text Available In this study, two optimal terminal guidance (OTG laws, one of which takes into account the final velocity vector constraint, are developed for exoatmospheric interception using optimal control theory. In exoatmospheric interception, because the proposed guidance laws give full consideration to the effect of gravity, they consume much less fuel than the traditional guidance laws while requiring a light computational load. In the development of the guidance laws, a unified optimal guidance problem is put forward, where the final velocity vector constraint can be considered or neglected by properly adjusting a parameter in the cost function. To make this problem analytically solvable, a linear model is used to approximate the gravity difference, the difference of the gravitational accelerations of the target and interceptor. Additionally, an example is provided to show that some achievements of this study can be used to significantly improve the fuel efficiency of the pulsed guidance employed by the interceptor whose divert thrust level is fixed.

  5. Optimal terminal guidance for exoatmospheric interception

    Institute of Scientific and Technical Information of China (English)

    Yu Wenbin; Chen Wanchun; Yang Liang; Liu Xiaoming; Zhou Hao

    2016-01-01

    In this study, two optimal terminal guidance (OTG) laws, one of which takes into account the final velocity vector constraint, are developed for exoatmospheric interception using optimal control theory. In exoatmospheric interception, because the proposed guidance laws give full consideration to the effect of gravity, they consume much less fuel than the traditional guidance laws while requiring a light computational load. In the development of the guidance laws, a unified optimal guidance problem is put forward, where the final velocity vector constraint can be consid-ered or neglected by properly adjusting a parameter in the cost function. To make this problem ana-lytically solvable, a linear model is used to approximate the gravity difference, the difference of the gravitational accelerations of the target and interceptor. Additionally, an example is provided to show that some achievements of this study can be used to significantly improve the fuel efficiency of the pulsed guidance employed by the interceptor whose divert thrust level is fixed.

  6. 在现代数学教学观指导下的微格教学实践探索%Exploration of Micro-teaching Practice under the Guidance of Modern Mathematics Teaching Conception

    Institute of Scientific and Technical Information of China (English)

    李莉

    2001-01-01

    Micro-teaching was a good way in normal colleges and universities. This article expounded the practice and exploration of micro-teaching through introducing some ways of teaching skills trained in micro-teaching. It put forward that it must materialize the mathematics thought way and modern teaching idea during the teaching, and enhanced the relation between skill training and taught contents and the course of the skills training, and strengthened the students' studying action.%微格教学是对高师院校学生进行教学技能训练的一种教学方式.教学中要体现数学思想方法和现代数学教学观念,进行教学语言的转化、教学内容的变化;加强技能训练与教学内容的联系,强化学生的学习活动,体现知识发现过程、思维活动过程和技能训练综合过程.

  7. International governmental agencies and career guidance

    OpenAIRE

    Conger, Stuart

    1999-01-01

    The international Organization for Economic Cooperation and Development (OECD), like many national and international organizations concerned with economic development believes that career guidance has an important role in promoting the development of a country's human resources. (Mapping the future: Young People and career guidance OECD, 1996). Generally the economic development agencies always recommend that career guidance services should be strengthened. Too frequently, however, they do no...

  8. 76 FR 33409 - Guidance on Deposit-Related Consumer Credit Products

    Science.gov (United States)

    2011-06-08

    ... sound banking practices in connection with deposit-related consumer credit products. Such products... sound banking practices in connection with deposit-related consumer credit products such as automated... Office of the Comptroller of the Currency Guidance on Deposit-Related Consumer Credit Products...

  9. 78 FR 70552 - Guidance on Supervisory Concerns and Expectations Regarding Deposit Advance Products

    Science.gov (United States)

    2013-11-26

    ... obligations, the FDIC believes the product's design results in consumer behavior that is frequently... and sound banking practices and consumer protection in connection with deposit advance products. FOR... Guidance to clarify the FDIC's application of principles of safe and sound banking practices and consumer...

  10. In vivo kinematic study of the tarsal joints complex based on fluoroscopic 3D-2D registration technique.

    Science.gov (United States)

    Chen Wang, M D; Geng, Xiang; Wang, Shaobai; Xin Ma, M D; Xu Wang, M D; Jiazhang Huang, M D; Chao Zhang, M D; Li Chen, M S; Yang, Junsheng; Wang, Kan

    2016-09-01

    The tarsal bones articulate with each other and demonstrate complicated kinematic characteristics. The in vivo motions of these tarsal joints during normal gait are still unclear. Seven healthy subjects were recruited and fourteen feet in total were tested in the current study. Three dimensional models of the tarsal bones were first created using CT scanning. Corresponding local 3D coordinate systems of each tarsal bone was subsequently established for 6DOF motion decompositions. The fluoroscopy system captured the lateral fluoroscopic images of the targeted tarsal region whilst the subject was walking. Seven key pose images during the stance phase were selected and 3D to 2D bone model registrations were performed on each image to determine joint positions. The 6DOF motions of each tarsal joint during gait were then obtained by connecting these positions together. The TNJ (talo-navicular joint) exhibited the largest ROMs (range of motion) on all rotational directions with 7.39±2.75°of dorsi/plantarflexion, 21.12±4.68°of inversion/eversion, and 16.11±4.44°of internal/external rotation. From heel strike to midstance, the TNJ, STJ (subtalar joint), and CCJ (calcaneao-cuboid joint) were associated with 5.97°, 5.04°, and 3.93°of dorsiflexion; 15.46°, 8.21°, and 5.82°of eversion; and 9.75°, 7.6°, and 4.99°of external rotation, respectively. Likewise, from midstance to heel off, the TNJ, STJ, and CCJ were associated with 6.39, 6.19°, and 4.47°of plantarflexion; 18.57°, 11.86°, and 6.32°of inversion and 13.95°, 9.66°, and 7.58°of internal rotation, respectively. In conclusion, among the tarsal joints, the TNJ exhibited the greatest rotational mobility. Synchronous and homodromous rotational motions were detected for TNJ, STJ, and CCJ during the stance phase.

  11. Hybrid Guidance System for Relative Navigation Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Future NASA architectures and missions will involve many distributed platforms that must work together. This in turn requires guidance, navigation and control...

  12. Stochastically optimized monocular vision-based navigation and guidance

    Science.gov (United States)

    Watanabe, Yoko

    The objective of this thesis is to design a relative navigation and guidance law for unmanned aerial vehicles, or UAVs, for vision-based control applications. The autonomous operation of UAVs has progressively developed in recent years. In particular, vision-based navigation, guidance and control has been one of the most focused on research topics for the automation of UAVs. This is because in nature, birds and insects use vision as the exclusive sensor for object detection and navigation. Furthermore, it is efficient to use a vision sensor since it is compact, light-weight and low cost. Therefore, this thesis studies the monocular vision-based navigation and guidance of UAVs. Since 2-D vision-based measurements are nonlinear with respect to the 3-D relative states, an extended Kalman filter (EKF) is applied in the navigation system design. The EKF-based navigation system is integrated with a real-time image processing algorithm and is tested in simulations and flight tests. The first closed-loop vision-based formation flight between two UAVs has been achieved, and the results are shown in this thesis to verify the estimation performance of the EKF. In addition, vision-based 3-D terrain recovery was performed in simulations to present a navigation design which has the capability of estimating states of multiple objects. In this problem, the statistical z-test is applied to solve the correspondence problem of relating measurements and estimation states. As a practical example of vision-based control applications for UAVs, a vision-based obstacle avoidance problem is specially addressed in this thesis. A navigation and guidance system is designed for a UAV to achieve a mission of waypoint tracking while avoiding unforeseen stationary obstacles by using vision information. An EKF is applied to estimate each obstacles' position from the vision-based information. A collision criteria is established by using a collision-cone approach and a time-to-go criterion. A minimum

  13. Risk management: concepts and guidance

    National Research Council Canada - National Science Library

    Pritchard, Carl L

    2015-01-01

    .... Supplying comprehensive coverage of risk management tools, practices, and protocols, the book presents powerful techniques that can enhance organizational risk identification, assessment, and management{u2014...

  14. Magnetic Resonance Enterography Findings in Crohn′s disease in the Pediatric Population and Correlation with Fluoroscopic and Multidetector Computed Tomographic Techniques

    Directory of Open Access Journals (Sweden)

    Parul Patel

    2011-01-01

    Full Text Available Traditionally, fluoroscopic examinations such as enteroclysis, upper GI studies, and small bowel follow through exams have been the procedures of choice in evaluating inflammatory bowel disease (IBD in pediatric populations. With the advent of multidetector computed tomography (MDCT, it has subsequently become a complementary examination in imaging inflammatory bowel disease. A major advantage of MDCT over fluoroscopic examination is its ability to directly visualize bowel mucosa, as well as demonstrate extra-enteric complications of IBD such as abscesses, fistulae, and sinus tracts. The major disadvantage of CT however is exposure to ionizing radiation, especially in IBD patients of the pediatric age group who maybe repeatedly imaged due to exacerbations. As a result, magnetic resonance enterography (MRE is becoming increasingly important in the evaluation and follow-up of pediatric patients with IBD. This pictorial essay will summarize the multi-modality imaging findings of IBD with emphasis on MRE including the imaging protocol and procedure. For the purposes of this article, patients less than 17 years of age have been considered to represent the pediatric population.

  15. Fluoroscopically guided caudal epidural steroid injection for management of degenerative lumbar spinal stenosis: short-term and long-term results

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Joon Woo; Myung, Jae Sung; Kang, Heung Sik [Seoul National University Bundang Hospital, Department of Radiology, Seong Nam, Gyeongi-do (Korea); Park, Kun Woo; Yeom, Jin S. [Seoul National University Bundang Hospital, Department of Orthopaedic Surgery, Seong Nam, Gyeongi-do (Korea); Kim, Ki-Jeong; Kim, Hyun-Jib [Seoul National University Bundang Hospital, Department of Neurosurgery, Seong Nam, Gyeongi-do (Korea)

    2010-07-15

    To evaluate the short-term and long-term effects of fluoroscopically guided caudal epidural steroid injection (ESI) for the management of degenerative lumbar spinal stenosis (DLSS) and to analyze outcome predictors. All patients who underwent caudal ESI in 2006 for DLSS were included in the study. Response was based on chart documentation (aggravated, no change, slightly improved, much improved, no pain). In June 2009 telephone interviews were conducted, using formatted questions including the North American Spine Society (NASS) patient satisfaction scale. For short-term and long-term effects, age difference was evaluated by the Mann-Whitney U test, and gender, duration of symptoms, level of DLSS, spondylolisthesis, and previous operations were evaluated by Fisher's exact test. Two hundred and sixteen patients (male: female = 75:141; mean age 69.2 years; range 48{proportional_to}91 years) were included in the study. Improvements (slightly improved, much improved, no pain) were seen in 185 patients (85.6%) after an initial caudal ESI and in 189 patients (87.5%) after a series of caudal ESIs. Half of the patients (89/179, 49.8%) replied positively to the NASS patient satisfaction scale (1 or 2). There were no significant outcome predictors for either the short-term or the long-term responses. Fluoroscopically guided caudal ESI was effective for the management of DLSS (especially central canal stenosis) with excellent short-term and good long-term results, without significant outcome predictors. (orig.)

  16. Computerizing clinical practice guidelines

    DEFF Research Database (Denmark)

    Lyng, Karen Marie

    . The analysis focuses on the emergence of general clinical work practice demands on guidance • An analysis of guidance demands from clinical work practice and business strategy, focusing on implications for the design of computerised CPGs. In my research, I have applied observation studies, interviews...... is comprised by fieldwork in three oncology departments and a case study of advanced life support. Although close to all patients within oncology are treated according to a CPG, I found limited application of physical CPGs and web-based CPG portals. However, I found comprehensive application of activity...... feasible • Designed in a way that provides room for local adaptations of guidance • Designed with focus on specific business strategic aims Further, based on my findings, I will suggest that design of computerized CPGs should be based on: 1) scrutinization of the clinical work practice, 2) articulation...

  17. 78 FR 37231 - Guidance for Industry; Guidance on Abbreviated New Drug Applications: Stability Testing of Drug...

    Science.gov (United States)

    2013-06-20

    ... HUMAN SERVICES Food and Drug Administration Guidance for Industry; Guidance on Abbreviated New Drug... the availability of a guidance for industry entitled ``ANDAs: Stability Testing of Drug Substances and... generic drug review, FDA is recommending that the generic drug industry follow the approach in...

  18. Guidance for evidence-informed policies about health systems: rationale for and challenges of guidance development.

    Directory of Open Access Journals (Sweden)

    Xavier Bosch-Capblanch

    Full Text Available In the first paper in a three-part series on health systems guidance, Xavier Bosch-Capblanch and colleagues examine how guidance is currently formulated in low- and middle-income countries, and the challenges to developing such guidance.

  19. THE READINESS OF FUTURE TEACHER OF INFORMATICS TO CAREER GUIDANCE ON IT-SPECIALTY AS A PEDAGOGICAL PROBLEM

    Directory of Open Access Journals (Sweden)

    Nataliia О. Ponomarova

    2017-06-01

    Full Text Available In today's realities, the problem of preparing future teachers to career guidance with pupils is of particular importance. The article is devoted to clarifying the essence of the readiness of future teachers of informatics to work career guidance of pupils on IT-specialty. The article disclosed the content of the main components of the same readiness: motivational, cognitive, practical-activity and reflective components. In the content of each of the components is selected the invariant part (base, independent of the subject of specialization of teachers and areas of career guidance and variable part (which takes into account the specific of subject area "Informatics" and the features of IT- industry as a sphere of career guidance.The detected specificity of these components should become a basis for the further justification and development of the practically demanded model of preparation of the future teacher of informatics to career guidance of pupils on IT-specialty.

  20. Spirituality in nursing practice.

    Science.gov (United States)

    Rogers, Melanie; Wattis, John

    2015-05-27

    Spirituality is an important aspect of holistic care that is frequently overlooked. This is because of difficulties in conceptualising spirituality and confusion about how it should be integrated into nursing care. This article explores what is meant by spirituality and spiritually competent practice. It examines attitudes to spirituality, describes factors that might affect the integration of spirituality into nursing care and offers practical guidance to equip nurses to incorporate spirituality into their practice.

  1. Guidance for performing preliminary assessments under CERCLA

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1991-09-01

    EPA headquarters and a national site assessment workgroup produced this guidance for Regional, State, and contractor staff who manage or perform preliminary assessments (PAs). EPA has focused this guidance on the types of sites and site conditions most commonly encountered. The PA approach described in this guidance is generally applicable to a wide variety of sites. However, because of the variability among sites, the amount of information available, and the level of investigative effort required, it is not possible to provide guidance that is equally applicable to all sites. PA investigators should recognize this and be aware that variation from this guidance may be necessary for some sites, particularly for PAs performed at Federal facilities, PAs conducted under EPA`s Environmental Priorities Initiative (EPI), and PAs at sites that have previously been extensively investigated by EPA or others. The purpose of this guidance is to provide instructions for conducting a PA and reporting results. This guidance discusses the information required to evaluate a site and how to obtain it, how to score a site, and reporting requirements. This document also provides guidelines and instruction on PA evaluation, scoring, and the use of standard PA scoresheets. The overall goal of this guidance is to assist PA investigators in conducting high-quality assessments that result in correct site screening or further action recommendations on a nationally consistent basis.

  2. Driving change : sustainable development action plans Guidance

    OpenAIRE

    Sustainable Development Commission

    2008-01-01

    This guidance builds upon the Sustainable Development Commission’s previous guidance, Getting Started (August 2005), which set out the basic elements that the Sustainable Development Commission would expect to see in a good Sustainable Development Action Plan. Publisher PDF Original published August 2005.

  3. Minimum variation guidance laws for interceptor missiles

    NARCIS (Netherlands)

    Weiss, M.; Shima, T.

    2014-01-01

    This paper introduces a new approach to guidance law design using linear quadratic optimal control theory, minimizing throughout the engagement the variation of the control input as well as the integral control effort. The guidance law is derived for arbitrary order missile dynamics and target maneu

  4. Career Guidance and Public Mental Health

    Science.gov (United States)

    Robertson, Peter J.

    2013-01-01

    Career guidance may have the potential to promote public health by contributing positively to both the prevention of mental health conditions and to population level well-being. The policy implications of this possibility have received little attention. Career guidance agencies are well placed to reach key target groups. Producing persuasive…

  5. Driving change : sustainable development action plans Guidance

    OpenAIRE

    Sustainable Development Commission

    2008-01-01

    This guidance builds upon the Sustainable Development Commission’s previous guidance, Getting Started (August 2005), which set out the basic elements that the Sustainable Development Commission would expect to see in a good Sustainable Development Action Plan. Publisher PDF Original published August 2005.

  6. State of Data Guidance in Journal Policies: A Case Study in Oncology

    Directory of Open Access Journals (Sweden)

    Deborah H. Charbonneau

    2015-06-01

    Full Text Available This article reports the results of a study examining the state of data guidance provided to authors by 50 oncology journals. The purpose of the study was the identification of data practices addressed in the journals’ policies. While a number of studies have examined data sharing practices among researchers, little is known about how journals address data sharing. Thus, what was discovered through this study has practical implications for journal publishers, editors, and researchers. The findings indicate that journal publishers should provide more meaningful and comprehensive data guidance to prospective authors. More specifically, journal policies requiring data sharing, should direct researchers to relevant data repositories, and offer better metadata consultation to strengthen existing journal policies. By providing adequate guidance for authors, and helping investigators to meet data sharing mandates, scholarly journal publishers can play a vital role in advancing access to research data.

  7. Characterization of image quality and image-guidance performance of a preclinical microirradiator

    Energy Technology Data Exchange (ETDEWEB)

    Clarkson, R.; Lindsay, P. E.; Ansell, S.; Wilson, G.; Jelveh, S.; Hill, R. P.; Jaffray, D. A. [Radiation Medicine Program, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9 (Canada); Radiation Medicine Program, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9 (Canada) and Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5S 1A1 (Canada); Radiation Medicine Program, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario M5 2M9 (Canada); Radiation Medicine Program, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9 (Canada) and Ontario Cancer Institute, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9 (Canada); Ontario Cancer Institute, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9 (Canada); Department of Medical Biophysics, University of Toronto, Toronto, Ontario M5S 1A1 (Canada) and Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5S 1A1 (Canada); Radiation Medicine Program, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9 (Canada); Ontario Cancer Institute, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9 (Canada); Department of Medical Biophysics, University of Toronto, Toronto, Ontario M5S 1A1 (Canada) and Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5S 1A1 (Canada)

    2011-02-15

    Purpose: To assess image quality and image-guidance capabilities of a cone-beam CT based small-animal image-guided irradiation unit (micro-IGRT). Methods: A micro-IGRT system has been developed in collaboration with the authors' laboratory as a means to study the radiobiological effects of conformal radiation dose distributions in small animals. The system, the X-Rad 225Cx, consists of a 225 kVp x-ray tube and a flat-panel amorphous silicon detector mounted on a rotational C-arm gantry and is capable of both fluoroscopic x-ray and cone-beam CT imaging, as well as image-guided placement of the radiation beams. Image quality (voxel noise, modulation transfer, CT number accuracy, and geometric accuracy characteristics) was assessed using water cylinder and micro-CT test phantoms. Image guidance was tested by analyzing the dose delivered to radiochromic films fixed to BB's through the end-to-end process of imaging, targeting the center of the BB, and irradiation of the film/BB in order to compare the offset between the center of the field and the center of the BB. Image quality and geometric studies were repeated over a 5-7 month period to assess stability. Results: CT numbers reported were found to be linear (R{sup 2}{>=}0.998) and the noise for images of homogeneous water phantom was 30 HU at imaging doses of approximately 1 cGy (to water). The presampled MTF at 50% and 10% reached 0.64 and 1.35 mm{sup -1}, respectively. Targeting accuracy by means of film irradiations was shown to have a mean displacement error of [{Delta}x,{Delta}y,{Delta}z]=[-0.12,-0.05,-0.02] mm, with standard deviations of [0.02, 0.20, 0.17] mm. The system has proven to be stable over time, with both the image quality and image-guidance performance being reproducible for the duration of the studies. Conclusions: The micro-IGRT unit provides soft-tissue imaging of small-animal anatomy at acceptable imaging doses ({<=}1 cGy). The geometric accuracy and targeting systems permit dose

  8. Fluoroscopic-Guided Radial Endobronchial Ultrasound Without Guide Sheath For Peripheral Pulmonary Lesions: A Safe And Efficient Combination.

    Science.gov (United States)

    Casutt, Alessio; Prella, Maura; Beigelman-Aubry, Catherine; Fitting, Jean-William; Nicod, Laurent; Koutsokera, Angela; Lovis, Alban

    2015-07-01

    Several guidelines recommend computed tomography scans for populations with high-risk for lung cancer. The number of individuals evaluated for peripheral pulmonary lesions (PPL) will probably increase, and with it non-surgical biopsies. Associating a guidance method with a target confirmation technique has been shown to achieve the highest diagnostic yield, but the utility of bronchoscopy with radial probe endobronchial ultrasound using fluoroscopy as guidance without a guide sheath has not been reported. We conducted a retrospective analysis of bronchoscopy with radial probe endobronchial ultrasound using fluoroscopy procedures for the investigation of PPL performed by experienced bronchoscopists with no specific previous training in this particular technique. Operator learning curves and radiological predictors were assessed for all consecutive patients examined during the first year of application of the technique. Fifty-one PPL were investigated. Diagnostic yield and visualization yield were 72.5 and 82.3% respectively. The diagnostic yield was 64.0% for PPL ≤20mm, and 80.8% for PPL>20mm. No false-positive results were recorded. The learning curve of all diagnostic tools showed a DY of 72.7% for the first sub-group of patients, 81.8% for the second, 72.7% for the third, and 81.8% for the last. Bronchoscopy with radial probe endobronchial ultrasound using fluoroscopy as guidance is safe and simple to perform, even without specific prior training, and diagnostic yield is high for PPL>and ≤20mm. Based on these findings, this method could be introduced as a first-line procedure for the investigation of PPL, particularly in centers with limited resources. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  9. Deprivation of Liberty: Collected Guidance Various authors Deprivation of Liberty: Collected Guidance 400pp £29.95 Law Society Publishing 9781784460433 1784460435 [Formula: see text].

    Science.gov (United States)

    2016-08-31

    Deprivation of liberty is a complicated and confusing subject, which can be challenging for healthcare professionals. Understanding and applying its safeguards can be difficult because of the complex set of regulations, as well as various sources of guidance, and it can be a challenge to find practical information that will help.

  10. Space shuttle guidance, navigation, and control design equations. Volume 3: Guidance

    Science.gov (United States)

    1973-01-01

    Space shuttle guidance, navigation, and control design equations are presented. The space-shuttle mission includes three relatively distinct guidance phases which are discussed; atmospheric boost, which is characterized by an adaptive guidance law; extra-atmospheric activities; and re-entry activities, where aerodynamic surfaces are the principal effectors. Guidance tasks include pre-maneuver targeting and powered flight guidance, where powered flight is defined to include the application of aerodynamic forces as well as thruster forces. A flow chart which follows guidance activities throughout the mission from the pre-launch phase through touchdown is presented. The main guidance programs and subroutines used in each phase of a typical rendezvous mission are listed. Detailed software requirements are also presented.

  11. 76 FR 63676 - Final Division of Safety Systems Interim Staff Guidance DSS-ISG-2010-01: Staff Guidance Regarding...

    Science.gov (United States)

    2011-10-13

    ... COMMISSION Final Division of Safety Systems Interim Staff Guidance DSS-ISG- 2010-01: Staff Guidance Regarding... final Division of Safety Systems Interim Staff Guidance, (DSS-ISG) DSS- ISG-2010-01, ``Staff Guidance... guidance to the NRC staff reviewer to address the increased complexity of recent spent fuel pool...

  12. Optofluidic control of axonal guidance

    Science.gov (United States)

    Gu, Ling; Ordonez, Simon; Black, Bryan; Mohanty, Samarendra K.

    2013-03-01

    Significant efforts are being made for control on axonal guidance due to its importance in nerve regeneration and in the formation of functional neuronal circuitry in-vitro. These include several physical (topographic modification, optical force, and electric field), chemical (surface functionalization cues) and hybrid (electro-chemical, photochemical etc) methods. Here, we report comparison of the effect of linear flow versus microfluidic flow produced by an opticallydriven micromotor in guiding retinal ganglion axons. A circularly polarized laser tweezers was used to hold, position and spin birefringent calcite particle near growth cone, which in turn resulted in microfluidic flow. The flow rate and resulting shear-force on axons could be controlled by a varying the power of the laser tweezers beam. The calcite particles were placed separately in one chamber and single particle was transported through microfluidic channel to another chamber containing the retina explant. In presence of flow, the turning of axons was found to strongly correlate with the direction of flow. Turning angle as high as 90° was achieved. Optofluidic-manipulation can be applied to other types of mammalian neurons and also can be extended to stimulate mechano-sensing neurons.

  13. Augmented Reality Repair Guidance System

    Directory of Open Access Journals (Sweden)

    Sidharth Bhatia

    2012-07-01

    Full Text Available The daily life of a common man revolves around various forms of appliances/gadgets he uses throughout the day such as a mobile phone, laptop, printer, microwave oven, washing machine, etc. Although these appliances/gadgets are taken by most of the people for granted, the problem occurs when any of these things do not work as they are expected to. Getting them to the repair shops for every small glitch is expensive as well as time consuming. Although most of the companies which produce these appliances/gadgets do supply them with basic manuals, which deal with how to solve these minor issues, but reading them and at the same time repairing the corresponding appliance/gadget can be a frustrating task at times. These problems can be reduced to a large extent if some kind of live guidance is available. In this paper we propose a method to do so with the help of an augmented reality based system that will guide the user to carry out small scale repair jobs on these gadgets. All that is required is a decent webcam and a computing device, with a processor of 1 GHz or more and a display screen.

  14. 78 FR 54949 - Major Project Financial Plan Guidance

    Science.gov (United States)

    2013-09-06

    ... TRANSPORTATION Federal Highway Administration Major Project Financial Plan Guidance AGENCY: Federal Highway... Major Project Financial Plan Guidance outlining the procedures the FHWA will follow when reviewing and approving Financial Plans. The proposed Major Project Financial Plan Guidance incorporates changes required...

  15. Program to prepare school level supervisors for professional pedagogical guidance.

    Directory of Open Access Journals (Sweden)

    Isdarey Hernández González

    2014-09-01

    Full Text Available Doing an appropriate professional pedagogical guidance becomes a social problem of top priority, due to the fact that when students get to Ninth Grade they face, for the first time, the chance to select a school to continue his studies. However, there are barriers around this social task; like the lack of schools staff preparation and particularly that of the school level supervisors who should lead the School Grade Boards, among its functions are to plan actions for labour and vocational development and also for the professional pedagogical guidance. This article is a result of a research activity carried out by the author who is a Ph. D. Candidate on Pedagogical Sciences. This investigation has as an objective to propose a developmental program to increase the school level supervisors preparation on the professional pedagogical guidance in Junior High School. This program is conceived as a system and starts with an upgrade course, goes on with workshops and ends with a training course. Its main axis is the research method acquisition. This program was carried out through pedagogical practice and showed its efficiency.

  16. Guidance for package approvals in the United Kingdom

    Energy Technology Data Exchange (ETDEWEB)

    Morgan-Warren, E. [Radioactive Materials Transport Div., Dept. for Transport, London (United Kingdom)

    2004-07-01

    Approval is required under the transport regulations for a wide range of package designs and operations, and applications for competent authority approval and validation are received from many sources, both in the United Kingdom and overseas. To assist package designers and applicants for approval, and to promote consistency in applications and their assessment, the UK Department for Transport issues guidance on the interpretation of the transport regulations and the requirements of an application for approval and its supporting safety case. The general guidance document, known as the ''Guide to an Application for UK Competent Authority Approval of Radioactive Material in Transport'', has been issued for many years and updated to encompass the provisions of each successive edition of the IAEA transport regulations. The Guide has been referred to in a number of international fora, including PATRAM, and was cited as a ''Good Practice'' in the report of the IAEA TRANSAS Appraisal of the UK in 2002. Specialist guides include the Guide to the Suitability of Elastomeric Seal Materials, which is the subject of a separate paper in this conference, and the Guide to the Approval of Freight Containers as Types IP-2 and IP-3 Packages. This paper discusses the guidance material and summarises the administrative and technical information required in support of applications for approval of package designs, special form and low dispersible radioactive materials, shipments, special arrangements, modifications and validations.

  17. BOOK REVIEW: Evaluating the Measurement Uncertainty: Fundamentals and practical guidance

    Science.gov (United States)

    Lira, Ignacio

    2003-08-01

    Evaluating the Measurement Uncertainty is a book written for anyone who makes and reports measurements. It attempts to fill the gaps in the ISO Guide to the Expression of Uncertainty in Measurement, or the GUM, and does a pretty thorough job. The GUM was written with the intent of being applicable by all metrologists, from the shop floor to the National Metrology Institute laboratory; however, the GUM has often been criticized for its lack of user-friendliness because it is primarily filled with statements, but with little explanation. Evaluating the Measurement Uncertainty gives lots of explanations. It is well written and makes use of many good figures and numerical examples. Also important, this book is written by a metrologist from a National Metrology Institute, and therefore up-to-date ISO rules, style conventions and definitions are correctly used and supported throughout. The author sticks very closely to the GUM in topical theme and with frequent reference, so readers who have not read GUM cover-to-cover may feel as if they are missing something. The first chapter consists of a reprinted lecture by T J Quinn, Director of the Bureau International des Poids et Mesures (BIPM), on the role of metrology in today's world. It is an interesting and informative essay that clearly outlines the importance of metrology in our modern society, and why accurate measurement capability, and by definition uncertainty evaluation, should be so important. Particularly interesting is the section on the need for accuracy rather than simply reproducibility. Evaluating the Measurement Uncertainty then begins at the beginning, with basic concepts and definitions. The third chapter carefully introduces the concept of standard uncertainty and includes many derivations and discussion of probability density functions. The author also touches on Monte Carlo methods, calibration correction quantities, acceptance intervals or guardbanding, and many other interesting cases. The book goes on to treat evaluation of expanded uncertainty, joint treatment of several measurands, least-squares adjustment, curve fitting and more. Chapter 6 is devoted to Bayesian inference. Perhaps one can say that Evaluating the Measurement Uncertainty caters to a wider reader-base than the GUM; however, a mathematical or statistical background is still advantageous. Also, this is not a book with a library of worked overall uncertainty evaluations for various measurements; the feel of the book is rather theoretical. The novice will still have some work to do—but this is a good place to start. I think this book is a fitting companion to the GUM because the text complements the GUM, from fundamental principles to more sophisticated measurement situations, and moreover includes intelligent discussion regarding intent and interpretation. Evaluating the Measurement Uncertainty is detailed, and I think most metrologists will really enjoy the detail and care put into this book. Jennifer Decker

  18. Caveat Chemicus: Practical Guidance to Searching Chemical Abstracts.

    Science.gov (United States)

    Roth, Dana L.

    1998-01-01

    Provides tips on searching Chemical Abstracts (CA). Discusses coverage, indexing policies, differences between the print and online versions, transliterations, arrangement of the print indexes, abbreviations, and importance of the CA Index Guide for effective searching. (MES)

  19. Toward good read-across practice (GRAP) guidance

    NARCIS (Netherlands)

    Ball, N.; Cronin, M.T.D.; Shen, J.; Blackburn, K.; Booth, E.D.; Bouhifd, M.; Donley, E.; Egnash, L.; Hastings, C.; Juberg, D.R.; Kleensang, A.; Kleinstreuer, N.; Kroese, E.D.; Lee, A.C.; Luechtefeld, T.; Maertens, A.; Marty, S.; Naciff, J.M.; Palmer, J.; Pamies, D.; Penman, M.; Richarz, A.N.; Russo, D.P.; Stuard, S.B.; Patlewicz, G.; Ravenzwaay, B. van; Wu, S.; Zhu, H.; Hartung, T.

    2016-01-01

    Grouping of substances and utilizing read-across of data within those groups represents an important data gap filling technique for chemical safety assessments. Categories/analogue groups are typically developed based on structural similarity and, increasingly often, also on mechanistic (biological)

  20. Cloud computing methods and practical approaches

    CERN Document Server

    Mahmood, Zaigham

    2013-01-01

    This book presents both state-of-the-art research developments and practical guidance on approaches, technologies and frameworks for the emerging cloud paradigm. Topics and features: presents the state of the art in cloud technologies, infrastructures, and service delivery and deployment models; discusses relevant theoretical frameworks, practical approaches and suggested methodologies; offers guidance and best practices for the development of cloud-based services and infrastructures, and examines management aspects of cloud computing; reviews consumer perspectives on mobile cloud computing an

  1. An exploration of fluoroscopically guided spinal steroid injections in patients with non-specific exercise-related lower-limb pain

    Directory of Open Access Journals (Sweden)

    Leon Neve

    2010-09-01

    Full Text Available Leon Neve1, John Orchard2, Nathan Gibbs3, Willem van Mechelen4, Evert Verhagen4, Ken Sesel5, Ian Burgess6, Brett Hines61VU University, Amsterdam, The Netherlands; 2School of Public Health, University of Sydney, Sydney, NSW, Australia; 3South Sydney Sports Medicine, Sydney, NSW, Australia; 4EMGO, VU University, Amsterdam, The Netherlands; 5Sydney X-ray Centre, Sydney, NSW, Australia; 6Mater Imaging, Sydney, NSW, AustraliaBackground: Fluoroscopically guided lumbar cortisone injections have been proven useful in cases of lower-limb pain caused by lumbar disc prolapse (with evidence levels ll-1/ll-2. These injections are also sometimes used clinically in sports medicine for patients with non-specific exercise-related lower-limb pain, where no prolapse or other obvious cause of nerve-impingement is diagnosed via magnetic resonance imaging (MRI or computed tomography (CT, even though this treatment scenario has not been adequately studied for this last diagnosis.Objectives: To explore whether fluoroscopically guided transforaminal lumbar cortisone injections may be a valid treatment method for non-specific exercise-related lower-limb pain.Study design: Retrospective case series.Methods: Patients were selected from databases at two sports clinics and divided into two groups: Group D, with back-related lower-limb pain and disc prolapse proven on CT or MR; and Group N, with non-specific exercise-related lower-limb pain. Patients were sent a questionnaire regarding: symptoms, improvement, effect of injections, satisfaction, side effects and other used treatments. Outcomes were compared between Group D and N.Results: 153 patients were eligible for the study (Group D: 93/Group N: 60. Eventually 110 patients responded (Group D: 67/Group N: 43. Twelve percent of Group D and 14% of Group N indicated that the injections had fully cured their symptoms. Altogether, 27% of Group D and 24% of Group N were certain the injections had improved their symptoms in the

  2. Guidance of magnetic space tug

    Science.gov (United States)

    Fabacher, Emilien; Lizy-Destrez, Stéphanie; Alazard, Daniel; Ankersen, Finn; Profizi, Alexandre

    2017-07-01

    Magnetic tugging of a target satellite without thrust capacity can be interesting in various contexts, as for example End-Of-Life management, or to complete launchers capabilities. The aim is to gradually modify the orbit of the target by constantly exerting on it a magnetic force. To do so, the chaser is assumed equipped with a steerable magnetic dipole, able to create both forces and torques on the magnetic torque rods carried by the target. The chaser is also supposed to carry electric thrusters, creating a continuous force which modifies the orbit of the whole formation composed of chaser and target. The relative motions of both satellites are derived, in order to assess the feasibility of such a concept. Relative configuration (attitudes and position) trajectories are derived, which are compliant with the dynamics, and enable the chaser to tug the target. Considering targets in Low Earth Orbit (LEO), the magnetic field of the Earth is taken into account, modeled by the International Geomagnetic Reference Field (IGRF). The position of the magnetic torque rod of the target may not be located at its center of mass. This lever-arm is taken into account in the dynamics. As for every Electro-Magnetic Formation Flight concept developed in the literature, satellites involved in magnetic tugging are constantly subjected to torques, created by the Earth magnetic field and by the magnetic fields created by the other satellites in the formation. In this study, the solution chosen to face this problem is to take into account the attitude equilibrium of the satellites early in the guidance phase, in order to avoid having to wave the dipole, as it is generally done. Promising results are presented for different types of orbit, showing that the concept could be feasible in many different scenarios.

  3. Significant Guidance Issued by the Federal Highway Administration

    Data.gov (United States)

    Department of Transportation — A list of Significant Guidance documents, which include guidance document disseminated to regulated entities or the general public that may reasonably be anticipated...

  4. Significant Guidance Issued by the Federal Aviation Administration

    Data.gov (United States)

    Department of Transportation — A list of Significant Guidance documents, which include guidance document disseminated to regulated entities or the general public that may reasonably be anticipated...

  5. Significant Guidance Issued by the Federal Transit Administration

    Data.gov (United States)

    Department of Transportation — A list of Significant Guidance documents, which include guidance document disseminated to regulated entities or the general public that may reasonably be anticipated...

  6. Significant Guidance Issued by the Federal Motor Carrier Safety Administration

    Data.gov (United States)

    Department of Transportation — A list of Significant Guidance documents, which include guidance document disseminated to regulated entities or the general public that may reasonably be anticipated...

  7. PILOT STUDY TO ASSESS MEAL PROGRESSION THROUGH THE GASTROINTESTINAL TRACT OF HABITUATED DOGS DETERMINED BY FLUOROSCOPIC IMAGING WITHOUT SEDATION OR PHYSICAL RESTRAINT.

    Science.gov (United States)

    Wrigglesworth, David J; Bailey, Michael Q; Colyer, Alison; Hughes, Kevin R

    2016-11-01

    A limiting factor of radiographic contrast studies is the requirement for restraint of the animal in order to reduce movement artifacts. To demonstrate that gastrointestinal transit can be analyzed by a barium meal in nonsedated and unrestrained dogs, a pilot study of six adult Labrador retriever dogs was undertaken. Study subjects were selected by convenience sampling from an available population of Labrador dogs and were trained to stand motionless during radiographic fluoroscopy. Following a meal containing 7% w/w powdered barium sulfate, radiographic images were generated using a digital fluoroscope C-arm, at intervals of 5, 15, and 30 min, and at 1, 2, 3, 4, 5, 6, 7, and 8 h. A qualitative assessment of fill density using a 5-point scale was made for the stomach, small intestine, and ascending, transverse, and descending regions of the colon at each timepoint. Gastric emptying half-time occurred between 1 and 2 h postmeal. Mean fill density of the small intestine increased from 15 min postmeal and reached a peak at 3 h postmeal. Mean fill density of the proximal large intestine mirrored that of the small intestine. The distal large intestine remained empty for the first 2 h postmeal, then increased between hours 2 and 5 postmeal, and was subsequently at maximum fill density from hour 6 postmeal onwards. Fluoroscopic observation of a barium contrast meal provided an effective indication of the amount and progression of ingested food through the various regions of the gastrointestinal tract in habituated, fully conscious dogs. © 2016 American College of Veterinary Radiology.

  8. Integration of kerma-area product and cumulative air kerma determination into a skin dose tracking system for fluoroscopic imaging procedures

    Science.gov (United States)

    Vijayan, Sarath; Shankar, Alok; Rudin, Stephen; Bednarek, Daniel R.

    2016-03-01

    The skin dose tracking system (DTS) that we developed provides a color-coded mapping of the cumulative skin dose distribution on a 3D graphic of the patient during fluoroscopic procedures in real time. The DTS has now been modified to also calculate the kerma area product (KAP) and cumulative air kerma (CAK) for fluoroscopic interventions using data obtained in real-time from the digital bus on a Toshiba Infinix system. KAP is the integral of air kerma over the beam area and is typically measured with a large-area transmission ionization chamber incorporated into the collimator assembly. In this software, KAP is automatically determined for each x-ray pulse as the product of the air kerma/ mAs from a calibration file for the given kVp and beam filtration times the mAs per pulse times the length and width of the beam times a field nonuniformity correction factor. Field nonuniformity is primarily the result of the heel effect and the correction factor was determined from the beam profile measured using radio-chromic film. Dividing the KAP by the beam area at the interventional reference point provides the area averaged CAK. The KAP and CAK per x-ray pulse are summed after each pulse to obtain the total procedure values in real-time. The calculated KAP and CAK were compared to the values displayed by the fluoroscopy machine with excellent agreement. The DTS now is able to automatically calculate both KAP and CAK without the need for measurement by an add-on transmission ionization chamber.

  9. Integrated Entry Guidance for Reusable Launch Vehicle

    Institute of Scientific and Technical Information of China (English)

    NING Guo-dong; ZHANG Shu-guang; FANG Zhen-ping

    2007-01-01

    A method for the implementation of integrated three-degree-of-freedom constrained entry guidance for reusable launch vehicle is presented. Given any feasible entry conditions, terminal area energy management interface conditions, and the reference trajectory generated onboard then, the method can generate a longitudinal guidance profile rapidly, featuring linear quadratic regular method and a proportional-integral-derivative tracking law with time-varying gains, which satisfies all the entry corridor constraints and meets the requirements with high precision. Afterwards, by utilizing special features of crossrange parameter, establishing bank-reversal corridor,and determining bank-reversals according to dynamically adjusted method, the algorithm enables the lateral entry guidance system to fly a wide range of missions and provides reliable and good performance in the presence of significant aerodynamic modeling uncertainty.Fast trajectory guidance profiles and simulations with a reusable launch vehicle model for various missions and aerodynamic uncertainties are presented to demonstrate the capacity and reliability of this method.

  10. Optimal guidance for the space shuttle transition

    Science.gov (United States)

    Stengel, R. F.

    1974-01-01

    A guidance method for the space shuttle's transition from hypersonic entry to subsonic cruising flight is presented. The method evolves from a numerical trajectory optimization technique in which kinetic energy and total energy (per unit weight) replace velocity and time in the dynamic equations. This allows the open end-time problem to be transformed to one of fixed terminal energy. In its ultimate form, E-Guidance obtains energy balance (including dynamic-pressure-rate damping) and path length control by angle-of-attack modulation and cross-range control by roll angle modulation. The guidance functions also form the basis for a pilot display of instantaneous maneuver limits and destination. Numerical results illustrate the E-Guidance concept and the optimal trajectories on which it is based.

  11. RCRA Programmatic Information Policy and Guidance

    Data.gov (United States)

    U.S. Environmental Protection Agency — This asset includes program policy and guidance documents that are used by the EPA regions, states, tribes and private parties to implement the hazardous waste...

  12. Beyond Black: An Alternative to Ethnocentric Guidance

    Science.gov (United States)

    Goldman, Robert C.

    1977-01-01

    This article is a clarification of the author's personal philosophy in the guidance and counseling of youth and adults, and clarification of commonalities that form the raison d'etre of all student personnel services. (Author)

  13. Much more than just another guidance document.

    Science.gov (United States)

    Kulkarni, K

    2016-11-01

    As a pediatric hematologist oncologist with clinical and research interests in thrombosis in high-risk pediatric populations, and also as a member of the ISTH Early Career Task Force, I had the opportunity to develop a guidance document on 'Thromboprophylaxis for central venous catheters in the pediatric population' for the 'Guidelines and Guidance Documents' committee. In this communication, I share my experiences to date; I discuss my excitement and initial success, the steep learning curve required to build research acumen, the lessons learnt, and the opportunities and challenges faced. My experience with preparing the guidance document was much more than writing 'just another guidance document'. © 2016 International Society on Thrombosis and Haemostasis.

  14. Intra-operative dosimetry of trans-rectal ultrasound guided 125I prostate implants using C-arm fluoroscopic images

    Directory of Open Access Journals (Sweden)

    Ravindran Paul

    2006-01-01

    Full Text Available Permanent implantation of radioactive seeds is a viable and effective therapeutic option widely used today for early-stage prostate cancer. The implant technique has improved considerably during the recent years due to the use of image guidance; however, real-time dose distributions would allow potential cold spots to be assessed and additional seeds added. In this study, we investigate the use of a conventional C-arm fluoroscopy unit for image acquisition and evaluation of dose distribution immediately after the implant. The phantom study indicates that it is possible to obtain seed positions within ±2 mm. A pilot study carried out with three patients indicated that it is possible to obtain seed positions and calculate the dose distribution with C-arm fluoroscopy and about 95% of the seeds were reconstructed within ±2 mm. The results could be further improved with better digital imaging.

  15. ROUTE PLAN DESIGNER FOR TRACTOR GUIDANCE SYSTEMS

    DEFF Research Database (Denmark)

    Sveistrup, Daniel; Jørgensen, Rasmus Nyholm; Green, Ole

    2010-01-01

    Earlier works have shown field trial designs to be very labor extensive, even when combining autoguidancesystems with conventional machinery.Designing routes for semi-automated systems in a controlled manner is both resource demandingand complicated. Different types of auto-guidance systems vary...... was outlined, it took less thanone hour entering the design into the software and generating the auto-guidance files.KeywordsGIS, Auto steering systems, plot trial design, full-scale field trials, Java...

  16. Ergonomic concerns with lightbar guidance displays.

    Science.gov (United States)

    Ima, C S; Mann, D D

    2004-05-01

    This article reviews some ergonomic factors associated with agricultural guidance displays. Any technology or management decision that improves the efficiency of an agricultural operation can be considered an aspect of precision farming. Agricultural guidance displays are one such tool because they help to reduce guidance error (i.e., skipping and overlapping of implements within the field), which result in improper application of crop inputs at increased cost. Although each of the guidance displays currently available functions using a different principle, their key objective is to communicate useful guidance information to the operator of the agricultural machine. The case with which the operator obtains the required information depends on a number of ergonomic factors, such as color perceptibility, flash rate, attentional demand, display size, viewing distance, and height of placement of the display in the cab. Ergonomics can be defined as the application of knowledge to create a safe, comfortable, and effective work environment. Consequently, it is critical to consider ergonomics when designing guidance displays or when locating a display in the tractor cab. Without considering ergonomics, it is unlikely that the efficiency of the human-machine system can be optimized.

  17. Lease Operations Environmental Guidance Document

    Energy Technology Data Exchange (ETDEWEB)

    Bureau of Land Management

    2001-02-14

    This report contains discussions in nine different areas as follows: (1) Good Lease Operating Practices; (2) Site Assessment and Sampling; (3) Spills/Accidents; (4) Containment and Disposal of Produced Waters; (5) Restoration of Hydrocarbon Impacted Soils; (6) Restoration of Salt Impacted Soils; (7) Pit Closures; (8) Identification, Removal and Disposal of Naturally Occurring Radioactive Materials (NORM); and (9) Site Closure and Construction Methods for Abandonment Wells/Locations. This report is primary directed towards the operation of oil and gas producing wells.

  18. Known-component 3D-2D registration for image guidance and quality assurance in spine surgery pedicle screw placement

    Science.gov (United States)

    Uneri, A.; Stayman, J. W.; De Silva, T.; Wang, A. S.; Kleinszig, G.; Vogt, S.; Khanna, A. J.; Wolinsky, J.-P.; Gokaslan, Z. L.; Siewerdsen, J. H.

    2015-03-01

    Purpose. To extend the functionality of radiographic / fluoroscopic imaging systems already within standard spine surgery workflow to: 1) provide guidance of surgical device analogous to an external tracking system; and 2) provide intraoperative quality assurance (QA) of the surgical product. Methods. Using fast, robust 3D-2D registration in combination with 3D models of known components (surgical devices), the 3D pose determination was solved to relate known components to 2D projection images and 3D preoperative CT in near-real-time. Exact and parametric models of the components were used as input to the algorithm to evaluate the effects of model fidelity. The proposed algorithm employs the covariance matrix adaptation evolution strategy (CMA-ES) to maximize gradient correlation (GC) between measured projections and simulated forward projections of components. Geometric accuracy was evaluated in a spine phantom in terms of target registration error at the tool tip (TREx), and angular deviation (TREΦ) from planned trajectory. Results. Transpedicle surgical devices (probe tool and spine screws) were successfully guided with TREx30° (easily accommodated on a mobile C-arm). QA of the surgical product based on 3D-2D registration demonstrated the detection of pedicle screw breach with TRExConclusions. 3D-2D registration combined with 3D models of known surgical components provides a novel method for near-real-time guidance and quality assurance using a mobile C-arm without external trackers or fiducial markers. Ongoing work includes determination of optimal views based on component shape and trajectory, improved robustness to anatomical deformation, and expanded preclinical testing in spine and intracranial surgeries.

  19. School Counselors Share Their Favorite Classroom Guidance Activities: Guide to Planning, Conducting, and Processing

    Science.gov (United States)

    DeLucia-Waack, J., Ed.; Mercurio, M., Ed.; Colvin, F., Ed.; Korta, S., Ed.; Maertin, K., Ed.; Martin, E., Ed.; Zawadski, L., Ed.

    2014-01-01

    In this book, practicing school counselors have provided more than 60 classroom guidance activities that are presented across the three major ASCA areas in the National Standards for Students: Academic Skills, Personal/Social Skills, and Career Development/College Preparation. Activities are designed to integrate the ASCA Model, Response to…

  20. Competencies for Early Childhood Educators in the Context of Inclusion: Issues and Guidance for States

    Science.gov (United States)

    Winton, Pam; West, Tracey

    2011-01-01

    This concept paper identifies issues and provides guidance to states as they develop, revise, and utilize early educator competencies in the context of inclusion. Key issues include ensuring that early educator competencies reflect knowledge, skills and emerging research on effective practices for working in inclusive settings with children with…

  1. Social Impact Assessment : Guidance for assessing and managing the social impacts of projects

    NARCIS (Netherlands)

    Vanclay, Francis; Esteves, Ana Maria; Aucamp, Ilse; Franks, Daniel

    2015-01-01

    The purpose of this Guidance Note is to provide advice to various stakeholders about what is expected in good practice social impact assessment (SIA) and social impact management processes, especially in relation to project development. Project development refers to dams, mines, oil and gas drilling

  2. Ethical Issues Associated with Information and Communication Technology in Counseling and Guidance

    Science.gov (United States)

    Sampson, James P., Jr.; Makela, Julia Panke

    2014-01-01

    For more than 50 years, literature on the use of information and communication technology in counseling and guidance has presented ethical issues related to the development and use of technologies in practice. This paper reviews the ethical issues raised, organizing them into three categories: Social equity, resources, and services. Career…

  3. Communication Services and Supports for Individuals with Severe Disabilities: Guidance for Assessment and Intervention

    Science.gov (United States)

    Brady, Nancy C.; Bruce, Susan; Goldman, Amy; Erickson, Karen; Mineo, Beth; Ogletree, Bill T.; Paul, Diane; Romski, Mary Ann; Sevcik, Rose; Siegel, Ellin; Schoonover, Judith; Snell, Marti; Sylvester, Lorraine; Wilkinson, Krista

    2016-01-01

    The National Joint Committee for the Communication Needs of People With Severe Disabilities (NJC) reviewed literature regarding practices for people with severe disabilities in order to update guidance provided in documents originally published in 1992. Changes in laws, definitions, and policies that affect communication attainments by persons…

  4. Ethical Issues Associated with Information and Communication Technology in Counseling and Guidance

    Science.gov (United States)

    Sampson, James P., Jr.; Makela, Julia Panke

    2014-01-01

    For more than 50 years, literature on the use of information and communication technology in counseling and guidance has presented ethical issues related to the development and use of technologies in practice. This paper reviews the ethical issues raised, organizing them into three categories: Social equity, resources, and services. Career…

  5. Nutrition guidance by family doctors in a changing world: Problems, opportunities and future possibilities

    NARCIS (Netherlands)

    Truswell, A.S.; Hiddink, G.J.; Blom, J.

    2003-01-01

    During the Third Heelsum International Workshop, Nutrition Guidance of Family Doctors Towards Best Practice, December 10-12, 2001, Heelsum, the Netherlands, 17 papers were presented. Each paper was discussed by all the participants at the workshop. These discussions were tape-recorded, transcribed,

  6. Toward a Script Theory of Guidance in Computer-Supported Collaborative Learning

    Science.gov (United States)

    Fischer, Frank; Kollar, Ingo; Stegmann, Karsten; Wecker, Christof

    2013-01-01

    This article presents an outline of a script theory of guidance for computer-supported collaborative learning (CSCL). With its 4 types of components of internal and external scripts (play, scene, role, and scriptlet) and 7 principles, this theory addresses the question of how CSCL practices are shaped by dynamically reconfigured internal…

  7. 75 FR 59893 - Commission Guidance on Presentation of Liquidity and Capital Resources Disclosures in Management...

    Science.gov (United States)

    2010-09-28

    ... banking agency guidance on funding and liquidity risk management, or any policies and practices that... discussion of liquidity and capital resources in Management's Discussion and Analysis of Financial Condition... to improve the presentation of information about funding and liquidity risk.\\1\\ In a...

  8. The Development of a Lifelong Guidance System in Hungary

    Science.gov (United States)

    Watts, A. G.; Borbely-Pecze, Bors Tibor

    2011-01-01

    The development of a lifelong guidance system in Hungary Systematic work is currently being undertaken in Hungary to develop a lifelong guidance system, in line with principles outlined by leading international organisations. The origins of career guidance in Hungary, and the nature of the current career guidance system, are outlined. The main…

  9. The voice of users in adult career guidance

    DEFF Research Database (Denmark)

    Plant, Peter

    2012-01-01

    Is the voice of users heard in adult career guidance? Pan-Nordic Research shows that users are seen as recipients rather than agents i adult career guidance.......Is the voice of users heard in adult career guidance? Pan-Nordic Research shows that users are seen as recipients rather than agents i adult career guidance....

  10. The voice of users in adult career guidance

    DEFF Research Database (Denmark)

    Plant, Peter

    2012-01-01

    Is the voice of users heard in adult career guidance? Pan-Nordic Research shows that users are seen as recipients rather than agents i adult career guidance.......Is the voice of users heard in adult career guidance? Pan-Nordic Research shows that users are seen as recipients rather than agents i adult career guidance....

  11. Non-Participation in Guidance: An Opportunity for Development?

    Science.gov (United States)

    Thomsen, Rie

    2014-01-01

    This article discusses how new opportunities for guidance can emerge from an analysis of the interplay between the participation (or lack of participation) of the individuals in career guidance, and the career guidance practitioner's response. The article suggests critical psychology as a framework for career guidance research and presents…

  12. The Development of a Lifelong Guidance System in Hungary

    Science.gov (United States)

    Watts, A. G.; Borbely-Pecze, Bors Tibor

    2011-01-01

    The development of a lifelong guidance system in Hungary Systematic work is currently being undertaken in Hungary to develop a lifelong guidance system, in line with principles outlined by leading international organisations. The origins of career guidance in Hungary, and the nature of the current career guidance system, are outlined. The main…

  13. Launch flexibility using NLP guidance and remote wind sensing

    Science.gov (United States)

    Cramer, Evin J.; Bradt, Jerre E.; Hardtla, John W.

    1990-01-01

    This paper examines the use of lidar wind measurements in the implementation of a guidance strategy for a nonlinear programming (NLP) launch guidance algorithm. The NLP algorithm uses B-spline command function representation for flexibility in the design of the guidance steering commands. Using this algorithm, the guidance system solves a two-point boundary value problem at each guidance update. The specification of different boundary value problems at each guidance update provides flexibility that can be used in the design of the guidance strategy. The algorithm can use lidar wind measurements for on pad guidance retargeting and for load limiting guidance steering commands. Examples presented in the paper use simulated wind updates to correct wind induced final orbit errors and to adjust the guidance steering commands to limit the product of the dynamic pressure and angle-of-attack for launch vehicle load alleviation.

  14. STORMWATER BEST MANAGEMENT PRACTICES DESIGN GUIDE VOLUME 2 - VEGETATIVE BIOFILTERS

    Science.gov (United States)

    This document is Volume 2 of a three volume document that provides guidance on the selection and design of stormwater management Best Management Practices (BMPs). This second volume provides specific design guidance for a group of onsite BMP control practices that are referred t...

  15. STORMWATER BEST MANAGEMENT PRACTICES DESIGN GUIDE VOLUME 2 - VEGETATIVE BIOFILTERS

    Science.gov (United States)

    This document is Volume 2 of a three volume document that provides guidance on the selection and design of stormwater management Best Management Practices (BMPs). This second volume provides specific design guidance for a group of onsite BMP control practices that are referred t...

  16. Progress in the development of a new angiography suite including the high resolution micro-angiographic fluoroscope (MAF): a control, acquisition, processing, and image display system (CAPIDS), and a new detector changer integrated into a commercial C-arm angiography unit to enable clinical use

    Science.gov (United States)

    Wang, Weiyuan; Ionita, Ciprian N.; Keleshis, Christos; Kuhls-Gilcrist, Andrew; Jain, Amit; Bednarek, Daniel; Rudin, Stephen

    2010-04-01

    Due to the high-resolution needs of angiographic and interventional vascular imaging, a Micro-Angiographic Fluoroscope (MAF) detector with a Control, Acquisition, Processing, and Image Display System (CAPIDS) was installed on a detector changer which was attached to the C-arm of a clinical angiographic unit. The MAF detector provides high-resolution, high-sensitivity, and real-time imaging capabilities and consists of a 300 μm-thick CsI phosphor, a dual stage micro-channel plate light image intensifier (LII) coupled to a fiber optic taper (FOT), and a scientific grade frame-transfer CCD camera, providing an image matrix of 1024×1024 35 μm square pixels with 12 bit depth. The Solid-State X-Ray Image Intensifier (SSXII) is an EMCCD (Electron Multiplying charge-coupled device) based detector which provides an image matrix of 1k×1k 32 μm square pixels with 12 bit depth. The changer allows the MAF or a SSXII region-of-interest (ROI) detector to be inserted in front of the standard flat-panel detector (FPD) when higher resolution is needed during angiographic or interventional vascular imaging procedures. The CAPIDS was developed and implemented using LabVIEW software and provides a user-friendly interface that enables control of several clinical radiographic imaging modes of the MAF or SSXII including: fluoroscopy, roadmapping, radiography, and digital-subtraction-angiography (DSA). The total system has been used for image guidance during endovascular image-guided interventions (EIGI) using prototype self-expanding asymmetric vascular stents (SAVS) in over 10 rabbit aneurysm creation and treatment experiments which have demonstrated the system's potential benefits for future clinical use.

  17. Raising the Profile of Career Guidance: Educational and Vocational Guidance Practitioner

    Science.gov (United States)

    Hiebert, Bryan

    2009-01-01

    In 2007 the International Association for Educational and Vocational Guidance (IAEVG) launched the Educational and Vocational Guidance Practitioner credential (EVGP) as one means of formally acknowledging the knowledge, skills, and personal attributes that practitioners need in order to provide quality career development services to clients. This…

  18. Impacto da orientação para a prática regular de atividade física dois anos após o parto Impact of guidance on the practice of regular physical activity two years after giving birth

    Directory of Open Access Journals (Sweden)

    Simone Cristina Scarpa

    2012-06-01

    Full Text Available OBJETIVOS: avaliar as modificações na prática de atividade física (AF e as barreiras para adoção de um estilo de vida saudável em mulheres que receberam orientações nutricionais e de AF durante a gestação e no primeiro ano após o parto. MÉTODOS: estudo de coorte com 57 mulheres (Grupo Controle = 29 e Grupo Intervenção = 28, e idade média igual a 28 (±6 anos. As informações foram obtidas através de entrevistas em visita domiciliar (durante a intervenção e inquérito telefônico (um ano após o término da intervenção, utilizou-se questionário de AF. Para análise das barreiras foi realizada uma entrevista semiestruturada com questões abertas, as quais foram codificadas e agrupadas para análise dos dados. Foram realizados testes de qui-quadrado, Mann-Whitney U e Friedman. RESULTADOS: aos seis meses, apenas 30% das mulheres do grupo Intervenção realizavam AF no lazer pelo menos 120 minutos por semana, contra 10% do grupo Controle, reduzindo para 18% e 4%, respectivamente, dois anos após o parto. As principais barreiras à prática de AF regular foram: falta de tempo (44%, cuidado com os filhos (37%, trabalho (21%, afazeres domésticos (21% e comodismo (26%. CONCLUSÕES: futuros programas devem priorizar a aquisição de conhecimento, visando à adoção de um estilo de vida ativo no pós-parto, considerando as barreiras maternas.OBJECTIVES: to evaluate changes in the practice of physical activity (PA and the barriers to adopting a healthy lifestyle among women who have received guidance on nutrition and PA during pregnancy and in the first year after giving birth. METHODS: cohort study with 57 women (Control Group = 29 and Intervention Group = 28, and mean age 28 (±6 years. The information was obtained through home visit interviews (during intervention and telephone interviews (one year after the end of intervention, using the PA questionnaire. To analyze the barriers a semi-structured interview with open questions

  19. Safety of magnetic fusion facilities: Guidance

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-05-01

    This document provides guidance for the implementation of the requirements identified in DOE-STD-6002-96, Safety of Magnetic Fusion Facilities: Requirements. This guidance is intended for the managers, designers, operators, and other personnel with safety responsibilities for facilities designated as magnetic fusion facilities. While the requirements in DOE-STD-6002-96 are generally applicable to a wide range of fusion facilities, this Standard, DOE-STD-6003-96, is concerned mainly with the implementation of those requirements in large facilities such as the International Thermonuclear Experimental Reactor (ITER). Using a risk-based prioritization, the concepts presented here may also be applied to other magnetic fusion facilities. This Standard is oriented toward regulation in the Department of Energy (DOE) environment as opposed to regulation by other regulatory agencies. As the need for guidance involving other types of fusion facilities or other regulatory environments emerges, additional guidance volumes should be prepared. The concepts, processes, and recommendations set forth here are for guidance only. They will contribute to safety at magnetic fusion facilities.

  20. Guidance Trade-off for Aerocapture Missions

    Science.gov (United States)

    Vernis, P.; Gelly, G.; Ferreira, E.; da Costa, R.; Ortega, G.

    In the very late 90's, EADS-ST began home funded studies on aerocapture problems. The objectives of these studies were at that time to prepare a possible cooperation within the NASA/Cnes MSR-Orbiter program by investigating this new orbital insertion technique studying different algorithmic solutions from a guidance point of view. According to these preliminary studies, EADS-ST was retained in 2002 by ESA to study insertion techniques such as aerocapture, aero-gravity assist or aerobraking techniques within the frame of Technological Research Program able to bring solutions to Aurora program. In the frame of the ATPE (Aeroassist Technologies for Planetary Exploration) TRP program, EADS-ST, led by Astrium-Gmbh (now part of EADS-ST), developed and implemented an efficient and simple guidance scheme able to cope with mission requirements for aerocapture on Mars, Venus or the Earth: the Feedback Trajectory Control, or FTC. The development of this guidance scheme was made according to a preliminary trade-off analysis using different guidance schemes. Among those ones was an original predictor-corrector guidance scheme, already analyzed within the frame of the MSR-O mission. But, the FTC algoritm was prefered because of its good results and high simplicity. This paper presents an upgrade of the original Apoapsis Predictor, or AP, with the improvement of its robustness woth respect to off-nomonal flight conditions and its process simplification. A new trade-off analysis is then detailed on a Mars Sample return mission.

  1. Guidance notes for the protection of persons against ionising radiations arising from veterinary use

    Energy Technology Data Exchange (ETDEWEB)

    1988-01-01

    These notes are not intended to provide detailed guidance on all the conditions that apply to veterinary practice but rather to indicate the types of arrangements which should be employed in order to comply with the main requirements of the Regulations. They also aim to establish a pattern by which good radiological practice can be achieved and radiation doses to veterinary surgeons, radiographic staff, and anyone else involved, minimised.

  2. Measuring Integrated Socioemotional Guidance at School: Factor Structure and Reliability of the Socioemotional Guidance Questionnaire (SEG-Q)

    Science.gov (United States)

    Jacobs, Karen; Struyf, Elke

    2013-01-01

    Socioemotional guidance of students has recently become an integral part of education, however no instrument exists to measure integrated socioemotional guidance. This study therefore examines the factor structure and reliability of the Socioemotional Guidance Questionnaire. Psychometric properties of the Socioemotional Guidance Questionnaire and…

  3. 78 FR 48201 - Japan Lessons-Learned Project Directorate Interim Staff Guidance JLD-ISG-2013-01; Guidance for...

    Science.gov (United States)

    2013-08-07

    ... COMMISSION Japan Lessons-Learned Project Directorate Interim Staff Guidance JLD-ISG-2013-01; Guidance for... Lessons-Learned Project Directorate Interim Staff Guidance (JLD-ISG), JLD-ISG-2013-01, ``Guidance for... to http://www.nrc.gov/reading-rm/doc-collections/isg/japan-lessons-learned.html and refer to...

  4. Human Genetic Disorders of Axon Guidance

    Science.gov (United States)

    Engle, Elizabeth C.

    2010-01-01

    This article reviews symptoms and signs of aberrant axon connectivity in humans, and summarizes major human genetic disorders that result, or have been proposed to result, from defective axon guidance. These include corpus callosum agenesis, L1 syndrome, Joubert syndrome and related disorders, horizontal gaze palsy with progressive scoliosis, Kallmann syndrome, albinism, congenital fibrosis of the extraocular muscles type 1, Duane retraction syndrome, and pontine tegmental cap dysplasia. Genes mutated in these disorders can encode axon growth cone ligands and receptors, downstream signaling molecules, and axon transport motors, as well as proteins without currently recognized roles in axon guidance. Advances in neuroimaging and genetic techniques have the potential to rapidly expand this field, and it is feasible that axon guidance disorders will soon be recognized as a new and significant category of human neurodevelopmental disorders. PMID:20300212

  5. Radiation dose and intra-articular access: comparison of the lateral mortise and anterior midline approaches to fluoroscopically guided tibiotalar joint injections

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Ambrose J.; Torriani, Martin; Bredella, Miriam A.; Chang, Connie Y.; Simeone, Frank J.; Palmer, William E. [Massachusetts General Hospital, Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Boston, MA (United States); Balza, Rene [Centro Medico de Occidente, Department of Radiology, Maracaibo (Venezuela, Bolivarian Republic of)

    2016-03-15

    To compare the lateral mortise and anterior midline approaches to fluoroscopically guided tibiotalar joint injections with respect to successful intra-articular needle placement, fluoroscopy time, radiation dose, and dose area product (DAP). This retrospective study was IRB-approved and HIPAA-compliant. 498 fluoroscopically guided tibiotalar joint injections were performed or supervised by one of nine staff radiologists from 11/1/2010-12/31/2013. The injection approach was determined by operator preference. Images were reviewed on a PACS workstation to determine the injection approach (lateral mortise versus anterior midline) and to confirm intra-articular needle placement. Fluoroscopy time (minutes), radiation dose (mGy), and DAP (μGy-m{sup 2}) were recorded and compared using the student's t-test (fluoroscopy time) or the Wilcoxon rank sum test (radiation dose and DAP). There were 246 lateral mortise injections and 252 anterior midline injections. Two lateral mortise injections were excluded from further analysis because no contrast was administered. Intra-articular location of the needle tip was documented in 242/244 lateral mortise injections and 252/252 anterior midline injections. Mean fluoroscopy time was shorter for the lateral mortise group than the anterior midline group (0.7 ± 0.5 min versus 1.2 ± 0.8 min, P < 0.0001). Mean radiation dose and DAP were less for the lateral mortise group than the anterior midline group (2.1 ± 3.7 mGy versus 2.5 ± 3.5 mGy, P = 0.04; 11.5 ± 15.3 μGy-m{sup 2} versus 13.5 ± 17.3 μGy-m{sup 2}, P = 0.006). Both injection approaches resulted in nearly 100 % rates of intra-articular needle placement, but the lateral mortise approach used approximately 40 % less fluoroscopy time and delivered 15 % lower radiation dose and DAP to the patient. (orig.)

  6. Aerospace plane guidance using geometric control theory

    Science.gov (United States)

    Van Buren, Mark A.; Mease, Kenneth D.

    1990-01-01

    A reduced-order method employing decomposition, based on time-scale separation, of the 4-D state space in a 2-D slow manifold and a family of 2-D fast manifolds is shown to provide an excellent approximation to the full-order minimum-fuel ascent trajectory. Near-optimal guidance is obtained by tracking the reduced-order trajectory. The tracking problem is solved as regulation problems on the family of fast manifolds, using the exact linearization methodology from nonlinear geometric control theory. The validity of the overall guidance approach is indicated by simulation.

  7. Active evacuation guidance using sensor agent robot

    Science.gov (United States)

    Ise, Daiki; Mita, Akira

    2012-04-01

    Evacuation systems for buildings are designed based on event scenarios, so they are not prepared for unexpected events that are not included in the scenarios. In this paper, we propose a new active evacuation guidance system using sensor agent robots. We first introduce a Structural Health Monitoring (SHM) system to be used in conjunction with sensor agent robots for active evacuation guidance. Then the role of sensor agent robots is explained. An algorithm to immediately access the safety of the building after a large earthquake is also proposed using only the information taken by a sensor agent robot.

  8. Virtual Ultrasound Guidance for Inexperienced Operators

    Science.gov (United States)

    Caine, Timothy; Martin, David

    2012-01-01

    Medical ultrasound or echocardiographic studies are highly operator-dependent and generally require lengthy training and internship to perfect. To obtain quality echocardiographic images in remote environments, such as on-orbit, remote guidance of studies has been employed. This technique involves minimal training for the user, coupled with remote guidance from an expert. When real-time communication or expert guidance is not available, a more autonomous system of guiding an inexperienced operator through an ultrasound study is needed. One example would be missions beyond low Earth orbit in which the time delay inherent with communication will make remote guidance impractical. The Virtual Ultrasound Guidance system is a combination of hardware and software. The hardware portion includes, but is not limited to, video glasses that allow hands-free, full-screen viewing. The glasses also allow the operator a substantial field of view below the glasses to view and operate the ultrasound system. The software is a comprehensive video program designed to guide an inexperienced operator through a detailed ultrasound or echocardiographic study without extensive training or guidance from the ground. The program contains a detailed description using video and audio to demonstrate equipment controls, ergonomics of scanning, study protocol, and scanning guidance, including recovery from sub-optimal images. The components used in the initial validation of the system include an Apple iPod Classic third-generation as the video source, and Myvue video glasses. Initially, the program prompts the operator to power-up the ultrasound and position the patient. The operator would put on the video glasses and attach them to the video source. After turning on both devices and the ultrasound system, the audio-video guidance would then instruct on patient positioning and scanning techniques. A detailed scanning protocol follows with descriptions and reference video of each view along with

  9. NSRD-10: Leak Path Factor Guidance Using MELCOR

    Energy Technology Data Exchange (ETDEWEB)

    Louie, David [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Humphries, Larry L. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2017-03-01

    Estimates of the source term from a U.S. Department of Energy (DOE) nuclear facility requires that the analysts know how to apply the simulation tools used, such as the MELCOR code, particularly for a complicated facility that may include an air ventilation system and other active systems that can influence the environmental pathway of the materials released. DOE has designated MELCOR 1.8.5, an unsupported version, as a DOE ToolBox code in its Central Registry, which includes a leak-path-factor guidance report written in 2004 that did not include experimental validation data. To continue to use this MELCOR version requires additional verification and validations, which may not be feasible from a project cost standpoint. Instead, the recent MELCOR should be used. Without any developer support and lack of experimental data validation, it is difficult to convince regulators that the calculated source term from the DOE facility is accurate and defensible. This research replaces the obsolete version in the 2004 DOE leak path factor guidance report by using MELCOR 2.1 (the latest version of MELCOR with continuing modeling development and user support) and by including applicable experimental data from the reactor safety arena and from applicable experimental data used in the DOE-HDBK-3010. This research provides best practice values used in MELCOR 2.1 specifically for the leak path determination. With these enhancements, the revised leak-path-guidance report should provide confidence to the DOE safety analyst who would be using MELCOR as a source-term determination tool for mitigated accident evaluations.

  10. An evaluation of two guidance programmes to promote breast-feeding

    Directory of Open Access Journals (Sweden)

    M. Steyn

    1989-09-01

    Full Text Available During the past ten years a comprehensive research project has been undertaken to develop a guidance programme in three adjacent communities in the South- Western Cape with the aim o f lowering the high incidence o f coronary heart disease. The purpose o f this substudy was to determine whether the guidance provided in the different communities had any influence on the knowledge o f and attitudes towards the nutrition o f pregnant women, babies and infants as well as breast-feeding practices o f the women who gave birth during the period 1980 to 1986. In the first community guidance was provided by means o f small mass media and interpersonal communication whereas only the small mass media were employed in the second. The third served as the control community. The findings suggest that the combined interpersonal and mass media programme was more successful than the mass media programme alone.

  11. Integration of existing systematic reviews into new reviews: identification of guidance needs

    Science.gov (United States)

    2014-01-01

    Background An exponential increase in the number of systematic reviews published, and constrained resources for new reviews, means that there is an urgent need for guidance on explicitly and transparently integrating existing reviews into new systematic reviews. The objectives of this paper are: 1) to identify areas where existing guidance may be adopted or adapted, and 2) to suggest areas for future guidance development. Methods We searched documents and websites from healthcare focused systematic review organizations to identify and, where available, to summarize relevant guidance on the use of existing systematic reviews. We conducted informational interviews with members of Evidence-based Practice Centers (EPCs) to gather experiences in integrating existing systematic reviews, including common issues and challenges, as well as potential solutions. Results There was consensus among systematic review organizations and the EPCs about some aspects of incorporating existing systematic reviews into new reviews. Current guidance may be used in assessing the relevance of prior reviews and in scanning references of prior reviews to identify studies for a new review. However, areas of challenge remain. Areas in need of guidance include how to synthesize, grade the strength of, and present bodies of evidence composed of primary studies and existing systematic reviews. For instance, empiric evidence is needed regarding how to quality check data abstraction and when and how to use study-level risk of bias assessments from prior reviews. Conclusions There remain areas of uncertainty for how to integrate existing systematic reviews into new reviews. Methods research and consensus processes among systematic review organizations are needed to develop guidance to address these challenges. PMID:24956937

  12. Mixed reality ultrasound guidance system: a case study in system development and a cautionary tale.

    Science.gov (United States)

    Ameri, Golafsoun; Baxter, John S H; Bainbridge, Daniel; Peters, Terry M; Chen, Elvis C S

    2017-08-31

    Real-time ultrasound has become a crucial aspect of several image-guided interventions. One of the main constraints of such an approach is the difficulty in interpretability of the limited field of view of the image, a problem that has recently been addressed using mixed reality, such as augmented reality and augmented virtuality. The growing popularity and maturity of mixed reality has led to a series of informal guidelines to direct development of new systems and to facilitate regulatory approval. However, the goals of mixed reality image guidance systems and the guidelines for their development have not been thoroughly discussed. The purpose of this paper is to identify and critically examine development guidelines in the context of a mixed reality ultrasound guidance system through a case study. A mixed reality ultrasound guidance system tailored to central line insertions was developed in close collaboration with an expert user. This system outperformed ultrasound-only guidance in a novice user study and has obtained clearance for clinical use in humans. A phantom study with 25 experienced physicians was carried out to compare the performance of the mixed reality ultrasound system against conventional ultrasound-only guidance. Despite the previous promising results, there was no statistically significant difference between the two systems. Guidelines for developing mixed reality image guidance systems cannot be applied indiscriminately. Each design decision, no matter how well justified, should be the subject of scientific and technical investigation. Iterative and small-scale evaluation can readily unearth issues and previously unknown or implicit system requirements. We recommend a wary eye in development of mixed reality ultrasound image guidance systems emphasizing small-scale iterative evaluation alongside system development. Ultimately, we recommend that the image-guided intervention community furthers and deepens this discussion into best practices in

  13. Autonomous gliding entry guidance with geographic constraints

    Institute of Scientific and Technical Information of China (English)

    Guo Jie; Wu Xuzhong; Tang Shengjing

    2015-01-01

    This paper presents a novel three-dimensional autonomous entry guidance for relatively high lift-to-drag ratio vehicles satisfying geographic constraints and other path constraints. The guidance is composed of onboard trajectory planning and robust trajectory tracking. For trajectory planning, a longitudinal sub-planner is introduced to generate a feasible drag-versus-energy profile by using the interpolation between upper boundary and lower boundary of entry corridor to get the desired trajectory length. The associated magnitude of the bank angle can be specified by drag profile, while the sign of bank angle is determined by lateral sub-planner. Two-reverse mode is utilized to satisfy waypoint constraints and dynamic heading error corridor is utilized to satisfy no-fly zone constraints. The longitudinal and lateral sub-planners are iteratively employed until all of the path constraints are satisfied. For trajectory tracking, a novel tracking law based on the active disturbance rejection control is introduced. Finally, adaptability tests and Monte Carlo simulations of the entry guidance approach are performed. Results show that the proposed entry guidance approach can adapt to different entry missions and is able to make the vehicle reach the prescribed target point precisely in spite of geographic constraints.

  14. Guidance for performing site inspections under CERCLA

    Energy Technology Data Exchange (ETDEWEB)

    1992-09-01

    This guidance presents EPA`s site inspection (SI) strategy. The strategy discusses procedural guidelines to investigate potential Superfund (CERCLA) sites for evaluation pursuant to the Hazard Ranking System (HRS), revised in accordance with the Superfund Amendments and Reauthorization Act of 1986. The HRS is the primary means by which EPA evaluates sites for superfund`s National Priorities List (NPL).

  15. Cannabinoid receptor CB2 modulates axon guidance

    DEFF Research Database (Denmark)

    Duff, Gabriel; Argaw, Anteneh; Cecyre, Bruno

    2013-01-01

    Navigation of retinal projections towards their targets is regulated by guidance molecules and growth cone transduction mechanisms. Here, we present in vitro and in vivo evidences that the cannabinoid receptor 2 (CB2R) is expressed along the retino-thalamic pathway and exerts a modulatory action ...

  16. Hypermedia Authoring with Writing Process Guidance

    Science.gov (United States)

    Chang, Kuo-En; Sung, Yao-Ting; Zheng, Jie-Wen

    2007-01-01

    A writing process of five stages, setting the topic and goals, planning the outline, organising the structure, building the content, and reviewing, is proposed to guide hypermedia authoring. To explore the effects of the system designed with writing-process guidance, this study enrolled 108 seventh graders at a junior high school as experimental…

  17. guidance and behaviour management in early childhood

    African Journals Online (AJOL)

    Elizabeth

    development and the general behaviour manifestation of children under the childcare ... given by care givers to infants in the pre-primary school classes). Guidance means an .... aids, such as films, recorders, video, TV., children play; ... Simulation and games: These are teaching techniques in which real life situations and ...

  18. MR Thermometry for guidance of thermal therapy

    NARCIS (Netherlands)

    Sprinkhuizen, S.M.

    2010-01-01

    The research described in this thesis has aimed to further investigate magnetic resonance (MR) thermometry (MRT) techniques as to become a reliable guidance tool for thermal therapy. The various physical processes allowing for temperature measurements based upon the MR signal are described. It is de

  19. The Guidance Counselor and the Reading Curriculum.

    Science.gov (United States)

    Ediger, Marlow

    There are many ways guidance counselors can help teachers achieve more optimal reading instruction. Counselors first may have to ascertain the kinds of problems faced by a student in learning to read. Assessing a student's ability to use picture clues to decipher words may be necessary with primary grade students. Knowledge about phonics, using…

  20. Research Requirements for Future Visual Guidance Systems

    Science.gov (United States)

    1994-02-01

    20591. 5. FAA Advisory Circular 150/5340-18, Standards for Airport Sign Systems, latest edition, Washington, DC 20591. 6. Bonaventura , Vincent...Dunlap and Associates, March 1952, New York. 8. Bonaventura , Vincent E., A Proposed Method of Color Coding Airport Taxi Guidance-Sins, The Port of New