WorldWideScience

Sample records for intrapartum valsalva maneuver

  1. Clinical Presentation and Conservative Management of Tympanic Membrane Perforation during Intrapartum Valsalva Maneuver

    Directory of Open Access Journals (Sweden)

    Jonathan D. Baum

    2010-01-01

    Full Text Available Background. Tympanic membrane perforation may occur when ear pressures are excessive, including valsalva maneuver associated with active labor and vaginal delivery. A pressure differential across the eardrum of about 5 psi can cause rupture; the increased intraabdominal pressure spikes repeatedly manifested by “pushing” during second-stage labor easily approach (and may exceed this level. Material and Method. We describe a healthy 21-year old nulliparous patient admitted in active labor at 39-weeks' gestational age. Results. Blood appeared asymptomatically in the left ear canal at delivery during active, closed-glottis pushing. Otoscopic examination confirmed perforation of the left tympanic membrane. Complete resolution of the eardrum rupture was noted at postpartum check-up six weeks later. Conclusion. While the precise incidence of intrapartum tympanic membrane rupture is not known, it may be unrecognized without gross blood in the ear canal or subjective hearing loss following delivery. Only one prior published report on tympanic membrane perforation during delivery currently appears in the medical literature; this is the first English language description of the event. Since a vigorous and repetitive valsalva effort is common in normal vaginal delivery, clinicians should be aware of the potential for otic complications associated with the increased intraabdominal pressure characteristic of this technique.

  2. Review about hiperventilation test and Valsalva Maneuver

    Directory of Open Access Journals (Sweden)

    Eduardo Antonio MENA-DOMÍNGUEZ

    2018-04-01

    Full Text Available Introduction and objective: With this paper, we pretend to explain the characteristics and the field of application of two clinical explorations used in the patient with suspected vestibular pathology, the hyperventilation maneuver and the Valsalva maneuver. Methodology: Narrative review. Results: Through different neurophysiological mechanisms, hyperventilation can induce nystagmus in cases of vestibular asymmetry, both peripheral and central. The Valsalva maneuver may also trigger nystagmus and vertigo because of direct transmission of internal ear pressure in cases of perilymphatic fistula, anomalies of the cranio-cervical junction (Arnold-Chiari malformation, and other ossicles, oval window and saccule pathologies. Discussion and conclusions: Both the hyperventilation test and the Valsalva maneuver should be included in the battery of tests for patients with vestibular pathology to, depending on the results obtained, anatomically locate the site of the lesion and justify the use of imaging techniques.

  3. Doppler ultrasonography measurement of hepatic hemodynamics during Valsalva maneuver: healthy volunteer study

    Directory of Open Access Journals (Sweden)

    Dong-Ho Bang

    2015-01-01

    Full Text Available Purpose: The aim of our study was to assess the hemodynamic change of liver during the Valsalva maneuver using Doppler ultrasonography. Methods: Thirty healthy men volunteers were enrolled (mean age, 25.5±3.64 years. The diameter, minimal and maximal velocities, and volume flow of intrahepatic inferior vena cava (IVC, middle hepatic vein (MHV, and right main portal vein (RMPV was measured during both rest and Valsalva maneuver. These changes were compared using paired t-test. Results: The mean diameters (cm of the intrahepatic IVC at rest and Valsalva maneuver were 1.94±0.40 versus 0.56±0.66 (P<0.001. The mean diameter (cm, minimal velocity (cm/sec, maximal velocity (cm/sec, and volume flow (mL/min of MHV at rest and Valsalva maneuver were 0.60±0.15 versus 0.38±0.20 (P<0.001, -7.98±5.47 versus 25.74±13.13 (P<0.001, 21.34±6.89 versus 35.12±19.95 (P=0.002, and 106.94±97.65 versus 153.90±151.80 (P=0.014, respectively. Those of RMPV at rest and Valsalva maneuver were 0.78±0.21 versus 0.76±0.20 (P=0.485, 20.21±8.22 versus 18.73±7.43 (P=0.351, 26.79±8.85 versus 24.93±9.91 (P=0.275, and 391.52±265.63 versus 378.43±239.36 (P=0.315, respectively. Conclusion: The blood flow velocity and volume flow of MHV increased significantly during Valsalva maneuver. These findings suggest that hepatic vein might play an important role to maintain venous return to the heart during the maneuver.

  4. Doppler ultrasonography measuement of hepatic hemodynamics during Valsalva maneuver: healthy volunteers study

    Energy Technology Data Exchange (ETDEWEB)

    Bang, Dong Ho; Son, Young Jin; Lee, Young Hwan; Yoon, Kwon Ha [Dept. of Radiology, Wonkwang University School of Medicine, Iksan (Korea, Republic of)

    2015-01-15

    The aim of our study was to assess the hemodynamic change of liver during the Valsalva maneuver using Doppler ultrasonography. Thirty healthy men volunteers were enrolled (mean age, 25.5±3.64 years). The diameter, minimal and maximal velocities, and volume flow of intrahepatic inferior vena cava (IVC), middle hepatic vein (MHV), and right main portal vein (RMPV) was measured during both rest and Valsalva maneuver. These changes were compared using paired t-test. The mean diameters (cm) of the intrahepatic IVC at rest and Valsalva maneuver were 1.94±0.40 versus 0.56±0.66 (P<0.001). The mean diameter (cm), minimal velocity (cm/sec), maximal velocity (cm/sec), and volume flow (mL/min) of MHV at rest and Valsalva maneuver were 0.60±0.15 versus 0.38±0.20 (P<0.001), -7.98±5.47 versus 25.74±13.13 (P<0.001), 21.34±6.89 versus 35.12±19.95 (P=0.002), and 106.94±97.65 versus 153.90±151.80 (P=0.014), respectively. Those of RMPV at rest and Valsalva maneuver were 0.78±0.21 versus 0.76±0.20 (P=0.485), 20.21±8.22 versus 18.73±7.43 (P=0.351), 26.79±8.85 versus 24.93±9.91 (P=0.275), and 391.52±265.63 versus 378.43±239.36 (P=0.315), respectively. The blood flow velocity and volume flow of MHV increased significantly during Valsalva maneuver. These findings suggest that hepatic vein might play an important role to maintain venous return to the heart during the maneuver.

  5. Hemodynamic responses during and after multiple sets of stretching exercises performed with and without the Valsalva maneuver.

    Science.gov (United States)

    Lima, Tainah P; Farinatti, Paulo T V; Rubini, Ercole C; Silva, Elirez B; Monteiro, Walace D

    2015-05-01

    This study investigated the acute hemodynamic responses to multiple sets of passive stretching exercises performed with and without the Valsalva maneuver. Fifteen healthy men aged 21 to 29 years with poor flexibility performed stretching protocols comprising 10 sets of maximal passive unilateral hip flexion, sustained for 30 seconds with equal intervals between sets. Protocols without and with the Valsalva maneuver were applied in a random counterbalanced order, separated by 48-hour intervals. Hemodynamic responses were measured by photoplethysmography pre-exercise, during the stretching sets, and post-exercise. The effects of stretching sets on systolic and diastolic blood pressure were cumulative until the fourth set in protocols performed with and without the Valsalva maneuver. The heart rate and rate pressure product increased in both protocols, but no additive effect was observed due to the number of sets. Hemodynamic responses were always higher when stretching was performed with the Valsalva maneuver, causing an additional elevation in the rate pressure product. Multiple sets of unilateral hip flexion stretching significantly increased blood pressure, heart rate, and rate pressure product values. A cumulative effect of the number of sets occurred only for systolic and diastolic blood pressure, at least in the initial sets of the stretching protocols. The performance of the Valsalva maneuver intensified all hemodynamic responses, which resulted in significant increases in cardiac work during stretching exercises.

  6. Comparison of Valsalva Maneuver, Amyl Nitrite, and Exercise Echocardiography to Demonstrate Latent Left Ventricular Outflow Obstruction in Hypertrophic Cardiomyopathy.

    Science.gov (United States)

    Ayoub, Chadi; Geske, Jeffrey B; Larsen, Carolyn M; Scott, Christopher G; Klarich, Kyle W; Pellikka, Patricia A

    2017-12-15

    Guidelines recommend exercise stress echocardiogram (ESE) for patients with hypertrophic cardiomyopathy (HC) if a 50 mm Hg gradient is not present at rest or provoked with Valsalva or amyl nitrite, to direct medical and surgical management. However, no study has directly compared all 3 methods. We sought to evaluate efficacy and degree of provocation of left ventricular outflow gradients by ESE, and compare with Valsalva and amyl nitrite. In patients with HC between 2002 and 2015, resting echocardiograms and ESEs within 1 year were retrospectively reviewed. Gradients elicited by each provocation method were compared. Rest and ESE were available in 97 patients (mean age 54 ± 18 years, 57% male); 78 underwent Valsalva maneuver and 41 amyl nitrite provocation. Median gradients (interquartile range) were 10 mm Hg (7,19) at rest, 16 mm Hg (9,34) with Valsalva, 23 mm Hg (13,49) with amyl nitrite, and 26 mm Hg (13,58) with ESE. ESE and amyl nitrite were able to provoke obstruction (≥30 mm Hg) and severe obstruction (≥50 mm Hg) more frequently than Valsalva. In patients with resting gradient <30 mm Hg (n = 83), provocation maneuvers demonstrated dynamic obstruction in 51%; in those with Valsalva gradient <30 mm Hg (n = 57), ESE or amyl nitrite provoked a gradient in 44%; and in those with amyl nitrite gradient <30 mm Hg (n = 20), ESE provoked a gradient in 29%. No demographic or baseline echocardiographic parameter predicted provocable obstruction. In conclusion, ESE is clinically useful; however, different provocation maneuvers may be effective in different patients with HC, and all maneuvers may be required to provoke dynamic obstruction in symptomatic patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Is cardiac autonomic modulation during upper limb isometric contraction and Valsalva maneuver impaired in COPD patients?

    Directory of Open Access Journals (Sweden)

    Goulart CL

    2017-03-01

    Full Text Available Cássia da Luz Goulart,1 Ramona Cabiddu,2 Paloma de Borba Schneiders,1 Elisabete Antunes San Martin,1 Renata Trimer,3 Audrey Borghi-Silva,2 Andréa Lúcia Gonçalves da Silva4,5 1Course of Physiotherapy, University of Santa Cruz do Sul, Rio Grande do Sul, Brazil; 2Cardiopulmonary Physiotherapy Laboratory, Nucleus of Research in Physical Exercise, Federal University of São Carlos, São Carlos, Brazil; 3Department of Physiotherapy, Federal University of Amazonas, Manaus, AM, Brazil; 4Course of Physiotherapy, Department of Health and Physical Education, University of Santa Cruz do Sul, Rio Grande do Sul, Brazil; 5Pulmonary Rehabilitation Program, Santa Cruz Hospital, Santa Cruz do Sul, Rio Grande do Sul, Brazil Purpose: To evaluate the heart rate variability (HRV indices and heart rate (HR responses during isometric contraction (IC and Valsalva maneuver (VM in COPD patients. Methods: Twenty-two stable moderate to severe COPD patients were evaluated. R-R intervals were recorded (monitor Polar® S810i during dominant upper limb IC (2 minutes. Stable signals were analyzed by Kubios HRV® software. Indices of HRV were computed in the time domain (mean HR; square root of the mean squared differences of successive RR intervals [RMSSD] and HRV triangular index [RR tri index] and in the frequency domain (high frequency [HF]; low frequency [LF] and LF/HF ratio. The HR responses were evaluated at rest, at the peak and at the nadir of the VM (15 seconds. The Valsalva index was also calculated. Results: During IC: time domain indices (mean HR increased [P=0.001], RMSSD, and RR tri index decreased [P=0.005 and P=0.005, respectively]; frequency domain indices (LF increased [P=0.033] and HF decreased [P=0.002]; associations were found between forced expiratory volume in 1 second (FEV1 vs RMSSD (P=0.04; r=–0.55, FEV1 vs HR (P=0.04; r=–0.48, forced vital capacity (FVC vs RMSSD (P=0.05; r=–0.62, maximum inspiratory pressure (MIP vs HF (P=0.02; r=0.68. FEV1

  8. Failure to unmask pseudonormal diastolic function by a valsalva maneuver: tricuspid insufficiency is a major factor.

    Science.gov (United States)

    Hu, Kai; Liu, Dan; Niemann, Markus; Hatle, Liv; Herrmann, Sebastian; Voelker, Wolfram; Ertl, Georg; Bijnens, Bart; Weidemann, Frank

    2011-11-01

    For the clinical assessment of patients with dyspnea, the inversion of the early (E) and late (A) transmitral flow during Valsalva maneuver (VM) frequently helps to distinguish pseudonormal from normal filling pattern. However, in an important number of patients, VM fails to reveal the change from dominant early mitral flow velocity toward larger late velocity. From December 2009 to October 2010, we selected consecutive patients with abnormal filling with (n=25) and without E/A inversion (n=25) during VM. Transmitral, tricuspid, and pulmonary Doppler traces were recorded and the degree of insufficiency was estimated. After evaluating all standard echocardiographic morphological, functional, and flow-related parameters, it became evident that the failure to unmask the pseudonormal filling pattern by VM was related to the degree of the tricuspid insufficiency (TI). TI was graded as mild in 24 of 25 patients in the group with E/A inversion during VM, whereas TI was graded as moderate to severe in 24 of the 25 patients with pseudonormal diastolic function without E/A inversion during VM. Our data suggest that TI is a major factor to prevent E/A inversion during a VM in patients with pseudonormal diastolic function. This probably is due to a decrease in TI resulting in an increase in forward flow rather than the expected decrease during the VM. Thus, whenever a pseudonormal diastolic filling pattern is suspected, the use of a VM is not an informative discriminator in the presence of moderate or severe TI.

  9. Doppler ultrasonographic measurement of short-term effects of valsalva maneuver on retrobulbar blood flow.

    Science.gov (United States)

    Kimyon, Sabit; Mete, Ahmet; Mete, Alper; Mete, Duçem

    2017-11-12

    To investigate the effects of Valsalva maneuver (VM) on retrobulbar blood flow parameters in healthy subjects. Participants without any ophthalmologic or systemic pathology were examined in supine position with color and pulsed Doppler imaging for blood flow measurement, via a paraocular approach, in the ophthalmic artery (OA), central retinal artery (CRA), central retinal vein (CRV), nasal posterior ciliary artery (NPCA), and temporal posterior ciliary artery (TPCA), 10 seconds after a 35- to 40-mm Hg expiratory pressure was reached. Peak systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI), and resistivity index (RI) values were recorded for each artery. PSV and EDV values were recorded for CRV. There were significant differences between resting and VM values of PSV and EDV of CRA, RI of NPCA, and PI, RI, and EDV of TPCA. Resting CRA-EDV, CRV-PSV, and CRV-EDV were positively correlated whereas resting OA-PSV and CRA-PI, and OA-PSV, CRA-PSV, and CRA-EDV during VM, were negatively correlated with age. VM induces a short-term increase in CRA blood flow and a decrease in NPCA and TPCA RI. Additional studies with a longer Doppler recording during VM, in a larger population sample, are required to allow definitive interpretation. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:551-555, 2017. © 2017 Wiley Periodicals, Inc.

  10. Valsalva's maneuver revisited: a quantitative method yielding insights into human autonomic control

    Science.gov (United States)

    Smith, M. L.; Beightol, L. A.; Fritsch-Yelle, J. M.; Ellenbogen, K. A.; Porter, T. R.; Eckberg, D. L.

    1996-01-01

    Seventeen healthy supine subjects performed graded Valsalva maneuvers. In four subjects, transesophageal echographic aortic cross-sectional areas decreased during and increased after straining. During the first seconds of straining, when aortic cross-sectional area was declining and peripheral arterial pressure was rising, peroneal sympathetic muscle neurons were nearly silent. Then, as aortic cross-sectional area and peripheral pressure both declined, sympathetic muscle nerve activity increased, in proportion to the intensity of straining. Poststraining arterial pressure elevations were proportional to preceding increases of sympathetic activity. Sympathetic inhibition after straining persisted much longer than arterial and right atrial pressure elevations. Similarly, R-R intervals changed in parallel with peripheral arterial pressure, until approximately 45 s after the onset of straining, when R-R intervals were greater and arterial pressures were smaller than prestraining levels. Our conclusions are as follows: opposing changes of carotid and aortic baroreceptor inputs reduce sympathetic muscle and increase vagal cardiac motor neuronal firing; parallel changes of barorsensory inputs provoke reciprocal changes of sympathetic and direct changes of vagal firing; and pressure transients lasting only seconds reset arterial pressure-sympathetic and -vagal response relations.

  11. Spontaneous Pushing in Lateral Position versus Valsalva Maneuver During Second Stage of Labor on Maternal and Fetal Outcomes: A Randomized Clinical Trial.

    Science.gov (United States)

    Vaziri, Farideh; Arzhe, Amene; Asadi, Nasrin; Pourahmad, Saeedeh; Moshfeghy, Zeinab

    2016-10-01

    There are concerns about the harmful effects of the Valsalva maneuver during the second stage of labor. Comparing the effects of spontaneous pushing in the lateral position with the Valsalva maneuver during the second stage of labor on maternal and fetal outcomes. Inclusion criteria in this randomized clinical trial conducted in Iran were as follows: nulliparous mothers, live fetus with vertex presentation, gestational age of 37 - 40 weeks, spontaneous labor, and no complications. The intervention group pushed spontaneously while they were in the lateral position, whereas the control group pushed using Valsalva method while in the supine position at the onset of the second stage of labor. Maternal outcomes such as pain and fatigue severity and fetal outcomes such as pH and pO2 of the umbilical cord blood were measured. Data pertaining to 69 patients, divided into the intervention group (35 subjects) and control group (34 subjects), were analyzed statistically. The mean pain (7.80 ± 1.21 versus 9.05 ± 1.11) and fatigue scores (46.59 ± 21 versus 123.36 ± 43.20) of the two groups showed a statistically significant difference (P pushing in the lateral position reduced fatigue and pain severity of the mothers. Also, it did not worsen fetal outcomes. Thus, it can be used as an alternative method for the Valsalva maneuver.

  12. Synergistic effect of energy drinks and overweight/obesity on cardiac autonomic testing using the Valsalva maneuver in university students.

    Science.gov (United States)

    Majeed, Farrukh; Yar, Talay; Alsunni, Ahmed; Alhawaj, Ali Fouad; AlRahim, Ahmed; Alzaki, Muneer

    2017-01-01

    Obesity and caffeine consumption may lead to autonomic disturbances that can result in a wide range of cardiovascular disorders. To determine autonomic disturbances produced by the synergistic effects of overweight or obesity (OW/OB) and energy drinks. Cross-sectional, analytical. Physiology department at a university in Saudi Arabia. University students, 18-22 years of age, of normal weight (NW) and OW/OB were recruited by convenience sampling. Autonomic testing by the Valsalva ratio (VR) along with systolic and diastolic blood pressure, pulse pressure, and mean arterial blood pressure were measured at baseline (0 minute) and 60 minutes after energy drink consumption. Autonomic disturbance, hemodynamic changes. In 50 (27 males and 23 females) subjects, 21 NW and 29 OW/OB, a significant decrease in VR was observed in OW/OB subjects and in NW and OW/OB females at 60 minutes after energy drink consumption. Values of systolic and diastolic blood pressure, pulse pressure and mean arterial blood pressure were also significantly higher in OW/OB and in females as compared to NW and males. BMI was negatively correlated with VR and diastolic blood pressure at 60 minutes. Obesity and energy drinks alter autonomic functions. In some individuals, OW/OB may augment these effects. Due to time and resource restraints, only the acute effects of energy drinks were examined.

  13. Avaliação da frequência cardíaca à medida de pressão expiratória máxima estática e à manobra de Valsalva em jovens saudáveis Heart rate assessment during maximal static expiratory pressure and Valsalva maneuver in healthy young men

    Directory of Open Access Journals (Sweden)

    Vinicius Minatel

    2012-10-01

    Full Text Available CONTEXTUALIZAÇÃO: A medida de pressão expiratória máxima (PEmáx possui algumas contraindicações, pois acredita-se que as respostas obtidas nessa medida são similares às respostas encontradas na manobra de Valsalva (MV. OBJETIVOS: O objetivo principal é avaliar a resposta da frequência cardíaca (FC durante a medida da PEmáx e da MV em jovens saudáveis, em diferentes posturas, para identificar se e em qual condição a PEmáx reproduz as respostas obtidas na MV e, adicionalmente, estimar o trabalho realizado nas manobras. MÉTODO: Doze jovens saudáveis foram avaliados, orientados e familiarizados com as manobras. A MV foi composta por um esforço expiratório (40 mmHg durante 15 segundos contra um manômetro. A PEmáx foi executada segundo a American Thoracic Society. Ambas as medidas foram realizadas nas posturas supino e sentado. Para a análise da variação da frequência cardíaca (∆FC, índice de Valsalva (IV, índice da PEmáx (IPEmáx e o trabalho estimado das manobras (Wtotal, Wisotime, Wtotal/∆FCtotal e Wisotime/∆FCisotime , utilizou-se ANOVA two-way com post-hoc de Holm-Sidak (pBACKGROUND: The measure of the maximal expiratory pressure (MEP has some contraindications, as it is believed that the responses obtained in this measure are similar to the Valsalva maneuver (VM. OBJECTIVE: The main purpose of this study was to evaluate the heart rate responses (HR during the MEP and the VM measures in healthy young men into different postures aiming to identify whether and in which situation the MEP reproduces the responses obtained in the VM. Additionally we aim to estimate the workload realized during the maneuvers. METHOD: Twelve healthy young men were evaluated, instructed and familiarized with the maneuvers. The VM was characterized by an expiratory effort (40 mmHg against a manometer for 15 seconds. The MEP measure has been performed according to the American Thoracic Society. Both measures were performed at sitting

  14. Valsalva maneuver procedures in the diagnosis of right-to-left shunt by contrast-enhanced transcranial doppler using agitated saline solution with blood as a contrast agent Manobra de Valsalva no diagnóstico de embolia paradoxal pelo doppler transcraniano contrastado com o uso de solução salina agitada associada a sangue como meio de contraste

    Directory of Open Access Journals (Sweden)

    Marcos Christiano Lange

    2010-06-01

    Full Text Available OBJECTIVE: To compare two different timings for the performance of the Valsalva maneuver (VM using an infusion of agitated saline solution with blood as contrast agent (CA to right-to-left shunt (RLS screening. METHOD: 42 patients were submitted to a standardized contrast-enhanced transcranial doppler (cTCD to screen for right-to-left shunt (RLS. cTCD technique was done with two different moments of the VM: [1] the CA injection during the VM (CAduringVM test; [2] the CA injection before the VM (CApreVM test. RESULTS: Positive MCA tests were observed in 47 (56% CAduringVM tests and in 50 (59.5% CApreVM tests, p=0.64. There was an almost perfect agreement for the positive tests between the CAduringVM and CApreVM test, r s=0.829 (95% CI 0.61-1.00, pOBJETIVO: Comparar dois momentos diferentes da manobra de Valsalva (MV com o uso de solução salina com sangue como meio de contraste (MC para investigação de embolia paradoxal (EP. MÉTODO: 42 pacientes foram submetidos a protocolo padronizado de DTCc com a MV em dois momentos diferentes: [1] injeção do MC durante a MV (teste ACduranteMV; [2] injeção de MC antes da MV (teste ACpreMV. RESULTADOS: Exames positivos foram observados em 47 (56% ACMs testes ACduranteMV e 50 (59.5% testes ACpreMV, p=0.64. Houve uma correlação quase perfeita entre ambos os testes, r s=0.829 (95% CI 0.61-1.00, p<0.001. CONCLUSÃO: O presente estudo demonstra que não existe diferença significativa na positividade de EP pelo DTCc quando são comparados dois momentos diferentes da MV.

  15. Contrast transcranial Doppler ultrasound in the detection of right-to-left shunts: comparison of Echovist-200 and Echovist-300, timing of the Valsalva maneuver, and general recommendations for the performance of the test.

    Science.gov (United States)

    Droste, Dirk W; Jekentaite, Ruta; Stypmann, Jörg; Grude, Matthias; Hansberg, Tjark; Ritter, Martin; Nabavi, Darius; Nam, Eun-Mi; Dittrich, Ralf; Wichter, Thomas; Ringelstein, E Bernd

    2002-01-01

    Cardiac right-to-left shunts (RLS) can be identified by transesophageal echocardiography (TEE) as well as by transcranial Doppler ultrasound (TCD) using contrast agents, such as Echovist-200 or Echovist-300 in conjunction with a Valsalva maneuver (VM) as provocation procedure. Both Echovist preparations are in use. Currently, the appropriate timing of the VM is still under debate. Sixty-four patients were investigated by both TEE and bilateral TCD of the middle cerebral arteries. The following protocol was applied in a randomized way: (1) no VM, (2) VM for 5 s starting with the beginning of Echovist-300 injection, (3) VM for 5 s starting 5 s after the beginning of Echovist-300 injection, (4) VM for 5 s starting 10 s after the beginning of Echovist-300 injection, and (5) VM for 5 s starting 5 s after the beginning of Echovist-200 injection. In 27 patients, an RLS was demonstrated by both TEE and contrast TCD (shunt-positive). Twenty-two patients were negative in both investigations, no patient was positive on TEE but negative on TCD, 15 patients were only positive on at least one TCD investigation but negative on TEE. Tests 3 and 5 were the most appropriate ones; test 3 was slightly superior to test 5. TCD using Echovist-300 or Echovist-200 is a sensitive method to identify TEE-proven cardiac RLS. To achieve the best diagnostic accuracy, the VM should be performed for a duration of 5 s starting at 5 s following the beginning of contrast injection. Copyright 2002 S. Karger AG, Basel

  16. Comparison of force exerted on the sternum during a sneeze versus during low-, moderate-, and high-intensity bench press resistance exercise with and without the valsalva maneuver in healthy volunteers.

    Science.gov (United States)

    Adams, Jenny; Schmid, Jack; Parker, Robert D; Coast, J Richard; Cheng, Dunlei; Killian, Aaron D; McCray, Stephanie; Strauss, Danielle; McLeroy Dejong, Sandra; Berbarie, Rafic

    2014-03-15

    Sternal precautions are intended to prevent complications after median sternotomy, but little data exist to support the consensus recommendations. To better characterize the forces on the sternum that can occur during everyday events, we conducted a prospective nonrandomized study of 41 healthy volunteers that evaluated the force exerted during bench press resistance exercise and while sneezing. A balloon-tipped esophageal catheter, inserted through the subject's nose and advanced into the thoracic cavity, was used to measure the intrathoracic pressure differential during the study activities. After the 1 repetition maximum (1-RM) was assessed, the subject performed the bench press at the following intensities, first with controlled breathing and then with the Valsalva maneuver: 40% of 1-RM (low), 70% of 1-RM (moderate), and 1-RM (high). Next, various nasal irritants were used to induce a sneeze. The forces on the sternum were calculated according to a cylindrical model, and a 2-tailed paired t test was used to compare the mean force exerted during a sneeze with the mean force exerted during each of the 6 bench press exercises. No statistically significant difference was found between the mean force from a sneeze (41.0 kg) and the mean total force exerted during moderate-intensity bench press exercise with breathing (41.4 kg). In conclusion, current guidelines and recommendations limit patient activity after a median sternotomy. Because these patients can repeatedly withstand a sneeze, our study indicates that they can withstand the forces from more strenuous activities than are currently allowed. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. EFFECT OF VALSALVA MANOEUVRE ON SHORT TERM VARIATION OF INTRA OCULAR PRESSURE

    Directory of Open Access Journals (Sweden)

    Rajendra

    2015-10-01

    Full Text Available BACKGROUND: Intra ocular Pressure (IOP changes during Valsalva manoeuver (VM. AIM: To study the effect of Valsalva manoeuvre on IOP and the heart rate response. MATERIALS AND METHODS: The study group consisted of 55 volunteers, visually normal as subjects, 30 boys and 25 girls in the age group of 18 to 20 ye ars. Independent measurements of the IOP of each eye were obtained with the subject in the upright position. ECG recorded continuously before, during and after the Valsalva manoeuvre. Keelar Pulsair air impulse tonometer was used in all the subjects for IO P measurement. IOP was measured in the department of Ophthalmology, Teaching Hospital between 08AM to 10 AM. STATISTICAL ANALYSIS : were done using Paired ‘t’ test. RESULTS: The mean IOP increased by 5.53±2.138 mmHg during VM. The changes were statistically significant (<0.001. Mean IOP decreased by 2.085±0.367 mmHg during VM in a small proportion of subjects (12% which was not statistically significant. Mean recovery IOP was also lower than the resting IOP which was statistically significant (<0.001. The Valsalva ratio is calculated as the ratio of the longest RR interval (ms after the maneuver divided by the shortest RR interval (ms during the test. Mean Valsalva ratio was normal at 1.687 (range 1.2 - 2.6. CONCLUSION: IOP increased during Valsalva man oeuvre in a large number of subjects (88%. Recovery IOP was also lower than the resting IOP during the period of measurement, post VM (over a period of 5 minutes.

  18. Spontaneous intrapartum vesicouterine fistula.

    Science.gov (United States)

    Kaaki, Bilal; Gyves, Michael; Goldman, Howard

    2006-02-01

    Vesicouterine fistulae as an obstetrical complication have been reported only in women with a history of cesarean. We present a patient with no such history who developed a vesicouterine fistula after vaginal delivery. A 43-year-old gravida 5 at term with no history of cesarean presented in the latent phase of labor. Gross hematuria was noted intrapartum, and a foley catheter was placed. A cystogram showed an extraperitoneal bladder perforation. The patient had urinary incontinence despite Foley catheter drainage. The diagnosis of vesicouterine fistula was made by cystoscopy and fistulogram. The patient had a successful repair at 3 months. This is a rare case of a vesicouterine fistula developing during a pregnancy with no previous cesarean. Accurate diagnosis is essential because surgical repair has an excellent outcome.

  19. The Valsalva manoeuvre versus tourniquet for venipuncture.

    Science.gov (United States)

    Villa, Gianluca; Chelazzi, Cosimo; Giua, Rosa; Lavacchini, Laura; Tofani, Lorenzo; Zagli, Giovanni; Barbani, Francesco; De Gaudio, A Raffaele; Romagnoli, Stefano; Pinelli, Fulvio

    2018-03-01

    During ultrasound-guided cannulation, venous filling is required for venipuncture. Tourniquet with an elastic tube at the axilla is the most common method to induce venous stasis for cannulation of the deep veins of the arm. Although effective, this method might be associated with short- and long-term complications. Valsalva manoeuvre has been used to produce venous filling in other extrathoracic veins. The aim of this observational study is to demonstrate the effect of Valsalva manoeuvre in respect of the elastic tourniquet on venous distention during echography-guided cannulation of the deep veins of the arm. Sixty-nine patients scheduled for cannulation of basilic or brachial vein were prospectively observed. Vein diameters were recorded at rest and after 10 s of Valsalva or tourniquet placement. The mean difference between basilic vein diameters during tourniquet and Valsalva manoeuvre was 0.006 mm (95% confidence interval = -inf, 0.09) with a standard deviation of 0.5 mm (95% confidence interval = 0.5, 0.7; p > 0.01). The mean difference between brachial vein diameters during tourniquet and Valsalva manoeuvre was 0.04 mm (95% confidence interval = -0.23, 0.15) with a standard deviation of 0.8 mm (95% confidence interval = 0.7, 0.9; p > 0.01). This increase in cross-sectional basilic and brachial vein diameters was not different to that obtained with the elastic tube tourniquet.

  20. Trans-aortic repair of a sinus of valsalva aneurysm.

    Science.gov (United States)

    Kapetanakis, Emmanouil I; Ieromonachos, Constantinos; Stavridis, George; Antoniou, Theofani A; Athanassopoulos, George; Cokkinos, Dennis V; Alivizatos, Peter A

    2007-01-01

    Sinus of Valsalva aneurysms are rare and vary in their presentation and approach of surgical repair. We report on a case of isolated right sinus of Valsalva aneurysm that underwent successful excision and patch repair with individual sutures placed through the annulus of the aortic valve.

  1. Radiological evaluation of sinus valsalva rupture

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yul; Park, Jae Hyung; Yeon, Kyung Mo; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1984-03-15

    We obtained the following results by reviewing the radiographic findings of 15 cases of Sinus valsalva rupture who were diagnosed surgically at Seoul National University Hospital since 1979. 1. Among distribution was from 15 years to 40 years with the mean age of 24 years. Among the 15 cases, 9 cases were male and 7 were female. 2. Ruptured sinus is right coronary sinus projecting to right ventricle in all 15 cases. Combined diseases are ventricular septal defect in 12 cases, Aortic Valvular heart disease in 4 cases, and narrowing of right ventricular outflow tract in 2 cases, and aneurysmal dilatation of right pulmonary artery in 1 cases. 3. Chest X-ray findings were that of left to right shunt, i.e, cardiomegaly, increased pulmonary vascularity but were normal in 3 cases. 4. Aortography showed sequential leakage of dye from right coronary sinus to right ventricle and finally to pulmonary artery in 9 cases, and in 9 cases of them the leakage is directly to right ventricular outflow tract without filling of sinus portion of the ventricle., i.e., type I. 5. The leakage was well shown in left ventricular diastolic phase and not shown in systolic phase. 6. Ventricular septal defects were not detected definitely in spite of taking left ventriculography. 7. Cine angiography is essential for detecting accurate site, degree and direction of sinus valsalva rupture and other associated cardiac abnormality.

  2. Radiological evaluation of sinus valsalva rupture

    International Nuclear Information System (INIS)

    Lee, Yul; Park, Jae Hyung; Yeon, Kyung Mo; Han, Man Chung

    1984-01-01

    We obtained the following results by reviewing the radiographic findings of 15 cases of Sinus valsalva rupture who were diagnosed surgically at Seoul National University Hospital since 1979. 1. Among distribution was from 15 years to 40 years with the mean age of 24 years. Among the 15 cases, 9 cases were male and 7 were female. 2. Ruptured sinus is right coronary sinus projecting to right ventricle in all 15 cases. Combined diseases are ventricular septal defect in 12 cases, Aortic Valvular heart disease in 4 cases, and narrowing of right ventricular outflow tract in 2 cases, and aneurysmal dilatation of right pulmonary artery in 1 cases. 3. Chest X-ray findings were that of left to right shunt, i.e, cardiomegaly, increased pulmonary vascularity but were normal in 3 cases. 4. Aortography showed sequential leakage of dye from right coronary sinus to right ventricle and finally to pulmonary artery in 9 cases, and in 9 cases of them the leakage is directly to right ventricular outflow tract without filling of sinus portion of the ventricle., i.e., type I. 5. The leakage was well shown in left ventricular diastolic phase and not shown in systolic phase. 6. Ventricular septal defects were not detected definitely in spite of taking left ventriculography. 7. Cine angiography is essential for detecting accurate site, degree and direction of sinus valsalva rupture and other associated cardiac abnormality

  3. Sinus of Valsalva aneurysm: An uncommon presentation

    Directory of Open Access Journals (Sweden)

    Ahmad Mirdamadi

    2012-10-01

    Full Text Available BACKGROUND: Sinus of Valsalva aneurysm (SVA may be congenital or acquired. They could mimic ventricular tumor symptoms and cause signs and symptoms of ventricular outflow tract obstruction. They may also involve the conduction system and cause palpitations or syncopal episodes. Both transthoracic echocardiography (TTE and transesophageal echocardiography (TEE serve as quick, noninvasive methods to provide information on size and location of aneurysmal dilatation and cardiac chamber involvement. These methods can identify any associated anomalies or complications. This study presents a patient with unruptured SVA. CASE REPORT: A 46-year-old man, who had been suffering from nonspecific symptoms such as exercise intolerance and weakness for a few months, referred to our clinic in Isfahan (Iran. In TTE, a large mass was observed in the right ventricle. SVA was suspected after meticulous probing. This diagnosis was confirmed by TEE and computed tomography angiography. At open heart surgery, an SVA with a lot of clots it was removed. CONCLUSION: SVA must be kept in mind when a tumor-like mass is observed in the right ventricle. Detailed evaluation would thus be necessary to rule out SVA and to prevent wrong diagnosis and treatment that can sometimes be catastrophic. Keywords: Sinus Valsalva, Aneurysm, Cardiac Tumor.

  4. Aneurisma del seno de Valsalva derecho

    Directory of Open Access Journals (Sweden)

    Rebeca Manrique

    2010-10-01

    Full Text Available Varón de 60 años con antecedente de hipertensión arterial, diagnosticado incidentalmente de aneurisma del seno de Valsalva derecho de 7 cm con insuficiencia aórtica ligera. Bajo circulación extracorpórea y pinzamiento aórtico se reseca el aneurisma y se reconstruye el defecto con un parche de prótesis Dacron Hemashield Platinum® (Maquet, Rastatt, Alemania, reimplantando el ostium coronario derecho y realizando derivación aortocoronaria a primera marginal con vena safena (hallazgo en cateterismo preoperatorio. La ecocardiografía intraoperatoria objetivó insuficiencia aórtica trivial residual. Como complicación postoperatoria presentó ictus en el territorio de la cerebral media izquierda, con restitutio ad integrum.

  5. "Endoview" project of intrapartum endoscopy.

    Science.gov (United States)

    Petrikovsky, Boris M; Ravens, Steven

    2002-01-01

    The change in obstetrical practices over the last decade in favor of trials of labor in patients with uterine scars has resulted in increased incidences of uterine ruptures. Although neither repeat cesarean delivery nor a trial of labor is risk free, evidence from a large multicenter study shows vaginal birth after the cesarean (VBAC) is associated with shorter hospital stays, fewer postpartum blood transfusions, and a decreased incidence of postpartum maternal fever. The uterine rupture remains the most serious complication associated with VBAC. Factors associated with uterine rupture include excessive exposure to oxytocin, dysfunctional labor, and a history of more than 1 cesarean delivery.2 Because uterine rupture may be a life-threatening event, intrapartum surveillance and the ability to perform an emergency surgery are both necessary when trial of labor is allowed. Until now, no early symptoms pathognomonic to uterine rupture had been described. We share our experiences with the novel approach to the problem - an intrapartum endoscopy. Endoscopic examination was accomplished by using the intraoperational fiberscope (Olympus and Endoview system (Costa Mesa, CA, USA). A gas-sterilized 25-cm long fiberscope is introduced into the amniotic cavity through the cervical canal after rupture of the membranes. The distance between the fiberscope and the object varies from 3 to 50 mm. The fiberscope has a separate channel for the fluid infusion (normal saline) throughout the procedure; the surgeon looks through the eyepiece directly and exhibits control over the flexible scope. The duration of endoscopy is less than 15 minutes. The inserting of the endoscopic device is very similar to that of insertion of an intrauterine pressure catheter. The IRB Committees of both participating institutions approved the study protocol. Twenty-eight patients with an unknown or poorly documented site of the uterine scar were included in the study. An ultrasound examination had been

  6. Modified Valsalva test differentiates primary from secondary cough headache.

    Science.gov (United States)

    Lane, Russell J M; Davies, Paul T G

    2013-03-28

    The current definition of cough headache includes provocation of the symptom by Valsalva manoeuvre, and it is generally believed that all cough headache results from a sudden increase in intracranial pressure. We sought to question that presumption and to determine whether the Valsalva test might distinguish primary from secondary cough headache. We examined 16 consecutive cough headache patients using a modified Valsalva test (exhalation into the connecting tube of a standard anaeroid sphygmomanometer to 60 mm Hg for 10 seconds). A positive response was recorded if the manoeuvre provoked headache. All patients subsequently underwent brain MRI. None of the patients had neurological signs. Eleven had positive modified Valsalva tests. Ten were found subsequently to have posterior fossa pathologies (secondary cough headache: 8 Chiari Type 1 malformations, 2 posterior fossa meningiomas). The cough headache was relieved following surgery in all cases. One patient with a positive Valsalva test had an apparently normal brain MRI but measurements of hindbrain and posterior fossa dimensions were consistent with 'posterior fossa crowdedness'. The remaining 5 patients had negative (4 patients) or equivocal (1 patient) Valsalva tests and normal MRI scans (primary cough headache). These findings suggest that secondary cough headache results from a transient increase in intracranial CSF pressure during exertion in the presence of obstruction to normal cerebrospinal fluid dynamics. The modified Valsalva test can also determine whether tonsillar herniation found on brain MRI is symptomatic. Primary cough headache appears to be caused by a different mechanism, possibly through congestion of the orbital venous plexus in the presence of jugular venous incompetence and a reduced threshold for trigeminal sensory activation.

  7. Sex Differences in Insular Cortex Gyri Responses to the Valsalva Maneuver

    OpenAIRE

    Macey, Paul M.; Rieken, Nicholas S.; Kumar, Rajesh; Ogren, Jennifer A.; Middlekauff, Holly R.; Wu, Paula; Woo, Mary A.; Harper, Ronald M.

    2016-01-01

    Sex differences in autonomic regulation may underlie cardiovascular disease variations between females and males. One key autonomic brain region is the insular cortex, which typically consists of five main gyri in each hemisphere, and shows a topographical organization of autonomic function across those gyri. The present study aims to identify possible sex differences in organization of autonomic function in the insula. We studied brain functional magnetic resonance imaging (fMRI) responses t...

  8. Maneuver Automation Software

    Science.gov (United States)

    Uffelman, Hal; Goodson, Troy; Pellegrin, Michael; Stavert, Lynn; Burk, Thomas; Beach, David; Signorelli, Joel; Jones, Jeremy; Hahn, Yungsun; Attiyah, Ahlam; hide

    2009-01-01

    The Maneuver Automation Software (MAS) automates the process of generating commands for maneuvers to keep the spacecraft of the Cassini-Huygens mission on a predetermined prime mission trajectory. Before MAS became available, a team of approximately 10 members had to work about two weeks to design, test, and implement each maneuver in a process that involved running many maneuver-related application programs and then serially handing off data products to other parts of the team. MAS enables a three-member team to design, test, and implement a maneuver in about one-half hour after Navigation has process-tracking data. MAS accepts more than 60 parameters and 22 files as input directly from users. MAS consists of Practical Extraction and Reporting Language (PERL) scripts that link, sequence, and execute the maneuver- related application programs: "Pushing a single button" on a graphical user interface causes MAS to run navigation programs that design a maneuver; programs that create sequences of commands to execute the maneuver on the spacecraft; and a program that generates predictions about maneuver performance and generates reports and other files that enable users to quickly review and verify the maneuver design. MAS can also generate presentation materials, initiate electronic command request forms, and archive all data products for future reference.

  9. Puerperal and intrapartum group A streptococcal infection.

    Science.gov (United States)

    Anteby, E Y; Yagel, S; Hanoch, J; Shapiro, M; Moses, A E

    1999-01-01

    OBJECTIVE: To determine the demographic and clinical variables characteristic of non-epidemic intrapartum or puerperal group A streptococcal (GAS) infection. METHODS: The records of 47 patients diagnosed with intrapartum or puerperal GAS infection over a 6 1/2 year period at Hadassah-University Hospital-Mt. Scopus, Jerusalem were reviewed. Data regarding 25,811 women, the general population of women that delivered during that period, were obtained from their computerized medical records. Frequency distributions, t-test, chi-square, and Spearman's Rank Correlation were used, as appropriate, to analyze and compare demographic and clinical variables associated with development of GAS infection, its clinical course and subsequent development of septic shock. RESULTS: Mean age of mothers with GAS infection was higher than that of our general pregnant population (30.4 versus 27.4 years, P = 0.0019), and a higher proportion of GAS infected patients (30% versus 12%, P < 0.005) experienced PROM. Thirty-one (66%) women had fever as their sole presenting symptom, eight (17%) had fever and abdominal pain, seven (15%) had fever and abnormal vaginal bleeding, and one patient (2%) presented with a rash. Three patients (6%) developed a septic shock. Two of these patients presented with symptoms more than 14 days after delivery. CONCLUSIONS: We describe the characteristics of non-epidemic intrapartum or puerperal GAS infection. Data from our study and review of the literature suggest that some patients who develop septic shock may present later in the puerperium than patients with an uncomplicated GAS infection. PMID:10598916

  10. Maneuver from the Air Domain

    Science.gov (United States)

    2016-05-26

    Overload From the previous discussion, cognitive maneuver seeks to degrade the enemy’s capacity for...in all domains, the ability to maneuver from the air domain in the cognitive sense, comes primarily from air power’s unique ability to overload the... cognitive maneuver mechanisms developed in the 1980s as part of broader maneuver warfare theory. The result is a proposed definition of maneuver from

  11. Sinus of Valsalva Pseudoaneurysm as a Sequela to Infective Endocarditis.

    Science.gov (United States)

    Lee, Chin C; Siegel, Robert J

    2016-02-01

    Pseudoaneurysm is an uncommon sequela of infective endocarditis. We treated a 44-year-old man who had an active case of group B streptococcal infective endocarditis of the aortic valve despite no evidence of valvular dysfunction or vegetation on his initial transesophageal echocardiogram. After completing 6 weeks of intravenous antibiotic therapy, the patient developed a sinus of Valsalva pseudoaneurysm and severe aortic regurgitation caused by partial detachment of the left coronary cusp. We used a pericardial patch to close the pseudoaneurysm and repair the coronary cusp. This case shows the importance of routine clinical follow-up evaluation in infective endocarditis, even after completion of antibiotic therapy. Late sequelae associated with infective endocarditis or its therapy include recurrent infection, heart failure caused by valvular dysfunction (albeit delayed), and antibiotic toxicity such as aminoglycoside-induced nephropathy and vestibular toxicity.

  12. Bacterial Endocarditis Caused by Lactobacillus acidophilus Leading to Rupture of Sinus of Valsalva Aneurysm.

    Science.gov (United States)

    Encarnacion, Carlos Omar; Loranger, Austin Mitchell; Bharatkumar, A G; Almassi, G Hossein

    2016-04-01

    Lactobacillus acidophilus rarely causes bacterial endocarditis, because it usually resides in the mucosa of the vagina, gastrointestinal tract, and oropharynx. Moreover, sinus of Valsalva aneurysms are rare cardiac anomalies, either acquired or congenital. We present the case of a middle-aged man whose bacterial endocarditis, caused by Lactobacillus acidophilus, led to an aneurysmal rupture of the sinus of Valsalva into the right ventricular outflow tract. The patient underwent successful surgical repair, despite numerous complications and sequelae.

  13. Ruptured Sinus of Valsalva Aneurysm and Coarctation of Aorta in a Woman at Early Postpartum Period

    Directory of Open Access Journals (Sweden)

    Erol Sener

    2014-01-01

    Full Text Available Coarctation of aorta and sinus of Valsalva aneurysm are frequently missed congenital cardiac defects that their diagnosis might be delayed. To our knowledge, coincidence of these cardiac defects is unusual and has not been reported in the literature before. Here, we present a patient with coarctation of aorta and ruptured noncoronary sinus of Valsalva aneurysm leading to aorto-right atrial fistula in the early postpartum period and our management of this unusual case.

  14. A Comparison of Obstetric Maneuvers for the Acute Management of Shoulder Dystocia

    Science.gov (United States)

    Hoffman, Matthew K; Bailit, Jennifer L; Branch, D. Ware; Burkman, Ronald T; Van Veldhusien, Paul; Lu, Li; Kominiarek, Michelle A.; Hibbard, Judith U; Landy, Helain J; Haberman, Shoshana; Wilkins, Isabelle; Gonzalez Quintero, Victor H; Gregory, Kimberly D; Hatjis, Christos G; Ramirez, Mildred M; Reddy, Uma M.; Troendle, James; Zhang, Jun

    2011-01-01

    Objective To assess the efficacy of obstetric maneuvers for resolving shoulder dystocia, and the effect that these maneuvers have on neonatal injury when shoulder dystocia occurs. Methods Using an electronic database encompassing 206,969 deliveries, we identified all women with a vertex fetus beyond 34 0/7 weeks of gestation who incurred a shoulder dystocia during the process of delivery. Women whose fetuses had a congenital anomaly and women with an antepartum stillbirth were excluded. Medical records of all cases were reviewed by trained abstractors. Cases involving neonatal injury (defined as brachial plexus injury, clavicular or humerus fracture, or hypoxic ischemic encephalopathy or intrapartum neonatal death attributed to the shoulder dystocia) were compared to those without injury. RESULTS Among 132,098 women who delivered a term cephalic liveborn fetus vaginally, 2,018 incurred a shoulder dystocia (1.5%), and 101 (5.2%) of these incurred a neonatal injury. Delivery of the posterior shoulder was associated with the highest rate of delivery when compared to other maneuvers (84.4% compared with 24.3% to 72.0% for other maneuvers; Pdystocia. The need for additional maneuvers was associated with higher rates of neonatal injury. PMID:21555962

  15. Intrauterine temperature during intrapartum amnioinfusion: a prospective observational study.

    Science.gov (United States)

    Tomlinson, T M; Schaecher, C; Sadovsky, Y; Gross, G

    2012-07-01

    To determine the influence of routine intrapartum amnioinfusion (AI) on intrauterine temperature. Prospective observational study. Maternity unit, Barnes Jewish Hospital, St Louis, MO, USA. Forty women with singleton gestations and an indication for intrapartum intrauterine pressure catheter placement. Using a temperature probe, we digitally recorded intrauterine temperature every 10 minutes during labour. Amnioinfusion was administered according to a standard protocol using saline equilibrated to the ambient temperature. Mean intrauterine temperature during labour. Participants were monitored for a mean of 280 minutes (range 20-820). A total of 164 intrauterine temperature readings in the AI cohort were compared with 797 control measurements. When compared with controls, we observed a lower intrauterine temperature in the AI cohort (36.4 versus 37.4°C, P<0.01). More measurements in the AI cohort were recorded in the presence of intrapartum fever (40% versus 30%). A subgroup analysis of measurements recorded in afebrile parturients revealed an even greater effect of AI (1.5°C decrease, 37.3 versus 35.8°C, P<0.01). Routine intrapartum AI using saline equilibrated to a mean ambient temperature of 25.0°C reduces intrauterine temperature and may thereby affect fetal core temperature. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

  16. The problem of intrapartum asphyxia and birth trauma: editorial ...

    African Journals Online (AJOL)

    The problem of intrapartum asphyxia and birth trauma: editorial. AP Macdonald. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL · AJOL's ...

  17. Associations between intrapartum death and piglet, placental, and umbilical characteristics.

    Science.gov (United States)

    Rootwelt, V; Reksen, O; Farstad, W; Framstad, T

    2012-12-01

    Intrapartum death in multiparous gestations in sows (Sus scrofa) is often caused by hypoxia. There is little information in the literature on the assessment of the placenta in relation to intrapartum death in piglets. The aim of this study was to evaluate the impact of the placental area and weight upon piglet birth characteristics and intrapartum death. Litters from 26 Landrace-Yorkshire sows were monitored during farrowing and the status of each piglet was recorded, including blood parameters of piglets and their umbilical veins. Of 413 piglets born, 6.5% were stillborn. Blood concentrations of glucose, lactate, and CO(2) partial pressure were increased in the stillborn piglets (P birth was increased for piglets born dead vs. live (P birth weight for piglets born dead was not different from live-born piglets (P = 0.631), whereas mean body mass index was reduced (P 0.2). Piglet BW was positively correlated with placental area and placental weight (P birth order group, and broken umbilical cords explained 71% of the stillbirths (P = 0.001). We conclude that placental area and placental weight are both positively associated with piglet birth weight, but not with the probability of being born dead. Placental area was a better predictor of piglet vitality than placental weight. Because umbilical cord rupture and prolonged birth time were associated with being born dead, umbilical cord rupture and placental detachment seem to be probable causes of intrapartum death.

  18. Suction/inspiration against resistance or standardized Mueller maneuver: a new breathing technique to improve contrast density within the pulmonary artery: a pilot CT study

    Energy Technology Data Exchange (ETDEWEB)

    Gutzeit, Andreas [Paracelsus Medical University Salzburg, Department of Radiology, Salzburg (Austria); Hirslanden Hospital St. Anna, Institute of Radiology and Nuclear Medicine, Clinical Research Unit, Lucerne (Switzerland); Kantonsspital Winterthur, Department of Radiology, Winterthur (Switzerland); Froehlich, Johannes M.; Weymarn, Constantin von; Goyen, Matthias [Hirslanden Hospital St. Anna, Institute of Radiology and Nuclear Medicine, Clinical Research Unit, Lucerne (Switzerland); Waelti, Stephan [Cantonal Hospital St. Gallen, Department of Radiology and Nuclear Medicine, St. Gallen (Switzerland); Roos, Justus E. [Duke University Medical Center, Department of Radiology, Durham, NC (United States); Meissnitzer, Matthias; Hergan, Klaus [Paracelsus Medical University Salzburg, Department of Radiology, Salzburg (Austria); Czell, David [Cantonal Hospital Winterthur, Department of Neurology, Winterthur (Switzerland); Reischauer, Carolin [Paracelsus Medical University Salzburg, Department of Radiology, Salzburg (Austria); Hirslanden Hospital St. Anna, Institute of Radiology and Nuclear Medicine, Clinical Research Unit, Lucerne (Switzerland)

    2015-11-15

    Our aim was to prospectively investigate whether the recently introduced suction/inspiration against resistance breathing method leads to higher computed tomography (CT) contrast density in the pulmonary artery compared to standard breathing. The present study was approved by the Medical Ethics committee and all subjects gave written informed consent. Fifteen patients, each without suspicious lung emboli, were randomly assigned to four different groups with different breathing maneuvers (suction against resistance, Valsalva, inspiration, expiration) during routine CT. Contrast enhancement in the central and peripheral sections of the pulmonary artery were measured and compared with one another. Peripheral enhancement during suction yielded increased mean densities of 138.14 Hounsfield units (HU) (p = 0.001), compared to Valsalva and a mean density of 67.97 HU superior to inspiration (p = 0.075). Finally, suction in comparison to expiration resulted in a mean increase of 30.51 HU (p = 0.42). Central parts of pulmonary arteries presented significantly increased enhancement values (95.74 HU) for suction versus the Valsalva technique (p = 0.020), while all other mean densities were in favour of suction (versus inspiration: p = 0.201; versus expiration: p = 0.790) without reaching significance. Suction/Inspiration against resistance is a promising technique to improve contrast density within pulmonary vessels, especially in the peripheral parts, in comparison to other breathing maneuvers. (orig.)

  19. Anomalous Origin of the Left Coronary Artery from the Right Sinus of Valsalva and Sever Mitral Stenosis

    Science.gov (United States)

    Abdi, Ahmadnoor; Hashemi Fard, Omid

    2011-01-01

    Congenital coronary anomalies are presented in approximately1% of patient referred for cardiac catheterization. Among the congenital coronary anomalies, a separated anomalous origin of all the coronary arteries from the right sinus of valsalva is very uncommon. We report a rare occurance of simultaneous occurence of mitral stenosis with ectopic origin of left main stem coronary artery from right sinus of Valsalva. PMID:22577434

  20. Support and maneuvering device

    Science.gov (United States)

    Wood, R.L.

    1987-03-23

    A support and maneuvering device includes an elongated flexible inflatable enclosure having a fixed end and a movable end. The movable end is collapsible toward the fixed end to a contracted position when the enclosure is in a noninflated condition. Upon inflation, the movable end is movable away from the fixed end to an extended position. The movable end includes means for mounting an article such as a solar reflector thereon. The device also includes a plurality of position controlling means disposed about the movable end to effect adjusting movement of portions thereof by predetermined amounts and for controlling an angle at which the article disposed at the movable end is oriented. The plurality of position controlling means limits a suitable number degrees of freedom of the movable end for transmitting a steering motion thereto and for controlling the position thereof. 9 figs.

  1. of Valsalva aneurysm atrium and right Rupture of sinus into both ...

    African Journals Online (AJOL)

    1983-04-16

    Apr 16, 1983 ... arrange for urgent transfer of the patient to Tygerberg Hospital. Physical ..... extremely thin and contained perforations near the implantation at the apex of the .... underlying lesion in a ruptured sinus of Valsalva is a lack of fusion or ... Occasionally, an apical mid-diastolic flow murmur is encoun- tered ...

  2. Transcatheter closure of ruptured sinus of valsalva aneurysms: evaluation of therapeutic results

    International Nuclear Information System (INIS)

    Wu Guangwei; Xu Nengwen; Wang Mengjie; Wu Xubin

    2014-01-01

    Objective: To discuss the clinical effects and safety, of transcatheter closure in treating ruptured sinus of valsalva aneurysm (RSVA). Methods: During the period from May 2007 to June 2012, 5 patients (4 males and 1 female) with RSVA were treated with interventional occlusion therapy at authors' hospital. The aortic root angiography and echocardiography indicated that all the five patients had single sinus of valsalva aneurysm, including rupture of right coronary sinus of valsalva aneurysm into the right ventricle (n=3) and into the right atrium (n=2). Results: The occluder placement was successfully accomplished in all the 5 patients. Patent arterial duct occluder was employed in two patients, while ventricular septal defect occluder was adopted in three patients, After the procedure, the five patients were followed up for 12- 60 months (mean 30.2 months), and echocardiography and electrocardiography were conducted to evaluate the clinical effects. After the interventional occlusion therapy, in all patients the inner-diameters of the right ventricular and right atrium were markedly reduced, and the heart murmur disappeared. The occluder was situated in the right place. No complications such as hemolysis or aortic regurgitation occurred. Conclusion: Transcatheter closure is a mini-invasive, safe, simple and effective technique for the treatment of ruptured sinus of valsalva aneurysm. The short-term result is satisfactory, although its long-term efficacy needs to be further studied. (authors)

  3. Transcatheter device closure of multiple defects in ruptured sinus of Valsalva aneurysm

    Directory of Open Access Journals (Sweden)

    A. Vamsidhar

    2015-12-01

    Full Text Available Ruptured sinus of Valsalva aneurysm (SOVA with multiple communications, ventricular septal defect, and aortic regurgitation are still best treated surgically. We report a case of 30-year-old male with right SOVA, with two communications with right ventricle. Both communications were successfully closed using antegrade and retrograde approaches, respectively.

  4. Rupture of Sinus of Valsalva Aneurysm Associated with Left Ventricular Noncompaction and Mitral Valve Prolapse

    Directory of Open Access Journals (Sweden)

    Sinan Aydoğdu

    2011-08-01

    Full Text Available We report a 27-year-old patient with ruptured sinus Valsalva aneurysm (SVA, left ventricular noncompaction and mitral valve prolapse. Whether the coexistence of ruptured SVA, left ventricular noncompaction and mitral valve prolapse is coincidental or due to a defect in a common developmental pathway requires further research.

  5. Rupture of sinus of Valsalva aneurysm into both right atrium and ...

    African Journals Online (AJOL)

    A young man had a congenital sinus of Valsalva aneurysm originating from the right coronary sinus, complicated by fistulas draining into both right atrium and right ventricle, as well as a congenitally abnormal aortic valve with mild aortic insufficiency. His dramatic clinical presentation, with the sudden appearance of severe ...

  6. Intrapartum transcervical amnioinfusion for meconium-stained amniotic fluid.

    Science.gov (United States)

    Das, A K; Jana, N; Dasgupta, S; Samanta, B

    2007-06-01

    To assess the rates of cesarean deliveries and perinatal outcome following intrapartum transcervical amnioinfusion in women with meconium-stained amniotic fluid (MSAF) in a setting with no electronic fetal monitoring or specialized neonatal care. In this prospective comparative study with 150 women who were in labor and had MSAF, 50 of the women received a transcervical amnioinfusion and the remaining 100 women received standard care. The inclusion criteria were a pregnancy of at least 37 weeks' duration, a single live fetus in cephalic presentation, no major medical or obstetric complications, and no known fetal malformation. The amnioinfusion was performed with 1000 mL of normal saline solution through a red rubber catheter. Amnioinfusion was associated with a significant decrease in the incidence of low Apgar score (amnioinfusion than in the control group (24% vs. 48%; RR, 0.5; 95% CI, 0.29-0.85). There were no major complications related to amnioinfusion. Intrapartum amnioinfusion for MSAF is a simple, safe, effective, and inexpensive procedure feasible in settings where intrapartum monitoring is limited. It is associated with improved perinatal outcome and could lower cesarean delivery rates in low-resource countries.

  7. Orbital maneuvering end effectors

    Science.gov (United States)

    Myers, W. Neill (Inventor); Forbes, John C. (Inventor); Barnes, Wayne L. (Inventor)

    1986-01-01

    This invention relates to an end effector device for grasping and maneuvering objects such as berthing handles of a space telescope. The device includes a V-shaped capture window defined as inclined surfaces in parallel face plates which converge toward a retainer recess in which the handle is retained. A pivotal finger (30) meshes with a pair of pivoted fingers which rotate in counterrotation. The fingers rotate to pull a handle within the capture window into recess where latches lock handle in the recess. To align the capture window, plates may be cocked plus or minus five degrees on base. Drive means is included in the form of a motor coupled with a harmonic drive speed reducer, which provides for slow movement of the fingers at a high torque so that large articles may be handled. Novelty of the invention is believed to reside in the combined intermeshing finger structure, drive means and the harmonic drive speed reducer, which features provide the required maneuverability and strength.

  8. Evaluation of a rapid, real-time intrapartum group B Streptococcus assay

    Science.gov (United States)

    YOUNG, Brett C.; DODGE, Laura E.; GUPTA, Munish; RHEE, Julie S.; HACKER, Michele R.

    2011-01-01

    OBJECTIVE To evaluate an intrapartum nucleic acid amplification test (NAAT) for Group B streptococcus (GBS). STUDY DESIGN Prospective cohort study of 559 women comparing intrapartum GBS culture with antepartum culture and intrapartum NAAT. RESULTS GBS prevalence was 19.5% by antepartum culture and 23.8% by intrapartum culture. Compared with intrapartum culture, antepartum culture had 69.2% sensitivity (60.6–76.9) and 96.0% specificity (93.7–97.7). The NAAT demonstrated sensitivity of 90.8% (84.6–95.2), specificity of 97.6% (95.6–98.8), and predictive values exceeding 92%. The incidence of discordant cultures was 10.4%. Of the women with negative antepartum and positive intrapartum cultures, only 1 (2.4%) received intrapartum antibiotics. Compared with white women, black (P=0.02) and Hispanic (P=0.02) women were more likely to have discordant cultures. CONCLUSION This intrapartum NAAT has excellent characteristics. It may be superior to antepartum culture for detecting intrapartum GBS—allowing more accurate management of laboring mothers and reducing neonatal GBS sepsis. PMID:21864820

  9. Intrapartum analgesia as a condition of human satisfaction at hospital

    Directory of Open Access Journals (Sweden)

    Concetta Polizzi

    2013-06-01

    Full Text Available The study investigates parturients’ satisfaction with intrapartum analgesia. It aims to assess their opinions about hospital and health staff involved in delivery, besides investigating emotional control, locus control and bond between mothers and their newborn infants. A multidimensional approach has been used to investigate the variable of woman as a person, the variable of context and the variable of bond with the newborn infant. The study was conducted according to a quasi-experimental design, with a control group. The study was performed within the Analgesia and Intensive Care Operational Unit of the Maternal-Infant Department of the P. Giaccone University General Hospital of Palermo. It involved 60 women subdivided into two groups of 30 women each, the experimental group (women who requested intrapartum analgesia called the A group, and the control group (women who refused it called the B group. The following tools were administered: the STAI-Y (State-Trait Anxiety Inventory, form Y scale; the Depression Questionnaire of CBA (Cognitive Behavioural Assessment scale; the Locus of Control questionnaire; and an interview designed for the purpose. The experimental A group women exhibited lower levels of state anxiety and depression post-partum than those of the control B group; moreover, the women in the A group exhibited higher levels of external locus of control and evaluated delivery more positively than those of the B group. There were no significant differences with regard to the relationship with their newborn infants. The study shows that intrapartum analgesia provides hospitals with the possibility to satisfy women’s needs for safety and well-being.

  10. Intrapartum fever and chorioamnionitis as risks for encephalopathy in term newborns: a case-control study.

    Science.gov (United States)

    Blume, Heidi K; Li, Christopher I; Loch, Christian M; Koepsell, Thomas D

    2008-01-01

    In this study we examined the relationship between diagnoses of isolated intrapartum fever or chorioamnionitis and the risk of encephalopathy in term newborns. We conducted a population-based, case-control study in Washington State using 1994 to 2002 linked data from the Washington State Birth Registry and the Comprehensive Hospital Abstract Reporting System (CHARS). We identified 1060 singleton, term newborns (602 males, 458 females) with International Classification of Diseases (ICD-9) diagnoses consistent with encephalopathy, and 5330 unaffected control newborns (2756 males, 2574 females). Intrapartum fever was defined by a diagnosis of intrapartum temperature of >38 degrees C in the birth registry or CHARS databases. Chorioamnionitis was defined using ICD-9 diagnoses recorded in CHARS. We identified 2.2 cases of encephalopathy per 1000 births. Isolated intrapartum fever was associated with a 3.1-fold (95% confidence interval [CI] 2.3-4.2) increased risk of newborn encephalopathy. Chorioamnionitis was associated with a 5.4-fold (95% CI 3.6-7.8) increased risk of encephalopathy. We found that isolated intrapartum fever and chorioamnionitis were independently associated with an increased risk of encephalopathy in term infants. Our data also indicate that there is a spectrum of risk for encephalopathy in term infants exposed to intrapartum fever. Infants born to women with signs of chorioamnionitis other than isolated intrapartum fever may be at higher risk of encephalopathy than those exposed only to isolated intrapartum fever.

  11. Aneurisma del seno de Valsalva disecando hacia el septo interventricular en una paciente embarazada

    Directory of Open Access Journals (Sweden)

    Edison Muñoz O.

    2015-11-01

    Full Text Available El aneurisma del seno de Valsalva es una entidad rara en la población general, con una incidencia de 0,14 al 3,5% en cirugías de corazón abierto; con un espectro clínico amplio y complicaciones cardiacas mecánicas o eléctricas que pueden ser fatales. En mujeres embarazadas también ha sido reportada esta entidad en unos cuantos casos en la literatura médica publicada. Se presenta un caso de una paciente gestante con aneurisma de seno de Valsalva, sus complicaciones y las medidas terapéuticas que se llevaron a cabo, además de una revisión del tema.

  12. Right Valsalva Sinus Aneurysm Protruding Into the Right Ventricle: A Case Report

    Directory of Open Access Journals (Sweden)

    Ata H. Afshar

    2015-09-01

    Full Text Available A separation between the aortic media and annulus fibrosus causes a rare cardiac abnormality called sinus of Valsalva aneurysm (SVA that may be congenital or acquired. It is more prevalent in the right coronary sinus (65%-85% but it has been seen rarely in non-coronary (10%-30%or Left coronary sinus (<5%. The most common complication is rupture of the Aneurysm. We present an 80-year-old male with expanding right Valsalva sinus aneurysm and protruding into right ventricle. The conventional treatment is surgical repair under cardio-pulmonary bypass or percutaneous catheter closure. The aneurysm was successfully excised surgically under direct guidance of trans-esophageal echocardiography (TEE.

  13. Single coronary artery originating from the right sinus Valsalva and ability to work.

    Science.gov (United States)

    De Rosa, Roberto; Ratti, Gennaro; Gerardi, Donato; Tedeschi, Carlo; Lamberti, Monica

    2015-01-01

    We present a case of a 56-year-old male electrician who was admitted to the hospital with atrial fibrillation, atypical chest pain and dyspnea. He gave a history that on the morning he had working for almost 4 hours carrying out various activities with considerable physical effort. After cardioversion, conventional coronary angiography revealed a suspect of single coronary vessel (SCA) arising from the right sinus of Valsalva. The patient underwent multislice computed tomography that showed a SCA arising from the right sinus Valsalva and dividing in Right Coronary Artery (RCA) and Left Main coronary artery (LM). The finding of posterior course of the LM without atherosclerotic has proved crucial for the expression of an opinion of working capacity even with limitation.

  14. Non-coronary sinus of Valsalva aneurysm diagnosed after a road traffic accident

    OpenAIRE

    Ribeiro, A; Fernandes, F; Costeira, A; Simões, A; Rodrigues, P

    1999-01-01

    A 38 year old man with a huge unruptured sinus of Valsalva aneurysm, complicated with severe valvar aortic regurgitation, is described. The aneurysm was detected by echocardiography in the asymptomatic patient who presented with an intense precordial diastolic rumble after a road traffic accident. The patient had successful surgery for the aneurysm and aortic valve replacement. Possible aetiologies for the aneurysm and a brief revision of clinical aspects and treatment are discussed.


Keywor...

  15. Improved Maneuver Criteria Evaluation Program

    Science.gov (United States)

    1979-11-01

    If the rotor rpm breakpoint (OMGBL2) is le :-s than the mininum rotor rpm (OMEGMN), then the rpm bleed :ate (OMGBDI) will be the only bleed rate used...VCP =60 PSU 1 EEF = 1 OMGBD1=2 OMGBD3=0 OMGRC2=0 VERR = 2 MPRINT= 1 OMEGMN=300 OMGBL.2=4 OMGBL4=0 OMGRD2=0 MUF = 1 BINERT:2860 TRPMMN= 0 OMGBD2=0 OMGBD4...height is within 2 feet of the measured height. These comparisons show that the MCEP maneuvers are accurate for simulating these types of maneuvers

  16. Valsalva-Related Subretinal Hemorrhage as a Presenting Symptom of Polypoidal Choroidal Vasculopathy

    Directory of Open Access Journals (Sweden)

    Yousif Subhi

    2017-01-01

    Full Text Available Purpose. To describe a case of Valsalva-related subretinal hemorrhage as a presenting symptom of polypoidal choroidal vasculopathy (PCV. The patient refrained from treatment against our best advice, and thus this is also a rare case of the natural course of an untreated PCV. Methods. Case report. Results. A 66-year-old female with a respiratory infection coughed intensely until exhaustion, after which she developed visual symptoms on the right eye. Primary care ophthalmologist examined the patient on the same day of the onset of symptoms and referred her to our tertiary medical retinal service for detailed retinal diagnosis including fluorescein and indocyanine green angiography. The right eye had a large subretinal hemorrhage and pigment epithelium detachment in the lower temporal arcade with foveal involvement. Against our best advice, the patient refused treatment. In the following 9 months, the BCVA decreased from 68 to 55 ETDRS letters, the subretinal hemorrhage almost regressed, pigment epithelium detachments persisted, and macular edema, intraretinal cysts, and subretinal fibrosis developed. Conclusions. Although classic Valsalva retinopathy with preretinal hemorrhage in most cases can be managed by careful observation and no treatment, this case demonstrates that Valsalva-related subretinal hemorrhage needs different attention and approach.

  17. Valsalva and gravitational variability of the internal jugular vein and common femoral vein: Ultrasound assessment

    Energy Technology Data Exchange (ETDEWEB)

    Beddy, P. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland)]. E-mail: pbeddy@eircom.net; Geoghegan, T. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Ramesh, N. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Buckley, O. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); O' Brien, J. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Colville, J. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Torreggiani, W.C. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland)

    2006-05-15

    Purpose: Central venous cannulation via the common femoral vein is an important starting point for many interventions. The purpose of this study was to determine the optimum conditions for cannulation of the femoral vein and to compare these with the relative changes in the internal jugular vein. Methods: High-resolution 2D ultrasound was utilised to determine variability of the calibre of the femoral and internal jugular veins in 10 healthy subjects. Venous diameter was assessed during the Valsalva manoeuvre and in different degrees of the Trendelenburg position. Results: The Valsalva manoeuvre significantly increased the size of the femoral and internal jugular veins. There was a relatively greater increase in femoral vein diameter when compared with the internal jugular vein of 40 and 29%, respectively. Changes in body inclination (Trendelenburg position) did not significantly alter the luminal diameter of the femoral vein. However, it significantly increased internal jugular vein diameter. Conclusions: Femoral vein cannulation is augmented by the Valsalva manoeuvre but not significantly altered by the gravitational position of the subject.

  18. Hemodynamics in the Valsalva sinuses after transcatheter aortic valve implantation (TAVI).

    Science.gov (United States)

    Ducci, Andrea; Tzamtzis, Spyridon; Mullen, Michael J; Burriesci, Gaetano

    2013-09-01

    The study aim was to assess, in vitro, the hemodynamic modifications produced by transcatheter valves in the Valsalva sinuses, by mean of phase-resolved particle image velocimetry (PIV) measurements. Flow measurements were performed on a glass mock aortic root that included three polymeric valve leaflets, before and after the implantation of a Medtronic CoreValve device and of an Edwards SAPIEN valve. All experiments were carried out in a hydro-mechanical cardiovascular pulse duplicator system (Vivitro Superpump System SP3891) that reproduced physiologically equivalent pressures and flow rates conforming to the requirements of the standard ISO 5840:2005. The flow dynamics, before and after implantation of the two prosthetic devices, was characterized on the basis of phase-resolved velocity field and viscous shear rate measurements. Direct comparison indicated that both transcatheter valves determined a significant variation of flow during the early stages of valve opening and during valve closure. In general, the presence of the two valve implants significantly reduced the flow activity in the Valsalva sinuses, promoting regions of stagnation at their base. The reduction in flow in the Valsalva sinuses could be associated with the higher incidence of ischemic events reported after transcatheter heart valve implantation.

  19. Professionally responsible intrapartum management of patients with major mental disorders.

    Science.gov (United States)

    Babbitt, Kriste E; Bailey, Kala J; Coverdale, John H; Chervenak, Frank A; McCullough, Laurence B

    2014-01-01

    Pregnant women with major mental disorders present obstetricians with a range of clinical challenges, which are magnified when a psychotic or agitated patient presents in labor and there is limited time for decision making. This article provides the obstetrician with an algorithm to guide professionally responsible decision making with these patients. We searched for articles related to the intrapartum management of pregnant patients with major mental disorders, using 3 main search components: pregnancy, chronic mental illness, and ethics. No articles were found that addressed the clinical ethical challenges of decision making during the intrapartum period with these patients. We therefore developed an ethical framework with 4 components: the concept of the fetus as a patient; the presumption of decision-making capacity; the concept of assent; and beneficence-based clinical judgment. On the basis of this framework we propose an algorithm to guide professionally responsible decision making that asks 5 questions: (1) Does the patient have the capacity to consent to treatment?; (2) Is there time to attempt restoration of capacity?; (3) Is there an opportunity for substituted judgment?; (4) Is the patient accepting treatment?; (5) Is there an opportunity for active assent?; and (6) coerced clinical management as the least worst alternative. The algorithm is designed to support a deliberative, clinically comprehensive, preventive-ethics approach to guide obstetricians in decision making with this challenging population of patients. Copyright © 2014 Mosby, Inc. All rights reserved.

  20. Rendezvous maneuvers using Genetic Algorithm

    International Nuclear Information System (INIS)

    Dos Santos, Denílson Paulo Souza; De Almeida Prado, Antônio F Bertachini; Teodoro, Anderson Rodrigo Barretto

    2013-01-01

    The present paper has the goal of studying orbital maneuvers of Rendezvous, that is an orbital transfer where a spacecraft has to change its orbit to meet with another spacecraft that is travelling in another orbit. This transfer will be accomplished by using a multi-impulsive control. A genetic algorithm is used to find the transfers that have minimum fuel consumption

  1. 33 CFR 84.23 - Maneuvering light.

    Science.gov (United States)

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Maneuvering light. 84.23 Section... RULES ANNEX I: POSITIONING AND TECHNICAL DETAILS OF LIGHTS AND SHAPES § 84.23 Maneuvering light. Notwithstanding the provisions of § 84.03(f), the maneuvering light described in Rule 34(b) shall be placed...

  2. [Intrapartum amnioinfusion in patients with meconium-stained amniotic fluid].

    Science.gov (United States)

    Engel, Karina; Samborska, Monika; Bilar, Marek; Sipak-Szmigiel, Olimpia; Ronin-Walknowska, Elzbieta

    2008-09-01

    The aim of the study was to evaluate the effect of intrapartum amnioinfusion in the presence of meconium stained amniotic fluid. 93 women with meconium-stained amniotic fluid were assigned to receive amnioinfusion or no amnioinfusion (128 women). The trials were evaluated for fetal distress syndrome, route of delivery, fetal acidemia, Apgar score at 1 and 5 min., meconium aspiration syndrome, postpartum endometritis and maternal hospital stays. Amnioinfusion in cases of meconium-stained fluid did not improve the number of fetal distress symptoms during fetal heart rate monitoring. Amnioinfusion was associated with a significant decrease of neonatal acidemia although it did not improve Apgar score. In our study amnioinfusion was not associated with reduction in the incidence of neonatal outcome and puerperial complications.

  3. Morbidly Adherent Placenta: Interprofessional Management Strategies for the Intrapartum Period.

    Science.gov (United States)

    Baird, Suzanne McMurtry; Troiano, Nan H; Kennedy, Margaret Betsy Babb

    "Morbidly adherent placenta" is a term that describes the continuum of placenta accreta, increta, and percreta. The incidence of this type of abnormal placentation has increased significantly over recent decades. The reason is probably multifactorial but, partly, because of factors such as the increasing number of cesarean births. Women at greatest risk are those who have myometrial damage caused by a previous cesarean birth, with either anterior or posterior placenta previa overlying the uterine scar. This condition poses significant risks of morbidity and/or mortality to the pregnant woman and her fetus. A multidisciplinary approach to care throughout pregnancy is essential. This article describes the classification of morbidly adherent placenta, risk factors, methods of diagnosis, potential maternal and fetal complications, and intrapartum clinical management strategies to optimize outcomes.

  4. Intelligent Prediction of Ship Maneuvering

    Directory of Open Access Journals (Sweden)

    Miroslaw Lacki

    2016-09-01

    Full Text Available In this paper the author presents an idea of the intelligent ship maneuvering prediction system with the usage of neuroevolution. This may be also be seen as the ship handling system that simulates a learning process of an autonomous control unit, created with artificial neural network. The control unit observes input signals and calculates the values of required parameters of the vessel maneuvering in confined waters. In neuroevolution such units are treated as individuals in population of artificial neural networks, which through environmental sensing and evolutionary algorithms learn to perform given task efficiently. The main task of the system is to learn continuously and predict the values of a navigational parameters of the vessel after certain amount of time, regarding an influence of its environment. The result of a prediction may occur as a warning to navigator to aware him about incoming threat.

  5. Neonatal Presentation of an Air-Filled Neck Mass that Enlarges with Valsalva: A Case Report

    Science.gov (United States)

    Patel, Jasminkumar Bharatbhai; Kilbride, Howard; Paulson, Lorien

    2015-01-01

    Branchial cleft cysts are common causes of congenital neck masses in the pediatric population. However, neonatal presentation of branchial cleft cysts is uncommon, but recognizable secondary to acute respiratory distress from airway compression or complications secondary to infection. We report a 1-day-old infant presenting with an air-filled neck mass that enlarged with Valsalva and was not associated with respiratory distress. The infant was found to have a third branchial cleft cyst with an internal opening into the pyriform sinus. The cyst was conservatively managed with endoscopic surgical decompression and cauterization of the tract and opening. We review the embryology of branchial cleft cysts and current management. PMID:26495186

  6. Sinus of Valsalva aneurysm and bicuspid aortic valve: detection and mechanism by cardiac magnetic resonance imaging

    Directory of Open Access Journals (Sweden)

    Jen Li Looi

    2011-09-01

    Full Text Available Cardiac magnetic resonance imaging (CMR demonstrated a sinus of Valsalva aneurysm (SVA with severe dilatation of the right coronary sinus in association with a congenital bicuspid aortic valve (BAV and subaortic membrane. The SVA had not been apparent on echocardiography as the dilatation was outside standard echo image planes. On both CMR and echo, blood flow was eccentrically directed into the right coronary sinus by the domed posterior leaflet of the BAV. The impact of the aortic jet on the wall of the right coronary sinus is probably important in the aetiology of the sinus dilatation. CMR proved valuable in demonstrating the SVA and understanding its aetiology.

  7. Sinus of Valsalva aneurysm and bicuspid aortic valve: detection and mechanism by cardiac magnetic resonance imaging

    Directory of Open Access Journals (Sweden)

    Jen Li Looi

    2011-10-01

    Full Text Available Cardiac magnetic resonance imaging (CMR demonstrated a sinus of Valsalva aneurysm (SVA with severe dilatation of the right coronary sinus in association with a congenital bicuspid aortic valve (BAV and subaortic membrane. The SVA had not been apparent on echocardiography as the dilatation was outside standard echo image planes. On both CMR and echo, blood flow was eccentrically directed into the right coronary sinus by the domed posterior leaflet of the BAV. The impact of the aortic jet on the wall of the right coronary sinus is probably important in the aetiology of the sinus dilatation. CMR proved valuable in demonstrating the SVA and understanding its aetiology.

  8. Ruptured Aneurysm of Noncoronary Sinus of Valsalva: Demonstration with Magnetic Resonance Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Dincer, T.C.; Basarici, I.; Calisir, C.; Mete, A.; Ermis, C.; Deger, N. (Guney MRI Center, Antalya (Turkey))

    2008-10-15

    There are few published reports regarding imaging findings of sinus of Valsalva aneurysms (SVA) with magnetic resonance imaging (MRI). We present an unusual form of ruptured SVA, emphasizing the diagnostic importance of MRI among a range of imaging techniques. This case report describes a case of idiopathic (thought to be congenital in origin), acutely symptomatic ruptured noncoronary SVA diagnosed by MRI and confirmed with conventional angiography and surgery. MRI accurately showed aneurysm size, location, and rupture into the right atrium and provided valuable information about this rare lesion

  9. Rupture of an aneurysm of the coronary sinus of Valsalva: diagnosis by helical CT angiography

    International Nuclear Information System (INIS)

    Azarine, A.; Lions, C.; Beregi, J.P.; Koussa, M.

    2001-01-01

    A 75-year-old man presented with a 5-day history of upper chest discomfort. On auscultation, there was a systolic murmur in the left parasternal area that radiated to the apex. Electrocardiography showed flat T waves in the anterior precordial leads. Chest X ray revealed mediastinal enlargement. Transthoracic echocardiography showed a dilated proximal ascending aorta with moderate aortic regurgitation. A contrast-enhanced helical CT scan, performed to eliminate an aortic dissection, showed a ruptured left coronary sinus of Valsalva aneurysm, confirmed at surgery. This case highlights the fact that helical CT, in patients with suspected aortic dissection, may reveal other pathology that accounts for the clinical presentation. (orig.)

  10. Rupture of an aneurysm of the coronary sinus of Valsalva: diagnosis by helical CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Azarine, A.; Lions, C.; Beregi, J.P. [Dept. of Vascular Surgery, Hopital Cardiologique, CHRU de Lille (France); Koussa, M. [Dept. of Vascular Radiology, Hopital Cardiologique, CHRU de Lille (France)

    2001-08-01

    A 75-year-old man presented with a 5-day history of upper chest discomfort. On auscultation, there was a systolic murmur in the left parasternal area that radiated to the apex. Electrocardiography showed flat T waves in the anterior precordial leads. Chest X ray revealed mediastinal enlargement. Transthoracic echocardiography showed a dilated proximal ascending aorta with moderate aortic regurgitation. A contrast-enhanced helical CT scan, performed to eliminate an aortic dissection, showed a ruptured left coronary sinus of Valsalva aneurysm, confirmed at surgery. This case highlights the fact that helical CT, in patients with suspected aortic dissection, may reveal other pathology that accounts for the clinical presentation. (orig.)

  11. The reduction of the intrapartum still birth rate at the Queen Victoria Memorial Hospital.

    Science.gov (United States)

    Anderson, I; Chang, A; Renou, P; Wood, C

    1977-06-18

    A significant reduction in intrapartum anoxic fetal deaths has occurred at the Queen Victoria Memorial Hospital over the last ten years. The possible explanations for this include a variety of factors, which may either improve the health of the population presenting to the hospital, or improve obstetric care. Epidemiological evidence suggests that the use of fetal diagnostic techniques has contributed to the reduction of intrapartum anoxic still births.

  12. [Transesophageal echocardiography diagnosis of ruptured aneurysm of the Valsalva sinus associated with aneurysm of the interatrial septum].

    Science.gov (United States)

    Imperadore, Ferdinando; Ferro, Aldo; Graffigna, Angelo; Vergara, Giuseppe

    2002-01-01

    Aneurysms of the sinus of Valsalva are uncommon heart defects that often remain undetected unless rupture occurs. They have been reported in association with other cardiac anomalies. The present case report deals with a 51-year-old man who was referred to our division with a diagnosis of recent-onset progressive heart failure. Echocardiographic evaluation, both transthoracic and transesophageal, disclosed rupture of an aneurysm of the non-coronary sinus of Valsalva into the right atrium. This anomaly was associated with an aneurysm of the atrial septum.

  13. An extracardiac unruptured right sinus of valsalva aneurysm complicated with atherothrombosis

    Directory of Open Access Journals (Sweden)

    Jun Zhang

    2016-04-01

    Full Text Available We present quite a rare case of extracardiac unruptured right sinus of valsalva aneurysm (SVA complicated with atherothrombosis in a young adult man. A 35-year-old male with a giant unruptured SVA arising from the right coronary sinus (RCS with extracardiac protrusion was diagnosed by echocardiography. Contrast-enhanced computed tomography (CT revealed a huge calcified aneurysm with mural thrombi originating from the aortic root, and about 80% stenosis at the initial segment of the right coronary artery (RCA. Intraoperative exploration demonstrated a giant unruptured aneurysm arising from the RCS. Different from other SVAs reported before, this aneurismal wall appeared thick and atheromatous-like. In this aneurysm, there was a small localized intima tearing and mural thrombosis, and the orifice of the RCA was almost blocked. This patient underwent surgical patch repair to prevent aneurysm rupture and coronary artery bypass grafting for RCA revascularization. In conclusion, the pathological examination demonstrated marked foam cells, inflammatory cells, and thrombosis in the aneurismal wall. Learning points: • Echocardiographic characteristics of sinus of valsalva aneurysm (SVA. • Diagnostic evaluation of extracardiac unruptured SVA. • Pathology of rare SVA.

  14. Coexisting ventricular septal defect affects the features of ruptured sinus of Valsalva aneurysms

    Directory of Open Access Journals (Sweden)

    Yan Jin

    2017-03-01

    Full Text Available Objectives: To determine the correlation exists between ventricular septal defect (VSD and ruptured sinus of Valsalva aneurysm (RSVA. Methods: Between September 2003 and April 2014, 80 RSVA patients underwent surgical repair. These patients were retrospectively divided into two groups: the VSD group (38 cases and the non-VSD group (42 cases. Results: Rupture points of SVA originated more frequently in the right coronary sinus (RCS of patients in the VSD group than those in the non-VSD group (p=0.002. In the VSD group, more than 92.1% tended to rupture into the right ventricular outflow tract. The rupture points are diverse in the non-VSD group. A significant difference was found in rupture points of RSVA between the two groups (p<0.001. Patients in the VSD group presented with aortic valve disease more often than those in the non-VSD group (p<0.001. A total of 67 patients were repaired with a patch at the opening of RSVA; of those, all patients in VSD group and 29 patients in non-VSD group were repaired with a patch. Nine patients in non-VSD group received transcatheter closure of RSVA. Conclusion: The presence or absence of VSD affects the rupture points of SVA, aortic valve disease involved, and therapeutic schedule. Ruptured sinus of Valsalva aneurysm type should be clinically modified on the basis of presence or absence of VSD.

  15. Umbilical Cord Blood pH in Intrapartum Hypoxia.

    Science.gov (United States)

    Perveen, Fouzia; Khan, Ayesha; Ali, Tahmina; Rabia, Syeda

    2015-09-01

    To determine the association of cord arterial blood pH with neonatal outcome in cases of intrapartum fetal hypoxia. Descriptive analytical study. Gynaecology Unit-II, Civil Hospital, Karachi, from September 2011 to November 2012. All singleton cephalic fetuses at term gestation were included in the study. Those with any anomaly, malpresentation, medical disorders, maternal age 7.25, neonatal outcome measures (healthy, NICU admission or neonatal death), color of liquor and mode of delivery recorded on predesigned proforma. Statistical analysis performed by SPSS 16 by using independent-t test or chi-square test and ANOVA test as needed. A total of 204 newborns were evaluated. The mean pH level was found to be significantly different (p=0.007) in two groups. The pH value 7.25 had significant association (p 7.25. Majority (63.6%) cases needed caesarean section as compared to 31.4% controls. There is a significant association of cord arterial blood pH at birth with neonatal outcome at pH 7.25; but below the level of pH 7.25 it is still inconclusive.

  16. Factors affecting midwives' confidence in intrapartum care: a phenomenological study.

    Science.gov (United States)

    Bedwell, Carol; McGowan, Linda; Lavender, Tina

    2015-01-01

    midwives are frequently the lead providers of care for women throughout labour and birth. In order to perform their role effectively and provide women with the choices they require midwives need to be confident in their practice. This study explores factors which may affect midwives' confidence in their practice. hermeneutic phenomenology formed the theoretical basis for the study. Prospective longitudinal data collection was completed using diaries and semi-structured interviews. Twelve midwives providing intrapartum care in a variety of settings were recruited to ensure a variety of experiences in different contexts were captured. the principal factor affecting workplace confidence, both positively and negatively, was the influence of colleagues. Perceived autonomy and a sense of familiarity could also enhance confidence. However, conflict in the workplace was a critical factor in reducing midwives' confidence. Confidence was an important, but fragile, phenomenon to midwives and they used a variety of coping strategies, emotional intelligence and presentation management to maintain it. this is the first study to highlight both the factors influencing midwives' workplace confidence and the strategies midwives employed to maintain their confidence. Confidence is important in maintaining well-being and workplace culture may play a role in explaining the current low morale within the midwifery workforce. This may have implications for women's choices and care. Support, effective leadership and education may help midwives develop and sustain a positive sense of confidence. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. Gender specific intrapartum and neonatal outcomes for term babies.

    Science.gov (United States)

    Dunn, Liam; Prior, Tomas; Greer, Ristan; Kumar, Sailesh

    2015-02-01

    The purpose of this study is to document the gender specific intrapartum and neonatal outcomes in term, singleton, appropriately grown babies. De-identified, routinely collected data of all women meeting inclusion criteria between 2001 and 2011 were examined (n=9223). Inclusion criteria were public (non-insured), primiparous women who had delivered singleton, appropriately grown babies at term. In this retrospective cohort study, we estimated 95% confidence intervals. Outcomes measured were maternal demographics, mode of delivery, birthweight, APGAR score, cord blood acidemia, respiratory distress, any resuscitation requirement, nursery admission and stillbirth rates. The sex ratio of male babies was 1.05:1 (4718 males; 4505 females, p=0.85). Male babies were more likely to be delivered by instrumental (p=0.004) or caesarean (pinfluencing factor on mode of delivery. Even after adjusting for birthweight, male babies were more likely to be delivered by instrumental delivery (OR 1.24, pgender may play an independent role in influencing pregnancy outcomes, although the underlying contributing physiology is not definitively established. The gender of the baby perhaps should be considered when counselling parents in the antepartum period. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  18. Intrapartum antibiotic exposure for group B Streptococcus treatment did not increase penicillin allergy in children.

    Science.gov (United States)

    May, Sara M; Hartz, Martha F; Joshi, Avni Y; Park, Miguel A

    2016-02-01

    Group B Streptococcus (GBS) is the leading infectious cause of neonatal morbidity and mortality in the United States. Intrapartum administration of antibiotics to mothers with positivity to GBS is performed for prevention, with penicillin being the drug of choice. Previous studies have noted an increase in atopic diseases other than drug allergy associated with intrapartum antibiotic exposure. To determine whether intrapartum exposure to penicillin for GBS increases the likelihood of penicillin allergy in children. Retrospective chart review was performed for patients from a birth cohort. The birth cohort included children born in 2007 at a tertiary care hospital and had local addresses. Information on GBS status of the mother, intrapartum antibiotic exposure, delivery mode, and birth order was collected and analyzed. Of 927 children identified, 804 were included in the cohort. Eighty children (10%) had a reported penicillin allergy; most were white (79%) and boys (61%). Intrapartum exposure to penicillin (odds ratio 0.84, 95% confidence interval 0.45-1.57, P = .59) or to amoxicillin or ampicillin (odds ratio 0.22, 95% confidence interval 0.01-3.71, P = .29) did not increase the risk of penicillin allergy in children. In addition, all other factors evaluated did not affect the risk of penicillin allergy in children. To the authors' knowledge, this is the first study to evaluate intrapartum exposure to penicillin for GBS treatment and subsequent development of penicillin allergy in the child. In contrast to other atopic diseases, intrapartum antibiotic exposure does not alter the risk of penicillin allergy. Parents and obstetricians should be reassured when using penicillin for prevention of neonatal GBS. Published by Elsevier Inc.

  19. [Risks factors associated with intra-partum foetal mortality in pre-term infants].

    Science.gov (United States)

    Zeballos Sarrato, Susana; Villar Castro, Sonia; Ramos Navarro, Cristina; Zeballos Sarrato, Gonzalo; Sánchez Luna, Manuel

    2017-03-01

    Pre-term delivery is one of the leading causes of foetal and perinatal mortality. However, perinatal risk factors associated with intra-partum foetal death in preterm deliveries have not been well studied. To analyse foetal mortality and perinatal risk factors associated with intra-partum foetal mortality in pregnancies of less than 32 weeks gestational age. The study included all preterm deliveries between 22 and 31 +1 weeks gestational age (WGA), born in a tertiary-referral hospital, over a period of 7 years (2008-2014). A logistic regression model was used to identify perinatal risk factors associated with intra-partum foetal mortality (foetal malformations and chromosomal abnormalities were excluded). During the study period, the overall foetal mortality was 63.1% (106/168) (≥22 weeks of gestation) occurred in pregnancies of less than 32 WGA. A total of 882 deliveries between 22 and 31+6 weeks of gestation were included for analysis. The rate of foetal mortality was 11.3% (100/882). The rate of intra-partum foetal death was 2.6% (23/882), with 78.2% (18/23) of these cases occurring in hospitalised pregnancies. It was found that Assisted Reproductive Techniques, abnormal foetal ultrasound, no administration of antenatal steroids, lower gestational age, and small for gestational age, were independent risk factors associated with intra-partum foetal mortality. This study showed that there is a significant percentage intra-partum foetal mortality in infants between 22 and 31+6 WGA. The analysis of intrapartum mortality and risk factors associated with this mortality is of clinical and epidemiological interest to optimise perinatal care and improve survival of preterm infants. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Detection of elevated pulmonary capillary wedge pressure in elderly patients with various cardiac disorders by the Valsalva manoeuvre.

    NARCIS (Netherlands)

    Remmen, J.J.; Aengevaeren, W.R.M.; Verheugt, F.W.A.; Jansen, R.W.M.M.

    2006-01-01

    In the present study, we assessed whether elevated (> or =15 mmHg) PCWP (pulmonary capillary wedge pressure) can be detected using the blood pressure response to the Valsalva manoeuvre in a group of elderly patients with various cardiac disorders, including atrial fibrillation and valvular heart

  1. Cassini-Huygens maneuver automation for navigation

    Science.gov (United States)

    Goodson, Troy; Attiyah, Amy; Buffington, Brent; Hahn, Yungsun; Pojman, Joan; Stavert, Bob; Strange, Nathan; Stumpf, Paul; Wagner, Sean; Wolff, Peter; hide

    2006-01-01

    Many times during the Cassini-Huygens mission to Saturn, propulsive maneuvers must be spaced so closely together that there isn't enough time or workforce to execute the maneuver-related software manually, one subsystem at a time. Automation is required. Automating the maneuver design process has involved close cooperation between teams. We present the contribution from the Navigation system. In scope, this includes trajectory propagation and search, generation of ephemerides, general tasks such as email notification and file transfer, and presentation materials. The software has been used to help understand maneuver optimization results, Huygens probe delivery statistics, and Saturn ring-plane crossing geometry. The Maneuver Automation Software (MAS), developed for the Cassini-Huygens program enables frequent maneuvers by handling mundane tasks such as creation of deliverable files, file delivery, generation and transmission of email announcements, generation of presentation material and other supporting documentation. By hand, these tasks took up hours, if not days, of work for each maneuver. Automated, these tasks may be completed in under an hour. During the cruise trajectory the spacing of maneuvers was such that development of a maneuver design could span about a month, involving several other processes in addition to that described, above. Often, about the last five days of this process covered the generation of a final design using an updated orbit-determination estimate. To support the tour trajectory, the orbit determination data cut-off of five days before the maneuver needed to be reduced to approximately one day and the whole maneuver development process needed to be reduced to less than a week..

  2. Reimplantation valve-sparing aortic root replacement in Marfan syndrome using the Valsalva conduit: an intercontinental multicenter study.

    Science.gov (United States)

    Settepani, Fabrizio; Szeto, Wilson Y; Pacini, Davide; De Paulis, Ruggero; Chiariello, Luigi; Di Bartolomeo, Roberto; Gallotti, Roberto; Bavaria, Joseph E

    2007-02-01

    Introduced by DePaulis in 2000, the Gelweave Valsalva graft (Sulzer Vascutek, Refrewshire, Scotland) is a modified Dacron conduit (DuPont, Wilmington, DE), with prefashioned sinuses of Valsalva. The aim of this study was to evaluate the mid-term results of the reimplantation valve-sparing aortic root replacement using the Gelweave Valsalva prosthesis in Marfan syndrome patients. A retrospective review was performed of 35 patients with Marfan syndrome in four centers who underwent the reimplantation valve-sparing aortic root replacement using the Gelweave Valsalva prosthesis. The patients were predominantly men, with a mean age of 36.5 +/- 12.6 years (range, 14 to 62 years). Two patients presented with acute type A dissections and underwent emergent operations. Elective hemiarch reconstruction using hypothermic circulatory arrest was required in 11 patients. Aortic valve cusp repair was performed in 2 patients. There were no operative or hospital deaths, and no patients died during follow-up. The mean follow-up was 19 months (range, 1 to 60 months). Significant (>2+) aortic insufficiency (AI), requiring aortic valve replacement, developed in 3 patients during follow-up that requiring aortic valve replacement. The 5-year freedom from reoperation owing to structural valve deterioration was 88.9% +/- 8.1%. There were no episodes of clinically significant thromboembolism. Reimplantation valve-sparing aortic root replacement with the Gelweave Valsalva prosthesis in Marfan patients provides satisfactory mid-term results, thus encouraging further use of this type of repair. However, long-term results are needed in order to define the durability of this technique.

  3. Neonatal morbidity associated with shoulder dystocia maneuvers.

    Science.gov (United States)

    Spain, Janine E; Frey, Heather A; Tuuli, Methodius G; Colvin, Ryan; Macones, George A; Cahill, Alison G

    2015-03-01

    We sought to examine neonatal morbidity associated with different maneuvers used among term patients who experience a shoulder dystocia. We conducted a retrospective cohort study of all women who experienced a clinically diagnosed shoulder dystocia at term requiring obstetric maneuvers at a single tertiary care hospital from 2005 through 2008. We excluded women with major fetal anomaly, intrauterine death, multiple gestation, and preterm. Women exposed to Rubin maneuver, Wood's screw maneuver, or delivery of the posterior arm were compared to women delivered by McRoberts/suprapubic pressure only, which served as the reference group. The primary outcome was a composite morbidity of neonatal injury (defined as clavicular or humeral fracture or brachial plexus injury) and neonatal depression (defined as Apgar dystocia, defined as time from delivery of fetal head to delivery of shoulders. Among the 231 women who met inclusion criteria, 135 were delivered by McRoberts/suprapubic pressure alone (57.9%), 83 women were exposed to Rubin maneuver, 53 women were exposed to Wood's screw, and 36 women were exposed to delivery of posterior arm. Individual maneuvers were not associated with composite morbidity, neonatal injury, or neonatal depression after adjusting for nulliparity and duration of shoulder dystocia. We found no association between shoulder dystocia maneuvers and neonatal morbidity after adjusting for duration, a surrogate for severity. Our results demonstrate that clinicians should utilize the maneuver most likely to result in successful delivery. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. 46 CFR 109.564 - Maneuvering characteristics.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Maneuvering characteristics. 109.564 Section 109.564 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS OPERATIONS Miscellaneous § 109.564 Maneuvering characteristics. (a) The master or person in charge of each...

  5. Linking families and facilities for care at birth: What works to avert intrapartum-related deaths?

    Science.gov (United States)

    Lee, Anne CC; Lawn, Joy E.; Cousens, Simon; Kumar, Vishwajeet; Osrin, David; Bhutta, Zulfiqar A.; Wall, Steven N.; Nandakumar, Allyala K.; Syed, Uzma; Darmstadt, Gary L.

    2012-01-01

    Background Delays in receiving effective care during labor and at birth may be fatal for the mother and fetus, contributing to 2 million annual intrapartum stillbirths and intrapartum-related neonatal deaths each year. Objective We present a systematic review of strategies to link families and facilities, including community mobilization, financial incentives, emergency referral and transport systems, prenatal risk screening, and maternity waiting homes. Results There is moderate quality evidence that community mobilization with high levels of community engagement can increase institutional births and significantly reduce perinatal and early neonatal mortality. Meta-analysis showed a doubling of skilled birth attendance and a 35% reduction in early neonatal mortality. However, no data are available on intrapartum-specific outcomes. Evidence is limited, but promising, that financial incentive schemes and community referral/transport systems may increase rates of skilled birth attendance and emergency obstetric care utilization; however, impact on mortality is unknown. Current evidence for maternity waiting homes and risk screening is low quality. Conclusions Empowering communities is an important strategy to reduce the large burden of intrapartum complications. Innovations are needed to bring the poor closer to obstetric care, such as financial incentives and cell phone technology. New questions need to be asked of “old” strategies such as risk screening and maternity waiting homes. The effect of all of these strategies on maternal and perinatal mortality, particularly intrapartum-related outcomes, requires further evaluation. PMID:19815201

  6. Flight Test Maneuvers for Efficient Aerodynamic Modeling

    Science.gov (United States)

    Morelli, Eugene A.

    2011-01-01

    Novel flight test maneuvers for efficient aerodynamic modeling were developed and demonstrated in flight. Orthogonal optimized multi-sine inputs were applied to aircraft control surfaces to excite aircraft dynamic response in all six degrees of freedom simultaneously while keeping the aircraft close to chosen reference flight conditions. Each maneuver was designed for a specific modeling task that cannot be adequately or efficiently accomplished using conventional flight test maneuvers. All of the new maneuvers were first described and explained, then demonstrated on a subscale jet transport aircraft in flight. Real-time and post-flight modeling results obtained using equation-error parameter estimation in the frequency domain were used to show the effectiveness and efficiency of the new maneuvers, as well as the quality of the aerodynamic models that can be identified from the resultant flight data.

  7. Experimental visualization of rapid maneuvering fish

    Science.gov (United States)

    Daigh, S.; Techet, A. H.

    2003-11-01

    A freshwater tropical fish, Danio aequippinatus, is studied undergoing rapid turning and fast starting maneuvers. This agile species of fish is ideal for this study as it is capable of quick turning and darting motions up to 5g's. The fgish studied are 4-5 cm in length. The speed and kinematics of the maneuvering is determined by video analysis. Planar and stereo Particle Image Velocimetry (PIV) is used to map the vortical patterns in the wake of the maneuvering fish. PIV visualizations reveal that during C-shaped maneuvers a ring shaped jet vortex is formed. Fast starting behavior is also presented. PIV data is used to approixmate the thrust vectoring force produced during each maneuver.

  8. Gigantic unruptured sinus of Valsalva aneurysm presenting as an incidental murmur.

    LENUS (Irish Health Repository)

    Yagoub, Hatim

    2012-01-01

    We report a case of a 56-year-old man referred by his family physician with an asymptomatic cardiac murmur. Trans-thoracic echocardiography (TTE) suggested an unruptured right sinus of Valsalva aneurysm (SVA) causing extrinsic compression of the right ventricular outflow tract. This was confirmed with an ECG-gated cardiac CT showing a large right SVA measuring 35×37×42 mm in size. Coronary angiography demonstrated non-obstructive coronary artery disease. Ascending thoracic anterior in the right anterior oblique view delineated the right SVA. The patient underwent aortic valve sparing surgical repair of the aneurysm with an excellent result. Echocardiography confirmed obliteration of the aneurysm and normal aortic valve function postoperatively.

  9. Effect of the sinus of valsalva on the closing motion of bileaflet prosthetic heart valves.

    Science.gov (United States)

    Ohta, Y; Kikuta, Y; Shimooka, T; Mitamura, Y; Yuhta, T; Dohi, T

    2000-04-01

    Conventional bileaflet prosthetic mechanical heart valves close passively with backflow. Naturally, the valve has problems associated with closure, such as backflow, water hammer effect, and fracture of the leaflet. On the other hand, in the case of the natural aortic valve, the vortex flow in the sinus of Valsalva pushes the leaflet to close, and the valve starts the closing motion earlier than the prosthetic valve as the forward flow decelerates. This closing mechanism is thought to decrease backflow at valve closure. In this study, we propose a new bileaflet mechanical valve resembling a drawbridge in shape, and the prototype valve was designed so that the leaflet closes with the help of the vortex flow in the sinus. The test valve was made of aluminum alloy, and its closing motion was compared to that of the CarboMedics (CM) valve. Both valves were driven by a computer controlled hydraulic mock circulator and were photographed at 648 frames/s by a high speed charge-coupled device (CCD) camera. Each frame of the valve motion image was analyzed with a personal computer, and the opening angles were measured. The flow rate was set as 5.0 L/min. The system was pulsed with 70 bpm, and the systolic/diastolic ratio was 0.3. Glycerin water was used as the circulation fluid at room temperature, and polystyrene particles were used to visualize the streamline. The model of the sinus of Valsalva was made of transparent silicone rubber. As a result, high speed video analysis showed that the test valve started the closing motion 41 ms earlier than the CM valve, and streamline analysis showed that the test valve had a closing mechanism similar to the natural one with the effect of vortex flow. The structure of the test valve was thought to be effective for soft closure and could solve problems associated with closure.

  10. The effect of short-term isometric muscle contraction and the Valsalva maneuver on systemic and pulmonary hemodynamics in patients with severe heart failure

    Czech Academy of Sciences Publication Activity Database

    Souček, M.; Fráňa, P.; Kára, J.; Sitar, J.; Halámek, Josef; Jurák, Pavel; Řiháček, I.; Špinarová, L.; Oral, I.

    2009-01-01

    Roč. 32, č. 6 (2009), E32-E39 ISSN 0160-9289 R&D Projects: GA ČR(CZ) GA102/05/0402 Institutional research plan: CEZ:AV0Z20650511 Keywords : leg muscle * muscle isometric contraction Subject RIV: FS - Medical Facilities ; Equipment Impact factor: 1.602, year: 2009

  11. Anesthesia for ex utero intrapartum treatment: renewed insight on a rare procedure

    Directory of Open Access Journals (Sweden)

    Miguel Vieira Marques

    2015-12-01

    Full Text Available The ex utero intrapartum treatment is a rare surgical procedure performed in cases of expected postpartum fetal airway obstruction. The technique lies on a safe establishment of a patent airway during labor in anticipation of a critical respiratory event, without interrupting maternal-fetal circulation. Anesthetic management is substantially different from that regarding standard cesarean delivery and its main goals include uterine relaxation, fetal anesthesia and preservation of placental blood flow. We present the case of an ex utero intrapartum treatment procedure performed on a fetus with a large cervical lymphangioma and prenatal evidence of airway compromise. Modifications to the classic ex utero intrapartum treatment management strategies were successfully adopted and will be discussed in the following report.

  12. Resuscitation and Obstetrical Care to Reduce Intrapartum-Related Neonatal Deaths: A MANDATE Study.

    Science.gov (United States)

    Kamath-Rayne, Beena D; Griffin, Jennifer B; Moran, Katelin; Jones, Bonnie; Downs, Allan; McClure, Elizabeth M; Goldenberg, Robert L; Rouse, Doris; Jobe, Alan H

    2015-08-01

    To evaluate the impact of neonatal resuscitation and basic obstetric care on intrapartum-related neonatal mortality in low and middle-income countries, using the mathematical model, Maternal and Neonatal Directed Assessment of Technology (MANDATE). Using MANDATE, we evaluated the impact of interventions for intrapartum-related events causing birth asphyxia (basic neonatal resuscitation, advanced neonatal care, increasing facility birth, and emergency obstetric care) when implemented in home, clinic, and hospital settings of sub-Saharan African and India for 2008. Total intrapartum-related neonatal mortality (IRNM) was acute neonatal deaths from intrapartum-related events plus late neonatal deaths from ongoing intrapartum-related injury. Introducing basic neonatal resuscitation in all settings had a large impact on decreasing IRNM. Increasing facility births and scaling up emergency obstetric care in clinics and hospitals also had a large impact on decreasing IRNM. Increasing prevalence and utilization of advanced neonatal care in hospital settings had limited impact on IRNM. The greatest improvement in IRNM was seen with widespread advanced neonatal care and basic neonatal resuscitation, scaled-up emergency obstetric care in clinics and hospitals, and increased facility deliveries, resulting in an estimated decrease in IRNM to 2.0 per 1,000 live births in India and 2.5 per 1,000 live births in sub-Saharan Africa. With more deliveries occurring in clinics and hospitals, the scale-up of obstetric care can have a greater effect than if modeled individually. Use of MANDATE enables health leaders to direct resources towards interventions that could prevent intrapartum-related deaths. A lack of widespread implementation of basic neonatal resuscitation, increased facility births, and emergency obstetric care are missed opportunities to save newborn lives.

  13. Intrapartum care could be improved according to Swedish fathers: mode of birth matters for satisfaction.

    Science.gov (United States)

    Johansson, Margareta; Hildingsson, Ingegerd

    2013-09-01

    Intrapartum care is expected to be shaped by parents' need and preferences. The aim was to explore Swedish fathers' intrapartum care quality experiences, with a specific focus on care deficiencies in relation to birth mode. A secondary aim was to explore which issues of quality that contributed most to dissatisfaction with the overall assessment of the care. Cross-sectional design, part of a prospective longitudinal survey in Sweden. A quality of care index was developed, based on perceived reality and subjective importance of given intrapartum care. Two months after birth 827 fathers answered nine questions related to quality of care. Descriptive statistics and logistic regression analysis were used. Dissatisfaction with overall intrapartum care was related to deficiencies in partner's medical care (OR 5.6; 2.7-11.2), involvement in decision-making during childbirth (OR 2.6; 1.3-4.9), midwives presence in the labour room (OR 2.4; 1.2-4.7), and ability to discuss the birth afterwards (OR 2.0; 1.1-3.8). After emergency caesarean section 46% judged the partner's medical intrapartum care as most deficient (OR 1.73; 1.05-2.86), and after elective caesarean section 40% of the fathers judged involvement in decision-making as deficient (OR 4.07; 1.95-8.50). When the fathers had participated in a spontaneous vaginal birth they were dissatisfied with the presence of the midwife in the labour room (OR 1.72; 1.03-2.87). Deficiencies existed in the intrapartum care and were judged differently depending on mode of birth. The fathers needed to feel secure about the women's medical care, and wanted to be involved and supported. Copyright © 2013 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  14. CT and MR in aneurysm of the sinus of Valsalva diagnosis: two cases. TC y RM en el diagnostico del aneurisma del seno de Valsalva: a proposito de dos casos

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez-Granda Fernandez, F.; Navarro Sanchis, E.; Valdes Solis, P.; Sanchez-Lafuente, J.; Rodriguez San Pedro, F.

    1994-01-01

    We report two cases of aneurysm of the sinus of Valsalva that appeared as mediastinal masses having no related symptomatology. CT and MR studies were carried out in both cases. The assessment of the findings obtained with these two imaging methods led to the diagnosis, which was later confirmed by means of angiocardiography in one case and after surgery in the other. (Author) 19 refs.

  15. Canadarm2 Maneuvers Quest Airlock

    Science.gov (United States)

    2001-01-01

    At the control of Expedition Two Flight Engineer Susan B. Helms, the newly-installed Canadian-built Canadarm2, Space Station Remote Manipulator System (SSRMS) maneuvers the Quest Airlock into the proper position to be mated onto the starboard side of the Unity Node I during the first of three extravehicular activities (EVA) of the STS-104 mission. The Quest Airlock makes it easier to perform space walks, and allows both Russian and American spacesuits to be worn when the Shuttle is not docked with the International Space Station (ISS). American suits will not fit through Russion airlocks at the Station. The Boeing Company, the space station prime contractor, built the 6.5-ton (5.8 metric ton) airlock and several other key components at the Marshall Space Flight Center (MSFC), in the same building where the Saturn V rocket was built. Installation activities were supported by the development team from the Payload Operations Control Center (POCC) located at the MSFC and the Mission Control Center at NASA's Johnson Space Flight Center in Houston, Texas.

  16. Automated Robust Maneuver Design and Optimization

    Data.gov (United States)

    National Aeronautics and Space Administration — NASA is seeking improvements to the current technologies related to Position, Navigation and Timing. In particular, it is desired to automate precise maneuver...

  17. 14 CFR 27.337 - Limit maneuvering load factor.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Limit maneuvering load factor. 27.337... Limit maneuvering load factor. The rotorcraft must be designed for— (a) A limit maneuvering load factor... load factor not less than 2.0 and any negative limit maneuvering load factor of not less than −0.5 for...

  18. 14 CFR 29.337 - Limit maneuvering load factor.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Limit maneuvering load factor. 29.337... Limit maneuvering load factor. The rotorcraft must be designed for— (a) A limit maneuvering load factor... load factor not less than 2.0 and any negative limit maneuvering load factor of not less than −0.5 for...

  19. Optimal Autonomous Spacecraft Resiliency Maneuvers Using Metaheuristics

    Science.gov (United States)

    2014-09-15

    This work was accepted for published by the American Institute of Aeronautics and Astronautics (AIAA) Journal of Spacecraft and Rockets in July 2014...publication in the AIAA Journal of Spacecraft and Rockets . Chapter 5 introduces an impulsive maneuvering strategy to deliver a spacecraft to its final...upon arrival r2 and v2 , respectively. The variable T2 determines the time of flight needed to make the maneuver, and the variable θ2 determines the

  20. Antepartum and intrapartum interventions to prevent preterm birth and its sequelae

    NARCIS (Netherlands)

    Nijman, T. A. J.; van Vliet, E. O. G.; Koullali, B.; Mol, B. W.; Oudijk, M. A.

    2016-01-01

    Preterm birth is the main cause of neonatal morbidity and mortality. This review provides an overview of antepartum and intrapartum management of threatened preterm birth. The most effective method to identify women at high risk of delivering within seven days is the combination of cervical length

  1. Intrapartum synthetic oxytocin reduce the expression of primitive reflexes associated with breastfeeding.

    Science.gov (United States)

    Marín Gabriel, Miguel A; Olza Fernández, Ibone; Malalana Martínez, Ana M; González Armengod, Carmen; Costarelli, Valeria; Millán Santos, Isabel; Fernández-Cañadas Morillo, Aurora; Pérez Riveiro, Pilar; López Sánchez, Francisco; García Murillo, Lourdes

    2015-05-01

    Several synthetic peptide manipulations during the time surrounding birth can alter the specific neurohormonal status in the newborn brain. This study is aimed at assessing whether intrapartum oxytocin administration has any effect on primitive neonatal reflexes and determining whether such an effect is dose-dependent. A cohort prospective study was conducted at a tertiary hospital. Mother-infant dyads who received intrapartum oxytocin (n=53) were compared with mother-infant dyads who did not receive intrapartum oxytocin (n=45). Primitive neonatal reflexes (endogenous, antigravity, motor, and rhythmic reflexes) were quantified by analyzing videotaped breastfeeding sessions in a biological nurturing position. Two observers blind to the group assignment and the oxytocin dose analyzed the videotapes and assesed the newborn's state of consciousness according to the Brazelton scale. The release of all rhythmic reflexes (p=0.01), the antigravity reflex (p=0.04), and total primitive neonatal reflexes (p=0.02) in the group exposed to oxytocin was lower than in the group not exposed to oxytocin. No correlations were observed between the dose of oxytocin administered and the percentage of primitive neonatal reflexes released (r=0.03; p=0.82). Intrapartum oxytocin administration might inhibit the expression of several primitive neonatal reflexes associated with breastfeeding. This correlation does not seem to be dose-dependent.

  2. Intrapartum fetal monitoring by ST-analysis of the fetal ECG

    NARCIS (Netherlands)

    Westerhuis, M.E.M.H.

    2010-01-01

    Objective Intrapartum fetal monitoring aims to identify fetuses at risk for neonatal and long-term injury due to asphyxia. To serve this purpose, cardiotocography (CTG) combined with ST-analysis of the fetal electrocardiogram (ECG), which is a relatively new method, may be used. The main aim of this

  3. Variation in intrapartum referral rates in primary midwifery care in the Netherlands: A discrete choice experiment

    NARCIS (Netherlands)

    Offerhaus, P.M.; Otten, W.; Boxem-Tiemessen, J.C.; Jonge, A. de; Pal-de Bruin, K.M. van der; Scheepers, P.L.; Lagro-Janssen, A.L.

    2015-01-01

    Objective in midwife-led care models of maternity care, midwives are responsible for intrapartum referrals to the obstetrician or obstetric unit, in order to give their clients access to secondary obstetric care. This study explores the influence of risk perception, policy on routine labour

  4. Variation in intrapartum referral rates in primary midwifery care in the Netherlands: a discrete choice experiment

    NARCIS (Netherlands)

    Offerhaus, P.M.; Otten, W.; Boxem-Tiemessen, J.C.G.; de Jonge, A.; de Bruin, K.; Scheepers, P.L.H.; Lagro-Janssen, A.L.M.

    2015-01-01

    Objective: in midwife-led care models of maternity care, midwives are responsible for intrapartum referrals to the obstetrician or obstetric unit, in order to give their clients access to secondary obstetric care. This study explores the influence of risk perception, policy on routine labour

  5. The influence of maternity units' intrapartum intervention rates and midwives' risk perception for women suitable for midwifery-led care.

    Science.gov (United States)

    Mead, Marianne M P; Kornbrot, Diana

    2004-03-01

    to test the hypothesis that midwives working in higher intervention units would have a higher perception of risk for the intrapartum care of women suitable for midwifery-led care than midwives working in lower intervention units. an initial retrospective analysis of the computerised records of 9887 healthy Caucasian women in spontaneous labour enabled the categorisation of 11 units as either 'lower intrapartum intervention' or 'higher intrapartum intervention' units. A survey of the midwives involved in intrapartum care in these 11 units, using standardised scenario questionnaires, was used to investigate midwives' options for intrapartum interventions, their perceptions of intrapartum risk and the accuracy of these perceptions in the light of actual maternity outcomes. midwives working in maternity units that had a higher level of intervention generally perceived intrapartum risks to be higher than midwives working in lower intervention units. However, midwives generally underestimated the ability of women to progress normally and overestimated the advantages of technological interventions, in particular epidural analgesia. variations in intrapartum care cannot be solely explained by the characteristics of the women. The influence of the workplace culture plays a significant role in shaping midwives' perceptions of risk, but it seems even more likely that the medicalisation of childbirth has had an influence on midwives' appreciation of intrapartum risks. Intervention rates for low-risk births are often higher than recommended by research. The level of interventions varies across hospitals and higher rates are associated with higher perception of risk by midwives. Attention needs to be given to the influence the workplace plays in shaping midwives' perception of risk; and to the effect of organisational culture on intervention rates.

  6. Nd:YAG laser hyaloidotomy for valsalva pre-macular haemorrhage.

    LENUS (Irish Health Repository)

    Kirwan, R P

    2012-02-01

    AIM: To report a case of successful drainage of a large pre-macular haemorrhage using laser photo-disruption of the posterior hyaloid membrane. MATERIALS AND METHODS: A case report. RESULTS: A 47-year-old man presented acutely to our emergency department complaining of a 24-h history of sudden onset, painless and persistent loss of vision in his left eye. Immediately before noticing this loss of vision, he had been vomiting violently from excessive alcohol intake. The left visual acuity was counting fingers. Dilated fundoscopy of the left eye revealed a large pre-macular haemorrhage which was 14 disc diametres in size. Clotting investigations were normal. A diagnosis of valsalva retinopathy was made and the patient elected to receive a prompt neodymium-doped yttrium aluminium garnet (Nd:YAG) laser posterior hyaloidotomy as an outpatient. At 1 week follow-up, the haemorrhage had drained completely into the vitreous space revealing a healthy macula and the visual acuity had improved to 6\\/12 unaided. At 6-month follow-up the left visual acuity stabilised at 6\\/9 unaided. CONCLUSION: Nd:YAG laser posterior hyaloidotomy is a useful outpatient procedure for successful clearance of large pre-macular haemorrhages that offers patients rapid recovery of visual acuity and the avoidance of more invasive intraocular surgery.

  7. Echocardiographic diagnosis of rare pathological patterns of sinus of Valsalva aneurysm.

    Directory of Open Access Journals (Sweden)

    Yali Yang

    Full Text Available To evaluate the value and improve the diagnostic accuracy of echocardiography in the diagnosis of a sinus of Valsalva aneurysm (SVA with rare pathological patterns.Echocardiographic features and surgical findings from 270 Chinese patients with SVA treated in the last 18 years (1995-2013 at the Union Hospital were compared retrospectively; 22 of 270 cases had rare patterns.The patients with SVA, a rare origin, a rare extending position, or a rare course accounted for 3.4%, 7.4%, and 0.4% of the 270 cases, respectively. The three most common aneurysmal complications of the patients with rare patterns were severe aortic regurgitation (16, obstruction of the ventricular outflow tract or valvular orifice (3, and conduction disturbance (3. The origin, course, extending position and rupture status of the SVAs determined by echocardiography were entirely consistent with surgical findings in 81.8% of the 22 cases. With the exception of one failed diagnosis of an aneurysmal wall dissection and one misdiagnosis of a descending aortic dissection, the echocardiographic results of SVA complications and associated cardiovascular lesions were also confirmed.We could accurately diagnose SVAs with rare pathological patterns by echocardiographic identification of distinguishing features. However, for several conditions, we could not accurately identify the origin or course of the aneurysm or define its relationship to adjacent structures using conventional echocardiography alone. Therefore, we recommend combining conventional echocardiography with different imaging techniques, such as transesophageal echocardiography, three-dimensional echocardiography, computed tomography angiography, and aortic angiography.

  8. Management of supraventricular tachycardia using the Valsalva manoeuvre: a historical review and summary of published evidence.

    Science.gov (United States)

    Smith, Gavin

    2012-12-01

    Use of the Valsalva manoeuvre (VM) as a first-line management tool for the reversion of supraventricular tachycardia (SVT) in both emergency medicine and prehospital emergency-care settings has presented challenges, requiring continuous examination and refinement to define both its appropriateness and effectiveness. This report details the evolution of knowledge related to SVT and the historical evolution and controversies associated with VM; it also highlights the ongoing development of an evidence-based model of practice for the management of SVT in the emergency medicine and prehospital emergency-care settings. A two-part review of the literature using electronic medical databases was conducted. Other relevant texts or articles unavailable within the electronic search were also identified. Part 1 of the search criteria identified the historical evolution of the pathophysiology of SVT, whereas part 2 identified the use of VM for the clinical management of SVT. Part 1 of the review identified a total of 38 articles with eight meeting the inclusion criteria, and part 2 of the review identified a total of 44 articles with 17 meeting the inclusion criteria. An evidence-based model of practice requires clarification. The differentiation of nodal re-entrant tachycardias may, with further research, lead to identification of the specificity of VM in reversion of SVT during the early stages of arrhythmia. There is a need for further prehospital and emergency department research to quantify an evidence-based approach to VM.

  9. Transcatheter device closure of ruptured sinus of Valsalva: Immediate results and short term follow up

    Directory of Open Access Journals (Sweden)

    Sen Supratim

    2009-01-01

    Full Text Available This is a retrospective, observational study comprising of eight patients with isolated rupture of the sinus of Valsalva (RSOV who underwent transcatheter device closure. The mean age of presentation was 32.8 ± 10.0 years. New York Heart Association (NYHA class at the time of presentation was II (six patients and III (two patients. The RSOVs were all closed using a patent ductus arteriosus device. The mean procedural time was 42.3 ± 5.4 minutes, while the fluoroscopic time was 24.5 ± 6.9 minutes. All had complete closure of the shunt. The average hospital stay was 2.9 ± 1.1 days. There were no major complications. The patients were followed up for a mean of 11.3 ± 4.1 months. At the time of the last follow up all the patients were in NYHA class I. We conclude that in the short term, transcatheter closure of isolated RSOV is a viable alternative to surgical repair.

  10. Prophylactic amnioinfusion for intrapartum oligohydramnios: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Pitt, C; Sanchez-Ramos, L; Kaunitz, A M; Gaudier, F

    2000-11-01

    To evaluate the effectiveness of intrapartum prophylactic amnioinfusion in pregnancies complicated by oligohydramnios. Randomized controlled trials of prophylactic amnioinfusion in women with oligohydramnios were identified using computerized databases, index reviews, and references cited in original studies and review articles. We evaluated, abstracted data from, and analyzed randomized studies of prophylactic intrapartum amnioinfusion in women with oligohydramnios. In every study the group allocation was based exclusively on presence of oligohydramnios. Only published studies with clearly documented outcome data were included. The quality of each trial was evaluated for methodology, inclusion and exclusion criteria, adequacy of randomization, amnioinfusion protocols, definition of outcomes, and statistical analyses. The trials were evaluated concerning cesarean deliveries for fetal heart rate (FHR) abnormalities, overall cesarean rates, acidemia at birth, intrapartum fetal heart rate abnormalities, Apgar scores under 7 at 5 minutes, and postpartum endometritis. Thirty-five studies were identified, of which 14 met the inclusion criteria for this systematic review. They included 1533 patients, 793 in the amnioinfusion group, and 740 controls. Odds ratios (OR) with their 95% confidence intervals (CI) for each outcome were calculated. We calculated an estimate of the OR and risk difference for dichotomous outcomes using random and fixed-effects models. A test of homogeneity was done across studies. Women with oligohydramnios who received intrapartum amnioinfusion had lower incidence of cesarean for FHR abnormalities (OR 0.23; 95% CI 0.15, 0.35). Intrapartum amnioinfusion also was associated with lower overall rates of cesarean deliveries (OR 0.52; 95% CI 0.40, 0. 68), acidemia at birth (OR 0.40; 95% CI 0.30, 0.55), FHR abnormalities during labor (OR 0.24; 95% CI 0.17, 0.34), and Apgar scores under 7 at 5 minutes (OR 0.52; 95% CI 0.29, 0.91). Postpartum endometritis

  11. The Art and Science of Operational Maneuver,

    Science.gov (United States)

    1988-05-04

    Classification) The Art and Science of Operational Maneuver (U) 12. PERSONAL AUTHOR(S) MAJ Joseph Schroedel 13a. TYPE OF REPORT 13b. TIME COVERED 14...CLASSIFICATION OF THIS PAGE VA) CL LA S F1 EP {fJE ART ANQ SCIENCE OlF OPERAIl NAL MANUVER By6 Mal or Josepi~ Schroeci, L U. S. Arm~y H Aciv -darILC Ced M ili t...Studies ,nIgz’raph ApprovwA. Name of Student: Major Jonevh Schroedel. U.S. Army Title ot Monograph: The Art and Science of Operational Maneuver Approved By

  12. Cassini Solstice Mission Maneuver Experience: Year Two

    Science.gov (United States)

    Arrieta, Juan; Ballard, Christopher G.; Hahn, Yungsun

    2012-01-01

    The Cassini Spacecraft was launched in October 1997 on a mission to observe Saturn and its moons; it entered orbit around Saturn in July 2004 for a nominal four-year Prime Mission, later augmented by two extensions: the Equinox Mission, from July 2008 through September 2010, and the Solstice Mission, from October 2010 through September 2017. This paper provides an overview of the maneuver activities from August 2011 through June 2012 which include the design of 38 Orbit Trim Maneuvers--OTM-288 through OTM-326-- for attaining 14 natural satellite encounters: seven with Titan, six with Enceladus, and one with Dione.

  13. Intrapartum amnioinfusion in meconium-stained liquor: a case-control study.

    Science.gov (United States)

    Bansal, Neeta; Gupta, Vineeta; Nanda, Anuja; Chaudhary, Priyanka; Tandon, Archna; Behl, Neelima

    2013-06-01

    The aim of this study was to investigate perinatal outcome and the rate of cesarean section (CS) following intrapartum amnioinfusion in women with meconium-stained amniotic fluid (MSAF). A total of 100 women at term in labor with meconium were randomized to infuse transcervical intrapartum amnioinfusion with saline (50) and routine obstetrical care (50). Perinatal outcome and obstetric outcome were recorded and analyzed in both groups by means of Chi-square test. The CS rate due to fetal distress was 40.0 % in the control group and 20.0 % in the study group. The difference was statistically significant (P Amnioinfusion in cases of meconium-stained liquor significantly improved neonatal outcome and CS rate without increasing any maternal and fetal complications.

  14. Intrapartum intervention rates and perinatal outcomes following successful external cephalic version.

    Science.gov (United States)

    Basu, A; Flatley, C; Kumar, S

    2016-06-01

    To determine intrapartum and perinatal outcomes following successful external cephalic version for breech presentation at term. This was a retrospective cohort study of outcomes following successful external cephalic version in 411 women at an Australian tertiary maternity unit between November 2008 and March 2015. The study cohort was compared with a control group of 1236 women with cephalic presentation who underwent spontaneous labor. Intrapartum intervention rates and adverse neonatal outcomes were compared between both groups. The success rate of external cephalic version (ECV) was 66.4%. The spontaneous vaginal delivery rate in the study cohort was 59.4% (224/411) vs 72.8% (900/1236) in the control cohort (P<0.001). Intrapartum intervention rates (emergency cesarean section (CS) and instrumental delivery) were higher in the ECV group (38% vs 27.2%, P<0.001). Rates of emergency CS for non-reassuring fetal status (9.5%, 39/411 vs 4.4%, 54/1236, P⩽0.001) and failure to progress (13.4%, 55/411 vs 4.1%, 51/1236, P<0.001) were higher in the study cohort. Neonatal outcomes were worse in the study cohort-Apgar score <7 at 5 min (2.2%, 9/411 vs 0.6%, 8/1236, P<0.001) and abnormal cord gases (8.5%, 35/411 vs 0.2%, 3/1236, P<0.001). Rates for resuscitation at birth and admission to the neonatal intensive care unit were higher in the study cohort (6.1% vs 4.1% and 1.9% vs 1.1%, respectively) but these were not statistically significant. Labor following successful ECV is more likely to result in increased intrapartum intervention rates and poorer neonatal outcomes.

  15. Intrapartum Temperature Elevation, Epidural Use, and Adverse Outcome in Term Infants

    Science.gov (United States)

    Wyshak, Grace; Ringer, Steven A.; Johnson, Lise C.; Rivkin, Michael J.; Lieberman, Ellice

    2012-01-01

    OBJECTIVES: To examine the association of intrapartum temperature elevation with adverse neonatal outcome among low-risk women receiving epidural analgesia and evaluate the association of epidural with adverse neonatal outcome without temperature elevation. METHODS: We studied all low-risk nulliparous women with singleton pregnancies ≥37 weeks delivering at our hospital during 2000, excluding pregnancies where infants had documented sepsis, meningitis, or a major congenital anomaly. Neonatal outcomes were compared between women receiving (n = 1538) and not receiving epidural analgesia (n = 363) in the absence of intrapartum temperature elevation (≤99.5°F) and according to the level of intrapartum temperature elevation within the group receiving epidural (n = 2784). Logistic regression was used to evaluate neonatal outcome while controlling for confounders. RESULTS: Maternal temperature >100.4°F developed during labor in 19.2% (535/2784) of women receiving epidural compared with 2.4% (10/425) not receiving epidural. In the absence of intrapartum temperature elevation (≤99.5°F), no significant differences were observed in adverse neonatal outcomes between women receiving and not receiving epidural. Among women receiving epidural, a significant linear trend was observed between maximum maternal temperature and all neonatal outcomes examined including hypotonia, assisted ventilation, 1- and 5-min Apgar scores 101°F had a two- to sixfold increased risk of all adverse outcomes examined. CONCLUSIONS: The proportion of infants experiencing adverse outcomes increased with the degree of epidural-related maternal temperature elevation. Epidural use without temperature elevation was not associated with any of the adverse outcomes we studied. PMID:22291120

  16. Reimplantation valve-sparing aortic root replacement with the Valsalva graft: what have we learnt after 100 cases?

    Science.gov (United States)

    Settepani, Fabrizio; Bergonzini, Marcello; Barbone, Alessandro; Citterio, Enrico; Basciu, Alessio; Ornaghi, Diego; Gallotti, Roberto; Tarelli, Giuseppe

    2009-07-01

    Reimplantation valve-sparing aortic root replacement has been increasingly performed with improving perioperative and mid-term results. The success of this operation primarily depends on preserving the highly sophisticated dynamic function of the aortic valve by recreating an anatomical three-dimensional configuration similar to the normal aortic root, thus minimizing the mechanical stress and strain on the cusps. Over the years several techniques have been proposed to reproduce the sinuses of Valsalva. We reviewed our experience with aortic valve reimplantation by means of a modified Dacron graft that incorporates sinuses of Valsalva, in a series of 100 consecutive patients. During a 60-month period, 100 patients with aortic root aneurysm underwent aortic valve reimplantation using the Gelweave Valsalva prosthesis. There were 74 males and the mean age was 60+/-12 years (range 28-83 years). Five patients had the Marfan's syndrome, 15 had a bicuspid aortic valve. Cusp repair was performed in five patients. The mean follow-up time was 28.6 months (range 1-60). Transesophageal echocardiogram was performed at the end of each procedure to assess the aortic valve in terms of competence, dynamic motion and level of coaptation within the graft. There was one hospital death and two late deaths. Overall survival at 60 months was 91.7+/-5.1%. Five patients developed severe aortic incompetence (AI) during follow-up requiring aortic valve replacement (AVR). The 60 months freedom from re-operation due to AI was 90.9+/-4.4%. One patient had moderate AI at latest echocardiographic study. The 60 months freedom from AI>2+ was 91.6+/-7.9%. Cox regression identified cusp's repair as independent risk factor (P=0.001) for late reimplantation failure (AVR or AI>2+). There were no episodes of endocarditis and the majority of the patients (88%) were in New York Heart Association functional class I. The aortic valve reimplantation with the Gelweave Valsalva prosthesis provided satisfactory

  17. Atrioventricular and Interventricular Groove and Septal Extension of Right Sinus of Valsalva Aneurysm: A Rare Cause of Complete Heart Block

    International Nuclear Information System (INIS)

    Khan, J.A.; Hussain, M.; Rizvi, N.H.; Fehmi, N.; Hussain, A.; Sial, J.A.

    2013-01-01

    A 26 years old male presented with vertigo and history of fall. The electrocardiogram revealed 2:1 second-degree heart block and later progression to complete heart block. Transthoracic echocardiography revealed aneurysm at the site of ascending aorta and computed tomographic scan showed an aneurysm of right sinsus of Valsalva extending into right atrioventricular and interventricular groove and causing complete heart block by compression on the conduction system. He also suffered from lymph node tuberculosis. This case report is unique because of rare presentation as complete heart block. (author)

  18. Ruptured Sinus of Valsalva Aneurysm into the Left Atrium with Multiple Fistulous Communications: A Rare Cause of Heart Failure

    Directory of Open Access Journals (Sweden)

    Yashwant Agrawal

    2015-01-01

    Full Text Available Ruptured noncoronary sinus of valsalva aneurysm with fistulous connections to multiple cardiac chambers has not been reported previously. We report a 66-year-old man who presented with worsening cough and exertional dyspnea. Transesophageal echocardiogram confirmed a large aneurysm involving the noncoronary cusp of the aortic sinus with aneurysmal extension to the left atrium. There were also two fistulous communications with the left atrium and one small fistulous connection with the right atrium. Open-heart surgery with aortic root replacement and reimplantation of coronary arteries along with primary closure and repair of aorta to the left atrial fistula was performed.

  19. Multislice CT imaging of ruptured left sinus of Valsalva aneurysm with fistulous track between left sinus and right atrium.

    Science.gov (United States)

    Pampapati, Praveenkumar; Rao, Hejmadi Tati Gururaj; Radhesh, Srinivasan; Anand, Hejjaji Krishnamurthy; Praveen, Lokkur Srinivasamurthy

    2011-01-01

    Sinus of valsalva aneurysm is a rare condition arising from any of the three aortic sinuses. Among them, an aneurysm arising from the left coronary sinus is the rarest. Most of these cases were earlier diagnosed using echocardiography and conventional angiography. But with the availability of advanced imaging modalities like 64 slice cardiac CT and MR modalities, this condition can be accurately assessed noninvasively. We report a case of ruptured aneurysm originating from the left coronary sinus with a long windsock type of fistulous track between the aneurysm and right atrium evaluated by 64 slice cardiac CT imaging. This was later confirmed perioperatively.

  20. [Intrapartum obstetrical transfers: sociodemographic, clinical and prognosistic aspects in Conakry, Guinea].

    Science.gov (United States)

    Baldé, I S; Diallo, F B; Diallo, Y; Diallo, A; Diallo, M H; Camara, M K; Sy, T; Diallo, M S

    2011-12-01

    The objectives of this descriptive prospective study were to determine the frequency of intrapartum obstetrical transfers, assess the sociodemographic profile of parturients requiring transfer, describe transfer modalities, and assess maternal and newborn outcomes. Study included all patients requiring intrepartum obstetrical transfer to the Ignace Deen University Hospital Gynecology Obstetrics Clinic in Conakry, Guinea from August 1st, 2009 to July 31st, 2010. Out of 3122 deliveries during the study period, intrapartum transfer was required in 220 cases, i.e. 7.05%. Mean patient age was 23.2 years (range, 14 to 44). The risk for intrapartum transfer was higher among multiparous or nulliparous women (incidence, 8.79%) and adolescents (incidence, 10%). Patients requiring transfer were mainly housewives (60%) and uneducated women (57.27%). Most had had an insufficient number (<4) of antenatal examinations (76.36%) and had been examined at peripheral maternity units (62.73%). In 175 cases (79.54%), patients were transferred by taxi. In 191 patients, treatment required surgery including 130 caesarian sections. There were 12 maternal deaths (5.45%) and 45 neonatal deaths out of 242 newborns including 22 twin deliveries (18.59%). Further work is necessary to improve referral and transfer at all levels of the health pyramid.

  1. Barriers to Implementing Evidence-Based Intrapartum Care: A Descriptive Exploratory Qualitative Study.

    Science.gov (United States)

    Iravani, Mina; Janghorbani, Mohsen; Zarean, Ellahe; Bahrami, Masod

    2016-02-01

    Evidence based practice is an effective strategy to improve the quality of obstetric care. Identification of barriers to adaptation of evidence-based intrapartum care is necessary and crucial to deliver high quality care to parturient women. The current study aimed to explore barriers to adaptation of evidence-based intrapartum care from the perspective of clinical groups that provide obstetric care in Iran. This descriptive exploratory qualitative research was conducted from 2013 to 2014 in fourteen state medical training centers in Iran. Participants were selected from midwives, specialists, and residents of obstetrics and gynecology, with a purposive sample and snowball method. Data were collected through face-to-face semi-structured in-depth interviews and analyzed according to conventional content analysis. Data analysis identified twenty subcategories and four main categories. Main categories included barriers were related to laboring women, persons providing care, the organization environment and health system. The adoption of evidence based intrapartum care is a complex process. In this regard, identifying potential barriers is the first step to determine and apply effective strategies to encourage the compliance evidence based obstetric care and improves maternity care quality.

  2. Predicting intrapartum fetal compromise using the fetal cerebro-umbilical ratio.

    Science.gov (United States)

    Sabdia, S; Greer, R M; Prior, T; Kumar, S

    2015-05-01

    The aim of this study was to explore the association between the cerebro-umbilical ratio measured at 35-37 weeks and intrapartum fetal compromise. This retrospective cross sectional study was conducted at the Mater Mothers' Hospital in Brisbane, Australia. Maternal demographics and fetal Doppler indices at 35-37 weeks gestation for 1381 women were correlated with intrapartum and neonatal outcomes. Babies born by caesarean section or instrumental delivery for fetal compromise had the lowest median cerebro-umbilical ratio 1.60 (IQR 1.22-2.08) compared to all other delivery groups (vaginal delivery, emergency delivery for failure to progress, emergency caesarean section for other reasons or elective caesarean section). The percentage of infants with a cerebro-umbilical ratio cerebro-umbilical ratio between the 10th-90th centile and 9.6% of infants with a cerebro-umbilical ratio > 90th centile required delivery for the same indication (p cerebro-umbilical ratio was associated with an increased risk of emergency delivery for fetal compromise, OR 2.03 (95% CI 1.41-2.92), p cerebro-umbilical ratio measured at 35-37 weeks is associated with a greater risk of intrapartum compromise. This is a relatively simple technique which could be used to risk stratify women in diverse healthcare settings. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. 32 CFR 644.137 - Maneuver agreements.

    Science.gov (United States)

    2010-07-01

    ... planning and acquires rights to use land and other facilities for Department of the Army exercises. The... and, after the maneuver is completed, will be responsible for negotiating restoration settlements and... director at field level whereby the command will assume responsibility for settlement of real estate...

  4. Optimizing interplanetary trajectories with deep space maneuvers

    Science.gov (United States)

    Navagh, John

    1993-09-01

    Analysis of interplanetary trajectories is a crucial area for both manned and unmanned missions of the Space Exploration Initiative. A deep space maneuver (DSM) can improve a trajectory in much the same way as a planetary swingby. However, instead of using a gravitational field to alter the trajectory, the on-board propulsion system of the spacecraft is used when the vehicle is not near a planet. The purpose is to develop an algorithm to determine where and when to use deep space maneuvers to reduce the cost of a trajectory. The approach taken to solve this problem uses primer vector theory in combination with a non-linear optimizing program to minimize Delta(V). A set of necessary conditions on the primer vector is shown to indicate whether a deep space maneuver will be beneficial. Deep space maneuvers are applied to a round trip mission to Mars to determine their effect on the launch opportunities. Other studies which were performed include cycler trajectories and Mars mission abort scenarios. It was found that the software developed was able to locate quickly DSM's which lower the total Delta(V) on these trajectories.

  5. Helicopter noise footprint prediction in unsteady maneuvers

    NARCIS (Netherlands)

    Gennaretti, Massimo; Bernardini, Giovanni; Serafini, Jacopo; Anobile, A.; Hartjes, S.

    2017-01-01

    This paper investigates different methodologies for the evaluation of the acoustic disturbance emitted by helicopter’s main rotors during unsteady maneuvers. Nowadays, the simulation of noise emitted by helicopters is of great interest to designers, both for the assessment of the acoustic impact

  6. About avatars and maneuvering in virtual environments

    NARCIS (Netherlands)

    Delleman, N.

    2006-01-01

    This paper is about the use of avatars and maneuvering in virtual environments for simulation-based design ergonomics. An avatar is a digital human model driven by an instrumented human who is immersed in a virtual environment. A presentation on locomotion devices is followed by descriptions of

  7. Demonstrative Maneuvers for Aircraft Agility Predictions

    Science.gov (United States)

    2008-03-01

    AIAA Paper 1996-3741. 19. Raymer , Daniel P. Aircraft Design: A Conceptual Approach. American Institute of Aeronautics and Astronautics, Inc., 3rd...Shaw, Robert L. Fighter Combat: Tactics and Maneuvering. Naval Institute Press, Annapolis, MD, 1985. 25. Smith, Steven W. The Scientist and

  8. Late Diagnosis of Anomalous Aortic Origin of a Coronary Artery from the Inappropriate Sinus of Valsalva during Investigation of Chest Pain

    Directory of Open Access Journals (Sweden)

    Brunna Priscylla Américo Carvalho

    2018-01-01

    Full Text Available In this work are reported two cases of anomalous aortic origin of a coronary artery (AAOCA, with the left main coronary artery (LMCA arising at the right sinus of Valsalva in a 77-year-old woman and in a 79-year-old man submitted to angiography after positive ischemic tests. The origin of the LMCA or the left descendant artery (LDA from the right sinus of Valsalva has a prevalence of 0.2%, the origin of the circumflex artery (CXA from the right sinus 0.5%, and the origin of the right coronary artery (RCA from the left sinus of Valsalva has a prevalence of 0.3%. It is the subgroup of the coronary anomalies that has the greatest potential for clinical repercussions, especially the sudden cardiac death (SCD. We discuss the diagnostic methods and treatment options for this kind of coronary anomaly in symptomatic cases.

  9. 23 CFR 660.517 - Maneuver area roads.

    Science.gov (United States)

    2010-04-01

    ... 23 Highways 1 2010-04-01 2010-04-01 false Maneuver area roads. 660.517 Section 660.517 Highways... PROGRAMS (DIRECT FEDERAL) Defense Access Roads § 660.517 Maneuver area roads. (a) Claims by a highway agency for costs incurred to restore, to their former condition, roads damaged by maneuvers involving a...

  10. Birth rights and rituals in rural south India: care seeking in the intrapartum period.

    Science.gov (United States)

    Matthews, Zoë; Ramakrishna, Jayashree; Mahendra, Shanti; Kilaru, Asha; Ganapathy, Saraswathy

    2005-07-01

    Maternal morbidity and mortality are high in the Indian context, but the majority of maternal deaths could be avoided by prompt and effective access to intrapartum care (WHO, 1999). Understanding the care seeking responses to intrapartum morbidities is crucial if maternal health is to be effectively improved, and maternal mortality reduced. This paper presents the results of a prospective study of 388 women followed through delivery and traditional postpartum in rural Karnataka in southern India. In this setting, few women use the existing health facilities and most deliveries occur at home. The analysis uses quantitative data, collected via questionnaires administered to women both during pregnancy and immediately after delivery. By virtue of its prospective design, the study gives a unique insight into intentions for intrapartum care during pregnancy as well as events following morbidities during labour. Routine care in the intrapartum period, both within institutions and at home, and impediments to appropriate care are also examined. The study was designed to collect information about health seeking decisions made by women and their families as pregnancies unfolded, rather than trying to capture women's experience from a retrospective instrument. The data set is therefore a rich source of quantitative information, which incorporates details of event sequences and health service utilization not previously collected in a Safe Motherhood study. Additional qualitative information was also available from concurrent in-depth interviews with pregnant women, their families, health care providers and other key informants in the area. The level of unplanned institutional care seeking during the intrapartum period within the study area was very high, increasing from 11% planning deliveries at a facility to an eventual 35% actually delivering in hospitals. In addition there was a significant move away from planned deliveries with the auxiliary nurse midwive (ANM), to births

  11. Fate of remnant sinuses of Valsalva in patients with bicuspid and trileaflet valves undergoing aortic valve, ascending aorta, and aortic arch replacement.

    Science.gov (United States)

    Milewski, Rita Karianna; Habertheuer, Andreas; Bavaria, Joseph E; Siki, Mary; Szeto, Wilson Y; Krause, Eric; Korutla, Varun; Desai, Nimesh D; Vallabhajosyula, Prashanth

    2017-08-01

    In patients presenting with aortic valvulopathy with concomitant ascending aortic aneurysm, surgical management of the sinus of Valsalva segment remains undefined, especially for moderately dilated aortic roots. In patients with this pathology undergoing aortic valve replacement with supracoronary ascending aorta replacement, we assessed the fate of the remnant preserved sinus of Valsalva segment stratified by aortic valve morphology and pathology. From 2002 to 2015, 428 patients underwent elective aortic valve replacement with supracoronary ascending aorta replacement. Patients were stratified on the basis of valvular morphology (bicuspid aortic valve [n = 254] and tricuspid aortic valve [n = 174]), valvular pathology (bicuspid aortic valve with aortic stenosis [n = 178], bicuspid aortic valve with aortic insufficiency [n = 76], tricuspid aortic valve with aortic stenosis [n = 61], tricuspid aortic valve with aortic insufficiency [n = 113]), and preoperative sinus of Valsalva dimensions (45 mm). Kaplan-Meier analysis revealed no significant difference in freedom from reoperation in tricuspid aortic valve versus bicuspid aortic valve (P = .576). Multivariable Cox regression model performed with sinus of Valsalva dimensions at baseline and follow-up as time-varying covariates did not adversely affect survival. A repeated-measure, mixed-effects model constructed to assess longitudinal sinus of Valsalva trends revealed that the retained sinus of Valsalva dimensions remain stable over long-term follow-up (discharge to ≥10 years), irrespective of valvular morphology/pathology (bicuspid aortic valve with aortic insufficiency, tricuspid aortic valve with aortic insufficiency, tricuspid aortic valve with aortic stenosis) and preoperative sinus of Valsalva groups (45 mm). In patients with nonaneurysmal sinuses of Valsalva undergoing aortic valve replacement with supracoronary ascending aorta replacement, the sinus segment can be preserved irrespective of

  12. Outcome Assessment of the Marshall Coughing Test during Cervix Reposition Maneuver in Women with Urinary Stress Incontinence with/without Genital Prolapse.

    Science.gov (United States)

    Antovska, Vesna

    2012-01-01

    Objectives. Outcome assessment of the Marshall coughing test (MT) during cervix reposition maneuver (CRM) in women with urinary stress incontinence (USI) with/without genital prolapse (GP). Study Design. 268 patients, divided into USIg (n = 132) with isolated USI and USIGPg (n = 136) with USI and GP stage I/II, additionally divided into USIGP(A) (n = 78) with USI and GP stage I and USIGP(B) (n = 58) with USI and GP stage II, were evaluated with pelvic organ prolapse quantification (POPQ), MT, and CRM. Results. (a) 7.58% had (+) MT with CRM in USIg; (b) in up to 96.15% MT became negative during CRM in USIGP(A); (c) in 51.72% MT became positive only during CRM, as a sign for occult USI in USIGP(B); (d) point Aa (POPQ), which is bladder neck(BN) projection on the anterior vaginal wall, was situated higher in rest position (RP), but moved lower during the Valsalva maneuver (VM) in USIg versus USIGPg (P CRM could be useful arm in selection of (1) patients with isolated USI and great chance for postoperative failure; (2) patients with USI+GP stage I, who need GP repair during antistress surgery; (3) patients with USI + GP stage II, who need antistress procedure during vaginal hysterectomy.

  13. Estimating maneuvers for precise relative orbit determination using GPS

    Science.gov (United States)

    Allende-Alba, Gerardo; Montenbruck, Oliver; Ardaens, Jean-Sébastien; Wermuth, Martin; Hugentobler, Urs

    2017-01-01

    Precise relative orbit determination is an essential element for the generation of science products from distributed instrumentation of formation flying satellites in low Earth orbit. According to the mission profile, the required formation is typically maintained and/or controlled by executing maneuvers. In order to generate consistent and precise orbit products, a strategy for maneuver handling is mandatory in order to avoid discontinuities or precision degradation before, after and during maneuver execution. Precise orbit determination offers the possibility of maneuver estimation in an adjustment of single-satellite trajectories using GPS measurements. However, a consistent formulation of a precise relative orbit determination scheme requires the implementation of a maneuver estimation strategy which can be used, in addition, to improve the precision of maneuver estimates by drawing upon the use of differential GPS measurements. The present study introduces a method for precise relative orbit determination based on a reduced-dynamic batch processing of differential GPS pseudorange and carrier phase measurements, which includes maneuver estimation as part of the relative orbit adjustment. The proposed method has been validated using flight data from space missions with different rates of maneuvering activity, including the GRACE, TanDEM-X and PRISMA missions. The results show the feasibility of obtaining precise relative orbits without degradation in the vicinity of maneuvers as well as improved maneuver estimates that can be used for better maneuver planning in flight dynamics operations.

  14. Can facility delivery reduce the risk of intrapartum complications-related perinatal mortality? Findings from a cohort study.

    Science.gov (United States)

    Khanam, Rasheda; Baqui, Abdullah H; Syed, Mamun Ibne Moin; Harrison, Meagan; Begum, Nazma; Quaiyum, Abdul; Saha, Samir K; Ahmed, Saifuddin

    2018-06-01

    Intrapartum complications increase the risk of perinatal deaths. However, population-based data from developing countries assessing the contribution of intrapartum complications to perinatal deaths is scarce. Using data from a cohort of pregnant women followed between 2011 and 2013 in Bangladesh, this study examined the rate and types of intrapartum complications, the association of intrapartum complications with perinatal mortality, and if facility delivery modified the risk of intrapartum-related perinatal deaths. Trained community health workers (CHWs) made two-monthly home visits to identify pregnant women, visited them twice during pregnancy and 10 times in the first two months postpartum. During prenatal visits, CHWs collected data on women's prior obstetric history, socio-demographic status, and complications during pregnancy. They collected data on intrapartum complications, delivery care, and pregnancy outcome during the first postnatal visit within 7 days of delivery. We examined the association of intrapartum complications and facility delivery with perinatal mortality by estimating odds ratios (OR) and 95% confidence intervals (CI) adjusting for covariates using multivariable logistic regression analysis. The overall facility delivery rate was low (3922/24 271; 16.2%). Any intrapartum complications among pregnant women were 20.9% (5,061/24,271) and perinatal mortality was 64.7 per 1000 birth. Compared to women who delivered at home, the risk of perinatal mortality was 2.4 times higher (OR = 2.40; 95% CI = 2.08-2.76) when delivered in a public health facility and 1.3 times higher (OR = 1.32, 95% CI = 1.06-1.64) when delivered in a private health facility. Compared to women who had no intrapartum complications and delivered at home, women with intrapartum complications who delivered at home had a substantially higher risk of perinatal mortality (OR = 3.45; 95% CI = 3.04-3.91). Compared to women with intrapartum complications who

  15. Colisional Cloud Debris and Propelled Evasive Maneuvers

    Science.gov (United States)

    Ferreira, L. S.; Jesus, A. D. C.; Carvalho, T. C. F.; Sousa, R. R.

    2017-10-01

    Space debris clouds exist at various altitudes in the environment outside the Earth. Fragmentation of debris and/or collision between the debris of a cloud increases the amount of debris, producing smaller debris. This event also increases significantly the chances of collision with operational vehicles in orbit. In this work we study clouds of debris that are close to a spacecraft in relation to its distance from the center of the Earth. The results show several layers of colliding debris depending on their size over time of evasive maneuvers of the vehicle. In addition, we have tested such maneuvers for propulsion systems with a linear and exponential mass variation model. The results show that the linear propulsion system is more efficient.

  16. Review of Tracktable for Satellite Maneuver Detection

    Energy Technology Data Exchange (ETDEWEB)

    Acquesta, Erin C.S. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Valicka, Christopher G. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Hinga, Mark B. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Ehn, Carollan Beret [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2016-10-01

    As a tool developed to translate geospatial data into geometrical descriptors, Tracktable offers a highly efficient means to detect anomalous flight and maritime behavior. Following the success of using geometrical descriptors for detecting anomalous trajectory behavior, the question of whether Tracktable could be used to detect satellite maneuvers arose. In answering this question, this re- port will introduce a brief description of how Tracktable has been used in the past, along with an introduction to the fundamental properties of astrodynamics for satellite trajectories. This will then allow us to compare the two problem spaces, addressing how easily the methods used by Tracktable will translate to orbital mechanics. Based on these results, we will then be able to out- line the current limitations as well as possible path forward for using Tracktable to detect satellite maneuvers.

  17. Identifying tacit strategies in aircraft maneuvers

    Science.gov (United States)

    Lewis, Charles M.; Heidorn, P. B.

    1991-01-01

    Two machine-learning methods are presently used to characterize the avoidance strategies used by skilled pilots in simulated aircraft encounters, and a general framework for the characterization of the strategic components of skilled behavior via qualitative representation of situations and responses is presented. Descriptions of pilot maneuvers that were 'conceptually equivalent' were ascertained by a concept-learning algorithm in conjunction with a classifier system that employed a generic algorithm; satisficing and 'buggy' strategies were thereby revealed.

  18. Decisive Army Strategic and Expeditionary Maneuver

    Science.gov (United States)

    2015-05-01

    emerging changes will impact strategic maneuver by 2025. For example, a rapid transition is occurring in the commercial air cargo market where 777...more readily available in the international defense market and in the inventories of potential adversaries. In short, the study team believes HPMs... Cisco Visual Networking Index (VNI), available at: http://www.cisco.com/c/en/us/solutions/collateral/service-provider/visual-networking-index- vni

  19. Mars Exploration Rovers Propulsive Maneuver Design

    Science.gov (United States)

    Potts, Christopher L.; Raofi, Behzad; Kangas, Julie A.

    2004-01-01

    The Mars Exploration Rovers Spirit and Opportunity successfully landed respectively at Gusev Crater and Meridiani Planum in January 2004. The rovers are essentially robotic geologists, sent on a mission to search for evidence in the rocks and soil pertaining to the historical presence of water and the ability to possibly sustain life. In order to conduct NASA's 'follow the water' strategy on opposite sides of the planet Mars, an interplanetary journey of over 300 million miles culminated with historic navigation precision. Rigorous trajectory targeting and control was necessary to achieve the atmospheric entry requirements for the selected landing sites. The propulsive maneuver design challenge was to meet or exceed these requirements while preserving the necessary design margin to accommodate additional project concerns. Landing site flexibility was maintained for both missions after launch, and even after the first trajectory correction maneuver for Spirit. The final targeting strategy was modified to improve delivery performance and reduce risk after revealing constraining trajectory control characteristics. Flight results are examined and summarized for the six trajectory correction maneuvers that were planned for each mission.

  20. Effect of spontaneous pushing versus Valsalva pushing in the second stage of labour on mother and fetus: a systematic review of randomised trials

    NARCIS (Netherlands)

    Prins, M. [=Marianne; Boxem, J.; Lucas, C.; Hutton, E.

    2011-01-01

    To critically evaluate any benefit or harm for the mother and her baby of Valsalva pushing versus spontaneous pushing in the second stage of labour. Electronic databases from MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials were systematically searched (last search May

  1. Intrapartum amnioinfusion for meconium-stained fluid: meta-analysis of prospective clinical trials.

    Science.gov (United States)

    Pierce, J; Gaudier, F L; Sanchez-Ramos, L

    2000-06-01

    To evaluate the effectiveness of intrapartum prophylactic amnioinfusion in pregnancies complicated by meconium-stained amniotic fluid. We identified prospective clinical trials of amnioinfusion in pregnancies complicated by meconium-stained amniotic fluid (AF) published in English by using computerized databases, references in published studies, and index reviews. We analyzed prospective studies of intrapartum amnioinfusion for meconium-stained AF. In every case, group allocation was based exclusively on meconium in AF. Only published studies with clearly documented outcome data were included. The trials were evaluated for meconium below the vocal cords, meconium aspiration syndrome, fetal acidemia, cesarean delivery, and postpartum endometritis. Each trial was evaluated for the quality of its methodology, inclusion and exclusion criteria, adequacy of randomization, amnioinfusion protocols, definition of outcomes, and statistical analyses. Thirteen studies met inclusion criteria for our systematic review. Odds ratios (ORs) with their 95% confidence intervals (CIs) were calculated for each outcome. Estimates of ORs and risk differences for dichotomous outcomes were calculated using random and fixed-effects models. We tested for homogeneity across the studies. We found that intrapartum amnioinfusion significantly reduced the frequency of meconium aspiration syndrome (OR 0.30; 95% CI 0.19, 0. 46), of meconium below the vocal cords, and neonatal acidemia. Subjects allocated to receive amnioinfusion also had a significantly lower overall cesarean rate (OR 0.74, 95% CI 0.59, 0.93) without increased postpartum endometritis. Amnioinfusion in cases of meconium-stained fluid significantly improves neonatal outcome, lowers the cesarean delivery rate, and does not increase the postpartum endometritis rate.

  2. Case Study of Intrapartum Antibiotic Prophylaxis and Subsequent Postpartum Beta-Lactam Anaphylaxis.

    Science.gov (United States)

    Stark, Mary Ann; Ross, Mary Frances; Kershner, Wendy; Searing, Kimberly

    2015-01-01

    Universal screening for maternal group B Streptococcus (GBS) in the prenatal period has led to administration of intrapartum antibiotic prophylaxis (IAP). Although IAP decreased the rate of early neonatal GBS disease, exposure of childbearing women to penicillin and other beta-lactam antibiotics has increased. Beta-lactam-induced anaphylaxis in the breastfeeding woman during the postpartum period illustrates risk factors for beta-lactam allergy and anaphylaxis. Treatment and nursing implications for this adverse reaction are suggested. © 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  3. Intrapartum caesarean rates differ significantly between ethnic groups--relationship to induction.

    LENUS (Irish Health Repository)

    Ismail, Khadijah I

    2012-01-31

    OBJECTIVE: Given international variation in obstetric practices and outcomes, comparison of labour outcomes in different ethnic groups could provide important information regarding the underlying reasons for rising caesarean delivery rates. Increasing numbers of women from Eastern European countries are now delivering in Irish maternity hospitals. We compared labour outcomes between Irish and Eastern European (EE) women in a large tertiary referral center. STUDY DESIGN: This was a prospective consecutive cohort study encompassing a single calendar year. The cohort comprised 5550 Irish and 867 EE women delivered in a single institution in 2009. Women who had multiple pregnancies, breech presentation, and elective or pre-labour caesarean sections (CS) were excluded. Data obtained from birth registers included maternal age, nationality, parity, gestation, onset of labour, mode of delivery and birth weight. RESULTS: The overall intrapartum CS rate was 11.4% and was significantly higher in Irish compared to EE women (11.8% vs. 8.8%; p=0.008). The proportion of primiparas was lower in Irish compared to EE women (44.8% vs. 63.6%; p<0.0001). The intrapartum CS rate was almost doubled in Irish compared to EE primiparas (20.7% vs. 11.0%; p<0.0001). Analysis of primiparas according to labour onset revealed a higher intrapartum CS rate in Irish primiparas in both spontaneous (13.5% vs. 7.2%; p<0.0001) and induced labour (29.5% vs. 19.3%; p=0.005). Irish women were older with 19.7% of primiparas aged more than 35, compared to 1.6% of EE women (p<0.0001). The primigravid CS rate in Irish women was significantly higher in women aged 35 years or older compared women aged less than 35 (30.6% vs. 18.3%; p<0.0001) consistent in both spontaneous and induced labour. The primiparous induction rate was 45.4% in Irish women compared to 32% in EE women, and more Irish women were induced before 41 weeks gestation. CONCLUSION: The results highlight that primigravid intrapartum CS rates were

  4. Intermittent Auscultation for Intrapartum Fetal Heart Rate Surveillance: American College of Nurse-Midwives.

    Science.gov (United States)

    2015-01-01

    Fetal heart rate surveillance is a standard component of intrapartum care. The fetal heart rate can be evaluated using intermittent auscultation or electronic fetal monitoring. Research that has compared these 2 strategies found them to be equivalent with respect to long-term neonatal outcomes. The purpose of this clinical bulletin by the American College of Nurse-Midwives is to review the evidence for use of intermittent auscultation and provide recommendations for intermittent auscultation technique, interpretation, and documentation. © 2015 by the American College of Nurse-Midwives.

  5. Ex utero intrapartum treatment for an infant with cerebro-costo-mandibular syndrome.

    Science.gov (United States)

    Ogasawara, Kei; Honda, Yoshinobu; Hosoya, Mitsuaki

    2014-08-01

    Cerebro-costo-mandibular syndrome (CCMS) is a rare disorder characterized by multiple rib abnormalities, micrognathia described as Pierre-Robin sequence, and cerebral involvement. Appropriate management of respiratory distress immediately after birth is crucial to rescue these patients. A boy, having a mother with Pierre-Robin sequence and a sister with CCMS, was diagnosed prenatally with CCMS and successfully treated with ex utero intrapartum treatment (EXIT) at 36 weeks 6 days of gestation. EXIT would be an effective option for rescuing patients with prenatally diagnosed CCMS and preventing neonatal hypoxia. © 2014 Japan Pediatric Society.

  6. Effect of spontaneous pushing versus Valsalva pushing in the second stage of labour on mother and fetus: a systematic review of randomised trials.

    Science.gov (United States)

    Prins, M; Boxem, J; Lucas, C; Hutton, E

    2011-05-01

    To critically evaluate any benefit or harm for the mother and her baby of Valsalva pushing versus spontaneous pushing in the second stage of labour. Electronic databases from MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials were systematically searched (last search May 2010). The reference lists of retrieved studies were searched by hand and an internet hand search of master theses and dissertations was performed. No date or language restriction was used. Randomised controlled trials that compared instructed pushing with spontaneous pushing in the second stage of labour were considered. Studies were evaluated independently for methodological quality and appropriateness for inclusion by two authors (MP and JB). The primary outcome was instrumental/operative delivery. Other outcomes were length of labour, any perineal repair, bladder function, maternal satisfaction. Infant outcomes included low Apgar score pushing technique (three studies; 425 women; mean difference 18.59 minutes; 95% CI 0.46-36.73 minutes). Neonatal outcomes did not differ significantly. Urodynamic factors measured 3 months postpartum were negatively affected by Valsalva pushing. Measures of first urge to void and bladder capacity were decreased (one study; 128 women; mean difference respectively 41.50 ml, 95% CI 8.40-74.60, and 54.60 ml, 95% CI 13.31-95.89). The evidence from our review does not support the routine use of Valsalva pushing in the second stage of labour. The Valsalva pushing method has a negative effect on urodynamic factors according to one study. The duration of the second stage of labour is shorter with Valsalva pushing but the clinical significance of this finding is uncertain. The primary studies are sparse, diverse and some flawed. Further research seems warranted. In the mean time supporting spontaneous pushing and encouraging women to choose their own method of pushing should be accepted as best clinical practice. © 2011 The Authors BJOG An

  7. Association between Intrapartum Magnesium Administration and the Incidence of Maternal Fever: A Retrospective Cross-sectional Study.

    Science.gov (United States)

    Lange, Elizabeth M S; Segal, Scott; Pancaro, Carlo; Wong, Cynthia A; Grobman, William A; Russell, Gregory B; Toledo, Paloma

    2017-12-01

    Intrapartum maternal fever is associated with several adverse neonatal outcomes. Intrapartum fever can be infectious or inflammatory in etiology. Increases in interleukin 6 and other inflammatory markers are associated with maternal fever. Magnesium has been shown to attenuate interleukin 6-mediated fever in animal models. We hypothesized that parturients exposed to intrapartum magnesium would have a lower incidence of fever than nonexposed parturients. In this study, electronic medical record data from all deliveries at Northwestern Memorial Hospital (Chicago, Illinois) between 2007 and 2014 were evaluated. The primary outcome was intrapartum fever (temperature at or higher than 38.0°C). Factors associated with the development of maternal fever were evaluated using a multivariable logistic regression model. Propensity score matching was used to reduce potential bias from nonrandom selection of magnesium administration. Of the 58,541 women who met inclusion criteria, 5,924 (10.1%) developed intrapartum fever. Febrile parturients were more likely to be nulliparous, have used neuraxial analgesia, and have been delivered via cesarean section. The incidence of fever was lower in women exposed to magnesium (6.0%) than those who were not (10.2%). In multivariable logistic regression, women exposed to magnesium were less likely to develop a fever (adjusted odds ratio = 0.42 [95% CI, 0.31 to 0.58]). After propensity matching (N = 959 per group), the odds ratio of developing fever was lower in women who received magnesium therapy (odds ratio = 0.68 [95% CI, 0.48 to 0.98]). Magnesium may play a protective role against the development of intrapartum fever. Future work should further explore the association between magnesium dosing and the incidence of maternal fever.

  8. Patterns and Determinants of Care-Seeking for Antepartum and Intrapartum Complications in Rural Bangladesh: Results from a Cohort Study.

    Science.gov (United States)

    Khanam, Rasheda; Creanga, Andreea A; Koffi, Alain K; Mitra, Dipak K; Mahmud, Arif; Begum, Nazma; Moin, Syed Mamun Ibne; Ram, Malathi; Quaiyum, Md Abdul; Ahmed, Saifuddin; Saha, Samir K; Baqui, Abdullah H

    2016-01-01

    The burden of maternal complications during antepartum and intrapartum periods is high and care seeking from a trained provider is low, particularly in low middle income countries of sub-Saharan Africa and South Asia. Identification of barriers to access to trained care and development of strategies to address them will contribute to improvements in maternal health. Using data from a community-based cohort of pregnant women, this study identified the prevalence of antepartum and intrapartum complications and determinants of care-seeking for these complications in rural Bangladesh. The study was conducted in 24,274 pregnant women between June 2011 and December 2013 in rural Sylhet district of Bangladesh. Women were interviewed during pregnancy to collect data on demographic and socioeconomic characteristics; prior miscarriages, stillbirths, live births, and neonatal deaths; as well as data on their ability to make decision to go to health center alone. They were interviewed within the first 7 days of child birth to collect data on self-reported antepartum and intrapartum complications and care seeking for those complications. Bivariate analysis was conducted to explore association between predisposing (socio-demographic), enabling (economic), perceived need, and service related factors with care-seeking for self-reported antepartum and intrapartum complications. Multivariable multinomial logistic regression was performed to examine the association of selected factors with care-seeking for self-reported antepartum and intrapartum complications adjusting for co-variates. Self-reported antepartum and intrapartum complications among women were 14.8% and 20.9% respectively. Among women with any antepartum complication, 58.9% sought care and of these 46.5% received care from a trained provider. Of the women with intrapartum complications, 61.4% sought care and of them 46.5% did so from a trained provider. Care-seeking for both antepartum and intrapartum complications from

  9. Aqua/Aura Updated Inclination Adjust Maneuver Performance Prediction Model

    Science.gov (United States)

    Boone, Spencer

    2017-01-01

    This presentation will discuss the updated Inclination Adjust Maneuver (IAM) performance prediction model that was developed for Aqua and Aura following the 2017 IAM series. This updated model uses statistical regression methods to identify potential long-term trends in maneuver parameters, yielding improved predictions when re-planning past maneuvers. The presentation has been reviewed and approved by Eric Moyer, ESMO Deputy Project Manager.

  10. Role of intrapartum transcervical amnioinfusion in patients with meconium-stained amniotic fluid.

    Science.gov (United States)

    Bhatia, Pushpa; Reena, Kumari; Nangia, Sangita

    2013-03-01

    The study was undertaken to evaluate maternal, perinatal outcomes following transcervical intrapartum amnioinfusion in women with meconium-stained amniotic fluid. A prospective comparative study was conducted on 100 women with meconium-stained amniotic fluid in labor. Group A: study group (50 cases) received amnioinfusion. Group B: control group (50 cases) did not receive amnioinfusion. FHR monitoring was done using cardiotocography. Significant relief from variable decelerations was seen in 68.18 % cases in the amnioinfusion group as compared to 7.1 % cases in the control group. 78 % cases who were given amnioinfusion had vaginal delivery as compared to 18 % cases in the control group. Fourteen percent cases in the study group had cesarean delivery as compared to 68 % cases in the control group. Meconium aspiration syndrome was seen in six percent neonates in the study group as compared to 20 % in the control group. Two neonates died in the control group due to meconium aspiration syndrome. There was no maternal mortality or major maternal complication. Intrapartum transcervical amnioinfusion is valuable in patients with meconium-stained amniotic fluid.

  11. What makes labour and birth traumatic? A survey of intrapartum 'hotspots'.

    Science.gov (United States)

    Harris, Rachel; Ayers, Susan

    2012-01-01

    Evidence suggests between 1% and 6% of women develop post-traumatic stress disorder (PTSD) after childbirth. 'Hotspots' are moments of extreme distress during traumatising events that are implicated in symptoms of PTSD. This cross-sectional internet survey of hotspots examined (1) the content of intrapartum hotspots and (2) whether particular events, cognitions or emotions during hotspots are related to PTSD. Women (N = 675) who experienced a difficult or traumatic birth completed a questionnaire composed of a validated measure of PTSD, questions concerning the existence of hotspots, and a newly developed measure of emotions and cognitions during hotspots. The majority of women (67.4%) reported at least one hotspot during birth and 52.9% had re-experiencing symptoms of these hotspots. Women were more likely to have PTSD if hotspots involved fear and lack of control (odds ratio (OR) 1.30, 95% CI 1.17-1.43) or intrapartum dissociation (OR 1.12, 95% CI 1.05-1.19). Risk of PTSD was higher if hotspots concerned interpersonal difficulties (OR 4.34, 95% CI 2.15-8.77) or obstetric complications (OR 3.35, 95% CI 1.64-6.87) compared to complications with the baby.

  12. Context matters: Successes and challenges of intrapartum care scale-up in four districts of Afghanistan.

    Science.gov (United States)

    Tappis, Hannah; Koblinsky, Marge; Winch, Peter J; Turkmani, Sabera; Bartlett, Linda

    2016-01-01

    Reducing preventable maternal mortality and achieving Sustainable Development Goal targets for 2030 will require increased investment in improving access to quality health services in fragile and conflict-affected states. This study explores the conditions that affect availability and utilisation of intrapartum care services in four districts of Afghanistan where mortality studies were conducted in 2002 and 2011. Information on changes in each district was collected through interviews with community members; service providers; and district, provincial and national officials. This information was then triangulated with programme and policy documentation to identify factors that affect the coverage of safe delivery and emergency obstetric care services. Comparison of barriers to maternal health service coverage across the four districts highlights the complexities of national health policy planning and resource allocation in Afghanistan, and provides examples of the types of challenges that must be addressed to extend the reach of life-saving maternal health interventions to women in fragile and conflict-affected states. Findings suggest that improvements in service coverage must be measured at a sub-national level, and context-specific service delivery models may be needed to effectively scale up intrapartum care services in extremely remote or insecure settings.

  13. Exploring family physicians' reasons to continue or discontinue providing intrapartum care: Qualitative descriptive study.

    Science.gov (United States)

    Dove, Marion; Dogba, Maman Joyce; Rodríguez, Charo

    2017-08-01

    To examine the reasons why family physicians continue or discontinue providing intrapartum care in their clinical practice. Qualitative descriptive study. Two hospitals located in a multicultural area of Montreal, Que, in November 2011 to June 2012. Sixteen family physicians who were current or former providers of obstetric care. Data were collected using semistructured qualitative interviews. Thematic analysis was used to analyze the interview transcripts. Three overarching themes that help create understanding of why family doctors continue to provide obstetric care were identified: their attraction, often initiated by role models early in their careers, to practising complete continuity of care and accompanying patients in a special moment in their lives; the personal, family, and organizational pressures experienced while pursuing a family medicine career that includes obstetrics; and their ongoing reflection about continuing to practise obstetrics. The practice of obstetrics was very attractive to family physician participants whether they provided intrapartum care or decided to stop. More professional support and incentives might help keep family doctors practising obstetrics. Copyright© the College of Family Physicians of Canada.

  14. Intra and interobserver variability of intrapartum transperineal ultrasound measurements with contraction and pushing.

    Science.gov (United States)

    Sainz, José A; Fernández-Palacín, Ana; Borrero, Carlota; Aquise, Adriana; Ramos, Zenaida; García-Mejido, José A

    2018-04-01

    The aim of this study was to evaluate the inter- and intraobserver correlation of the different intrapartum-transperineal-ultrasound-parameters(ITU) (angle of progression (AoP), progression-distance (PD), head-direction (HD), midline-angle (MLA) and head-perineum distance (HPD)) with contraction and pushing. We evaluated 28 nulliparous women at full dilatation under epidural analgesia. We performed a transperineal ultrasound evaluating AoP and PD in the longitudinal plane, and MLA and HPD in the transverse plane. Interclass correlation coefficients (ICC) with 95% CIs and Bland-Altman analysis were used to assess intra- and interobserver measurement's repeatability. The ICC of the ITU for the same observer was adequate for all the parameters (p pushing under epidural analgesia. Impact statement What is already known on this subject: The intrapartum transperineal ultrasound parameters can be used with contraction and pushing under epidural analgesia. What the results of this study add to what we know: ITU may be used to evaluate the difficulty of instrumental delivery/to evaluate the difficulty of instrumentation in vaginal operative deliveries and this study concludes that ITU is reproducible during uterine contraction with pushing. What the implications are of these findings for clinical practice and/or further research: Therefore, ITU could be used without difficulty with an adequate intra- and interobserver correlation for the prediction of instrumentation difficulty in operative vaginal deliveries.

  15. Intrapartum electrocardiogram alteration in fetuses with congenital heart disease: a case-control study.

    Science.gov (United States)

    Gay, Estelle; Bornallet, Géraldine; Gaucherand, Pascal; Doret, Muriel

    2015-11-01

    To assess if the fetal electrocardiogram especially ST segment is modified by congenital heart diseases: modifications in frequencies of the different ST events and modifications in signal quality. A retrospective case-control study, comparing frequencies of the different ST events and the quality of the signal between fetuses with congenital heart diseases and fetuses without congenital heart disease. From 2000 to 2011, fifty-eight fetuses with congenital heart disease had their heart rate recording using a STAN device during labor. Control group was fetuses who were born just before a case and had a STAN as a second line for intrapartum surveillance. Cases and controls were matched on parity, gestational age at birth, presence of growth restriction and umbilical artery pH. Frequencies of the different ST event and quality of the signal were first analyzed for the global labor recording, and then separately for the first and the second phase of labor. No statistically significant difference in ST event frequencies between fetuses with congenital heart disease and the control group was found. Regarding the quality of the signal, 11.49% (±18.82) of recording time is a signal loss for fetus with congenital heart disease whereas only 5.18% (±10.67) for the control group (p=0.028). This is the first study investigating for intrapartum electrocardiogram modification in fetus with congenital heart disease. Congenital heart diseases do not modify frequencies of ST events. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  16. Marine Corps Maneuver Squad Leader Mastery Model

    Science.gov (United States)

    2012-12-17

    H. L., & Dreyfus, S. E. (1986). Mind over machine: The power of human intuitive expertise in the  era of the computer. New York: The  Free  Press...at them then  squat  down to begin playing a dice game. The  maneuver squad leader judged this behavior as an anomaly, because  the boys didn’t begin

  17. Coordination Logic for Repulsive Resolution Maneuvers

    Science.gov (United States)

    Narkawicz, Anthony J.; Munoz, Cesar A.; Dutle, Aaron M.

    2016-01-01

    This paper presents an algorithm for determining the direction an aircraft should maneuver in the event of a potential conflict with another aircraft. The algorithm is implicitly coordinated, meaning that with perfectly reliable computations and information, it will in- dependently provide directional information that is guaranteed to be coordinated without any additional information exchange or direct communication. The logic is inspired by the logic of TCAS II, the airborne system designed to reduce the risk of mid-air collisions between aircraft. TCAS II provides pilots with only vertical resolution advice, while the proposed algorithm, using a similar logic, provides implicitly coordinated vertical and horizontal directional advice.

  18. ESBWR power maneuvering via feedwater temperature control

    International Nuclear Information System (INIS)

    Saha, P.; Marquino, W.; Tucker, L. J.

    2008-01-01

    The ESBWR is a Generation III+ Boiling Water Reactor (BWR) driven by natural circulation. For a given geometry/hardware, system pressure, downcomer water level and feedwater temperature, the core flow rate in the ESBWR is only a function of reactor power, controlled through the control blade movement. In order to provide operational flexibility, another method of core-wide or global power maneuvering via feedwater temperature control has been developed. This is independent of power maneuvering via control blade movement, and it lowers the linear heat generation rate (LHGR) changes near the tip of control blades, which improves fuel reliability. All required stability, anticipated operational occurrences (AOOs), infrequent events, special events including anticipated transients without scram (ATWS), and loss-of-coolant accident (LOCA) analyses have been performed for the 4500 MWt ESBWR. Based on the results of these analyses at 'high', nominal and 'low' feedwater temperatures, a safe Power - Feedwater Temperature operating domain has been developed. This paper summarizes the results of these analyses and presents the ESBWR Power - Feedwater Temperature operating domain or map. (authors)

  19. Anatomical basis of the liver hanging maneuver.

    Science.gov (United States)

    Trotovsek, Blaz; Belghiti, Jacques; Gadzijev, Eldar M; Ravnik, Dean; Hribernik, Marija

    2005-01-01

    The anterior approach to right hepatectomy using the liver hanging maneuver without liver mobilization claims to be anatomically evaluated. During this procedure a 4 to 6-cm blind dissection between the inferior vena cava and the liver is performed. Short subhepatic veins, entering the inferior vena cava could be torn and a hemorrhage, difficult to control, could occur. On 100 corrosive casts of livers the anterior surface of the inferior vena cava was studied to evaluate the position, diameter and draining area of short subhepatic veins and inferior right hepatic vein. The width of the narrowest point on the planned route of blind dissection was determined. The average value of the narrowest point on the planned route of blind dissection was 8.7+/-2.3mm (range 2-15mm). The ideal angle of dissection being 0 degrees was found in 93% of cases. In 7% we found the angle of 5 degrees toward the right border of inferior vena cava to be the better choice. Our results show that liver hanging maneuver is a safe procedure. With the dissection in the proposed route the risk of disrupting short subhepatic veins is low (7%).

  20. General and Specific Strategies Used to Facilitate Locomotor Maneuvers.

    Directory of Open Access Journals (Sweden)

    Mengnan Wu

    Full Text Available People make anticipatory changes in gait patterns prior to initiating a rapid change of direction. How they prepare will change based on their knowledge of the maneuver. To investigate specific and general strategies used to facilitate locomotor maneuvers, we manipulated subjects' ability to anticipate the direction of an upcoming lateral "lane-change" maneuver. To examine specific anticipatory adjustments, we observed the four steps immediately preceding a maneuver that subjects were instructed to perform at a known time in a known direction. We hypothesized that to facilitate a specific change of direction, subjects would proactively decrease margin of stability in the future direction of travel. Our results support this hypothesis: subjects significantly decreased lateral margin of stability by 69% on the side ipsilateral to the maneuver during only the step immediately preceding the maneuver. This gait adaptation may have improved energetic efficiency and simplified the control of the maneuver. To examine general anticipatory adjustments, we observed the two steps immediately preceding the instant when subjects received information about the direction of the maneuver. When the maneuver direction was unknown, we hypothesized that subjects would make general anticipatory adjustments that would improve their ability to actively initiate a maneuver in multiple directions. This second hypothesis was partially supported as subjects increased step width and stance phase hip flexion during these anticipatory steps. These modifications may have improved subjects' ability to generate forces in multiple directions and maintain equilibrium during the onset and execution of the rapid maneuver. However, adapting these general anticipatory strategies likely incurred an additional energetic cost.

  1. Intrapartum PCR assay versus antepartum culture for assessment of vaginal carriage of group B streptococci in a Danish cohort at birth

    DEFF Research Database (Denmark)

    Khalil, Mohammed Rohi; Uldbjerg, Niels; Thorsen, Poul Bak

    2017-01-01

    The aim of this study was to compare the performances of two strategies for predicting intrapartum vaginal carriage of group B streptococci (GBS). One strategy was based on an antepartum culture and the other on an intrapartum polymerase chain reaction (PCR). We conducted a prospective observatio......The aim of this study was to compare the performances of two strategies for predicting intrapartum vaginal carriage of group B streptococci (GBS). One strategy was based on an antepartum culture and the other on an intrapartum polymerase chain reaction (PCR). We conducted a prospective...... observational study enrolling 902 pregnant women offered GBS screening before delivery by two strategies. The Culture-strategy was based on vaginal and rectal cultures at 35-37 weeks' gestation, whereas the PCR-strategy was based on PCR assay on intrapartum vaginal swab samples. An intrapartum vaginal culture...... (NPV) of 98%, and Likelihood ratio (LH+) of 9.2. The PCR-strategy showed corresponding values as sensitivity of 83%, specificity of 97%, PPV of 78%, NPV of 98%, and LH+ of 27.5. We conclude that in a Danish population with a low rate of early-onset neonatal infection with GBS, the intrapartum PCR assay...

  2. A randomised clinical trial of intrapartum fetal monitoring with computer analysis and alerts versus previously available monitoring

    Directory of Open Access Journals (Sweden)

    Santos Cristina

    2010-10-01

    Full Text Available Abstract Background Intrapartum fetal hypoxia remains an important cause of death and permanent handicap and in a significant proportion of cases there is evidence of suboptimal care related to fetal surveillance. Cardiotocographic (CTG monitoring remains the basis of intrapartum surveillance, but its interpretation by healthcare professionals lacks reproducibility and the technology has not been shown to improve clinically important outcomes. The addition of fetal electrocardiogram analysis has increased the potential to avoid adverse outcomes, but CTG interpretation remains its main weakness. A program for computerised analysis of intrapartum fetal signals, incorporating real-time alerts for healthcare professionals, has recently been developed. There is a need to determine whether this technology can result in better perinatal outcomes. Methods/design This is a multicentre randomised clinical trial. Inclusion criteria are: women aged ≥ 16 years, able to provide written informed consent, singleton pregnancies ≥ 36 weeks, cephalic presentation, no known major fetal malformations, in labour but excluding active second stage, planned for continuous CTG monitoring, and no known contra-indication for vaginal delivery. Eligible women will be randomised using a computer-generated randomisation sequence to one of the two arms: continuous computer analysis of fetal monitoring signals with real-time alerts (intervention arm or continuous CTG monitoring as previously performed (control arm. Electrocardiographic monitoring and fetal scalp blood sampling will be available in both arms. The primary outcome measure is the incidence of fetal metabolic acidosis (umbilical artery pH ecf > 12 mmol/L. Secondary outcome measures are: caesarean section and instrumental vaginal delivery rates, use of fetal blood sampling, 5-minute Apgar score Discussion This study will provide evidence of the impact of intrapartum monitoring with computer analysis and real

  3. Linking spatial and dynamic models for traffic maneuvers

    DEFF Research Database (Denmark)

    Olderog, Ernst-Rüdiger; Ravn, Anders Peter; Wisniewski, Rafal

    2015-01-01

    For traffic maneuvers of multiple vehicles on highways we build an abstract spatial and a concrete dynamic model. In the spatial model we show the safety (collision freedom) of lane-change maneuvers. By linking the spatial and dynamic model via suitable refinements of the spatial atoms to distance...

  4. 14 CFR 23.155 - Elevator control force in maneuvers.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Elevator control force in maneuvers. 23.155 Section 23.155 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION... Controllability and Maneuverability § 23.155 Elevator control force in maneuvers. (a) The elevator control force...

  5. Safety analysis of passing maneuvers using extreme value theory

    Directory of Open Access Journals (Sweden)

    Haneen Farah

    2017-04-01

    The results indicate that this is a promising approach for safety evaluation. On-going work of the authors will attempt to generalize this method to other safety measures related to passing maneuvers, test it for the detailed analysis of the effect of demographic factors on passing maneuvers' crash probability and for its usefulness in a traffic simulation environment.

  6. Ruptured congenital aneurysm of the right sinus of Valsalva into the right ventricle: with special reference to pathoanatomic and hemodynamic characteristics in symptomless cases.

    Science.gov (United States)

    Chen, J J; Lien, W P; Chang, F Z; Lee, Y S; Hung, C R; Chu, S S; Wu, T L

    1980-02-01

    Clinical features of 19 cases with congenital aneurysm of the right sinus of Valsalva rupturing into the right ventricular outflow region (Type 1) were analysed in relation to their pathoanatomic lesions and hemodynamic alterations. Sixteen cases were operated with one surgical death. All were catheterized together with ascending aortographic study. Rupture of the aneurysm in many cases was silent or symptomless and progressive heart failure was not quite common. Symptomatology of the patients did not seem to be related entirely to status of the pathoanatomical lesions or hemodynamic alterations. Time of the rupture, and inherent right ventricular characteristics, tolerating volume overload rather well, might be, in part, responsible for its better prognosis in some cases. However, all patients with ruptured aneurysm of the sinus of Valsalva should be treated surgically. Bacterial endocarditis is a serious complication leading to death.

  7. Adaptive Maneuvering Frequency Method of Current Statistical Model

    Institute of Scientific and Technical Information of China (English)

    Wei Sun; Yongjian Yang

    2017-01-01

    Current statistical model(CSM) has a good performance in maneuvering target tracking. However, the fixed maneuvering frequency will deteriorate the tracking results, such as a serious dynamic delay, a slowly converging speedy and a limited precision when using Kalman filter(KF) algorithm. In this study, a new current statistical model and a new Kalman filter are proposed to improve the performance of maneuvering target tracking. The new model which employs innovation dominated subjection function to adaptively adjust maneuvering frequency has a better performance in step maneuvering target tracking, while a fluctuant phenomenon appears. As far as this problem is concerned, a new adaptive fading Kalman filter is proposed as well. In the new Kalman filter, the prediction values are amended in time by setting judgment and amendment rules,so that tracking precision and fluctuant phenomenon of the new current statistical model are improved. The results of simulation indicate the effectiveness of the new algorithm and the practical guiding significance.

  8. Planar reorientation maneuvers of space multibody systems using internal controls

    Science.gov (United States)

    Reyhanoglu, Mahmut; Mcclamroch, N. H.

    1992-01-01

    In this paper a reorientation maneuvering strategy for an interconnection of planar rigid bodies in space is developed. It is assumed that there are no exogeneous torques, and torques generated by joint motors are used as means of control so that the total angular momentum of the multibody system is a constant, assumed to be zero in this paper. The maneuver strategy uses the nonintegrability of the expression for the angular momentum. We demonstrate that large-angle maneuvers can be designed to achieve an arbitrary reorientation of the multibody system with respect to an inertial frame. The theoretical background for carrying out the required maneuvers is briefly summarized. Specifications and computer simulations of a specific reorientation maneuver, and the corresponding control strategies, are described.

  9. AIRCRAFT CONFLICTS RESOLUTION BY COURSE MANEUVERING

    Directory of Open Access Journals (Sweden)

    В. Харченко

    2011-02-01

    Full Text Available Enhancement of requirements for air traffic efficiency at increasing of flights intensity determines the necessity of development of new optimization methods for aircraft conflict resolutions. The statement of problem of optimal conflict resolutions at Cooperative Air Traffic Management was done. The method for optimal aircraft conflict  resolution by course maneuvering has been  developed. The method using dynamic programming provides planning of aircraft conflict-free trajectory with minimum length. The decomposition of conflict resolution process on phases and stages, definition of states, controls and recursive  equations for generation of optimal course control program were done. Computer modeling of aircraft conflict resolution by developed method was done

  10. Inadequacies with the ACOG and AAP statements on managing ethical conflict during the intrapartum period.

    Science.gov (United States)

    Chervenak, Frank A; McCullough, Laurence B

    1991-01-01

    [The American College of Obstetricians and Gynecologists] takes the view that respect for the autonomy of the pregnant woman should be almost absolute and [the American Academy of Pediatrics] takes the view that respect for the autonomy of the pregnant woman should be limited or prima facie in character. ACOG's reading of this central bioethical principle admits of virtually no exceptions, while AAP's reading does allow exceptions....A complete account of obstetric ethics that would apply in clinical practice during the intrapartum period must take into account both negative and positive autonomy-based rights of the pregnant woman and beneficence-based obligations to the at-term fetus -- and to the pregnant woman, as well. Such an account will be, we believe, more clinically applicable than the accounts offered by ACOG and AAP.

  11. Analysis of ship maneuvering data from simulators

    Science.gov (United States)

    Frette, V.; Kleppe, G.; Christensen, K.

    2011-03-01

    We analyze complex manuevering histories of ships obtained from training sessions on bridge simulators. Advanced ships are used in fields like offshore oil exploration: dive support vessels, supply vessels, anchor handling vessels, tugs, cable layers, and multi-purpose vessels. Due to high demands from the operations carried out, these ships need to have very high maneuverability. This is achieved through a propulsion system with several thrusters, water jets, and rudders in addition to standard propellers. For some operations, like subsea maintenance, it is crucial that the ship accurately keeps a fixed position. Therefore, bridge systems usually incorporate equipment for Dynamic Positioning (DP). DP is a method to keep ships and semi submersible rigs in a fixed position using the propulsion systems instead of anchors. It may also be used for sailing a vessel from one position to another along a predefined route. Like an autopilot on an airplane, DP may operate without human involvement. The method relies on accurate determination of position from external reference systems like GPS, as well as a continuously adjusted mathematical model of the ship and external forces from wind, waves and currents. In a specific simulator exercise for offshore crews, a ship is to be taken up to an installation consisting of three nearby oil platforms connected by bridges (Frigg field, North Sea), where a subsea inspection is to be carried out. Due to the many degrees of freedom during maneuvering, including partly or full use of DP, the chosen routes vary significantly. In this poster we report preliminary results on representations of the complex maneuvering histories; representations that allow comparison between crew groups, and, possibly, sorting of the different strategic choices behind.

  12. Therapeutic amnioinfusion for intrapartum fetal distress using a pediatric feeding tube.

    Science.gov (United States)

    Abdel-Aleem, H; Amin, A F; Shokry, M; Radwan, R A

    2005-08-01

    To evaluate the role of therapeutic amnioinfusion using a pediatric feeding tube in cases of intrapartum fetal distress. A randomized clinical trial including 438 women admitted in labor at Assiut University Hospital with nonreassuring fetal heart rate tracing. Using sealed opaque envelopes, the women were randomized to 2 groups. In the amnioinfusion group they underwent transcervical amnioinfusion (1000 mL of warmed sterile saline solution) in addition to conventional treatment. In the control group they received conventional treatment only. The primary outcome was cesarean section rate for fetal distress. The secondary outcomes were neonatal and maternal complications. The amnioinfusion group showed a significant reduction in the rate of cesarean section for fetal distress (relative risk [RR], 0.7; 95% confidence interval [CI], 0.6-0.83), and a 30% reduction in abnormal fetal heart rate patterns (RR, 0.7; 95% CI, 0.6-0.83). Significantly fewer newborns had Apgar scores less than 7 at 1 and 5 min in the amnioinfusion group than in the control group (RR, 0.38; 95% CI, 0.26-0.55 and RR, 0.31; 95% CI, 0.15-0.64, respectively). Significantly fewer newborns had meconium below the vocal cords in the amnioinfusion group than in the control group (RR, 0.36; 95% CI, 0.13-0.97). Moreover, 14 newborns in the amnioinfusion group needed admission to the intensive care unit vs. 31 newborns in the control group. There were no significant differences between the 2 groups regarding the incidence rates of uterine hypertonus and maternal temperature higher than 38 degrees C. Therapeutic amnioinfusion is a simple and effective intervention that reduces the rates of cesarean section for intrapartum nonreassuring fetal heart tracing. In under-resourced settings, it can be performed using inexpensive catheters.

  13. The effect of prenatal and intrapartum care on the stillbirth rate among women in rural Ethiopia.

    Science.gov (United States)

    Ballard, Karen; Belete, Zelalem; Kinfu, Hirut; Tadesse, Mebkyou; Amin, Mohammed; Atnafu, Habtamu

    2016-05-01

    To determine whether community-based prenatal and intrapartum care in Ethiopia results in a lower stillbirth rate. Between May and December 2014, a randomly selected sample of women in northern and eastern Ethiopia who had delivered a neonate in the preceding 12months completed a face-to-face survey about their experiences of maternal services and the fetal outcome for each delivery. The stillbirth rates among women delivering at home and at health facilities were compared. Overall, 4442 women completed surveys. Stillbirth was reported by 42 (1.7%) of the 2437 women who had received prenatal care and 53 (2.8%) of the 1921 women who did not receive prenatal care (P=0.01). The stillbirth rate was similar among women who delivered in a health center (27/1417 [1.9%]), in a hospital (6/126 [4.8%]), and at home (62/2725 [2.3%]; P=0.13). However, women experiencing an intrapartum emergency were twice as likely to deliver in a health facility (odds ratio 2.6, 95% confidence interval 2.2-3.0). Satisfaction with health-center care was moderately good (median score 77.5/100). The stillbirth rate was reduced among women receiving prenatal care, although delivering in a health facility did not reduce the risk of stillbirth. Improving the quality of health-center care could lead to their planned use for childbirth, which might reduce stillbirth rates. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  14. Quality along the continuum: a health facility assessment of intrapartum and postnatal care in Ghana.

    Directory of Open Access Journals (Sweden)

    Robin C Nesbitt

    Full Text Available To evaluate quality of routine and emergency intrapartum and postnatal care using a health facility assessment, and to estimate "effective coverage" of skilled attendance in Brong Ahafo, Ghana.We conducted an assessment of all 86 health facilities in seven districts in Brong Ahafo. Using performance of key signal functions and the availability of relevant drugs, equipment and trained health professionals, we created composite quality categories in four dimensions: routine delivery care, emergency obstetric care (EmOC, emergency newborn care (EmNC and non-medical quality. Linking the health facility assessment to surveillance data we estimated "effective coverage" of skilled attendance as the proportion of births in facilities of high quality.Delivery care was offered in 64/86 facilities; only 3-13% fulfilled our requirements for the highest quality category in any dimension. Quality was lowest in the emergency care dimensions, with 63% and 58% of facilities categorized as "low" or "substandard" for EmOC and EmNC, respectively. This implies performing less than four EmOC or three EmNC signal functions, and/or employing less than two skilled health professionals, and/or that no health professionals were present during our visit. Routine delivery care was "low" or "substandard" in 39% of facilities, meaning 25/64 facilities performed less than six routine signal functions and/or had less than two skilled health professionals and/or less than one midwife. While 68% of births were in health facilities, only 18% were in facilities with "high" or "highest" quality in all dimensions.Our comprehensive facility assessment showed that quality of routine and emergency intrapartum and postnatal care was generally low in the study region. While coverage with facility delivery was 68%, we estimated "effective coverage" of skilled attendance at 18%, thus revealing a large "quality gap." Effective coverage could be a meaningful indicator of progress towards

  15. Falling caesarean section rate and improving intra-partum outcomes: a prospective cohort study.

    Science.gov (United States)

    Amin, Pina; Zaher, Summia; Penketh, Richard; Cherian, Sobha; Collis, Rachel E; Sanders, Julia; Bhal, Kiron

    2018-02-19

    To evaluate caesarean section (CS) rates and moderate to severe hypoxaemic ischaemic encephalopathy (HIE) rates with other core intra-partum outcomes following reconfiguration of maternity services in Cardiff, South Wales, UK. Cohort study of births from 2006 to 2015. A University tertiary referral centre for foetal and maternal medicine with 6000 births/year, University Hospital of Wales, United Kingdom. Data relating to births from 1 January 2006 to 31 December 2015 were extracted from the computerized maternity database on a yearly basis. Case notes of all mothers and babies for the same duration were hand searched for documentation of HIE. HIE data was also collected prospectively by neonatologist (SC) and obstetrician (PA). Incidence of caesarean section births, babies with moderate to severe HIE, instrumental vaginal births, obstetric anal sphincter injuries (OASIS) associated with instrumental delivery, and major post-partum haemorrhage (MPPH) of 2500 mL or more. During this 10-year period, a downward trend in emergency CS rate was seen from 15.6% in 2006 to 10.5% in 2015, reducing total CS rate from 25.5% in 2006 to 21.2% in 2015. A downward trend in the incidence of moderate and severe HIE was seen over the same period. There was an increase in operative vaginal births (OVB) from 12.8% to 15%. The rate of spontaneous vaginal births (SVB) remained stable. The incidence of OASIS remained constant and MPPH rate has fallen. Following amalgamation of two medium sized obstetric units and the opening of a Midwifery Led Unit (MLU), core intrapartum outcomes have improved. Contributing factors are the introduction of regular multidisciplinary training with enhanced team working, compulsory education for obstetricians and midwives on cardiotocograph (CTG) interpretation, increased consultant presence on delivery suite, robust risk management systems and broad multidisciplinary agreement on clinical guidelines promoting vaginal birth.

  16. Intrapartum and neonatal mortality in primary midwife-led and secondary obstetrician-led care in the Amsterdam region of the Netherlands: A retrospective cohort study

    NARCIS (Netherlands)

    Wiegerinck, M.M.J.; van der Goes, B.Y.; Ravelli, A.C.J.; van der Post, J.A.M.; Klinkert, J.; Brandenbarg, J.; Buist, F.C.D.; Wouters, M.G.A.J.; Tamminga, P.; de Jonge, A.; Mol, B.W.

    2015-01-01

    Objective: to compare intrapartum- and neonatal mortality and intervention rates in term women starting labour in primary midwife-led versus secondary obstetrician-led care. Design: retrospective cohort study. Setting: Amsterdam region of the Netherlands. Participants: women with singleton

  17. The characteristics of women who use hypnotherapy for intrapartum pain management: Preliminary insights from a nationally-representative sample of Australian women.

    Science.gov (United States)

    Steel, A; Frawley, J; Sibbritt, D; Broom, A; Adams, J

    2016-04-01

    This manuscript presents a preliminary examination of the characteristics of women who choose intrapartum hypnosis for pain management. Cross-sectional analysis of 2445 women (31-36 years) from a sub-study of the Australian Longitudinal Study on Women's Health (ALSWH), employing Fisher exact tests. Australia. Use of intrapartum hypnosis, or hypnobirthing, for pain management during labour and birth. Women using hypnobirthing were more likely to have consulted with an acupuncturist or naturopath, or attended yoga/meditation classes during pregnancy (phypnotherapy for intrapartum pain management less commonly identified as feeling safer knowing that an obstetrician is providing their care (phypnotherapy for intrapartum pain management. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Intrapartum-related neonatal encephalopathy incidence and impairment at regional and global levels for 2010 with trends from 1990

    Science.gov (United States)

    Lee, Anne CC; Kozuki, Naoko; Blencowe, Hannah; Vos, Theo; Bahalim, Adil; Darmstadt, Gary L.; Niermeyer, Susan; Ellis, Matthew; Robertson, Nicola J.; Cousens, Simon; Lawn, Joy E.

    2013-01-01

    Background: Intrapartum hypoxic events (“birth asphyxia”) may result in stillbirth, neonatal or postneonatal mortality, and impairment. Systematic morbidity estimates for the burden of impairment outcomes are currently limited. Neonatal encephalopathy (NE) following an intrapartum hypoxic event is a strong predictor of long-term impairment. Methods: Linear regression modeling was conducted on data identified through systematic reviews to estimate NE incidence and time trends for 184 countries. Meta-analyses were undertaken to estimate the risk of NE by sex of the newborn, neonatal case fatality rate, and impairment risk. A compartmental model estimated postneonatal survivors of NE, depending on access to care, and then the proportion of survivors with impairment. Separate modeling for the Global Burden of Disease 2010 (GBD2010) study estimated disability adjusted life years (DALYs), years of life with disability (YLDs), and years of life lost (YLLs) attributed to intrapartum-related events. Results: In 2010, 1.15 million babies (uncertainty range: 0.89–1.60 million; 8.5 cases per 1,000 live births) were estimated to have developed NE associated with intrapartum events, with 96% born in low- and middle-income countries, as compared with 1.60 million in 1990 (11.7 cases per 1,000 live births). An estimated 287,000 (181,000–440,000) neonates with NE died in 2010; 233,000 (163,000–342,000) survived with moderate or severe neurodevelopmental impairment; and 181,000 (82,000–319,000) had mild impairment. In GBD2010, intrapartum-related conditions comprised 50.2 million DALYs (2.4% of total) and 6.1 million YLDs. Conclusion: Intrapartum-related conditions are a large global burden, mostly due to high mortality in low-income countries. Universal coverage of obstetric care and neonatal resuscitation would prevent most of these deaths and disabilities. Rates of impairment are highest in middle-income countries where neonatal intensive care was more recently

  19. Ship maneuvering digital simulator; Simulador digital de manobras de navios

    Energy Technology Data Exchange (ETDEWEB)

    Souza Junior, Jesse Rebello; Tannuri, Eduardo Aoun; Oshiro, Anderson Takehiro [Universidade de Sao Paulo (USP), SP (Brazil). Escola Politecnica. Dept. de Engenharia Naval e Oceanica

    2008-07-01

    This paper reports on two case studies making use of a digital simulator to investigate the maneuvering motions of ships in canals with shallow and restricted waters. The first case study corresponds to a maneuvering analysis conducted for the Port of Rio Grande (RS - Brazil), whose aim was to assess the potential impact upon maneuvers of the presence of a large offshore platform (the PETROBRAS P-53) which is to remain docked for several months at the Port to complete its construction. The second study made use of the simulator to evaluate the maneuvering conditions along the approach route and maneuvering basin of the Port of Ponta do Felix (PR - Brazil). The simulator includes a complete mathematical model of the ship dynamics in the horizontal plane when subjected to wind and current forces. It also comprises detailed models for the action of thrusters and propellers, both fixed and azimuth, employed to control maneuvers and dynamically position ships, as well as rudders and tugboats. He models used by the simulator allow for the effects of shallow and restricted waters, including the increase in resistance and lateral forces, increase in additional mass and the appearance of lateral and vertical suction (squatting). The simulator is implemented via an interactive interface through which the user is able to apply control actions (rudder angle, main engine, thrusters and tugboats) in real time during maneuvers, thereby reproducing to some extent the action of a pilot. (author)

  20. Helicopter Pilot Performance for Discrete-maneuver Flight Tasks

    Science.gov (United States)

    Heffley, R. K.; Bourne, S. M.; Hindson, W. S.

    1984-01-01

    This paper describes a current study of several basic helicopter flight maneuvers. The data base consists of in-flight measurements from instrumented helicopters using experienced pilots. The analysis technique is simple enough to apply without automatic data processing, and the results can be used to build quantitative matah models of the flight task and some aspects of the pilot control strategy. In addition to describing the performance measurement technqiue, some results are presented which define the aggressiveness and amplitude of maneuvering for several lateral maneuvers including turns and sidesteps.

  1. Constellation Mission Operation Working Group: ESMO Maneuver Planning Process Review

    Science.gov (United States)

    Moyer, Eric

    2015-01-01

    The Earth Science Mission Operation (ESMO) Project created an Independent Review Board to review our Conjunction Risk evaluation process and Maneuver Planning Process to identify improvements that safely manages mission conjunction risks, maintains ground track science requirements, and minimizes overall hours expended on High Interest Events (HIE). The Review Board is evaluating the current maneuver process which requires support by multiple groups. In the past year, there have been several changes to the processes although many prior and new concerns exist. This presentation will discuss maneuver process reviews and Board comments, ESMO assessment and path foward, ESMO future plans, recent changes and concerns.

  2. Improvements to the adaptive maneuvering logic program

    Science.gov (United States)

    Burgin, George H.

    1986-01-01

    The Adaptive Maneuvering Logic (AML) computer program simulates close-in, one-on-one air-to-air combat between two fighter aircraft. Three important improvements are described. First, the previously available versions of AML were examined for their suitability as a baseline program. The selected program was then revised to eliminate some programming bugs which were uncovered over the years. A listing of this baseline program is included. Second, the equations governing the motion of the aircraft were completely revised. This resulted in a model with substantially higher fidelity than the original equations of motion provided. It also completely eliminated the over-the-top problem, which occurred in the older versions when the AML-driven aircraft attempted a vertical or near vertical loop. Third, the requirements for a versatile generic, yet realistic, aircraft model were studied and implemented in the program. The report contains detailed tables which make the generic aircraft to be either a modern, high performance aircraft, an older high performance aircraft, or a previous generation jet fighter.

  3. Effects-Based Operations: The End of Dominant Maneuver?

    National Research Council Canada - National Science Library

    Cheek, Gary

    2002-01-01

    ... without dominant ground maneuver. The paper concludes that such thinking misreads a historical warfare lethality trend in a potentially dangerous effort to vindicate the Air Force doctrine of strategic attack...

  4. Close Proximity Robotic Maneuvering through Flux Pinning Manipulation

    Data.gov (United States)

    National Aeronautics and Space Administration — Non-contacting actuation technology like flux pinning has never been demonstrated in space. The development of a nonphysical joint is critical for maneuvers such as...

  5. Automated Precision Maneuvering and Landing in Extreme and Constrained Environments

    Data.gov (United States)

    National Aeronautics and Space Administration — Autonomous, precise maneuvering and landing in extreme and constrained environments is a key enabler for future NASA missions. Missions to map the interior of a...

  6. Tongue-Driven Wheelchair Out-Maneuvers the Competition

    Science.gov (United States)

    ... 2, 2014 Tongue-Driven Wheelchair Out-Maneuvers the Competition Researchers funded by the National Institute of Biomedical ... significant step towards vastly improving the independence and quality of life of individuals with tetraplegia, and is ...

  7. THE DUBINS TRAVELING SALESMAN PROBLEM WITH CONSTRAINED COLLECTING MANEUVERS

    Directory of Open Access Journals (Sweden)

    Petr Váňa

    2016-11-01

    Full Text Available In this paper, we introduce a variant of the Dubins traveling salesman problem (DTSP that is called the Dubins traveling salesman problem with constrained collecting maneuvers (DTSP-CM. In contrast to the ordinary formulation of the DTSP, in the proposed DTSP-CM, the vehicle is requested to visit each target by specified collecting maneuver to accomplish the mission. The proposed problem formulation is motivated by scenarios with unmanned aerial vehicles where particular maneuvers are necessary for accomplishing the mission, such as object dropping or data collection with sensor sensitive to changes in vehicle heading. We consider existing methods for the DTSP and propose its modifications to use these methods to address a variant of the introduced DTSP-CM, where the collecting maneuvers are constrained to straight line segments.

  8. Diversity and composition of vaginal microbiota of pregnant women at risk for transmitting Group B Streptococcus treated with intrapartum penicillin.

    Directory of Open Access Journals (Sweden)

    Luiz Fernando Wurdig Roesch

    Full Text Available Administering intravenous antibiotics during labor to women at risk for transmitting Group B Streptococcus (GBS can prevent infections in newborns. However, the impact of intrapartum antibiotic prophylaxis on mothers' microbial community composition is largely unknown. We compared vaginal microbial composition in pregnant women experiencing preterm birth at ≤ 32 weeks gestation that received intrapartum antibiotic prophylaxis with that in controls.Microbiota in vaginal swabs collected shortly before delivery from GBS positive women that received penicillin intravenously during labor or after premature rupture of membranes was compared to controls. Microbiota was analyzed by 16S rRNA sequencing using the PGM Ion Torrent to determine the effects of penicillin use during hospitalization and GBS status on its composition.Penicillin administration was associated with an altered vaginal microbial community composition characterized by increased microbial diversity. Lactobacillus sp. contributed only 13.1% of the total community in the women that received penicillin compared to 88.1% in the controls. Streptococcus sp. were present in higher abundance in GBS positive woman compared to controls, with 60% of the total vaginal microbiota in severe cases identified as Streptococcus sp.Vaginal communities of healthy pregnant women were dominated by Lactobacillus sp. and contained low diversity, while Group B Streptococcus positive women receiving intrapartum antibiotic prophylaxis had a modified vaginal microbiota composition with low abundance of Lactobacillus but higher microbial diversity.

  9. Diversity and composition of vaginal microbiota of pregnant women at risk for transmitting Group B Streptococcus treated with intrapartum penicillin.

    Science.gov (United States)

    Roesch, Luiz Fernando Wurdig; Silveira, Rita C; Corso, Andréa L; Dobbler, Priscila Thiago; Mai, Volker; Rojas, Bruna S; Laureano, Álvaro M; Procianoy, Renato S

    2017-01-01

    Administering intravenous antibiotics during labor to women at risk for transmitting Group B Streptococcus (GBS) can prevent infections in newborns. However, the impact of intrapartum antibiotic prophylaxis on mothers' microbial community composition is largely unknown. We compared vaginal microbial composition in pregnant women experiencing preterm birth at ≤ 32 weeks gestation that received intrapartum antibiotic prophylaxis with that in controls. Microbiota in vaginal swabs collected shortly before delivery from GBS positive women that received penicillin intravenously during labor or after premature rupture of membranes was compared to controls. Microbiota was analyzed by 16S rRNA sequencing using the PGM Ion Torrent to determine the effects of penicillin use during hospitalization and GBS status on its composition. Penicillin administration was associated with an altered vaginal microbial community composition characterized by increased microbial diversity. Lactobacillus sp. contributed only 13.1% of the total community in the women that received penicillin compared to 88.1% in the controls. Streptococcus sp. were present in higher abundance in GBS positive woman compared to controls, with 60% of the total vaginal microbiota in severe cases identified as Streptococcus sp. Vaginal communities of healthy pregnant women were dominated by Lactobacillus sp. and contained low diversity, while Group B Streptococcus positive women receiving intrapartum antibiotic prophylaxis had a modified vaginal microbiota composition with low abundance of Lactobacillus but higher microbial diversity.

  10. Predictors of Women’s Satisfaction with Hospital-Based Intrapartum Care in Asmara Public Hospitals, Eritrea

    Directory of Open Access Journals (Sweden)

    Meron Mehari Kifle

    2017-01-01

    Full Text Available Background. Exploring patient satisfaction contributes to provide quality maternity care, but there is paucity of epidemiologic data in Eritrea. Objectives. To determine the predictors of women's satisfaction with intrapartum care in Asmara public maternity hospitals in Eritrea. Methods. A cross-sectional study among 771 mothers who gave birth in three public Hospitals. Chi-square tests were done to analyze the difference in proportion and logistic regression to assess the predictors of satisfaction with intrapartum care. Results. Overall, only 20.8% of the participants were satisfied with intrapartum service. The key predictors of satisfaction with intrapartum care were provision of clean bed and beddings (AOR = 18.87, 2.33–15.75, privacy during examinations (AOR = 10.22, 4.86–21.48, using understandable language (AOR = 8.72, 3.57–21.27, showing how to summon for help (AOR = 8.16, 4.30–15.48, showing baby immediately after birth (AOR = 8.14, 2.87–23.07, control of the delivery room (AOR = 6.86, 2.65–17.75, receiving back massage (AOR = 6.43, 3.23–12.81, toilet access and cleanliness (AOR = 6.09, 3.25–11.42, availability of chairs for relatives (AOR = 5.96, 3.14–11.30, allowing parents to stay during labour (AOR = 3.52, 1.299–9.56, and request for permission before any procedure (AOR = 2.39, 1.28–4.46. Conclusion. To increase satisfaction with intrapartum care, maternity service providers need to address the general maternity ward cleanliness, improve the quality of physical facilities, and sensitize health providers for better communication with clients. Policy makers need to adopt strategies that ensure more women involvement in decision making and consideration of privacy and reassurance needs during the whole delivery process.

  11. Selective intrapartum anti-bioprophylaxy of group B streptococci infection of neonates: a prospective study in 2454 subsequent deliveries.

    Science.gov (United States)

    Poulain, P; Betremieux, P; Donnio, P Y; Proudhon, J F; Karege, G; Giraud, J R

    1997-04-01

    To investigate the efficacy of a selective intrapartum prophylaxy of group B streptococci (GBS) infection of the neonates. A prospective protocol of universal antepartum screening of GBS and selective intrapartum treatment from the 1st February 1994 to the 31st December 1995, on 2454 subsequent deliveries was designed. Our policy included: (1) antepartum screening as soon as possible after 28 weeks by a single vaginal and perianal sample for culture; (2) intrapartum recognition of one condition of high risk of fetal contamination during labor (these conditions included: a temperature of 38 degrees C during labor, rupture of membranes for more than 12 h or prolonged labor for more than 12 h with rupture of membranes, prematurity, twins, maternal diabetes, previous pregnancy with GBS infection of the neonate); and (3) intrapartum anti-bioprophylaxy (amoxicillin) for women with positive screening during pregnancy and one condition of high risk of fetal contamination during labor. We studied the outcome of neonates during this period to look for immediate GBS severe infection of the neonates in the form of bacteraemia or meningitis and compared the results with the rate of neonatal infection before this protocol (4.5/1000 live births in 1993). We noted that 11% of pregnant women were carriers, 25% of which led to antibiotic chemoprophylaxis during the labor. We noticed four cases of neonatal bacteraemia of GBS. One case arose from the group of carriers (but no condition of risk of fetal contamination during the labor and no chemoprophylaxy). The three other cases were from women with a negative antepartum screening. There was no case of meningitis and all four babies were in good health at day 10 of life. Comparing with results prior to the study, we noticed that the rate of neonatal bacteraemia dropped from 4.5 to 1.6 per 1000 livebirths (P < 0.0001). This protocol of intrapartum anti-bioprophylaxy significantly decreases the rate of GBS neonatal sepsis. We propose to

  12. Intrapartum sacral stress fracture due to pregnancy-related osteoporosis: a case report.

    Science.gov (United States)

    Oztürk, Gülcan; Külcü, Duygu Geler; Aydoğ, Ece

    2013-01-01

    Low back pain (LBP) and hip pain frequently occur during pregnancy and postpartum period. Although pelvic and mechanic lesions of the soft tissues are most responsible for the etiology, sacral fracture is also one of the rare causes. A 32-year-old primigravid patient presented with LBP and right hip pain which started 3 days after vaginal delivery. Although direct radiographic examination was normal, magnetic resonance imaging of the sacrum revealed sacral stress fracture. Lumbar spine and femoral bone mineral density showed osteoporosis as a risk factor. There were no other risk factors such as trauma, excessive weight gain, and strenuous physical activity. It is considered that the patient had sacral fatigue and insufficiency fracture in intrapartum period. The patient's symptoms subsided in 3 months after physical therapy and rest. In conclusion, sacral fractures during pregnancy and postpartum period, especially resulting from childbirth, are very rare. To date, there are two cases in the literature. In cases who even do not have risk factors related to vaginal delivery such as high birth weight infant and the use of forceps, exc., sacral fracture should be considered in the differential diagnosis of LBP and hip pain started soon after child birth. Pregnancy-related osteoporosis may lead to fracture during vaginal delivery.

  13. Effect of intrapartum fetal stress associated with obstetrical interventions on viability and survivability of canine neonates

    Directory of Open Access Journals (Sweden)

    Karthik V. Kuttan

    2016-12-01

    Full Text Available Aim: This study was conducted with the objective of identifying and evaluating intrapartum fetal stress in connection with the type of delivery in bitches. Materials and Methods: A total of 26 bitches between 1 and 5 years, belonging to 10 different breeds were evaluated. Bitches were subjected to detailed clinico-gynecological examination based on history. Neonatal stress associated with spontaneous whelping (SW, assisted whelping (AW, and emergency cesarean section (EC was evaluated using umbilical vein lactate (UL estimation by collecting the blood from umbilical vein. Results: A high umbilical vein lactate value was associated with fetal distress. The mean umbilical lactate value was highest in EC (12.54±0.8 mmol/L followed by AW (8.86±0.9 mmol/L and the lowest value was found in SW (7.56±0.58 mmol/L. A significant increase (p<0.05 in umbilical lactate level was observed in EC group of canine neonates compared with AW and SW groups. Overall mean umbilical lactate values of neonates which died within 24 h (13.31±1.08 mmol/L and the neonates which survived beyond 24 h (8.87±0.55 mmol/L differed significantly at 5% level. Conclusion: Immediate identification of neonatal distress by use of umbilical vein lactate estimation is helpful for the clinician to undertake resuscitation or medical therapy to ensure better neonatal survivability.

  14. An overview of Suomi NPP VIIRS calibration maneuvers

    Science.gov (United States)

    Butler, James J.; Xiong, Xiaoxiong; Barnes, Robert A.; Patt, Frederick S.; Sun, Junqiang; Chiang, Kwofu

    2012-09-01

    The first Visible Infrared Imager Radiometer Suite (VIIRS) instrument was successfully launched on-board the Suomi National Polar-orbiting Partnership (SNPP) spacecraft on October 28, 2011. Suomi NPP VIIRS observations are made in 22 spectral bands, from the visible (VIS) to the long-wave infrared (LWIR), and are used to produce 22 Environmental Data Records (EDRs) with a broad range of scientific applications. The quality of these VIIRS EDRs strongly depends on the quality of its calibrated and geo-located Sensor Date Records (SDRs). Built with a strong heritage to the NASA's EOS MODerate resolution Imaging Spectroradiometer (MODIS) instrument, the VIIRS is calibrated on-orbit using a similar set of on-board calibrators (OBC), including a solar diffuser (SD) and solar diffuser stability monitor (SDSM) system for the reflective solar bands (RSB) and a blackbody (BB) for the thermal emissive bands (TEB). Onorbit maneuvers of the SNPP spacecraft provide additional calibration and characterization data from the VIIRS instrument which cannot be obtained pre-launch and are required to produce the highest quality SDRs. These include multiorbit yaw maneuvers for the characterization of SD and SDSM screen transmission, quasi-monthly roll maneuvers to acquire lunar observations to track sensor degradation in the visible through shortwave infrared, and a driven pitch-over maneuver to acquire multiple scans of deep space to determine TEB response versus scan angle (RVS). This paper provides an overview of these three SNPP calibration maneuvers. Discussions are focused on their potential calibration and science benefits, pre-launch planning activities, and on-orbit scheduling and implementation strategies. Results from calibration maneuvers performed during the Intensive Calibration and Validation (ICV) period for the VIIRS sensor are illustrated. Also presented in this paper are lessons learned regarding the implementation of calibration spacecraft maneuvers on follow

  15. Exploring precrash maneuvers using classification trees and random forests.

    Science.gov (United States)

    Harb, Rami; Yan, Xuedong; Radwan, Essam; Su, Xiaogang

    2009-01-01

    Taking evasive actions vis-à-vis critical traffic situations impending to motor vehicle crashes endows drivers an opportunity to avoid the crash occurrence or at least diminish its severity. This study explores the drivers, vehicles, and environments' characteristics associated with crash avoidance maneuvers (i.e., evasive actions or no evasive actions). Rear-end collisions, head-on collisions, and angle collisions are analyzed separately using decision trees and the significance of the variables on the binary response variable (evasive actions or no evasive actions) is determined. Moreover, the random forests method is employed to rank the importance of the drivers/vehicles/environments characteristics on crash avoidance maneuvers. According to the exploratory analyses' results, drivers' visibility obstruction, drivers' physical impairment, drivers' distraction are associated with crash avoidance maneuvers in all three types of accidents. Moreover, speed limit is associated with rear-end collisions' avoidance maneuvers and vehicle type is correlated with head-on collisions and angle collisions' avoidance maneuvers. It is recommended that future research investigates further the explored trends (e.g., physically impaired drivers, visibility obstruction) using driving simulators which may help in legislative initiatives and in-vehicle technology recommendations.

  16. Dynamic cerebral autoregulation changes during sub-maximal handgrip maneuver.

    Directory of Open Access Journals (Sweden)

    Ricardo C Nogueira

    Full Text Available PURPOSE: We investigated the effect of handgrip (HG maneuver on time-varying estimates of dynamic cerebral autoregulation (CA using the autoregressive moving average technique. METHODS: Twelve healthy subjects were recruited to perform HG maneuver during 3 minutes with 30% of maximum contraction force. Cerebral blood flow velocity, end-tidal CO₂ pressure (PETCO₂, and noninvasive arterial blood pressure (ABP were continuously recorded during baseline, HG and recovery. Critical closing pressure (CrCP, resistance area-product (RAP, and time-varying autoregulation index (ARI were obtained. RESULTS: PETCO₂ did not show significant changes during HG maneuver. Whilst ABP increased continuously during the maneuver, to 27% above its baseline value, CBFV raised to a plateau approximately 15% above baseline. This was sustained by a parallel increase in RAP, suggestive of myogenic vasoconstriction, and a reduction in CrCP that could be associated with metabolic vasodilation. The time-varying ARI index dropped at the beginning and end of the maneuver (p<0.005, which could be related to corresponding alert reactions or to different time constants of the myogenic, metabolic and/or neurogenic mechanisms. CONCLUSION: Changes in dynamic CA during HG suggest a complex interplay of regulatory mechanisms during static exercise that should be considered when assessing the determinants of cerebral blood flow and metabolism.

  17. Dynamic Cerebral Autoregulation Changes during Sub-Maximal Handgrip Maneuver

    Science.gov (United States)

    Nogueira, Ricardo C.; Bor-Seng-Shu, Edson; Santos, Marcelo R.; Negrão, Carlos E.; Teixeira, Manoel J.; Panerai, Ronney B.

    2013-01-01

    Purpose We investigated the effect of handgrip (HG) maneuver on time-varying estimates of dynamic cerebral autoregulation (CA) using the autoregressive moving average technique. Methods Twelve healthy subjects were recruited to perform HG maneuver during 3 minutes with 30% of maximum contraction force. Cerebral blood flow velocity, end-tidal CO2 pressure (PETCO2), and noninvasive arterial blood pressure (ABP) were continuously recorded during baseline, HG and recovery. Critical closing pressure (CrCP), resistance area-product (RAP), and time-varying autoregulation index (ARI) were obtained. Results PETCO2 did not show significant changes during HG maneuver. Whilst ABP increased continuously during the maneuver, to 27% above its baseline value, CBFV raised to a plateau approximately 15% above baseline. This was sustained by a parallel increase in RAP, suggestive of myogenic vasoconstriction, and a reduction in CrCP that could be associated with metabolic vasodilation. The time-varying ARI index dropped at the beginning and end of the maneuver (p<0.005), which could be related to corresponding alert reactions or to different time constants of the myogenic, metabolic and/or neurogenic mechanisms. Conclusion Changes in dynamic CA during HG suggest a complex interplay of regulatory mechanisms during static exercise that should be considered when assessing the determinants of cerebral blood flow and metabolism. PMID:23967113

  18. Investigation of piloting aids for manual control of hypersonic maneuvers

    Science.gov (United States)

    Raney, David L.; Phillips, Michael R.; Person, Lee H., Jr.

    1995-01-01

    An investigation of piloting aids designed to provide precise maneuver control for an air-breathing hypersonic vehicle is described. Stringent constraints and nonintuitive high-speed flight effects associated with maneuvering in the hypersonic regime raise the question of whether manual control of such a vehicle should even be considered. The objectives of this research were to determine the extent of manual control that is desirable for a vehicle maneuvering in this regime and to identify the form of aids that must be supplied to the pilot to make such control feasible. A piloted real-time motion-based simulation of a hypersonic vehicle concept was used for this study, and the investigation focused on a single representative cruise turn maneuver. Piloting aids, which consisted of an auto throttle, throttle director, autopilot, flight director, and two head-up display configurations, were developed and evaluated. Two longitudinal control response types consisting of a rate-command/attitude-hold system and a load factor-rate/load-factor-hold system were also compared. The complete set of piloting aids, which consisted of the autothrottle, throttle director, and flight director, improved the average Cooper-Harper flying qualities ratings from 8 to 2.6, even though identical inner-loop stability and control augmentation was provided in all cases. The flight director was determined to be the most critical of these aids, and the cruise turn maneuver was unachievable to adequate performance specifications in the absence of this flight director.

  19. Aortic root surgery in Marfan syndrome: Bentall procedure with the composite mechanical valved conduit versus aortic valve reimplantation with Valsalva graft.

    Science.gov (United States)

    Nardi, Paolo; Pellegrino, Antonio; Versaci, Francesco; Mantione, Ludmilla; Polisca, Patrizio; Iorio, Fiore S; Chiariello, Luigi

    2010-09-01

    The aim of the study is to compare mid-term results of Bentall aortic root replacement with composite mechanical valved conduit and aortic valve reimplantation procedure using the Valsalva graft for the treatment of aortic root aneurysm in patients with Marfan syndrome. We retrospectively compared data of 23 patients (mean age 38 + or - 14 years) who had undergone the Bentall procedure (group B) to those of 24 patients (mean age 36 + or - 12 years) who had undergone aortic valve reimplantation (group R) during a 14-year period. Follow-up (mean duration 65 + or - 44 months) was 100% complete. There were no operative deaths in either group. In group B, as compared with group R, preoperative aortic insufficiency (3.2 + or - 1.1/4 vs. 1.7 + or - 1.4/4, P Marfan patients, the Bentall procedure is associated with excellent mid-term outcome. The reimplantation technique, adopted for less dilated aortas, provides similarly satisfactory results. The Valsalva graft seems, with time, to allow a stable aortic valve function.

  20. Antenatal and intrapartum interventions for preventing cerebral palsy: an overview of Cochrane systematic reviews.

    Science.gov (United States)

    Shepherd, Emily; Salam, Rehana A; Middleton, Philippa; Makrides, Maria; McIntyre, Sarah; Badawi, Nadia; Crowther, Caroline A

    2017-08-08

    Cerebral palsy is an umbrella term encompassing disorders of movement and posture, attributed to non-progressive disturbances occurring in the developing fetal or infant brain. As there are diverse risk factors and causes, no one strategy will prevent all cerebral palsy. Therefore, there is a need to systematically consider all potentially relevant interventions for their contribution to prevention. To summarise the evidence from Cochrane reviews regarding the effects of antenatal and intrapartum interventions for preventing cerebral palsy. We searched the Cochrane Database of Systematic Reviews on 7 August 2016, for reviews of antenatal or intrapartum interventions reporting on cerebral palsy. Two authors assessed reviews for inclusion, extracted data, assessed review quality, using AMSTAR and ROBIS, and quality of the evidence, using the GRADE approach. We organised reviews by topic, and summarised findings in text and tables. We categorised interventions as effective (high-quality evidence of effectiveness); possibly effective (moderate-quality evidence of effectiveness); ineffective (high-quality evidence of harm or of lack of effectiveness); probably ineffective (moderate-quality evidence of harm or of lack of effectiveness); and no conclusions possible (low- to very low-quality evidence). We included 15 Cochrane reviews. A further 62 reviews pre-specified the outcome cerebral palsy in their methods, but none of the included randomised controlled trials (RCTs) reported this outcome. The included reviews were high quality and at low risk of bias. They included 279 RCTs; data for cerebral palsy were available from 27 (10%) RCTs, involving 32,490 children. They considered interventions for: treating mild to moderate hypertension (two) and pre-eclampsia (two); diagnosing and preventing fetal compromise in labour (one); preventing preterm birth (four); preterm fetal maturation or neuroprotection (five); and managing preterm fetal compromise (one). Quality of

  1. Intrapartum Antibiotic Chemoprophylaxis Policies for the Prevention of Group B Streptococcal Disease Worldwide: Systematic Review.

    Science.gov (United States)

    Le Doare, Kirsty; O'Driscoll, Megan; Turner, Kim; Seedat, Farah; Russell, Neal J; Seale, Anna C; Heath, Paul T; Lawn, Joy E; Baker, Carol J; Bartlett, Linda; Cutland, Clare; Gravett, Michael G; Ip, Margaret; Madhi, Shabir A; Rubens, Craig E; Saha, Samir K; Schrag, Stephanie; Sobanjo-Ter Meulen, Ajoke; Vekemans, Johan; Kampmann, Beate

    2017-11-06

    Intrapartum antibiotic chemoprophylaxis (IAP) prevents most early-onset group B streptococcal (GBS) disease. However, there is no description of how IAP is used around the world. This article is the sixth in a series estimating the burden of GBS disease. Here we aimed to review GBS screening policies and IAP implementation worldwide. We identified data through (1) systematic literature reviews (PubMed/Medline, Embase, Literature in the Health Sciences in Latin America and the Caribbean [LILACS], World Health Organization library database [WHOLIS], and Scopus) and unpublished data from professional societies and (2) an online survey and searches of policies from medical societies and professionals. We included data on whether an IAP policy was in use, and if so whether it was based on microbiological or clinical risk factors and how these were applied, as well as the estimated coverage (percentage of women receiving IAP where indicated). We received policy information from 95 of 195 (49%) countries. Of these, 60 of 95 (63%) had an IAP policy; 35 of 60 (58%) used microbiological screening, 25 of 60 (42%) used clinical risk factors. Two of 15 (13%) low-income, 4 of 16 (25%) lower-middle-income, 14 of 20 (70%) upper-middle-income, and 40 of 44 (91%) high-income countries had any IAP policy. The remaining 35 of 95 (37%) had no national policy (25/33 from low-income and lower-middle-income countries). Coverage varied considerably; for microbiological screening, median coverage was 80% (range, 20%-95%); for clinical risk factor-based screening, coverage was 29% (range, 10%-50%). Although there were differences in the microbiological screening methods employed, the individual clinical risk factors used were similar. There is considerable heterogeneity in IAP screening policies and coverage worldwide. Alternative global strategies, such as maternal vaccination, are needed to enhance the scope of global prevention of GBS disease. © The Author 2017. Published by Oxford

  2. On spacecraft maneuvers control subject to propellant engine modes.

    Science.gov (United States)

    Mazinan, A H

    2015-09-01

    The paper attempts to address a new control approach to spacecraft maneuvers based upon the modes of propellant engine. A realization of control strategy is now presented in engine on mode (high thrusts as well as further low thrusts), which is related to small angle maneuvers and engine off mode (specified low thrusts), which is also related to large angle maneuvers. There is currently a coarse-fine tuning in engine on mode. It is shown that the process of handling the angular velocities are finalized via rate feedback system in engine modes, where the angular rotations are controlled through quaternion based control (QBCL)strategy in engine off mode and these ones are also controlled through an optimum PID (OPIDH) strategy in engine on mode. Copyright © 2015 ISA. Published by Elsevier Ltd. All rights reserved.

  3. A Maneuvering Flight Noise Model for Helicopter Mission Planning

    Science.gov (United States)

    Greenwood, Eric; Rau, Robert; May, Benjamin; Hobbs, Christopher

    2015-01-01

    A new model for estimating the noise radiation during maneuvering flight is developed in this paper. The model applies the Quasi-Static Acoustic Mapping (Q-SAM) method to a database of acoustic spheres generated using the Fundamental Rotorcraft Acoustics Modeling from Experiments (FRAME) technique. A method is developed to generate a realistic flight trajectory from a limited set of waypoints and is used to calculate the quasi-static operating condition and corresponding acoustic sphere for the vehicle throughout the maneuver. By using a previously computed database of acoustic spheres, the acoustic impact of proposed helicopter operations can be rapidly predicted for use in mission-planning. The resulting FRAME-QS model is applied to near-horizon noise measurements collected for the Bell 430 helicopter undergoing transient pitch up and roll maneuvers, with good agreement between the measured data and the FRAME-QS model.

  4. Morphology, muscle capacity, skill, and maneuvering ability in hummingbirds.

    Science.gov (United States)

    Dakin, Roslyn; Segre, Paolo S; Straw, Andrew D; Altshuler, Douglas L

    2018-02-09

    How does agility evolve? This question is challenging because natural movement has many degrees of freedom and can be influenced by multiple traits. We used computer vision to record thousands of translations, rotations, and turns from more than 200 hummingbirds from 25 species, revealing that distinct performance metrics are correlated and that species diverge in their maneuvering style. Our analysis demonstrates that the enhanced maneuverability of larger species is explained by their proportionately greater muscle capacity and lower wing loading. Fast acceleration maneuvers evolve by recruiting changes in muscle capacity, whereas fast rotations and sharp turns evolve by recruiting changes in wing morphology. Both species and individuals use turns that play to their strengths. These results demonstrate how both skill and biomechanical traits shape maneuvering behavior. Copyright © 2018 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.

  5. Maneuver Planning for Conjunction Risk Mitigation with Ground-track Control Requirements

    Science.gov (United States)

    McKinley, David

    2008-01-01

    The planning of conjunction Risk Mitigation Maneuvers (RMM) in the presence of ground-track control requirements is analyzed. Past RMM planning efforts on the Aqua, Aura, and Terra spacecraft have demonstrated that only small maneuvers are available when ground-track control requirements are maintained. Assuming small maneuvers, analytical expressions for the effect of a given maneuver on conjunction geometry are derived. The analytical expressions are used to generate a large trade space for initial RMM design. This trade space represents a significant improvement in initial maneuver planning over existing methods that employ high fidelity maneuver models and propagation.

  6. Impact of Maternal Body Mass Index on Intrapartum and Neonatal Outcomes in Brisbane, Australia, 2007 to 2013.

    Science.gov (United States)

    Foo, Xin Y; Greer, Ristan M; Kumar, Sailesh

    2016-12-01

    The aim of this study was to evaluate the influence of maternal body mass index on intrapartum and neonatal outcomes at one of the largest maternity hospitals in Australia. A retrospective cross-sectional study of 55,352 term singleton deliveries at the Mater Mothers' Hospital in Brisbane, Australia, was conducted. The study cohort was stratified into six groups based on the World Health Organization's body mass index classification. The normal body mass index category was the reference group for all comparisons. Multivariate logistic regression was used to examine the effect of maternal body mass index, adjusted for maternal age, ethnicity, parity, and preexisting conditions (e.g., diabetes mellitus and hypertension), on selected intrapartum and neonatal outcomes. Women in the overweight and Obese I, II, and III categories were more likely to have chronic or gestational hypertension/preeclampsia, and preexisting or gestational diabetes mellitus. They also had an increased risk for induction of labor, elective and emergency cesarean, and postpartum hemorrhage. Underweight women were less likely to require induction of labor and emergency cesarean. Infants born to women with increased body mass index were more likely to require neonatal resuscitation, neonatal intensive care unit admission, and have lower Apgar scores at 5 minutes. There is an increased risk of adverse intrapartum and neonatal outcomes for women who are overweight and obese, with the risks increasing with rising body mass index. Appropriately targeted weight management strategies and health education may yield improved maternal and perinatal outcomes if effectively implemented before pregnancy. These may particularly be of benefit in the teenage cohort that has yet to embark on pregnancy. © 2016 Wiley Periodicals, Inc.

  7. Planned home compared with planned hospital births in the Netherlands: intrapartum and early neonatal death in low-risk pregnancies.

    Science.gov (United States)

    van der Kooy, Jacoba; Poeran, Jashvant; de Graaf, Johanna P; Birnie, Erwin; Denktasş, Semiha; Steegers, Eric A P; Bonsel, Gouke J

    2011-11-01

    The purpose of our study was to compare the intrapartum and early neonatal mortality rate of planned home birth with planned hospital birth in community midwife-led deliveries after case mix adjustment. The perinatal outcome of 679,952 low-risk women was obtained from the Netherlands Perinatal Registry (2000-2007). This group represents all women who had a choice between home and hospital birth. Two different analyses were performed: natural prospective approach (intention-to-treat-like analysis) and perfect guideline approach (per-protocol-like analysis). Unadjusted and adjusted odds ratios (ORs) were calculated. Case mix was based on the presence of at least one of the following: congenital abnormalities, small for gestational age, preterm birth, or low Apgar score. We also investigated the potential risk role of intended place of birth. Multivariate stepwise logistic regression was used to investigate the potential risk role of intended place of birth. Intrapartum and neonatal death at 0-7 days was observed in 0.15% of planned home compared with 0.18% in planned hospital births (crude relative risk 0.80, 95% confidence interval [CI] 0.71-0.91). After case mix adjustment, the relation is reversed, showing nonsignificant increased mortality risk of home birth (OR 1.05, 95% CI 0.91-1.21). In certain subgroups, additional mortality may arise at home if risk conditions emerge at birth (up to 20% increase). Home birth, under routine conditions, is generally not associated with increased intrapartum and early neonatal death, yet in subgroups, additional risk cannot be excluded.

  8. Maneuver Acoustic Flight Test of the Bell 430 Helicopter

    Science.gov (United States)

    Watts, Michael E.; Snider, Royce; Greenwood, Eric; Baden, Joel

    2012-01-01

    A cooperative flight test by NASA, Bell Helicopter and the U.S. Army to characterize the steady state acoustics and measure the maneuver noise of a Bell Helicopter 430 aircraft was accomplished. The test occurred during June/July, 2011 at Eglin Air Force Base, Florida. This test gathered a total of 410 data points over 10 test days and compiled an extensive data base of dynamic maneuver measurements. Three microphone configurations with up to 31 microphones in each configuration were used to acquire acoustic data. Aircraft data included DGPS, aircraft state and rotor state information. This paper provides an overview of the test.

  9. Space Objects Maneuvering Detection and Prediction via Inverse Reinforcement Learning

    Science.gov (United States)

    Linares, R.; Furfaro, R.

    This paper determines the behavior of Space Objects (SOs) using inverse Reinforcement Learning (RL) to estimate the reward function that each SO is using for control. The approach discussed in this work can be used to analyze maneuvering of SOs from observational data. The inverse RL problem is solved using the Feature Matching approach. This approach determines the optimal reward function that a SO is using while maneuvering by assuming that the observed trajectories are optimal with respect to the SO's own reward function. This paper uses estimated orbital elements data to determine the behavior of SOs in a data-driven fashion.

  10. Virtual simulation of maneuvering captive tests for a surface vessel

    Directory of Open Access Journals (Sweden)

    Ahmad Hajivand

    2015-09-01

    Full Text Available Hydrodynamic derivatives or coefficients are required to predict the maneuvering characteristics of a marine vehicle. These derivatives are obtained numerically for a DTMB 5512 model ship by virtual simulating of captive model tests in a CFD environment. The computed coefficients are applied to predict the turning circle and zigzag maneuvers of the model ship. The comparison of the simulated results with the available experimental data shows a very good agreement among them. The simulations show that the CFD is precise and affordable tool at the preliminary design stage to obtain maneuverability performance of a marine vehicles.

  11. Evaluating the content and quality of intrapartum care in vaginal births: An example of a state hospital.

    Science.gov (United States)

    Karaçam, Zekiye; Arslan Kurnaz, Döndü; Güneş, Gizem

    2017-03-01

    The purpose of the research was to assess the content and quality of the intrapartum care offered in vaginal births in Turkey, based on the example of a state hospital. This cross-sectional study was conducted between January 1 st , 2013 and December 31 st , 2014 at Aydın Maternity and Children's Hospital. The study sample consisted of 303 women giving vaginal birth, who were recruited into the study using the method of convenience sampling. Research data were collected with a questionnaire created by the researchers and assessed using the Bologna score. Numbers and percentages were assessed in the data analysis. The mean age of the women was 25.14±5.37 years and 40.5% had given one live birth. Of the women, 45.2% were admitted to hospital in the latent phase, 76.6% were administered an enema, 3.3% had epidural anesthesia, 2.6% delivered using vacuum extraction, and 54.1% underwent an episiotomy. Some 23.8% of the women experienced spontaneous laceration that needed sutures. The babies of two women exhibited an Apgar score below 7 in the fifth minute. When the quality of the intrapartum care given to the women was assessed with the Bologna score, it was found that 92.7% went into labor spontaneously, 100% of the births were supervised by midwives and doctors, 97.7% of the women had no supporting companion, and the nonsupine position was only used in 0.3% of the women. A partogram was used to follow up on the birth process in 72.6% of the women, and 82.5% achieved contact with their babies within the first hour after birth. Induction was applied in 76.6% of the women and fundal pressure in 27.4%. The study revealed that the quality of intrapartum care in vaginal births was inadequate. Reformulating the guidelines regarding intrapartum care in accordance with World Health Organization recommendations and evidence-based practices may contribute to improving mother and infant health.

  12. Complete Heart Block with Diastolic Heart Failure and Pulmonary Edema Secondary to Enlarging Previously Diagnosed Thrombosed Aneurysm of Sinus of Valsalva in a Patient with History of Autosomal Dominant Polycystic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Sherif Ali Eltawansy

    2015-01-01

    Full Text Available Autosomal dominant polycystic kidney disease (ADPKD is associated with vascular aneurysms that can affect any part of the vascular tree, like ascending aorta or coronary arteries. Sinus of Valsalva is known as an anatomical dilation at the root of aorta above the aortic valve and very few cases show aneurysm at that site in patients with ADPKD. Sinus of Valsalva aneurysm (SVA can present with rupture and acute heart failure and infective endocarditis or could be asymptomatic accidentally discovered during cardiac catheterization. We report a case of a 76-year-old male with a unique constellation of cardiovascular anomalies associated with ADPKD. Patient was previously diagnosed with aneurysms affecting ascending aorta, sinus of Valsalva, and coronary arteries. Several years later, he came with complete heart block which was discovered later to be secondary to enlargement of his previously diagnosed thrombosed SVA. His case was complicated with acute heart failure and pulmonary edema. Conclusion. Patients with ADPKD can present with extrarenal manifestations. In our case, aneurysm at sinus of Valsalva was progressively enlarging and presented with complete heart block.

  13. Transient Structured Distance as a Maneuver in Marital Therapy

    Science.gov (United States)

    Greene, Bernard L.; And Others

    1973-01-01

    Experience with 73 cases has shown the value of Transient Structured Distance as a maneuver in marriage therapy. While the TSD is a radical form of intervention with risks of anxiety reactions, homosexual panic, or divorce, it has proved effective with difficult forms of acute or chronic marital disharmony. (Author)

  14. 47 CFR 25.282 - Orbit raising maneuvers.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Orbit raising maneuvers. 25.282 Section 25.282 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES SATELLITE COMMUNICATIONS... geostationary satellite orbit under this part is also authorized to transmit in connection with short-term...

  15. A Small State Maneuvering in the Changing World Order

    DEFF Research Database (Denmark)

    Sørensen, Camilla T. N.

    2016-01-01

    , especially the Danish approach to the BRICs, has developed in recent years, I show how Denmark – a small state – is trying to maneuver in the changing world order through a “creative agency” approach characterized by pragmatic low-profile activism. I develop a neoclassical realist framework and use...

  16. A prospective randomized trial of two solutions for intrapartum amnioinfusion: effects on fetal electrolytes, osmolality, and acid-base status.

    Science.gov (United States)

    Pressman, E K; Blakemore, K J

    1996-10-01

    Our purpose was to compare the effects of intrapartum amnioinfusion with normal saline solution versus lactated Ringer's solution plus physiologic glucose on neonatal electrolytes and acid-base balance. Patients undergoing amnioinfusion for obstetric indications were randomized to receive normal saline solution or lactated Ringer's solution plus physiologic glucose at standardized amnioinfusion rates. Data were collected prospectively on maternal demographics, course of labor, and maternal and neonatal outcome. Arterial cord blood was obtained for analysis of electrolytes, glucose, osmolality, lactic acid, and blood gases. Control subjects with normal fetal heart rate patterns, and clear amniotic fluid not receiving amnioinfusion were studied concurrently. Data were collected on 59 patients (21 normal saline solution, 18 lactated Ringer's solution plus physiologic glucose, and 20 controls). Maternal demographics, course of labor, and neonatal outcome were similar in all three groups. Cesarean sections were performed more often in the amnioinfusion groups (33.3% for normal saline solution, 38.9% for lactated Ringer's solution plus physiologic glucose) than in the control group (5.0%), p amnioinfusion with either solution. Intrapartum amnioinfusion with normal saline solution or lactated Ringer's solution plus physiologic glucose has no effect on neonatal electrolytes or acid-base balance.

  17. Unruptured Aneurysm of Sinus of Valsalva Coexisting with the Large Ventricular Septal Defect and Severe Aortic Regurgitation in a Young Man

    Directory of Open Access Journals (Sweden)

    Pouya Nezafati

    2015-01-01

    Full Text Available Introduction. Unruptured sinus of valsalva aneurysm (SVA is a rare congenital anomaly, particularly, when it coexists with a ventricular septal defect (VSD and aortic regurgitation due to the prolapse of the elongated aortic cusp into the VSD. In this report, we present the case of a 19-year-old young man with VSD challenging in spite of dyspnea and lower limb edema. Presentation of Case. Its diagnosis was made on the basis of transthoracic echocardiography results. Surgical management consisted of replacing the SVA with mechanical valve prosthesis. A Gore-Tex patch repaired the VSD. Discussion. In the follow-up periods, clinical and echocardiographic tests showed that the patient was in excellent status. Conclusion. SVA requires a surgical procedure due to its high risk of mortality in unoperated patients and a good safety of surgery.

  18. 296. Aneurisma de Seno de Valsalva no Coronariano Fistulizado a Aurícula Derecha Acompañado de Comunicación Auricular Tipo Ostium Secundum

    Directory of Open Access Journals (Sweden)

    M. García Vieites

    2012-04-01

    Los aneurismas del seno de Valsalva tienen una prevalencia estimada de 0,14%, siendo más comunes en la población masculina. Su localización más frecuente es el seno coronario derecho (70–90%, seguido de seno no coronariano (10–20%, y raramente de seno coronariano izquierdo. Aunque frecuentemente se presentan con defectos congénitos, su asociación con comunicación interauricular es baja. Evolucionan hacia la dilatación progresiva que puede llevar a rotura hacia pericardio o bien fistulizar a cavidades cardíacas. Un diagnóstico e intervención quirúrgica precoz son fundamentales, con una tasa de mortalidad posquirúrgica baja a corto y largo plazo.

  19. Associating crash avoidance maneuvers with driver attributes and accident characteristics: a mixed logit model approach.

    Science.gov (United States)

    Kaplan, Sigal; Prato, Carlo Giacomo

    2012-01-01

    The current study focuses on the propensity of drivers to engage in crash avoidance maneuvers in relation to driver attributes, critical events, crash characteristics, vehicles involved, road characteristics, and environmental conditions. The importance of avoidance maneuvers derives from the key role of proactive and state-aware road users within the concept of sustainable safety systems, as well as from the key role of effective corrective maneuvers in the success of automated in-vehicle warning and driver assistance systems. The analysis is conducted by means of a mixed logit model that represents the selection among 5 emergency lateral and speed control maneuvers (i.e., "no avoidance maneuvers," "braking," "steering," "braking and steering," and "other maneuvers) while accommodating correlations across maneuvers and heteroscedasticity. Data for the analysis were retrieved from the General Estimates System (GES) crash database for the year 2009 by considering drivers for which crash avoidance maneuvers are known. The results show that (1) the nature of the critical event that made the crash imminent greatly influences the choice of crash avoidance maneuvers, (2) women and elderly have a relatively lower propensity to conduct crash avoidance maneuvers, (3) drowsiness and fatigue have a greater negative marginal effect on the tendency to engage in crash avoidance maneuvers than alcohol and drug consumption, (4) difficult road conditions increase the propensity to perform crash avoidance maneuvers, and (5) visual obstruction and artificial illumination decrease the probability to carry out crash avoidance maneuvers. The results emphasize the need for public awareness campaigns to promote safe driving style for senior drivers and warning about the risks of driving under fatigue and distraction being comparable to the risks of driving under the influence of alcohol and drugs. Moreover, the results suggest the need to educate drivers about hazard perception, designing

  20. Intrapartum and neonatal mortality in primary midwife-led and secondary obstetrician-led care in the Amsterdam region of the Netherlands: A retrospective cohort study

    NARCIS (Netherlands)

    Wiegerinck, M. M. J.; van der Goes, B. Y.; Ravelli, A. C. J.; van der Post, J. A. M.; Klinkert, J.; Brandenbarg, J.; Buist, F. C. D.; Wouters, M. G. A. J.; Tamminga, P.; de jonge, A.; Mol, B. W.

    2015-01-01

    To compare intrapartum- and neonatal mortality and intervention rates in term women starting labour in primary midwife-led versus secondary obstetrician-led care. Retrospective cohort study. Amsterdam region of the Netherlands. Women with singleton pregnancies who gave birth beyond 37+0 weeks

  1. A rare case of aortic sinuses of valsalva fistula to multiple cardiac chambers secondary to periannular aortic abscess formation from underlying Brucella endocarditis

    Directory of Open Access Journals (Sweden)

    Sabzi, Feridoun

    2015-11-01

    Full Text Available The concomitant presence of abnormal connection from three aortic valsalva sinuses to cardiac chambers is a rare complication of native aortic endocarditis. This case report presents a 37-year-old Iranian female patient who had native aortic valve endocarditis complicated by periannular abscess formation and subsequent perforation to multi-cardiac chambers associated with congestive heart failure and left bundle branch block. Multiple aorto-cavitary fistulas to right atrium, main pulmonary artery, and formation of a pocket over left atrial roof were detected by transthoracic echocardiogram (TTE. She had received a full course of antibiotics therapy in a local hospital and was referred to our center for further surgery. TTE not only detected multiple aorto-cavitary fistulas but also revealed large vegetation in aortic and mitral valve leaflets and also small vegetation in the entrance of fistula to right atrium. However, the tricuspid valve was not involved in infective endocarditis. She underwent open cardiac surgery with double valve replacement with biologic valves and reconstruction of left sinus of valsalva fistula to supra left atrial pocket by pericardial patch repair. The two other fistulas to main pulmonary artery and right atrium were closed via related chambers. The post-operative course was complicated by renal failure and prolonged dependency to ventilator that was managed accordingly with peritoneal dialysis and tracheostomy. The patient was discharged on the 25 day after admission in relatively good condition. The TTE follow-up one year after discharge revealed mild paravalvular leakage in aortic valve position, but the function of mitral valve was normal and no residual fistulas were detected.

  2. Evasive Maneuvers in Space Debris Environment and Technological Parameters

    Directory of Open Access Journals (Sweden)

    Antônio D. C. Jesus

    2012-01-01

    Full Text Available We present a study of collisional dynamics between space debris and an operational vehicle in LEO. We adopted an approach based on the relative dynamics between the objects on a collisional course and with a short warning time and established a semianalytical solution for the final trajectories of these objects. Our results show that there are angular ranges in 3D, in addition to the initial conditions, that favor the collisions. These results allowed the investigation of a range of technological parameters for the spacecraft (e.g., fuel reserve that allow a safe evasive maneuver (e.g., time available for the maneuver. The numerical model was tested for different values of the impact velocity and relative distance between the approaching objects.

  3. Thermally-Constrained Fuel-Optimal ISS Maneuvers

    Science.gov (United States)

    Bhatt, Sagar; Svecz, Andrew; Alaniz, Abran; Jang, Jiann-Woei; Nguyen, Louis; Spanos, Pol

    2015-01-01

    Optimal Propellant Maneuvers (OPMs) are now being used to rotate the International Space Station (ISS) and have saved hundreds of kilograms of propellant over the last two years. The savings are achieved by commanding the ISS to follow a pre-planned attitude trajectory optimized to take advantage of environmental torques. The trajectory is obtained by solving an optimal control problem. Prior to use on orbit, OPM trajectories are screened to ensure a static sun vector (SSV) does not occur during the maneuver. The SSV is an indicator that the ISS hardware temperatures may exceed thermal limits, causing damage to the components. In this paper, thermally-constrained fuel-optimal trajectories are presented that avoid an SSV and can be used throughout the year while still reducing propellant consumption significantly.

  4. Novel Fractional Order Calculus Extended PN for Maneuvering Targets

    Directory of Open Access Journals (Sweden)

    Jikun Ye

    2017-01-01

    Full Text Available Based on the theory of fractional order calculus (FOC, a novel extended proportional guidance (EPN law for intercepting the maneuvering target is proposed. In the first part, considering the memory function and filter characteristic of FOC, the novel extended PN guidance algorithm is developed based on the conventional PN after introducing the properties and operation rules of FOC. Further, with the help of FOC theory, the average load and ballistics characteristics of proposed guidance law are analyzed. Then, using the small offset kinematic model, the robustness of the new guidance law against autopilot parameters is studied theoretically by analyzing the sensitivity of the closed loop guidance system. At last, representative numerical results show that the designed guidance law obtains a better performance than the traditional PN for maneuvering target.

  5. Parametric Dependence of Initial LEV Behavior on Maneuvering Wings

    Science.gov (United States)

    Berdon, Randall; Wabick, Kevin; Buchholz, James; Johnson, Kyle; Thurow, Brian; University of Iowa Team; Auburn University Team

    2017-11-01

    A maneuvering rectangular wing of aspect ratio 2 is examined experimentally using dye visualization and PIV to characterize the initial development of the leading-edge vortex (LEV) during a rolling maneuver in a uniform free stream. Understanding the underlying physics during the early evolution of the vortex is important for developing strategies to manipulate vortex evolution. Varying the dimensionless radius of gyration of the wing (Rg/c, where Rg is the radius of gyration and c is the chord) and the advance ratio (J=U/ ΩRg, where U is the free-stream velocity and Ω is the roll rate) affects the structure of the vortex and its propensity to remain attached. The influence of these parameters will be discussed, toward identification of similarity parameters governing vortex development. This work is supported by the Air Force Office of Scientific Research (Grant Number FA9550-16-1-0107, Dr. Douglas Smith, program manager).

  6. Differential Evolution Optimization for Targeting Spacecraft Maneuver Plans

    Science.gov (United States)

    Mattern, Daniel

    2016-01-01

    Previous analysis identified specific orbital parameters as being safer for conjunction avoidance for the TDRS fleet. With TDRS-9 being considered an at-risk spacecraft, a potential conjunction concern was raised should TDRS-9 fail while at a longitude of 12W. This document summarizes the analysis performed to identify if these specific orbital parameters could be targeted using the remaining drift-termination maneuvers for the relocation of TDRS-9 from 41W longitude to 12W longitude.

  7. An expert system for pressurized water reactor load maneuvers

    International Nuclear Information System (INIS)

    Chaung Lin; Jungping Chen; Yihjiunn Lin; Lianshin Lin

    1993-01-01

    Restartup after reactor shutdown and load-follow operations are the important tasks in operating pressurized water reactors. Generally, the most efficient method is to apply constant axial offset control (CAOC) strategy during load maneuvers. An expert system using CAOC strategy, fuzzy reasoning, a two-node core model, and operational constraints has been developed. The computation time is so short that this system, which leads to an approximate closed-loop control, could be useful for on-site calculation

  8. Maintenance Maneuver Automation for an Adapted Cylindrical Shape TEC

    Directory of Open Access Journals (Sweden)

    Rafael Morales

    2016-09-01

    Full Text Available Several manufacturers have developed devices with which to harness tidal/current power in areas where the depth does not exceed 40 m. These are the so-called first generation Tidal Energy Converters (TEC, and they are usually fixed to the seabed by gravity. When carrying out maintenance tasks on these devices it is, therefore, necessary to remove the nacelles from their bases and raise them to the surface of the sea. They must subsequently be placed back on their bases. These tasks require special high performance ships, signifying high maintenance costs. The automation of emersion and immersion maneuvers will undoubtedly lead to lower costs, given that ships with less demanding requirements will be required for the aforementioned maintenance tasks. This research presents a simple two degrees of freedom dynamic model that can be used to control a first generation TEC that has been conceived of to harness energy from marine currents. The control of the system is carried out by means of a water ballast system located inside the nacelle of the main power unit and is used as an actuator to produce buoying vertical forces. A nonlinear control law based on a decoupling term for the closed loop depth and/or orientation control is also proposed in order to ensure adequate behavior when the TEC performs emersion and immersion maneuvers with only hydrostatic buoyancy forces. The control scheme is composed of an inner loop consisting of a linear and decoupled input/output relationship and the vector of friction and compressibility terms and an outer loop that operates with the tracking error vector in order to ensure the asymptotically exponential stability of the TEC posture. Finally, the effectiveness of the dynamic model and the controller approach is demonstrated by means of numerical simulations when the TEC is carrying out an emersion maneuver for the development of general maintenance tasks and an emersion maneuver for blade-cleaning maintenance

  9. Trajectory Control of Rendezvous with Maneuver Target Spacecraft

    Science.gov (United States)

    Zhou, Zhinqiang

    2012-01-01

    In this paper, a nonlinear trajectory control algorithm of rendezvous with maneuvering target spacecraft is presented. The disturbance forces on the chaser and target spacecraft and the thrust forces on the chaser spacecraft are considered in the analysis. The control algorithm developed in this paper uses the relative distance and relative velocity between the target and chaser spacecraft as the inputs. A general formula of reference relative trajectory of the chaser spacecraft to the target spacecraft is developed and applied to four different proximity maneuvers, which are in-track circling, cross-track circling, in-track spiral rendezvous and cross-track spiral rendezvous. The closed-loop differential equations of the proximity relative motion with the control algorithm are derived. It is proven in the paper that the tracking errors between the commanded relative trajectory and the actual relative trajectory are bounded within a constant region determined by the control gains. The prediction of the tracking errors is obtained. Design examples are provided to show the implementation of the control algorithm. The simulation results show that the actual relative trajectory tracks the commanded relative trajectory tightly. The predicted tracking errors match those calculated in the simulation results. The control algorithm developed in this paper can also be applied to interception of maneuver target spacecraft and relative trajectory control of spacecraft formation flying.

  10. State Estimation for Landing Maneuver on High Performance Aircraft

    Science.gov (United States)

    Suresh, P. S.; Sura, Niranjan K.; Shankar, K.

    2018-01-01

    State estimation methods are popular means for validating aerodynamic database on aircraft flight maneuver performance characteristics. In this work, the state estimation method during landing maneuver is explored for the first of its kind, using upper diagonal adaptive extended Kalman filter (UD-AEKF) with fuzzy based adaptive tunning of process noise matrix. The mathematical model for symmetrical landing maneuver consists of non-linear flight mechanics equation representing Aircraft longitudinal dynamics. The UD-AEKF algorithm is implemented in MATLAB environment and the states with bias is considered to be the initial conditions just prior to the flare. The measurement data is obtained from a non-linear 6 DOF pilot in loop simulation using FORTRAN. These simulated measurement data is additively mixed with process and measurement noises, which are used as an input for UD-AEKF. Then, the governing states that dictate the landing loads at the instant of touch down are compared. The method is verified using flight data wherein, the vertical acceleration at the aircraft center of gravity (CG) is compared. Two possible outcome of purely relying on the aircraft measured data is highlighted. It is observed that, with the implementation of adaptive fuzzy logic based extended Kalman filter tuned to adapt for aircraft landing dynamics, the methodology improves the data quality of the states that are sourced from noisy measurements.

  11. Development of power change maneuvering method for BWR

    International Nuclear Information System (INIS)

    Fukuzaki, Takaharu; Yamada, Naoyuki; Kiguchi, Takashi; Sakurai, Mikio.

    1985-01-01

    A power change maneuvering method for BWR has been proposed to generate an optimal power control maneuver, which realizes the power change operation closest to a power change demand pattern under operating constraints. The method searches for the maneuver as an optimization problem, where the variables are thermal power levels sampled from the demand pattern, the performance index is defined to express the power mismatch between demand and feasible patterns, and the constraints are limit lines on the thermal power-core flow rate map and limits on keeping fuel integrity. The usable feasible direction method is utilized as the optimization algorithm, with newly developed techniques for initial value generation and step length determination, which apply one-dimensional search and inverse-interpolation methods, respectively, to realize the effective search of the optimal solution. Simulation results show that a typical computing time is about 5 min by a general purpose computer and the method has been verified to be practical even for on-line use. (author)

  12. Capturing and analyzing wheelchair maneuvering patterns with mobile cloud computing.

    Science.gov (United States)

    Fu, Jicheng; Hao, Wei; White, Travis; Yan, Yuqing; Jones, Maria; Jan, Yih-Kuen

    2013-01-01

    Power wheelchairs have been widely used to provide independent mobility to people with disabilities. Despite great advancements in power wheelchair technology, research shows that wheelchair related accidents occur frequently. To ensure safe maneuverability, capturing wheelchair maneuvering patterns is fundamental to enable other research, such as safe robotic assistance for wheelchair users. In this study, we propose to record, store, and analyze wheelchair maneuvering data by means of mobile cloud computing. Specifically, the accelerometer and gyroscope sensors in smart phones are used to record wheelchair maneuvering data in real-time. Then, the recorded data are periodically transmitted to the cloud for storage and analysis. The analyzed results are then made available to various types of users, such as mobile phone users, traditional desktop users, etc. The combination of mobile computing and cloud computing leverages the advantages of both techniques and extends the smart phone's capabilities of computing and data storage via the Internet. We performed a case study to implement the mobile cloud computing framework using Android smart phones and Google App Engine, a popular cloud computing platform. Experimental results demonstrated the feasibility of the proposed mobile cloud computing framework.

  13. A Fuel-Efficient Conflict Resolution Maneuver for Separation Assurance

    Science.gov (United States)

    Bowe, Aisha Ruth; Santiago, Confesor

    2012-01-01

    Automated separation assurance algorithms are envisioned to play an integral role in accommodating the forecasted increase in demand of the National Airspace System. Developing a robust, reliable, air traffic management system involves safely increasing efficiency and throughput while considering the potential impact on users. This experiment seeks to evaluate the benefit of augmenting a conflict detection and resolution algorithm to consider a fuel efficient, Zero-Delay Direct-To maneuver, when resolving a given conflict based on either minimum fuel burn or minimum delay. A total of twelve conditions were tested in a fast-time simulation conducted in three airspace regions with mixed aircraft types and light weather. Results show that inclusion of this maneuver has no appreciable effect on the ability of the algorithm to safely detect and resolve conflicts. The results further suggest that enabling the Zero-Delay Direct-To maneuver significantly increases the cumulative fuel burn savings when choosing resolution based on minimum fuel burn while marginally increasing the average delay per resolution.

  14. Evaluation of Mathematical Models for Tankers’ Maneuvering Motions

    Directory of Open Access Journals (Sweden)

    Erhan AKSU

    2017-03-01

    Full Text Available In this study, the maneuvering performance of two tanker ships, KVLCC1 and KVLCC2 which have different stern forms are predicted using a system-based method. Two different 3 DOF (degrees of freedom mathematical models based on the MMG(Maneuvering Modeling Group concept areappliedwith the difference in representing lateral force and yawing moment by second and third order polynomials respectively. Hydrodynamic coefficients and related parameters used in the mathematical models of the same scale models of KVLCC1 and KVLCC2 ships are estimated by using experimental data of NMRI (National Maritime Research Institute. The simulations of turning circle with rudder angle ±35o , zigzag(±10o /±10o and zigzag (±20o /±20o maneuvers are carried out and compared with free running model test data of MARIN (Maritime Research Institute Netherlands in this study. As a result of the analysis, it can be summarised that MMG model based on the third order polynomial is superior to the one based on the second order polynomial in view of estimation accuracy of lateral hull force and yawing moment.

  15. "Spaghetti Maneuver": A useful tool in pediatric laparoscopy - Our experience

    Directory of Open Access Journals (Sweden)

    Antonio Marte

    2011-01-01

    Full Text Available Aims: The laparoscopic "Spaghetti Maneuver" consists in holding an organ by its extremity with a grasper and rolling it up around the tool to keep the organ stable and facilitate its traction within a small space. We describe our experience with the "Spaghetti Maneuver" in some minimally invasive procedures. Materials and Methods: We successfully adopted this technique in 13 patients (5F : 8M aged between 6 and 14 years (average age, 10 on whom we performed 7 appendectomies, 2 ureteral reimplantation and 4 cholecystectomies. In all cases, after the first steps, the appendix, the gallbladder and the ureter were rolled around the grasper and easily isolated; hemostasis was thus induced and the organ was mobilized until removal during cholecystectomy and appendectomy, and before the reimplantation in case of ureteral reimplantation. Results: We found that this technique facilitated significantly the acts of holding, isolating and removing, when necessary, the structures involved, which remained constantly within the visual field of the operator. This allowed a very ergonomic work setting, overcoming the problem of the "blind" zone, which represents a dangerous and invisible area out of the operator′s control during laparoscopy. Moreover the isolation maneuvers resulted easier and reduced operating time. Conclusion: We think that this technique is easy to perform and very useful, because it facilitates the dissection of these organs, by harmonizing and stabilizing the force of traction exercised.

  16. Health facility service availability and readiness for intrapartum and immediate postpartum care in Malawi: A cross-sectional survey.

    Directory of Open Access Journals (Sweden)

    Naoko Kozuki

    Full Text Available This analysis seeks to identify strengths and gaps in the existing facility capacity for intrapartum and immediate postpartum fetal and neonatal care, using data collected as a part of Malawi's Helping Babies Breath program evaluation. From August to September 2012, the Maternal and Child Health Integrated Program (MCHIP conducted a cross-sectional survey in 84 Malawian health facilities to capture current health facility service availability and readiness and health worker capacity and practice pertaining to labor, delivery, and immediate postpartum care. The survey collected data on availability of equipment, supplies, and medications, and health worker knowledge and performance scores on intrapartum care simulation and actual management of real clients at a subset of facilities. We ran linear regression models to identify predictors of high simulation performance of routine delivery care and management of asphyxiated newborns across all facilities surveyed. Key supplies for infection prevention and thermal care of the newborn were found to be missing in many of the surveyed facilities. At the health center level, 75% had no clinician trained in basic emergency obstetric care or newborn care and 39% had no midwife trained in the same. We observed that there were no proportional increases in available transport and staff at a facility as catchment population increased. In simulations of management of newborns with breathing problems, health workers were able to complete a median of 10 out of 16 tasks for a full-term birth case scenario and 20 out of 30 tasks for a preterm birth case scenario. Health workers who had more years of experience appeared to perform worse. Our study provides a benchmark and highlights gaps for future evaluations and studies as Malawi continues to make strides in improving facility-based care. Further progress in reducing the burden of neonatal and fetal death in Malawi will be partly predicated on guaranteeing

  17. Intrapartum and Postpartum Transfers to a Tertiary Care Hospital from Out-of-Hospital Birth Settings: A Retrospective Case Series.

    Science.gov (United States)

    Lundeen, Tiffany

    2016-01-01

    This study describes the reasons for and outcomes of maternal transfers from private homes and freestanding birthing suites to a large academic hospital in order to better understand and meet the needs of transferring women and their families. The convenience sample included all adult women admitted to the labor and birth unit or emergency room within a 5-year period who: 1) had planned to give birth out-of-hospital but developed complications at term before the onset of labor and were admitted to the hospital for labor induction; 2) had planned to give birth at home or in a birthing suite but transferred to the hospital during labor; or 3) arrived at the hospital for care within 24 hours after a planned birth at home or in a birthing suite. Descriptive data for each transfer were obtained from the medical record. Fifty-one transfers were identified: 11 prior to labor, 38 during labor, and 2 postpartum. Only 4 transfers were considered urgent by the referring provider. The most common reasons for intrapartum transfer were prolonged labor (n = 19) and desire for epidural analgesia (n = 10). Only 25% of the medical records had documentation that the referring provider accompanied the woman to the hospital during the care transition or was involved in her hospital course; however, the prenatal and/or intrapartum records had been delivered by the referring provider, were referenced in the hospital admission note, and had become part of the permanent hospital medical record for 85% of the women. On average, one transfer per year was complicated by neonatal morbidity, and one transfer per year involved significant disagreement between hospital providers and the women presenting for care. Collecting and reviewing data about a facility's perinatal transfer events can help the local multi-stakeholder group appraise current practice and plan for quality improvement. © 2016 by the American College of Nurse-Midwives.

  18. Maternal characteristics associated with antenatal, intrapartum, and neonatal zidovudine use in four US cities, 1994-1998.

    Science.gov (United States)

    Orloff, S L; Bulterys, M; Vink, P; Nesheim, S; Abrams, E J; Schoenbaum, E; Palumbo, P; Steketee, R W; Simonds, R J

    2001-09-01

    To evaluate implementation of 1994 United States Public Health Service guidelines for zidovudine (ZDV) use in HIV-infected women and their newborns by describing the prevalence of use of perinatal ZDV and other antiretrovirals and by investigating determinants of not receiving perinatal ZDV. The Perinatal AIDS Collaborative Transmission Study is a prospective cohort study designed to collect information related to mother-to-child HIV transmission that was conducted in New York City (NY), Newark (NJ), Baltimore (MD), and Atlanta (GA), U.S.A. The current analysis was restricted to infants born between July 1994 and June 1998. Utilization rates for antenatal, intrapartum, and neonatal ZDV increased from 41% to 70% during the 4-year period. Use of combination antiretrovirals increased from fewer than 2% of women in 1994 to 1995 to 35% in 1997 to 1998. Antenatal and neonatal ZDV use increased each year, but intrapartum ZDV use reached a plateau after 1996. Mother-infant pairs with the following characteristics were less likely to have received a complete 3-part ZDV regimen: older maternal age, CD4 count >500 cells/microl, preterm birth, cocaine or heroin use during pregnancy, positive newborn drug screen test result, and smoking or alcohol use during pregnancy. By multivariate logistic regression adjusted for hospital and year of birth, cocaine or heroin use during pregnancy (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.6-3.3), maternal CD4 count (OR, 0.4; 95% CI, 0.2-0.8; comparing 500 cells/microl), and preterm birth (OR, 1.6; 95% CI, 1.1-2.5) remained independently associated with not receiving the complete ZDV regimen. ZDV use by pregnant HIV-infected women and their infants has increased dramatically since publication of the 1994 guidelines. Nevertheless, women who abuse substances, give birth preterm, or have less advanced immunosuppression, were at substantial risk of not receiving the complete ZDV regimen.

  19. Health facility service availability and readiness for intrapartum and immediate postpartum care in Malawi: A cross-sectional survey.

    Science.gov (United States)

    Kozuki, Naoko; Oseni, Lolade; Mtimuni, Angella; Sethi, Reena; Rashidi, Tambudzai; Kachale, Fannie; Rawlins, Barbara; Gupta, Shivam

    2017-01-01

    This analysis seeks to identify strengths and gaps in the existing facility capacity for intrapartum and immediate postpartum fetal and neonatal care, using data collected as a part of Malawi's Helping Babies Breath program evaluation. From August to September 2012, the Maternal and Child Health Integrated Program (MCHIP) conducted a cross-sectional survey in 84 Malawian health facilities to capture current health facility service availability and readiness and health worker capacity and practice pertaining to labor, delivery, and immediate postpartum care. The survey collected data on availability of equipment, supplies, and medications, and health worker knowledge and performance scores on intrapartum care simulation and actual management of real clients at a subset of facilities. We ran linear regression models to identify predictors of high simulation performance of routine delivery care and management of asphyxiated newborns across all facilities surveyed. Key supplies for infection prevention and thermal care of the newborn were found to be missing in many of the surveyed facilities. At the health center level, 75% had no clinician trained in basic emergency obstetric care or newborn care and 39% had no midwife trained in the same. We observed that there were no proportional increases in available transport and staff at a facility as catchment population increased. In simulations of management of newborns with breathing problems, health workers were able to complete a median of 10 out of 16 tasks for a full-term birth case scenario and 20 out of 30 tasks for a preterm birth case scenario. Health workers who had more years of experience appeared to perform worse. Our study provides a benchmark and highlights gaps for future evaluations and studies as Malawi continues to make strides in improving facility-based care. Further progress in reducing the burden of neonatal and fetal death in Malawi will be partly predicated on guaranteeing properly equipped and

  20. The expected and actual communication of health care workers during the management of intrapartum: An interpretive multiple case study

    Directory of Open Access Journals (Sweden)

    Doreen K.M. M'Rithaa

    2015-12-01

    Full Text Available Background: Daily activities within a health care organisation are mediated by information communication processes (ICP involving multiple health care professionals at different levels of care. Effective perinatal management requires critical information to be accurately communicated. If there is a breakdown in this communication patient safety is at risk for various reasons such as: inadequate critical information, misconception of information and uninformed decisions being made. The purpose of this study was to interpret the complexities around ICP in order to contribute to the effective management of the intrapartum period. Methods: Multi method, multiple case study approach was used to understand the ICP during the management of the intrapartum period. During the study, the expected ICP, the actual ICP, the challenges involved and the desired ICP were analysed. Twenty-four in-depth interviews with skilled birth attendants (SBAs employing observer-as-participant roles, field notes, and document review methods were utilised to gather the data. Thematic analysis was utilised to analyse the data using Atlas TI software. Results: The study revealed three subthemes which emerged from the expected ICP, whilst three others that emerged formed the theme actual ICP. The subthemes from the expected ICP included: accessibility of obstetric services, expected referral, recommended tools, expected communication and expected documentation. The theme actual ICP held threee merging subthemes: the handover processes, collaborative information seeking, information communicated and referral processes. Conclusion: This study showed that what was expected was not what was actually happening. The requirements of the policies and protocols need to be effectively implemented to improve practice building these into current biomedical guidelines.

  1. Is sonographically measured cervical length at 37 weeks of gestation associated with intrapartum cesarean section? A prospective cohort study.

    Science.gov (United States)

    de Vries, Bradley; Narayan, Rajit; McGeechan, Kevin; Santiagu, Stanley; Vairavan, Ramesh; Burke, Minke; Phipps, Hala; Hyett, Jon

    2018-02-16

    Cesarean section rates continue to increase globally. Prediction of intrapartum cesarean section could lead to preventive measures. Our aim was to assess the association between sonographically measured cervical length at 37 weeks of gestation and cesarean section among women planning a vaginal birth. The population was women with a low-risk pregnancy or with gestational diabetes. This was a prospective cohort study conducted in a tertiary referral hospital in Sydney, Australia. In all, 212 women with a low-risk pregnancy or with gestational diabetes were recruited including 158 nulliparous and 54 parous women. Maternal demographic, clinical and ultrasound characteristics were collected at 37 weeks of gestation. Semi-Bayesian logistic regression and Markov chain Monte Carlo simulation were used to assess the relationship between cervical length and cesarean section in labor. Rates of cesarean section were 5% (2/55) for cervical length ≤20 mm, 17% (17/101) for cervical length 20-32 mm, and 27% (13/56) for cervical length >32 mm. These rates were 4, 22 and 33%, respectively, in nulliparous women. In the semi-Bayesian analysis, the odds ratio for cesarean section was 6.2 (95% confidence interval 2.2-43) for cervical length 20-32 mm and 10 (95% confidence interval 4.8-74) for cervical length >32 mm compared with the lowest quartile of cervical length, after adjusting for maternal age, parity, height, prepregnancy body mass index, gestational diabetes, induction of labor, neonatal sex and birthweight centile. Cervical length at 37 weeks of gestation is associated with intrapartum cesarean section. © 2018 Nordic Federation of Societies of Obstetrics and Gynecology.

  2. Using the Two-Burn Escape Maneuver for Fast Transfers in the Solar System and Beyond

    Science.gov (United States)

    Adams, Robert B.; Richardson, Georgia A.

    2010-01-01

    The two-burn maneuver to escape the gravitational pull of a central body is described. The maneuver, originally suggested by Hermann Oberth, improves efficiency considerably for a wide range of missions of interest in space exploration and scientific investigation. A clear delineation of when the maneuver is more effective is given, as are methods to extract the most advantage when using the maneuver. Some examples are given of how this maneuver can enable exploration of the outer solar system, near interstellar space, and crewed missions to Mars and beyond. The maneuver has the potential to halve the required infrastructure associated with a crewed mission to Mars and achieve increased solar escape velocities with existing spacecraft technologies.

  3. Computing and Visualizing Reachable Volumes for Maneuvering Satellites

    International Nuclear Information System (INIS)

    Jiang, M.; de Vries, W.H.; Pertica, A.J.; Olivier, S.S.

    2011-01-01

    Detecting and predicting maneuvering satellites is an important problem for Space Situational Awareness. The spatial envelope of all possible locations within reach of such a maneuvering satellite is known as the Reachable Volume (RV). As soon as custody of a satellite is lost, calculating the RV and its subsequent time evolution is a critical component in the rapid recovery of the satellite. In this paper, we present a Monte Carlo approach to computing the RV for a given object. Essentially, our approach samples all possible trajectories by randomizing thrust-vectors, thrust magnitudes and time of burn. At any given instance, the distribution of the 'point-cloud' of the virtual particles defines the RV. For short orbital time-scales, the temporal evolution of the point-cloud can result in complex, multi-reentrant manifolds. Visualization plays an important role in gaining insight and understanding into this complex and evolving manifold. In the second part of this paper, we focus on how to effectively visualize the large number of virtual trajectories and the computed RV. We present a real-time out-of-core rendering technique for visualizing the large number of virtual trajectories. We also examine different techniques for visualizing the computed volume of probability density distribution, including volume slicing, convex hull and isosurfacing. We compare and contrast these techniques in terms of computational cost and visualization effectiveness, and describe the main implementation issues encountered during our development process. Finally, we will present some of the results from our end-to-end system for computing and visualizing RVs using examples of maneuvering satellites.

  4. Simulation of upwind maneuvering of a sailing yacht

    Science.gov (United States)

    Harris, Daniel Hartrick

    A time domain maneuvering simulation of an IACC class yacht suitable for the analysis of unsteady upwind sailing including tacking is presented. The simulation considers motions in six degrees of freedom. The hydrodynamic and aerodynamic loads are calculated primarily with unsteady potential theory supplemented by empirical viscous models. The hydrodynamic model includes the effects of incident waves. Control of the rudder is provided by a simple rate feedback autopilot which is augmented with open loop additions to mimic human steering. The hydrodynamic models are based on the superposition of force components. These components fall into two groups, those which the yacht will experience in calm water, and those due to incident waves. The calm water loads are further divided into zero Froude number, or "double body" maneuvering loads, hydrostatic loads, gravitational loads, free surface radiation loads, and viscous/residual loads. The maneuvering loads are calculated with an unsteady panel code which treats the instantaneous geometry of the yacht below the undisturbed free surface. The free surface radiation loads are calculated via convolution of impulse response functions derived from seakeeping strip theory. The viscous/residual loads are based upon empirical estimates. The aerodynamic model consists primarily of a database of steady state sail coefficients. These coefficients treat the individual contributions to the total sail force of a number of chordwise strips on both the main and jib. Dynamic effects are modeled by using the instantaneous incident wind velocity and direction as the independent variables for the sail load contribution of each strip. The sail coefficient database was calculated numerically with potential methods and simple empirical viscous corrections. Additional aerodynamic load calculations are made to determine the parasitic contributions of the rig and hull. Validation studies compare the steady sailing hydro and aerodynamic loads

  5. Computing and Visualizing Reachable Volumes for Maneuvering Satellites

    Science.gov (United States)

    Jiang, M.; de Vries, W.; Pertica, A.; Olivier, S.

    2011-09-01

    Detecting and predicting maneuvering satellites is an important problem for Space Situational Awareness. The spatial envelope of all possible locations within reach of such a maneuvering satellite is known as the Reachable Volume (RV). As soon as custody of a satellite is lost, calculating the RV and its subsequent time evolution is a critical component in the rapid recovery of the satellite. In this paper, we present a Monte Carlo approach to computing the RV for a given object. Essentially, our approach samples all possible trajectories by randomizing thrust-vectors, thrust magnitudes and time of burn. At any given instance, the distribution of the "point-cloud" of the virtual particles defines the RV. For short orbital time-scales, the temporal evolution of the point-cloud can result in complex, multi-reentrant manifolds. Visualization plays an important role in gaining insight and understanding into this complex and evolving manifold. In the second part of this paper, we focus on how to effectively visualize the large number of virtual trajectories and the computed RV. We present a real-time out-of-core rendering technique for visualizing the large number of virtual trajectories. We also examine different techniques for visualizing the computed volume of probability density distribution, including volume slicing, convex hull and isosurfacing. We compare and contrast these techniques in terms of computational cost and visualization effectiveness, and describe the main implementation issues encountered during our development process. Finally, we will present some of the results from our end-to-end system for computing and visualizing RVs using examples of maneuvering satellites.

  6. Maneuvering a pilot implementation to align agendas across sectors

    DEFF Research Database (Denmark)

    Mønsted, Troels; Hertzum, Morten; Søndergaard, Jens

    2017-01-01

    A prerequisite for pilot implementations in complex organizational settings is that the agendas of the stakeholders of the system are maneuvered into alignment. In this paper we present a study of the pilot implementation of the IT-supported, preventive intervention TOF (Tidlig Opsporing og...... Forebyggelse). A core element of TOF is an IT system that stratifies citizens into risk groups on the basis of self-reported lifestyle information and data retrieved from the medical records of the general practitioners (GPs). In addition, the system facilitates cross-sectoral coordination between preventive...

  7. Near Earth Asteroid redirect missions based on gravity assist maneuver

    Science.gov (United States)

    Ledkov, Anton; Shustov, Boris M.; Eismont, Natan; Boyarsky, Michael; Nazirov, Ravil; Fedyaev, Konstantin

    During last years several events attracted world community attention to the hazards of hitting the Earth by sky objects. One of these objects is Apophis asteroid what was expected with nonzero probability to hit the Earth in 2036. Luckily after more precise measurements this event is considered as practically improbable. But the other object has really reached the Earth, entered the atmosphere in the Chelyabinsk area and caused vast damages. After this the hazardous near Earth objects problem received practical confirmation of the necessity to find the methods of its resolution. The methods to prevent collision of the dangerous sky object with the Earth proposed up to now look not practical enough if one mentions such as gravitational tractor or changing the reflectivity of the asteroid surface. Even the method supposing the targeting of the spacecraft to the hazardous object in order to deflect it from initial trajectory by impact does not work because its low mass as compared with the mass of asteroid to be deflected. For example the mass of the Apophis is estimated to be about 40 million tons but the spacecraft which can be launched to intercept the asteroid using contemporary launchers has the mass not more than 5 tons. So the question arises where to find the heavier projectile which is possible to direct to the dangerous object? The answer proposed in our paper is very simple: to search it among small near Earth asteroids. As small ones we suppose those which have the cross section size not more than 12-15 meters and mass not exceeding 1500 -1700 tons. According to contemporary estimates the number of such asteroids is not less than 100000. The other question is how to redirect such asteroid to the dangerous one. In the paper the possibilities are studied to use for that purpose gravity assist maneuvers near Earth. It is shown that even among asteroids included in contemporary catalogue there are the ones which could be directed to the trajectory of the

  8. Improving aggregate behavior in parking lots with appropriate local maneuvers

    KAUST Repository

    Rodriguez, Samuel

    2013-11-01

    In this paper we study the ingress and egress of pedestrians and vehicles in a parking lot. We show how local maneuvers executed by agents permit them to create trajectories in constrained environments, and to resolve the deadlocks between them in mixed-flow scenarios. We utilize a roadmap-based approach which allows us to map complex environments and generate heuristic local paths that are feasible for both pedestrians and vehicles. Finally, we examine the effect that some agent-behavioral parameters have on parking lot ingress and egress. © 2013 IEEE.

  9. Space Shuttle OMS engine valve technology. [Orbital Maneuvering System

    Science.gov (United States)

    Wichmann, H.

    1974-01-01

    Valve technology program to determine shutoff valve concepts suitable for the Orbital Maneuvering System (OMS) engine of the Space Shuttle. The tradeoff studies selected the electric torque motor operated dual poppet and ball valves as the most desirable valve concepts for the OMS Engine Shutoff Valve. A prototype of one of these concepts was built and subjected to a design verification program. A number of unique features were designed to include the required contamination insensitivity, operating fluid compatibility, decontamination capability, minimum maintenance requirement and long service life capability.

  10. Limited War in the Precision Engagement Era: The Balance Between Dominant Maneuver and Precision Engagement

    National Research Council Canada - National Science Library

    Hedstrom, Marvin

    2001-01-01

    .... German historian Hans Delbruck's two strategies of warfare: annihilation and exhaustion, and American military theorist Robert Leonhard's concepts of attrition and maneuver are examined to establish the relationship...

  11. Study on zigzag maneuver characteristics of V-U very large crude oil (VLCC) tankers

    Science.gov (United States)

    Jaswar, Maimun, A.; Wahid, M. A.; Priyanto, A.; Zamani, Pauzi, Saman

    2012-06-01

    The Department of Marine Technology at the Faculty of Mechanical Engineering, University Teknologi Malaysia has recently developed an Ship Maneuverability tool which intends to upgrade student's level understanding the application of fluid dynamic on interaction between hull, propeller, and rudder during maneuvering. This paper discusses zigzag maneuver for conventional Very Large Crude Oil (VLCC) ships with the same principal dimensions but different stern flame shape. 10/10 zigzag maneuver characteristics of U and V types of VLCC ships are investigated. Simulation results for U-type show a good agreement with the experimental data, but V-type not good agreement with experimental one. Further study on zigzag maneuver characteristics are required.

  12. Outcome of the use of tension-free vaginal tape in women with mixed urinary incontinence, previous failed surgery, or low valsalva pressure.

    Science.gov (United States)

    Abdel-Hady, El-Said; Constantine, Glyn

    2005-02-01

    To assess the safety and efficacy of the use of tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in women with mixed incontinence, previous failed incontinence surgery or low valsalva leak point pressure (VLPP). Six hundred and fifty-eight women with SUI underwent the TVT procedure. These included women with mixed stress and urge incontinence (n=128), previous surgery for SUI (n=118), low VLPP (n=80), and those over 70 years old (n=68). The procedure was carried out under spinal anesthetic and operative and immediate postoperative data was collected for all women. Six-month follow-up data was available on 454 women, with the first 300 women completing a quality of life (QOL) questionnaire before and after surgery. The overall subjective cure rate at 6 months was 91%, with 8% of women reporting significant (>50%) improvement in their symptoms. Subgroups with a body mass index > 30, age > 70 years, coexisting instability, previous failed surgery, and low VLPP showed cure rates of 81-89%. QOL improvements for all groups were highly significant. Significant complications included voiding difficulties in 29 women (4.4%), retropubic hematomas in four (0.6%), and thromboembolic episodes in three (0.5%). The simplicity and high efficacy of the TVT makes it the first choice for the treatment of women with SUI, including those with more complex problems or coexisting risk factors.

  13. The woman, partner and midwife: An integration of three perspectives of labour when intrapartum transfer from a birth centre to a tertiary obstetric unit occurs.

    Science.gov (United States)

    Kuliukas, Lesley J; Hauck, Yvonne C; Lewis, Lucy; Duggan, Ravani

    2017-04-01

    When transfer in labour takes place from a birth centre to a tertiary maternity hospital the woman, her partner and the midwife (the triad) are involved, representing three different perspectives. The purpose of this paper is to explore the integration of these intrapartum transfer experiences for the birth triad. Giorgi's descriptive phenomenological method of analysis was used to explore the 'lived' experiences of Western Australian women, their partners and midwives across the birth journey. Forty-five interviews were conducted. Findings revealed that experiences of intrapartum transfer were unique to each member of the triad (woman, partner and midwife) and yet there were also shared experiences. All three had three themes in common: 'The same journey through three different lenses'; 'In my own world' and 'Talking about the birth'. The woman and partner shared two themes: 'Lost birth dream' and 'Grateful to return to a familiar environment'. The woman and midwife both had: 'Gratitude for continuity of care model' and the partner and midwife both found they were: 'Struggling to adapt to a changing care model' and their 'Inside knowledge was not appreciated'. Insight into the unique integrated experiences during a birth centre intrapartum transfer can inform midwives, empowering them to better support parents through antenatal education before and by offering discussion about the birth and transfer after. Translation of findings to practice also reinforces how midwives can support their colleagues by recognising the accompanying midwife's role and knowledge of the woman. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  14. Cerebroplacental ratio thresholds measured within two weeks of birth and the risk of Cesarean section for intrapartum fetal compromise and adverse neonatal outcome.

    Science.gov (United States)

    N Bligh, Larissa; Alsolai, Amal A; Greer, Ristan M; Kumar, Sailesh

    2017-06-08

    Prediction of intrapartum fetal compromise in uncomplicated, term pregnancies is a global obstetric challenge. Currently, no widely accepted screening test for this condition exists, although the cerebroplacental ratio (CPR) shows promise. We aimed to prospectively evaluate the screening performance of the CPR 10 th centile for detection of Cesarean section for intrapartum fetal compromise (IFC) and composite adverse neonatal outcome (ANO) in low-risk women from 36 weeks and to determine the best CPR threshold from three previously described in the literature. In a blinded, prospective, observational, cohort study, 483 women with uncomplicated singleton pregnancies underwent fortnightly CPR measurement from 36 weeks to delivery and intrapartum and neonatal outcomes were recorded. The CPR 10 th centile threshold screening test performance was calculated for emergency Cesarean section for IFC and composite ANO, incorporating acidosis at birth, Apgar Cesarean section for IFC and 17.9% had a composite ANO. Sensitivity and specificity for CPR Cesarean section IFC and composite ANO, respectively. Comparing the three CPR thresholds, CPR Cesarean section for IFC area under the receiver operating characteristic curve = 0.72, composite ANO area under the receiver operating characteristic curve = 0.58), although its predictive utility was only fair for Cesarean section for IFC and poor for composite ANO. The CPR 10 th centile may be useful as a component of a risk assessment tool for Cesarean section for IFC in low risk pregnancies at term. This article is protected by copyright. All rights reserved.

  15. Self-hypnosis for intrapartum pain management in pregnant nulliparous women: a randomised controlled trial of clinical effectiveness.

    Science.gov (United States)

    Downe, S; Finlayson, K; Melvin, C; Spiby, H; Ali, S; Diggle, P; Gyte, G; Hinder, S; Miller, V; Slade, P; Trepel, D; Weeks, A; Whorwell, P; Williamson, M

    2015-08-01

    (Primary) To establish the effect of antenatal group self-hypnosis for nulliparous women on intra-partum epidural use. Multi-method randomised control trial (RCT). Three NHS Trusts. Nulliparous women not planning elective caesarean, without medication for hypertension and without psychological illness. Randomisation at 28-32 weeks' gestation to usual care, or to usual care plus brief self-hypnosis training (two × 90-minute groups at around 32 and 35 weeks' gestation; daily audio self-hypnosis CD). Follow up at 2 and 6 weeks postnatal. Primary: epidural analgesia. Secondary: associated clinical and psychological outcomes; cost analysis. Six hundred and eighty women were randomised. There was no statistically significant difference in epidural use: 27.9% (intervention), 30.3% (control), odds ratio (OR) 0.89 [95% confidence interval (CI): 0.64-1.24], or in 27 of 29 pre-specified secondary clinical and psychological outcomes. Women in the intervention group had lower actual than anticipated levels of fear and anxiety between baseline and 2 weeks post natal (anxiety: mean difference -0.72, 95% CI -1.16 to -0.28, P = 0.001); fear (mean difference -0.62, 95% CI -1.08 to -0.16, P = 0.009) [Correction added on 7 July 2015, after first online publication: 'Mean difference' replaced 'Odds ratio (OR)' in the preceding sentence.]. Postnatal response rates were 67% overall at 2 weeks. The additional cost in the intervention arm per woman was £4.83 (CI -£257.93 to £267.59). Allocation to two-third-trimester group self-hypnosis training sessions did not significantly reduce intra-partum epidural analgesia use or a range of other clinical and psychological variables. The impact of women's anxiety and fear about childbirth needs further investigation. © 2015 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

  16. Birthplace in Australia: Processes and interactions during the intrapartum transfer of women from planned homebirth to hospital.

    Science.gov (United States)

    Fox, Deborah; Sheehan, Athena; Homer, Caroline

    2018-02-01

    the aim of the study was to explore the views and experiences of women, midwives and obstetricians on the intrapartum transfer of women from planned homebirth to hospital in Australia. a Constructivist Grounded Theory approach was taken, to conceptualise the social interactions and processes grounded in the data. urban and regional areas in four states of south-eastern Australia. semi-structured qualitative interviews were conducted with 36 women, midwives and obstetricians who had experienced an intrapartum homebirth transfer within three years prior to the interview. Interviews were audio recorded and transcribed verbatim. women who were transferred to hospital from a planned homebirth made physical and psychological journeys out of their comfort zone, as they faced the uncertainty of changing expectations for their birth. The trusting relationship between a woman and her homebirth midwife was crucial to women's sense of safety and well-being in hospital. Midwives and obstetricians, when congregating in the hospital birthing rooms of transferred women, also felt out of their comfort zones. This was due to the challenges of converging with others who possessed conflicting paradigms of safety and risk in birth that were at odds with their own, and adapting to different routines, roles and responsibilities. These differences were derived from diverse professional, social and personal influences and often manifested in stereotyping behaviours and 'us and them' dynamics. When midwife-woman partnerships were respected as an inclusive part of women's care, collaboration ensued, conflict was ameliorated, and smooth transfers could be celebrated as successes of the maternity care system. supporting woman centred care in homebirth transfers means acknowledging the social challenges of collaborating in the unique context of a transferred woman's hospital birthing room. Understanding the power of the midwife-woman partnership, and its value to the health and well-being of

  17. How hummingbirds hum: Acoustic holography of hummingbirds during maneuvering flight

    Science.gov (United States)

    Hightower, Ben; Wijnings, Patrick; Ingersoll, Rivers; Chin, Diana; Scholte, Rick; Lentink, David

    2017-11-01

    Hummingbirds make a characteristic humming sound when they flap their wings. The physics and the biological significance of hummingbird aeroacoustics is still poorly understood. We used acoustic holography and high-speed cameras to determine the acoustic field of six hummingbirds while they either hovered stationary in front of a flower or maneuvered to track flower motion. We used a robotic flower that oscillated either laterally or longitudinally with a linear combination of 20 different frequencies between 0.2 and 20 Hz, a range that encompasses natural flower vibration frequencies in wind. We used high-speed marker tracking to dissect the transfer function between the moving flower, the head, and body of the bird. We also positioned four acoustic arrays equipped with 2176 microphones total above, below, and in front of the hummingbird. Acoustic data from the microphones were back-propagated to planes adjacent to the hummingbird to create the first real-time holograms of the pressure field a hummingbird generates in vivo. Integration of all this data offers insight into how hummingbirds modulate the acoustic field during hovering and maneuvering flight.

  18. Propulsive Maneuver Design for the 2007 Mars Phoenix Lander Mission

    Science.gov (United States)

    Raofi, Behzad; Bhat, Ramachandra S.; Helfrich, Cliff

    2008-01-01

    On May 25, 2008, the Mars Phoenix Lander (PHX) successfully landed in the northern planes of Mars in order to continue and complement NASA's "follow the water" theme as its predecessor Mars missions, such as Mars Odyssey (ODY) and Mars Exploration Rovers, have done in recent years. Instruments on the lander, through a robotic arm able to deliver soil samples to the deck, will perform in-situ and remote-sensing investigations to characterize the chemistry of materials at the local surface, subsurface, and atmosphere. Lander instruments will also identify the potential history of key indicator elements of significance to the biological potential of Mars, including potential organics within any accessible water ice. Precise trajectory control and targeting were necessary in order to achieve the accurate atmospheric entry conditions required for arriving at the desired landing site. The challenge for the trajectory control maneuver design was to meet or exceed these requirements in the presence of spacecraft limitations as well as other mission constraints. This paper describes the strategies used, including the specialized targeting specifically developed for PHX, in order to design and successfully execute the propulsive maneuvers that delivered the spacecraft to its targeted landing site while satisfying the planetary protection requirements in the presence of flight system constraints.

  19. Foetal electrocardiograph (ST-analyser or STAN) for intrapartum foetal heart rate monitoring: a friend or a foe?

    Science.gov (United States)

    Chandraharan, Edwin

    2018-01-01

    Cardiotocograph (CTG) is associated with a high false positive rate of up to 60% which may increase the risk of unnecessary intrapartum interventions (emergency caesarean sections or operative vaginal deliveries) without any significant benefits. A recent study on variation of caesarean section rates in England has concluded that there was a very wide variation even in the adjusted rates of caesarean section from 14.9% to 32.1%. Cochrane Systematic Reviews have concluded that the use of FBS does not reduce caesarean section rate or any pre-specified neonatal outcomes. Fetal ECG (ST-Analyser or STAN) has been used in the clinical practice for more than 20 years. Although, initial randomised controlled trials (RCTs) showed great promise regarding the role of STAN in reducing operative delivery rates (instrumental vaginal births and emergency caesarean sections) and neonatal metabolic acidosis, subsequent studies have questioned the role of STAN in clinical practice. A recent meta-analysis which included six randomised controlled trials (a total of 26,446 women) has concluded that there was a 36% reduction in the rate of neonatal metabolic acidosis. Practising clinicians currently face a dilemma as to whether STAN has a place in contemporary obstetric practice or whether it?s use should be discouraged and discontinued.

  20. Issues of informed consent for intrapartum trials: a suggested consent pathway from the experience of the Release trial [ISRCTN13204258

    Directory of Open Access Journals (Sweden)

    Weeks Andrew

    2006-05-01

    Full Text Available Abstract Service users within the NHS are increasingly being asked to participate in clinical research. In Liverpool Women's NHS Foundation Trust, approximately 35% of women take part in research during their pregnancy. For many studies the consent process is simple; information is provided and signed consent is given. There is a difficulty, however, with obtaining informed consent from women in pregnancy who become eligible only when they develop unforeseen complications, especially when they occur acutely. The problem is compounded with women in labour who may be frightened, vulnerable, in pain, under the effect of opiate analgesia, or all of the above. If research to improve the care of these women is to continue, then special consent procedures are needed. These procedures must ensure that the woman's autonomy is protected whilst recognising that women under these circumstances vary enormously, both in their desire for information and their ability to comprehend it. This paper will discuss the obtaining of consent in this situation, and describe an information and consent pathway for intrapartum research which has been developed in collaboration with consumer groups as a way in which these issues can be tackled.

  1. Increased risk of mother-to-infant transmission of hepatitis C virus by intrapartum infantile exposure to maternal blood.

    Science.gov (United States)

    Steininger, Christoph; Kundi, Michael; Jatzko, Gerlinde; Kiss, Herbert; Lischka, Andreas; Holzmann, Heidemarie

    2003-02-01

    Virological and clinical data from 73 hepatitis C virus (HCV)-infected pregnant women who gave birth to 75 children were merged retrospectively, by logistic regression analysis, to investigate risk factors for vertical transmission of HCV. Eighty-two percent of the HCV-infected mothers were HCV-RNA-positive during pregnancy, and 10% were coinfected with human immunodeficiency virus (HIV). Nine children were HCV infected, 1 was HIV infected, but none was HIV-HCV coinfected. Among vaginal deliveries, the mean HCV load of mothers who transmitted HCV to their infants was higher than that of those who did not (8.1 x 10(5) vs. 1.4 x 10(4) copies/mL; P=.056). A reduction in umbilical cord-blood pH (relative risk, 3.9; P=.04) or the occurrence of perineal or vaginal laceration (relative risk, 6.4; P=.028) during vaginal delivery significantly increased the risk of vertical HCV transmission. In conclusion, high maternal viremia, infantile hypoxia, and intrapartum exposure to virus-contaminated maternal blood increased the risk of HCV transmission during vaginal deliveries. Consequently, cesarean section may reduce the risk of vertical HCV transmission in selected cases.

  2. Third- or Fourth-Degree Intrapartum Anal Sphincter Tears Are Associated With Levator Ani Avulsion in Primiparas.

    Science.gov (United States)

    Valsky, Dan V; Cohen, Sarah M; Lipschuetz, Michal; Hochner-Celnikier, Drorith; Daum, Hagit; Yagel, Itai; Yagel, Simcha

    2016-04-01

    We evaluated primiparous women with clinically diagnosed third- and fourth-degree and anal sphincter tears, to evaluate the rate of levator ani muscle injury compared to primiparous women without sphincter tears. Primiparous women delivering in our maternity ward with intrapartum diagnoses of third- or fourth-degree anal sphincter tears, repaired by the overlapping technique, were recruited to undergo 3-dimensional transperineal sonography of the pelvic floor anatomy, including the anterior and posterior compartments. Primiparas with uncomplicated vaginal deliveries were recruited as a comparison group. Patient files were examined, and maternal backgrounds and delivery and neonatal details were extracted for all patients. Ninety-four women with tears were recruited to the study group, and 464 women with normal vaginal deliveries constituted the comparison group. The groups differed significantly in the rates of levator ani defects: 38 of 94 women (40.4%) in the study group versus 75 of 464 (16.2%) in the comparison group (P tears are associated with levator ani avulsion. Knowledge of complex pelvic floor damage may allow for prompt referral to secondary preventive measures for pelvic floor disorders. © 2016 by the American Institute of Ultrasound in Medicine.

  3. Comparison of hypnosis with conventional relaxation for antenatal and intrapartum use: a feasibility study in general practice

    Science.gov (United States)

    Brann, Les R.; Guzvica, Sally A.

    1987-01-01

    A hypnosis programme for antenatal and intrapartum use has been developed and successfully introduced into a practice as an alternative to conventional relaxation training. Of 96 women from the practice who delivered during the 10-month period of the study 51 opted for the psychoprophylaxis and 45 for the hypnosis. Details of the pregnancy, labour and postnatal period were collected for both groups, together with a subjective assessment of their satisfaction with labour. Disparity between the ages and parity of the two groups made comparisons difficult. The duration of the first stage of labour was markedly reduced in the hypnosis group by 98 minutes for primiparas and 40 minutes for multiparas. A small (five minutes) increase in the length of the second stage may have been a result of the hypnotic relaxation. The verbalization has been amended accordingly. The hypnosis group were more satisfied with labour than the psychoprophylaxis group (mean satisfaction score 7.4 versus 5.6) and they reported other benefits of hypnosis, for example, reduction in anxiety and help with getting to sleep.Further studies are planned. PMID:3333169

  4. Cases requiring increased number of repositioning maneuvers in benign paroxysmal positional vertigo

    Directory of Open Access Journals (Sweden)

    Mukadder Korkmaz

    Full Text Available ABSTRACT INTRODUCTION: Benign paroxysmal positional vertigo (BPPV is a clinical syndrome that is proposed to be caused by dislocated utricular debris into semicircular canals. Although the majority of patients are treated by one or two repositioning maneuvers, some of the patients need repeated maneuvers for relief. OBJECTIVE: The goal of this study was to investigate the factors associated with patients with benign paroxysmal positional vertigo who required multiple repositioning procedures for treatment. METHODS: Data were obtained from the clinical records of 153 patients diagnosed with benign paroxysmal positional vertigo. Patients were treated by repositioning maneuvers. Demographic data and the factors including age, sex, canal type, duration of symptoms, comorbidities and number of repositioning maneuvers for relief were documented for statistical analysis. RESULTS: Age, sex, canal type and the duration of symptoms had no impact on the number of maneuvers. The most common comorbidity was spine problems. Hypertension was the only comorbidity that significantly associated with increased number of maneuvers. CONCLUSION: The presence of hypertension is a risk factor for repeated maneuvers in benign paroxysmal positional vertigo treatment. Physicians should be aware of the increased probability of repeated repositioning maneuvers in these group of patients. The role of comorbidities and vascular factors need to be further clarified in the course of benign paroxysmal positional vertigo.

  5. The effects of betahistine in addition to epley maneuver in posterior canal benign paroxysmal positional vertigo.

    Science.gov (United States)

    Guneri, Enis Alpin; Kustutan, Ozge

    2012-01-01

    The purpose of this study is to evaluate the effects of betahistine in addition to Epley maneuver on the quality of life of patients with posterior semicircular canal benign paroxysmal positional vertigo (BPPV) of the canalithiasis type. Double-blind, randomized, controlled clinical trial. Academic university hospital. Seventy-two patients were enrolled in the study. The first group was treated with Epley maneuver only. The second group received placebo drug 2 times daily for 1 week in addition to Epley maneuver, and the third group received 24 mg betahistine 2 times daily for 1 week in addition to Epley maneuver. The effectiveness of the treatments was assessed in each group as well as between them by analyzing and comparing data of 4 different vertigo symptom scales. Epley maneuver, alone or combined with betahistine or placebo, was found to be very effective with a primary success rate of 86.2%. The symptoms were significantly reduced in group 3 patients overall, and those patients younger or older than 50 years of age who had hypertension, with symptom onset <1 month, and with attack duration of less than a minute did significantly better with the combination of betahistine 48 mg daily. Betahistine in addition to Epley maneuver is more effective than Epley maneuver alone or combined with placebo with regard to improvement of symptoms in certain patients. However, future clinical studies covering more patients to investigate the benefit of medical treatments in addition to Epley maneuver are needed.

  6. Cases requiring increased number of repositioning maneuvers in benign paroxysmal positional vertigo.

    Science.gov (United States)

    Korkmaz, Mukadder; Korkmaz, Hakan

    2016-01-01

    Benign paroxysmal positional vertigo (BPPV) is a clinical syndrome that is proposed to be caused by dislocated utricular debris into semicircular canals. Although the majority of patients are treated by one or two repositioning maneuvers, some of the patients need repeated maneuvers for relief. The goal of this study was to investigate the factors associated with patients with benign paroxysmal positional vertigo who required multiple repositioning procedures for treatment. Data were obtained from the clinical records of 153 patients diagnosed with benign paroxysmal positional vertigo. Patients were treated by repositioning maneuvers. Demographic data and the factors including age, sex, canal type, duration of symptoms, comorbidities and number of repositioning maneuvers for relief were documented for statistical analysis. Age, sex, canal type and the duration of symptoms had no impact on the number of maneuvers. The most common comorbidity was spine problems. Hypertension was the only comorbidity that significantly associated with increased number of maneuvers. The presence of hypertension is a risk factor for repeated maneuvers in benign paroxysmal positional vertigo treatment. Physicians should be aware of the increased probability of repeated repositioning maneuvers in these group of patients. The role of comorbidities and vascular factors need to be further clarified in the course of benign paroxysmal positional vertigo. Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  7. 32 CFR 552.38 - Acquisition of maneuver agreements for Army commanders.

    Science.gov (United States)

    2010-07-01

    ... Real Estate and Interest Therein § 552.38 Acquisition of maneuver agreements for Army commanders. (a... specific areas desired for use. (b) Real estate coverage. Real estate coverage will be in the form of agreements with landowners, granting the right to conduct maneuvers at a given time or periodically. Short...

  8. Closeup of STS-26 Discovery, OV-103, orbital maneuvering system (OMS) leak

    Science.gov (United States)

    1988-01-01

    Closeup of STS-26 Discovery, Orbiter Vehicle (OV) 103, orbital maneuvering system (OMS) reaction control system (RCS) nitrogen tetroxide gas leak was captured by a Cobra borescope and displayed on a video monitor. The borescope has a miniature videocamera at the end of a flexible rubber tube and is able to be maneuvered into other inaccessible locations.

  9. Applying Dynamical Systems Theory to Optimize Libration Point Orbit Stationkeeping Maneuvers for WIND

    Science.gov (United States)

    Brown, Jonathan M.; Petersen, Jeremy D.

    2014-01-01

    NASA's WIND mission has been operating in a large amplitude Lissajous orbit in the vicinity of the interior libration point of the Sun-Earth/Moon system since 2004. Regular stationkeeping maneuvers are required to maintain the orbit due to the instability around the collinear libration points. Historically these stationkeeping maneuvers have been performed by applying an incremental change in velocity, or (delta)v along the spacecraft-Sun vector as projected into the ecliptic plane. Previous studies have shown that the magnitude of libration point stationkeeping maneuvers can be minimized by applying the (delta)v in the direction of the local stable manifold found using dynamical systems theory. This paper presents the analysis of this new maneuver strategy which shows that the magnitude of stationkeeping maneuvers can be decreased by 5 to 25 percent, depending on the location in the orbit where the maneuver is performed. The implementation of the optimized maneuver method into operations is discussed and results are presented for the first two optimized stationkeeping maneuvers executed by WIND.

  10. Platelet injectors for Space Shuttle orbit maneuvering engine

    Science.gov (United States)

    Kahl, R. C.; Labotz, R. J.; Bassham, L. B.

    1974-01-01

    The Space Shuttle Orbit Maneuvering Subsystem Rocket Engine employs a platelet element injector concept. This injector has demonstrated 316-sec vacuum specific impulse performance under simulated altitude conditions when tested with a milled slot/electroformed nickel close-out regenerative chamber and a full 71 area ratio nozzle. To date, over 300 altitude engine tests and 300 stability bomb tests have demonstrated stable, erosion free operation with this concept to test durations of 150 seconds. The injector and chamber also meet the reusable requirements of the shuttle with a cycle life capability in excess of 1000 cycles. An extensive altitude restart program has also demonstrated OMS-engine operation over large variations in the burn and coast times with helium saturated propellants.

  11. Space shuttle orbital maneuvering engine platelet injector program

    Science.gov (United States)

    1975-01-01

    A platelet-face injector for the fully reusable orbit maneuvering system OMS on the space shuttle was evaluated as a means of obtaining additional design margin and low cost. Performance, heat transfer, and combustion stability were evaluated over the anticipated range of OMS operating conditions. The effects of acoustic cavity configuration on combustion stability, including cavity depth, open area, inlet contour, and other parameters, were investigated using sea level bomb tests. Prototype injector and chamber behavior was evaluated for a variety of conditions; these tests examined the effects of film cooling, helium saturated propellants, chamber length, inlet conditions, and operating point, on performance, heat transfer and engine transient behavior. Helium bubble ingestion into both propellant circuits was investigated, as was chugging at low pressure operation, and hot and cold engine restart with and without a purge.

  12. Helicopter Acoustic Flight Test with Altitude Variation and Maneuvers

    Science.gov (United States)

    Watts, Michael E.; Greenwood, Eric; Sim, Ben; Stephenson, James; Smith, Charles D.

    2016-01-01

    A cooperative flight test campaign between NASA and the U.S. Army was performed from September 2014 to February 2015. The purposes of the testing were to: investigate the effects of altitude variation on noise generation, investigate the effects of gross weight variation on noise generation, establish the statistical variability in acoustic flight testing of helicopters, and characterize the effects of transient maneuvers on radiated noise for a medium-lift utility helicopter. This test was performed at three test sites (0, 4000, and 7000 feet above mean sea level) with two aircraft (AS350 SD1 and EH-60L) tested at each site. This report provides an overview of the test, documents the data acquired and describes the formats of the stored data.

  13. Sequential Probability Ratio Test for Spacecraft Collision Avoidance Maneuver Decisions

    Science.gov (United States)

    Carpenter, J. Russell; Markley, F. Landis

    2013-01-01

    A document discusses sequential probability ratio tests that explicitly allow decision-makers to incorporate false alarm and missed detection risks, and are potentially less sensitive to modeling errors than a procedure that relies solely on a probability of collision threshold. Recent work on constrained Kalman filtering has suggested an approach to formulating such a test for collision avoidance maneuver decisions: a filter bank with two norm-inequality-constrained epoch-state extended Kalman filters. One filter models the null hypotheses that the miss distance is inside the combined hard body radius at the predicted time of closest approach, and one filter models the alternative hypothesis. The epoch-state filter developed for this method explicitly accounts for any process noise present in the system. The method appears to work well using a realistic example based on an upcoming, highly elliptical orbit formation flying mission.

  14. Non-Toxic Orbital Maneuvering System Engine Development

    Science.gov (United States)

    Green, Christopher; Claflin, Scott; Maeding, Chris; Butas, John

    1999-01-01

    Recent results using the Aestus engine operated with LOx/ethanol propellant are presented. An experimental program at Rocketdyne Propulsion and Power is underway to adapt this engine for the Boeing Reusable Space Systems Division non-toxic Orbital Maneuvering System/Reaction control System (OMS/RCS) system. Daimler-Chrysler Aerospace designed the Aestus as an nitrogen tetroxide/monomethyl hydrazine (NTO/MMH) upper-stage engine for the Ariane 5. The non-toxic OMS/RCS system's preliminary design requires a LOx/ethanol (O2/C2H5OH) engine that operates with a mixture ratio of 1.8, a specific impulse of 323 seconds, and fits within the original OMS design envelope. This paper describes current efforts to meet these requirements including, investigating engine performance using LOx/ethanol, developing the en-ine system sizing package, and meeting the vehicle operation parameters. Data from hot-fire testing are also presented and discussed.

  15. Behavior learning in differential games and reorientation maneuvers

    Science.gov (United States)

    Satak, Neha

    method is the Direct Approximation of Value Function (DAVF) method. In this method, unlike the CSR method, the player formulates an objective function for the opponent but does not formulates a strategy directly; rather, indirectly the player assumes that the opponent is playing optimally. Thus, a value function satisfying the HJB equation corresponding to the opponent's cost function exists. The DAVF method finds an approximate solution for the value function based on previous observations of the opponent's control. The approximate solution to the value function is then used to predict the opponent's future behavior. Game examples in which only a single player is learning its opponent's behavior are simulated. Subsequently, examples in which both players in a two-player game are learning each other's behavior are simulated. In the second part of this research, a reorientation control maneuver for a spinning spacecraft will be developed. This will aid the application of behavior learning and differential games concepts to the specific scenario involving multiple spinning spacecraft. An impulsive reorientation maneuver with coasting will be analytically designed to reorient the spin axis of the spacecraft using a single body fixed thruster. Cooperative maneuvers of multiple spacecraft optimizing fuel and relative orientation will be designed. Pareto optimality concepts will be used to arrive at mutually agreeable reorientation maneuvers for the cooperating spinning spacecraft.

  16. Mars Exploration Rovers Launch Performance and TCM-1 Maneuver Design

    Science.gov (United States)

    Kangas, Julie A.; Potts, Christopher L.; Raofi, Behzad

    2004-01-01

    The Mars Exploration Rover (MER) project successfully landed two identical rovers on Mars in order to remotely conduct geologic investigations, including characterization of rocks and soils that may hold clues to past water activity. Two landing sites, Gusev crater and Meridiani Planum, were selected out of nearly 200 candidate sites after balancing science returns and flight system engineering and safety. Precise trajectory targeting and control was necessary to achieve the atmospheric entry requirements for the selected landing sites within the flight system constraints. This paper discusses the expected and achieved launch vehicle performance and the impacts of that performance on the first Trajectory Correction Maneuver (TCM-1) while maintaining targeting flexibility in accommodating additional project concerns about landing site safety and possible in-flight retargeting to alternate landing sites.

  17. Propulsive maneuver design for the Mars Exploration Rover mission

    Science.gov (United States)

    Potts, Christopher L.; Kangas, Julie A.; Raofi, Behzad

    2006-01-01

    Starting from approximately 150 candidate Martian landing sites, two distinct sites have been selected for further investigation by sophisticated rovers. The two rovers, named 'Spirit' and 'Opportunity', begin the surface mission respectively to Gusec Crater and Meridiani Planum in January 2004. the rovers are essentially robotic geologists, sent on a mission to research for evidence in the rocks and soil pertaining to the historical presence of water and the ability to possibly sustain life. Before this scientific search can commence, precise trajectory targeting and control is necessary to achieve the entry requirements for the selected landing sites within the constraints of the flight system. The maneuver design challenge is to meet or exceed these requirements while maintaining the necessary design flexibility to accommodate additional project concerns. Opportunities to improve performance and reduce risk based on trajectory control characteristics are also evaluated.

  18. Nuclear space power systems for orbit raising and maneuvering

    International Nuclear Information System (INIS)

    Buden, D.; Sullivan, J.A.

    1984-01-01

    Reference is made to recent studies which have shown that direct thrust nuclear rockets for routine orbit raising and near-earth space tug missions are probably not cost-effective. The need for additional trade-off studies and comparisons of direct-thrust nuclear systems with chemical systems to clarify the role of nuclear rockets in missions requiring rapid orbit maneuvering is stressed. Attention is confined here to nuclear electric propulsion considerations. Low-mass nuclear power plants are constructed to optimize nuclear electric propulsion systems. Electric power levels from 100 kilowatts to as much as several megawatts are desirable. The goals for the power plant specific mass are 20-30 kg/kW at the lower powers to 2-4 kg/kW at the higher powers

  19. Identification and risk estimation of movement strategies during cutting maneuvers.

    Science.gov (United States)

    David, Sina; Komnik, Igor; Peters, Markus; Funken, Johannes; Potthast, Wolfgang

    2017-12-01

    Approximately 70% of anterior cruciate ligament (ACL) injuries occur in non-contact situations during cutting and landing maneuvers. Parameters such as footstrike patterns and trunk orientation were found to influence ACL relevant knee loading, however, the relationship between the whole body movement and injury risk is debated. This study identifies whole body movement strategies that increase injury risk, and provides training recommendations to reduce this risk or enable a save return to sports after injury. Experimental cross-sectional study design. Three dimensional movement analysis was carried out to investigate 50 participants performing anticipated 90° cutting maneuvers. To identify and characterize movement strategies, footstrike pattern, knee valgus moment, knee internal rotation moment, angle of attack, shoulder and pelvis axis were analyzed using statistical parametric mapping. Three different movement strategies were identified. One strategy included rearfoot striking in combination with a relatively upright body position which generated higher knee joint loads than the second strategy, forefoot striking in combination with more backwards leaning and pre-rotation of the trunk towards the new movement direction. A third strategy combined forefoot striking with less preorientation which increased the ACL relevant knee joint load compared to the second strategy. The identified movement strategies clearly pre-determine the injury risk during non-contact situations with the third strategy as the most unfavorable one. Compared to the study of isolated parameters, the analysis of the whole body movement allowed for detailed separation of more risky from less risky cutting strategies. These results give practical recommendations for the prevention of ACL injury. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  20. Propulsion System and Orbit Maneuver Integration in CubeSats: Trajectory Control Strategies Using Micro Ion Propulsion

    Science.gov (United States)

    Hudson, Jennifer; Martinez, Andres; Petro, Andrew

    2015-01-01

    The Propulsion System and Orbit Maneuver Integration in CubeSats project aims to solve the challenges of integrating a micro electric propulsion system on a CubeSat in order to perform orbital maneuvers and control attitude. This represents a fundamentally new capability for CubeSats, which typically do not contain propulsion systems and cannot maneuver far beyond their initial orbits.

  1. A general method for closed-loop inverse simulation of helicopter maneuver flight

    Directory of Open Access Journals (Sweden)

    Wei WU

    2017-12-01

    Full Text Available Maneuverability is a key factor to determine whether a helicopter could finish certain flight missions successfully or not. Inverse simulation is commonly used to calculate the pilot controls of a helicopter to complete a certain kind of maneuver flight and to assess its maneuverability. A general method for inverse simulation of maneuver flight for helicopters with the flight control system online is developed in this paper. A general mathematical describing function is established to provide mathematical descriptions of different kinds of maneuvers. A comprehensive control solver based on the optimal linear quadratic regulator theory is developed to calculate the pilot controls of different maneuvers. The coupling problem between pilot controls and flight control system outputs is well solved by taking the flight control system model into the control solver. Inverse simulation of three different kinds of maneuvers with different agility requirements defined in the ADS-33E-PRF is implemented based on the developed method for a UH-60 helicopter. The results show that the method developed in this paper can solve the closed-loop inverse simulation problem of helicopter maneuver flight with high reliability as well as efficiency. Keywords: Closed-loop, Flying quality, Helicopters, Inverse simulation, Maneuver flight

  2. Dynamic sensor tasking and IMM EKF estimation for tracking impulsively maneuvering satellites

    Science.gov (United States)

    Lace, Arthur A.

    In order to efficiently maintain space situational awareness, care must be taken to optimally allocate expensive observation resources. In most situations the available sensors capable of tracking spacecraft have their time split between many different monitoring responsibilities. Tracking maneuvering spacecraft can be especially difficult as the schedule of maneuvers may not be known and will often throw off previous orbital models. Effectively solving this tasking problem is an ongoing focus of research in the area of space situational awareness. Most methods of automated tasking do not make use of interacting multiple model extended Kalman filter techniques to better track satellites during maneuvers. This paper proposes a modification to a Fisher information gain and estimated state covariance based sensor tasking method to take maneuver probability and multiple model dynamics into account. By incorporating the probabilistic maneuvering model, sensor tasking can be improved during satellite maneuvers using constrained resources. The proposed methods are verified through the use of numerical simulations with multiple maneuvering satellites and both orbital and ground-based sensors.

  3. Women's views and experiences of two alternative consent pathways for participation in a preterm intrapartum trial: a qualitative study.

    Science.gov (United States)

    Sawyer, Alexandra; Chhoa, Celine; Ayers, Susan; Pushpa-Rajah, Angela; Duley, Lelia

    2017-09-09

    The Cord Pilot Trial compared alternative policies for timing of cord clamping at very preterm birth at eight UK hospitals. In addition to standard written consent, an oral assent pathway was developed for use when birth was imminent. The aim of this study was to explore women's views and experiences of two alternative consent pathways to participate in the Cord Pilot Trial. We conducted a qualitative study using semi-structured interviews. A total of 179 participants in the Cord Pilot Trial were sent a postal invitation to take part in interviews. Women who agreed were interviewed in person or by telephone to explore their experiences of two consent pathways for a preterm intrapartum trial. Data were analysed using inductive systematic thematic analysis. Twenty-three women who gave either written consent (n = 18) or oral assent followed by written consent (n = 5) to participate in the trial were interviewed. Five themes were identified: (1) understanding of the implications of randomisation, (2) importance of staff offering participation, (3) information about the trial and time to consider participation, (4) trial secondary in women's minds and (5) reasons for agreeing to take part in the trial. Experiences were similar for the two consent pathways. Women recruited by the oral assent pathway reported being given less information about the trial but felt it was sufficient to make a decision regarding participation. There were gaps in women's understanding of the trial and intervention, regardless of the consent pathway. Overall, women were positive about their experiences of being invited to participate in the trial. The oral assent pathway seems an acceptable option for women if the intervention is low-risk and time is limited. ISRCTN Registry, ISRCTN21456601 . Registered on 28 February 2013.

  4. Minimum Propellant Low-Thrust Maneuvers near the Libration Points

    Science.gov (United States)

    Marinescu, A.; Dumitrache, M.

    The impulse technique certainly can bring the vehicle on orbits around the libration points or close to them. The question that aries is, by what means can the vehicle arrive in such cases at the libration points? A first investigation carried out in this paper can give an answer: the use of the technique of low-thrust, which, in addition, can bring the vehicle from the libration points near to or into orbits around these points. This aspect is considered in this present paper where for the applications we have considered the transfer for orbits of the equidistant point L4 and of the collinear point L2, from Earth-moon system. This transfer maneuver can be used to insertion one satellite on libration points orbits. In Earth- moon system the points L 4 and L 5 because an vehicle in on of the equidistant points in quite stable and remains in its vicinity of perturbed, have potential interest for the establishment of transporder satellite for interplanetary tracking. In contrast an vehicle in one of the collinear points is quite instable and it will oscillate along the Earth-moon-axis at increasing amplitude and gradually escape from the libration point. Let use assume that a space vehicle equipped with a low-thrust propulsion is near a libration point L. We consider the planar motion in the restricted frame of the three bodies in the rotating system L, where the Earth-moon distance D=l. The unit of time T is period of the moon's orbit divided by 2 and multiplied by the square root of the quantity one plus the moon/Earth mass ratio, and the unit of mass is the Earth's mass. With these predictions the motion equatios of the vehicle equiped with a low-thrust propulsion installation in the linear approximation near the libration point, have been established. The parameters of the motion at the beginning and the end of these maneuvers are known, the variational problem has been formulated as a Lagrange type problem with fixed extremities. On established the differential

  5. Does the Janani Suraksha Yojana cash transfer programme to promote facility births in India ensure skilled birth attendance? A qualitative study of intrapartum care in Madhya Pradesh

    Directory of Open Access Journals (Sweden)

    Sarika Chaturvedi

    2015-07-01

    Full Text Available Background: Access to facility delivery in India has significantly increased with the Janani Suraksha Yojana (JSY cash transfer programme to promote facility births. However, a decline in maternal mortality has only followed secular trends as seen from the beginning of the decade well before the programme began. We, therefore, examined the quality of intrapartum care provided in facilities under the JSY programme to study whether it ensures skilled attendance at birth. Design: 1 Non-participant observations (n=18 of intrapartum care during vaginal deliveries at a representative sample of 11 facilities in Madhya Pradesh to document what happens during intrapartum care. 2 Interviews (n=10 with providers to explore reasons for this care. Thematic framework analysis was used. Results: Three themes emerged from the data: 1 delivery environment is chaotic: delivery rooms were not conducive to safe, women-friendly care provision, and coordination between providers was poor. 2 Staff do not provide skilled care routinely: this emerged from observations that monitoring was limited to assessment of cervical dilatation, lack of readiness to provide key elements of care, and the execution of harmful/unnecessary practices coupled with poor techniques. 3 Dominant staff, passive recipients: staff sometimes threatened, abused, or ignored women during delivery; women were passive and accepted dominance and disrespect. Attendants served as ‘go-betweens’ patients and providers. The interviews with providers revealed their awareness of the compromised quality of care, but they were constrained by structural problems. Positive practices were also observed, including companionship during childbirth and women mobilising in the early stages of labour. Conclusions: Our observational study did not suggest an adequate level of skilled birth attendance (SBA. The findings reveal insufficiencies in the health system and organisational structures to provide an

  6. Does the Janani Suraksha Yojana cash transfer programme to promote facility births in India ensure skilled birth attendance? A qualitative study of intrapartum care in Madhya Pradesh.

    Science.gov (United States)

    Chaturvedi, Sarika; De Costa, Ayesha; Raven, Joanna

    2015-01-01

    Access to facility delivery in India has significantly increased with the Janani Suraksha Yojana (JSY) cash transfer programme to promote facility births. However, a decline in maternal mortality has only followed secular trends as seen from the beginning of the decade well before the programme began. We, therefore, examined the quality of intrapartum care provided in facilities under the JSY programme to study whether it ensures skilled attendance at birth. 1) Non-participant observations (n=18) of intrapartum care during vaginal deliveries at a representative sample of 11 facilities in Madhya Pradesh to document what happens during intrapartum care. 2) Interviews (n=10) with providers to explore reasons for this care. Thematic framework analysis was used. Three themes emerged from the data: 1) delivery environment is chaotic: delivery rooms were not conducive to safe, women-friendly care provision, and coordination between providers was poor. 2) Staff do not provide skilled care routinely: this emerged from observations that monitoring was limited to assessment of cervical dilatation, lack of readiness to provide key elements of care, and the execution of harmful/unnecessary practices coupled with poor techniques. 3) Dominant staff, passive recipients: staff sometimes threatened, abused, or ignored women during delivery; women were passive and accepted dominance and disrespect. Attendants served as 'go-betweens' patients and providers. The interviews with providers revealed their awareness of the compromised quality of care, but they were constrained by structural problems. Positive practices were also observed, including companionship during childbirth and women mobilising in the early stages of labour. Our observational study did not suggest an adequate level of skilled birth attendance (SBA). The findings reveal insufficiencies in the health system and organisational structures to provide an 'enabling environment' for SBA. We highlight the need to ensure

  7. Concurrent image-based visual servoing with adaptive zooming for non-cooperative rendezvous maneuvers

    Science.gov (United States)

    Pomares, Jorge; Felicetti, Leonard; Pérez, Javier; Emami, M. Reza

    2018-02-01

    An image-based servo controller for the guidance of a spacecraft during non-cooperative rendezvous is presented in this paper. The controller directly utilizes the visual features from image frames of a target spacecraft for computing both attitude and orbital maneuvers concurrently. The utilization of adaptive optics, such as zooming cameras, is also addressed through developing an invariant-image servo controller. The controller allows for performing rendezvous maneuvers independently from the adjustments of the camera focal length, improving the performance and versatility of maneuvers. The stability of the proposed control scheme is proven analytically in the invariant space, and its viability is explored through numerical simulations.

  8. Statistical study of overvoltages by maneuvering in switches in high voltage using EMTP-RV

    International Nuclear Information System (INIS)

    Dominguez Herrera, Diego Armando

    2013-01-01

    The transient overvoltages produced by maneuvering of switches are studied in a statistical way and through a variation the sequential closing times of switches in networks larger than 230 kV. This study is performed according to time delays and typical deviation ranges, using the tool EMTP- RV (ElectroMagnetic Trasient Program Restructured Version). A conceptual framework related with the electromagnetic transients by maneuver is developed in triphasic switches installed in nominal voltages higher than 230 kV. The methodology established for the execution of statistical studies of overvoltages by switch maneuver is reviewed and evaluated by simulating two fictitious cases in EMTP-RV [es

  9. The Dix-Hallpike test and the canalith repositioning maneuver.

    Science.gov (United States)

    Viirre, Erik; Purcell, Ian; Baloh, Robert W

    2005-01-01

    The Dix-Hallpike test and the canalith repositioning maneuver (CRM) are used to diagnose and treat benign positional vertigo (BPV). Dix-Hallpike is the standard procedure for diagnosis of BPV, but if the horizontal canal is not tested for BPV and the Dix-Hallpike is only carried out once, the condition may not be diagnosed and appropriately treated. We describe our method of testing for BPV and treating it with CRM. The Dix-Hallpike test involves rapidly moving the patient from a sitting position to "head hanging," where the patient's head is at least 10 degrees below horizontal. This is performed initially for the posterior semicircular canals. If these movements fail to elicit vertigo and nystagmus, tests of the horizontal semicircular canals are performed by laying the patient on each side. Importantly, if there is no vertigo or nystagmus elicited by testing the horizontal semi-circular canals, the posterior semicircular canals are tested again. It appears that being held in the head hanging positions and then left and right lateral positions will often allow the canaliths to collect such that the Dix-Hallpike test will become positive. Failure to repeat the tests of the posterior semicircular canals may result in a falsely negative test. Testing the horizontal canals and repeating the Dix-Hallpike test will reduce the likelihood of patients undergoing extra testing or other consequences of misdiagnosis. If, during any of this testing, a movement elicits vertigo or nystagmus, the appropriate CRM is then carried out.

  10. Combilift ideal for maneuvering oil and gas equipment

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    2009-07-15

    This article described an innovative forklift that responds to the oil industry's need for a safer, better and easier way to move long tubular products that cannot be carried high in the air. The Gator Jaw is a duplex pipe clamp attachment that secures to the Combilift forklift carriage. The clamp arm can be hydraulically moved upwards to allow the operator full use of the forks without interference from the hold down arm. The Combilift's platform is ideal for maneuvering oil and gas equipment close to the ground. Since it can travel sideways, the length of the load is not critical. The Gator Jaw's unique design makes it possible for one forklift to handle both skids and pallets. The C-Series product extends to the subsea oil and gas industry, which works with long loads such as oil drilling tools and pipe. The benefits include safer product handling, significant space savings, increased productivity and versatile indoor and outdoor use. The machines are available with a fuel-efficient liquefied petroleum gas (LPG) or diesel engine. 1 fig.

  11. Space shuttle orbit maneuvering engine reusable thrust chamber program

    Science.gov (United States)

    Senneff, J. M.

    1975-01-01

    Reusable thrust chamber and injector concepts were evaluated for the space shuttle orbit maneuvering engine (OME). Parametric engine calculations were carried out by computer program for N2O4/amine, LOX/amine and LOX/hydrocarbon propellant combinations for engines incorporating regenerative cooled and insulated columbium thrust chambers. The calculation methods are described including the fuel vortex film cooling method of combustion gas temperature control, and performance prediction. A method of acceptance of a regeneratively cooled heat rejection reduction using a silicone oil additive was also demonstrated by heated tube heat transfer testing. Regeneratively cooled thrust chamber operation was also demonstrated where the injector was characterized for the OME application with a channel wall regenerative thrust chamber. Bomb stability testing of the demonstration chambers/injectors demonstrated recovery for the nominal design of acoustic cavities. Cavity geometry changes were also evaluated to assess their damping margin. Performance and combustion stability was demonstrated of the originally developed 10 inch diameter combustion pattern operating in an 8 inch diameter thrust chamber.

  12. Spacecraft Attitude Tracking and Maneuver Using Combined Magnetic Actuators

    Science.gov (United States)

    Zhou, Zhiqiang

    2010-01-01

    The accuracy of spacecraft attitude control using magnetic actuators only is low and on the order of 0.4-5 degrees. The key reason is that the magnetic torque is two-dimensional and it is only in the plane perpendicular to the magnetic field vector. In this paper novel attitude control algorithms using the combination of magnetic actuators with Reaction Wheel Assembles (RWAs) or other types of actuators, such as thrusters, are presented. The combination of magnetic actuators with one or two RWAs aligned with different body axis expands the two-dimensional control torque to three-dimensional. The algorithms can guarantee the spacecraft attitude and rates to track the commanded attitude precisely. A design example is presented for Nadir pointing, pitch and yaw maneuvers. The results show that precise attitude tracking can be reached and the attitude control accuracy is comparable with RWAs based attitude control. The algorithms are also useful for the RWAs based attitude control. When there are only one or two workable RWAs due to RWA failures, the attitude control system can switch to the control algorithms for the combined magnetic actuators with the RWAs without going to the safe mode and the control accuracy can be maintained.

  13. Development of Strategy Generator for PWRs Core Maneuver

    International Nuclear Information System (INIS)

    Deswandri

    2003-01-01

    Generally, nuclear power plants are utilized for base-load operation. However, if the nuclear capacity constitutes a large fraction of the total electric capacity in a country, the ability of nuclear power plants to perform load following operation is inevitable. In the load following operation, the reactor power is adjusted based on the fluctuation of electric power demand in the grid. That changes of power level can cause unbalance in the reactor, therefore, the control actions should be done during the power maneuvering. In order that the control actions could be effective and efficient, guidance for the reactor operators is needed. Strategy generator refers to a tool which provides guidance for operators as to control actions to be taken. This work developed the strategy generator based on the three concepts of control strategy. By numerical simulation, performance of these three strategies was tested and compared. The simulation result shows the unique characteristic for each strategy and discussion was provided to evaluate the abilities of each strategy in achieving the control targets. (author)

  14. Open Platform for Limit Protection with Carefree Maneuver Applications

    Science.gov (United States)

    Jeram, Geoffrey J.

    2004-01-01

    This Open Platform for Limit Protection guides the open design of maneuver limit protection systems in general, and manned, rotorcraft, aerospace applications in particular. The platform uses three stages of limit protection modules: limit cue creation, limit cue arbitration, and control system interface. A common set of limit cue modules provides commands that can include constraints, alerts, transfer functions, and friction. An arbitration module selects the "best" limit protection cues and distributes them to the most appropriate control path interface. This platform adopts a holistic approach to limit protection whereby it considers all potential interface points, including the pilot's visual, aural, and tactile displays; and automatic command restraint shaping for autonomous limit protection. For each functional module, this thesis guides the control system designer through the design choices and information interfaces among the modules. Limit cue module design choices include type of prediction, prediction mechanism, method of critical control calculation, and type of limit cue. Special consideration is given to the nature of the limit, particularly the level of knowledge about it, and the ramifications for limit protection design, especially with respect to intelligent control methods such as fuzzy inference systems and neural networks.

  15. Spacecraft Attitude Tracking and Maneuver Using Combined Magnetic Actuators

    Science.gov (United States)

    Zhou, Zhiqiang

    2012-01-01

    A paper describes attitude-control algorithms using the combination of magnetic actuators with reaction wheel assemblies (RWAs) or other types of actuators such as thrusters. The combination of magnetic actuators with one or two RWAs aligned with different body axis expands the two-dimensional control torque to three-dimensional. The algorithms can guarantee the spacecraft attitude and rates to track the commanded attitude precisely. A design example is presented for nadir-pointing, pitch, and yaw maneuvers. The results show that precise attitude tracking can be reached and the attitude- control accuracy is comparable with RWA-based attitude control. When there are only one or two workable RWAs due to RWA failures, the attitude-control system can switch to the control algorithms for the combined magnetic actuators with the RWAs without going to the safe mode, and the control accuracy can be maintained. The attitude-control algorithms of the combined actuators are derived, which can guarantee the spacecraft attitude and rates to track the commanded values precisely. Results show that precise attitude tracking can be reached, and the attitude-control accuracy is comparable with 3-axis wheel control.

  16. Tactical approach to maneuvering within the chemical contamination labyrinth

    Energy Technology Data Exchange (ETDEWEB)

    Joseph, T.W. [Department of Energy, Oak Ridge, TN (United States)

    1990-12-31

    The Department of Energy (DOE) recognized the need and accepts the responsibility for understanding the reality and mitigating the consequence of the complex chemical contamination legacy it inherited as well as controlling, reducing, and eliminating extant emissions and effluents. The key to maneuvering through this complicated and multifaceted labyrinth of concerns, from which a meaningful, high quality, and cost-effective restoration/mitigation machine is then set in motions, is the ability to perform accurate, factual, and explicit health and environmental/ecological risk assessments. Likewise, the common denominator for carrying out this essential task is to have access to comprehensive and reliable data of known quality with which to perform those analyses. DOE is committed to identifying the data universe; to technically scrutinize and ensure the quality of that data; to develop efficient and cost-effective means to maximize the handling, utilization, and sharing of that universe; and to undertake those assessments. DOE views this as an effort that can only be accomplished through a merging of the technical excellence that exists within federal and state agencies, academia, and industry. The task at hand is so large that only by integrating that intelligence base can we hope to accomplish the goals of establishing meaningful standards, developing functional and effective solutions, and providing quality guidance at a national scale.

  17. Steering characteristic of an articulated bus under quasi steady maneuvering

    Science.gov (United States)

    Ubaidillah, Setiawan, Budi Agus; Aridharma, Airlangga Putra; Lenggana, Bhre Wangsa; Caesar, Bernardus Placenta Previo

    2018-02-01

    Articulated buses have been being preferred as public transportation modes due to their operational capacity. Therefore, passenger safety must be the priority of this public service vehicle. This research focused on the analytical approach of steering characteristics of an articulated bus when it maneuvered steadily. Such turning condition could be referred as a stability parameter of the bus for preliminary handling assessment. The analytical approach employed kinematics relationship between front and rear bodies as well as steering capabilities. The quasi steady model was developed to determine steering parameters such as turning radius, oversteer, and understeer. The mathematical model was useful for determining both coefficients of understeer and oversteer. The dimension of articulated bus followed a commonly used bus as utilized in Trans Jakarta busses. Based on the simulation, for one minimum center of the body, the turning radius was calculated about 8.8 m and 7.6 m at steady turning speed of 10 km/h. In neutral condition, the minimum road radius should be 6.5 m at 10 km/h and 6.9 m at 40 km/h. For two centers of the body and oversteer condition, the front body has the turning radius of 8.8 m, while, the rear body has the turning radius of 9.8 m at both turning speeds of 40 km/h. The other steering parameters were discussed accordingly.

  18. Anterior but not posterior choroid changed before and during Valsalva manoeuvre in healthy Chinese: a UBM and SS-OCT study

    Science.gov (United States)

    Li, Fei; Gao, Kai; Li, Xingyi; Chen, Shida; Huang, Wenbin; Zhang, Xiulan

    2017-01-01

    Purpose To determine if the anterior choroid is involved in ocular change during the Valsalva manoeuvre (VM). Materials and methods Fifty-three healthy volunteers aged 18–65 years with normal visual field test results and no history of intraocular pressure (IOP) exceeding 21 mm Hg were recruited. Anterior and posterior choroidal changes before and during VM were recorded by ultrasound microscope and swept-source optical coherence tomography, respectively. Parameters of the anterior segment included ciliary body thickness (CBT0), thickness of the choroid at a distance of 4 mm from the root of the iris (CT4), anterior placement of the ciliary body (APCB) and trabecular–ciliary angle (TCA). Thickness of different layers of retina and posterior choroid were also measured and compared before and during VM. IOP, blood pressure (BP), heart rate (HR), axial length, spherical equivalent refractive error and pupil diameter (PD) were also recorded and analysed. Results VM caused elevated IOP, systolic BP, diastolic BP and increased HR. There was a significant increase in anterior parameters including CBT0, CT4 and APCB (p0.05). The mean change of CBT0, CT4 and APCB were: from 1.00±0.09 mm to 1.11±0.10 mm (p<0.001), from 0.29±0.04 mm to 0.36±0.05 mm (p<0.001), from 0.76±0.11 mm to 0.88±0.13 mm (p<0.001), respectively. However, there is no significant change in posterior choroid (from 215.74±60.23 µm to 214.82±61.32 µm, p=0.17). Conclusion We found that VM did not affect the posterior choroid, but it did cause thickening of the anterior choroid and the ciliary body, both of which led to a larger anterior placement of the ciliary body and a narrowed anterior chamber. The anterior (but not the posterior) choroid could be related to IOP elevation and a narrowed anterior chamber in primary angle closure diseases. PMID:28432110

  19. A safe-repositioning maneuver for the management of benign paroxysmal positional vertigo: Gans vs. Epley maneuver; a randomized comparative clinical trial.

    Science.gov (United States)

    Saberi, Alia; Nemati, Shadman; Sabnan, Salah; Mollahoseini, Fatemeh; Kazemnejad, Ehsan

    2017-08-01

    Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo. Some repositioning maneuvers have been described for its management. The aim of this study was comparing the therapeutic effect of Epley and Gans maneuvers in BPPV. This randomized clinical trial was performed from September to December 2015. 73 patients with true vertigo diagnosed as BPPV enrolled the study. They randomly assigned in quadripartite blocks to modified Epley maneuver group (E) or Gans maneuver group (G). 1 day and 1 week after intervention, the objective and subjective responses to treatment were assessed. Statistical analysis was performed using the Chi-square test and regression model in the SPSS software version 21. Thirty patients enrolled each group with a mean age of 46.9 ± 13.4 (E group) and 46.7 ± 7.5 year (G group). 23.3 % of E group and 26.7 % of G group were men (p = 0.766). In E and G groups in the first day, subjective outcomes revealed 86.7 and 60 % rate of success (p = 0.02); and 86.7 and 56.7 % of patients exhibited objective improvement, respectively (p = 0.01). After 1 week, the subjective and objective outcomes revealed improvement among 70 % of E group and 46.7 % of G group (p = 0.067). The only complication with significant difference was cervical pain with a higher rate in E group (23.3 vs. 0.0 %, p = 0.005). These results revealed the similar long-term efficacy of Epley and Gans maneuver for the treatment of BPPV. Cervical pain was most frequent complication of Epley maneuver.

  20. Efficacy of Epley’s Maneuver in Treating BPPV Patients: A Prospective Observational Study

    Directory of Open Access Journals (Sweden)

    Sushil Gaur

    2015-01-01

    Full Text Available Vertigo and balance disorders are among the most common symptoms encountered in patients who visit ENT outpatient department. This is associated with risk of falling and is compounded in elderly persons with other neurologic deficits and chronic medical problems. BPPV is the most common cause of peripheral vertigo. BPPV is a common vestibular disorder leading to significant morbidity, psychosocial impact, and medical costs. The objective of Epley’s maneuver, which is noninvasive, inexpensive, and easily administered, is to move the canaliths out of the canal to the utricle where they no longer affect the canal dynamics. Our study aims to analyze the response to Epley’s maneuver in a series of patients with posterior canal BPPV and compares the results with those treated exclusively by medical management alone. Even though many studies have been conducted to prove the efficacy of this maneuver, this study reinforces the validity of Epley’s maneuver by comparison with the medical management.

  1. Importance of back blow maneuvers in a 6 month old patient with sudden upper airway obstruction

    Directory of Open Access Journals (Sweden)

    Pinar Gencpinar

    2015-12-01

    Full Text Available Foreign body aspiration in children under four years old is one of the most frequently observed reasons for accident related deaths. It is more common in this age group due to inadequate swallowing functions and exploration of objects with the mouth. The most frequently encountered foreign bodies are food and toy parts. Life threatening complete laryngeal obstruction is rarely observed. Dyspnea, hypersalivation, cough and cyanosis can be seen. The basic and life-saving treatment approach is complete removal of foreign body maneuvers in the sudden onset of total obstruction. Here we report a six-month old male, who ingested a foreign body and was treated with back blow maneuvers successfully. In this case we emphasized the importance of back blow maneuvers. Keywords: Upper airway obstruction, Child, Back blows maneuvers

  2. A Computer Simulation of the System-Wide Effects of Parallel-Offset Route Maneuvers

    Science.gov (United States)

    Lauderdale, Todd A.; Santiago, Confesor; Pankok, Carl

    2010-01-01

    Most aircraft managed by air-traffic controllers in the National Airspace System are capable of flying parallel-offset routes. This paper presents the results of two related studies on the effects of increased use of offset routes as a conflict resolution maneuver. The first study analyzes offset routes in the context of all standard resolution types which air-traffic controllers currently use. This study shows that by utilizing parallel-offset route maneuvers, significant system-wide savings in delay due to conflict resolution of up to 30% are possible. It also shows that most offset resolutions replace horizontal-vectoring resolutions. The second study builds on the results of the first and directly compares offset resolutions and standard horizontal-vectoring maneuvers to determine that in-trail conflicts are often more efficiently resolved by offset maneuvers.

  3. Pulsed Electrogasdynamic Thruster for Attitude Control and Orbit Maneuver, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — A new pulsed electric thruster, named "pulsed electrogasdynamic thruster," for attitude control and orbit maneuver is proposed. In this thruster, propellant gas is...

  4. The application of the random regret minimization model to drivers’ choice of crash avoidance maneuvers

    DEFF Research Database (Denmark)

    Kaplan, Sigal; Prato, Carlo Giacomo

    This study explores the plausibility of regret minimization as behavioral paradigm underlying the choice of crash avoidance maneuvers. Alternatively to previous studies that considered utility maximization, this study applies the random regret minimization (RRM) model while assuming that drivers ...

  5. The application of the random regret minimization model to drivers’ choice of crash avoidance maneuvers

    DEFF Research Database (Denmark)

    Kaplan, Sigal; Prato, Carlo Giacomo

    2012-01-01

    This study explores the plausibility of regret minimization as behavioral paradigm underlying the choice of crash avoidance maneuvers. Alternatively to previous studies that considered utility maximization, this study applies the random regret minimization (RRM) model while assuming that drivers ...

  6. Determination of the optimal conditions for inclination maneuvers using a Swing-by

    Science.gov (United States)

    Moura, O.; Celestino, C. C.; Prado, A. F. B. A.

    2018-05-01

    The search for methods to reduce the fuel consumption in orbital transfers is something relevant and always current in astrodynamics. Therefore, the maneuvers assisted by the gravity, also called Swing-by maneuvers, can be an advantageous option to save fuel. The proposal of the present research is to explore the influence of some parameters in a Swing-by of an artificial satellite orbiting a planet with one of the moons of this mother planet, with the goal of changing the inclination of the artificial satellite around the main body of the system. The fuel consumption of this maneuver is compared with the required consumption to perform the same change of inclination using the classical approach of impulsive maneuvers.

  7. Development of a Ground Vehicle Maneuver Ontology to Support the Common Operational Picture

    National Research Council Canada - National Science Library

    Richmond, Paul W; Blais, Curtis L; Goerger, Niki C

    2006-01-01

    .... This paper describes both the Mobility-COP, from which warfighters can assess the ability of forces to maneuver effectively under multiple environmental and tactical conditions, and a formal ontology...

  8. The Rapier or the Club: The Relationship between Attrition and Maneuver Warfare

    National Research Council Canada - National Science Library

    Springman, Jeffrey A

    2006-01-01

    ...? This project compares the relationship between attrition and maneuver warfare. The study considers whether there are times when wars of attrition should be fought, and whether there are conditions that force wars of attrition...

  9. Use of Lung Opening Maneuver in Patients with Acute Respiratory Failure After Cardiosurgical Operations

    Directory of Open Access Journals (Sweden)

    A. A. Yeremenko

    2006-01-01

    Full Text Available Postoperative respiratory failure is a most common complication and a main cause of postoperative death. The lung opening maneuver is a most effective method of respiratory therapy for this syndrome.Objective. To evaluate the impact of recruiting maneuver on gas exchange parameters, the biomechanical properties of the lung, and hemodynamic parameters. To determine whether the lung opening maneuver can be fully performed in patients undergoing cardiac surgery.Materials and methods. The study covered 19 patients aged 53 to 70 years who had postoperative failure. The indication for the recruiting maneuver was a decrease in the oxygenation index below 250 mm Hg during assisted ventilation (AV with FiO2>0.5, an inspiratory-expira-tory phase ratio of 1:1 to 3:1, and a positive end-expiratory pressure of 5—10 cm H2O.Results. A decrease in the oxygenation index to 139±36 mm Hg was observed before the recruiting maneuver was applied. Cd;n. averaged 41.1±8.4 ml/cm H2O. After use of the recruiting maneuver, there were increases in the oxygenation index up to 371±121 mm Hg and in Cd;n. up to 64.3±10 ml/cm H2O in all the patients. When the recruiting maneuver was employed, 14 patients were observed to have elevated blood pressures corrected with a vasopressor. One patient developed pneumothorax that was drained in proper time.Conclusion. The application of the lung opening maneuver leads to a considerable improvement of gas exchange parameters and lung mechanical properties.

  10. CFD Analysis of a Maneuvering F/A-18E Super Hornet

    Science.gov (United States)

    2016-10-12

    tools for aircraft, ships, and radio - frequency antenna design and analysis. The resulting program is called the Computational Research and Engineering...accurately predicting the forces and moments on the F/A-18E Super Hornet while performing several complicated maneuvers. Past F/A-18E computational studies... predicting the forces and moments on the F/A-18E Super Hornet while performing several complicated maneuvers. Past F/A-18E computational studies have

  11. Know Before You Do: Anticipating Maneuvers via Learning Temporal Driving Models

    Science.gov (United States)

    2015-04-01

    features/index.htm. Accessed: 2014-09-30. [3] Google self driving car . http://en.wikipedia.org/wiki/ Google driverless car . Accessed: 2014-10-11. [4...and outside the car , GPS, and speed information, with lane and driving maneuver annotations. II. RELATED WORK Assistive features for vehicles . Recent...made driving safer over the last decade. They prepare vehicles for unsafe road conditions and alert drivers if they perform a dangerous maneuver

  12. Cases requiring increased number of repositioning maneuvers in benign paroxysmal positional vertigo

    OpenAIRE

    Korkmaz, Mukadder; Korkmaz, Hakan

    2016-01-01

    ABSTRACT INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is a clinical syndrome that is proposed to be caused by dislocated utricular debris into semicircular canals. Although the majority of patients are treated by one or two repositioning maneuvers, some of the patients need repeated maneuvers for relief. OBJECTIVE: The goal of this study was to investigate the factors associated with patients with benign paroxysmal positional vertigo who required multiple repositioning proced...

  13. A general method for closed-loop inverse simulation of helicopter maneuver flight

    OpenAIRE

    Wei WU

    2017-01-01

    Maneuverability is a key factor to determine whether a helicopter could finish certain flight missions successfully or not. Inverse simulation is commonly used to calculate the pilot controls of a helicopter to complete a certain kind of maneuver flight and to assess its maneuverability. A general method for inverse simulation of maneuver flight for helicopters with the flight control system online is developed in this paper. A general mathematical describing function is established to provid...

  14. What is to blame for postnatal pelvic floor dysfunction in primiparous women-Pre-pregnancy or intrapartum risk factors?

    Science.gov (United States)

    Durnea, Constantin M; Khashan, Ali S; Kenny, Louise C; Durnea, Uliana A; Dornan, James C; O'Sullivan, Suzanne M; O'Reilly, Barry A

    2017-07-01

    The aetiology of pelvic floor dysfunction (PFD) is still poorly understood. However childbearing is recognized as a major risk factor. To elucidate the natural history of PFD by investigating the impact of the mode of delivery on postnatal pelvic floor dysfunction in primiparas, when PFD existing before the first pregnancy is taken into consideration. 4P-study (Prevalence and Predictors of Pelvic floor dysfunction in Primips) is a prospective cohort study, nested within the Screening for Pregnancy Endpoints (SCOPE) study set in a tertiary referral teaching hospital with 9000 deliveries annually. Established and proposed risk factors for urinary, fecal, prolapse and sexual dysfunction and the severity of symptoms for each of these outcomes were assessed using the Australian Pelvic Floor Questionnaire in 1482 nulliparous women, who each completed the questionnaire in early pregnancy. Of these, 1060 (72%) repeated the questionnaire 12 months postpartum.Outcomes were analyzed using multivariate ordinal logistic regression. Significant (ppregnancy presence of similar symptoms Odds Ratio (OR) (5.0-30.0), smoking (OR 2.2-4.6), recurrent UTI (OR 2.2-17.3), high hip circumference (OR1.4-1.6), vigorous exercising (OR 3.1-17.9), induction of labor (OR 1.5-2.3), forceps delivery (OR 1.8-8.8), and 3rd degree perineal tear (OR 2.4-2.7). Cesarean section was associated with a lower risk of stress urinary incontinence (OR 0.3-0.5). Other common pre-pregnancy significant (ppregnancy were: diagnosed depression - (OR 1.6-2.1), high BMI (OR 3.1), strenuous exercising (OR 1.3-2.2), recurrent UTI (OR 1.5-2.5) and lower educational achievement (OR 1.5-1.6). Pre-pregnancy PFD was mainly associated with modifiable risk factors such as smoking and exercising. The main risk factor for postpartum PFD was the presence of similar symptoms prior to pregnancy, followed by anthropometric and intrapartum factors. Hip circumference seems to be a better predictor of PFD compared to BMI. When pre

  15. A unified flight control methodology for a compound rotorcraft in fundamental and aerobatic maneuvering flight

    Science.gov (United States)

    Thorsen, Adam

    This study investigates a novel approach to flight control for a compound rotorcraft in a variety of maneuvers ranging from fundamental to aerobatic in nature. Fundamental maneuvers are a class of maneuvers with design significance that are useful for testing and tuning flight control systems along with uncovering control law deficiencies. Aerobatic maneuvers are a class of aggressive and complex maneuvers with more operational significance. The process culminating in a unified approach to flight control includes various control allocation studies for redundant controls in trim and maneuvering flight, an efficient methodology to simulate non-piloted maneuvers with varying degrees of complexity, and the setup of an unconventional control inceptor configuration along with the use of a flight simulator to gather pilot feedback in order to improve the unified control architecture. A flight path generation algorithm was developed to calculate control inceptor commands required for a rotorcraft in aerobatic maneuvers. This generalized algorithm was tailored to generate flight paths through optimization methods in order to satisfy target terminal position coordinates or to minimize the total time of a particular maneuver. Six aerobatic maneuvers were developed drawing inspiration from air combat maneuvers of fighter jet aircraft: Pitch-Back Turn (PBT), Combat Ascent Turn (CAT), Combat Descent Turn (CDT), Weaving Pull-up (WPU), Combat Break Turn (CBT), and Zoom and Boom (ZAB). These aerobatic maneuvers were simulated at moderate to high advance ratios while fundamental maneuvers of the compound including level accelerations/decelerations, climbs, descents, and turns were investigated across the entire flight envelope to evaluate controller performance. The unified control system was developed to allow controls to seamlessly transition between manual and automatic allocations while ensuring that the axis of control for a particular inceptor remained constant with flight

  16. Manned maneuvering unit applications for automated rendezvous and capture

    Science.gov (United States)

    Brehm, Donald L.; Cuseo, John A.; Lenda, Joseph A.; Ray, Lex; Whitsett, C. Edward

    Automated Rendezvous and Capture (AR&C) is an important technology to multiple National Aeronautics and Space Administration (NASA) programs and centers. The recent Johnson Spacecraft Center (JSC) AR&C Quality Function Deployment (QFD) has listed on-orbit demonstration of related technologies as a near term priority. Martin Marietta has been evaluating use of the Manned Maneuvering Unit (MMU) for a low cost near term on-orbit demonstration of AR&C technologies such as control algorithms, sensors, and processors as well as system level performance. The MMU Program began in 1979 as the method of repairing the Space Shuttle (STS) Thermal Protection System (the tiles). The units were not needed for this task, but were successfully employed during three Shuttle flights in 1984: a test flight was flown in in February as proof of concept, in April the MMU participated in the Solar Max Repair Mission, and in November the MMU's returned to space to successfully rescue the two errant satellites, Westar and Palapa. In the intervening years, the MMU simulator and MMU Qualification Test Unit (QTU) have been used for Astronaut training and experimental evaluations. The Extra-Vehicular Activities (EVA) Retriever has used the QTU, in an unmanned form, as a free-flyer on the Johnson Space Center (JSC) Precision Air Bearing Floor (PABF). Currently, the MMU is undergoing recertification for flight. The two flight units were removed from storage in September, 1991 and evaluation tests were performed. The tests demonstrated that the units are in good shape with no discrepancies that would preclude further use. The Return to Flight effort is currently clearing up recertification issues and evaluating the design against the present Shuttle environments.

  17. Correlação entre a pressão de perda à manobra de Valsalva e a pressão máxima de fechamento uretral com a história clínica em mulheres com incontinência urinária de esforço Correlation of Valsalva leak point pressure and maximal urethral closure pressure with clinical history in women with stress urinary incontinence

    Directory of Open Access Journals (Sweden)

    Paulo Cezar Feldner Jr

    2002-08-01

    Full Text Available Objetivo: analisar a relação entre a pressão de perda com manobra de Valsalva e a pressão máxima de fechamento uretral com a queixa clínica em mulheres com incontinência urinária de esforço. Métodos: estudo retrospectivo no qual foram incluídas 164 pacientes com diagnóstico de incontinência urinária de esforço ou mista atendidas no setor de Uroginecologia e Cirurgia Vaginal do Departamento de Ginecologia da UNIFESP/EPM. As pacientes submeteram-se à anamnese padronizada, exame físico e estudo urodinâmico. A pressão de perda foi mensurada sob manobra de Valsalva (Valsalva leak point pressure - VLPP, com volume vesical de 200 mL. O perfil uretral foi realizado utilizando-se cateter de fluxo número 8, sendo medida a pressão máxima de fechamento uretral (PMFU. As pacientes foram agrupadas conforme a queixa clínica de perda urinária aos esforços e realizou-se análise estatística por meio do teste de chi² para verificar a proporção entre as variáveis. Utilizou-se, a seguir, a análise de variância (ANOVA para verificar diferenças entre VLPP e PMFU com relação à gravidade subjetiva da incontinência. Resultados: a média de idade foi de 51,2 anos (19-82, sendo que 79 encontravam-se no menacme (48,2% e 85 (51,8% na pós-menopausa. A paridade média foi de 4,0 filhos (0-18. Houve correlação entre o número de pacientes com VLPP inferior a 60 cmH2O e a queixa clínica (pPurpose: to analyze the correlation between Valsalva leak point pressure and maximum urethral closure pressure and clinical symptoms in women with stress urinary incontinence. Methods: we analyzed retrospectively 164 patients with urodynamic diagnosis of stress and mixed urinary incontinence established by the Urogynecology and Vaginal Surgery Sector of UNIFESP/EPM. All patients were submmited to medical interview, physical examination and urodynamic study. Patients were divided into groups according to the subjective degree of stress urinary

  18. An Analytical Solution for Yaw Maneuver Optimization on the International Space Station and Other Orbiting Space Vehicles

    Science.gov (United States)

    Dobrinskaya, Tatiana

    2015-01-01

    This paper suggests a new method for optimizing yaw maneuvers on the International Space Station (ISS). Yaw rotations are the most common large maneuvers on the ISS often used for docking and undocking operations, as well as for other activities. When maneuver optimization is used, large maneuvers, which were performed on thrusters, could be performed either using control moment gyroscopes (CMG), or with significantly reduced thruster firings. Maneuver optimization helps to save expensive propellant and reduce structural loads - an important factor for the ISS service life. In addition, optimized maneuvers reduce contamination of the critical elements of the vehicle structure, such as solar arrays. This paper presents an analytical solution for optimizing yaw attitude maneuvers. Equations describing pitch and roll motion needed to counteract the major torques during a yaw maneuver are obtained. A yaw rate profile is proposed. Also the paper describes the physical basis of the suggested optimization approach. In the obtained optimized case, the torques are significantly reduced. This torque reduction was compared to the existing optimization method which utilizes the computational solution. It was shown that the attitude profiles and the torque reduction have a good match for these two methods of optimization. The simulations using the ISS flight software showed similar propellant consumption for both methods. The analytical solution proposed in this paper has major benefits with respect to computational approach. In contrast to the current computational solution, which only can be calculated on the ground, the analytical solution does not require extensive computational resources, and can be implemented in the onboard software, thus, making the maneuver execution automatic. The automatic maneuver significantly simplifies the operations and, if necessary, allows to perform a maneuver without communication with the ground. It also reduces the probability of command

  19. [Effects of recruitment maneuver in prone position on hemodynamics in patients with severe pulmonary infection].

    Science.gov (United States)

    Fan, Yuan-hua; Liu, Yuan-fei; Zhu, Hua-yong; Zhang, Min

    2012-02-01

    To evaluate effects of recruitment maneuver in prone position on hemodynamics in patients with severe pulmonary infection, based on the protective pulmonary ventilation strategy. Ninety-seven cases with severe pulmonary infection admitted to intensive care unit (ICU) of Ganzhou City People's Hospital undergoing mechanical ventilation were involved. Volume controlled ventilation mode with small tidal volume (8 ml/kg) and positive end-expiratory pressure (PEEP) of 6 cm H(2)O [1 cm H(2)O = 0.098 kPa] was conducted. Each patient underwent recruitment maneuver in supine position and then in prone position [PEEP 20 cm H(2)O+pressure control (PC) 20 cm H(2)O]. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation [SpO(2)] and blood gas analysis data were recorded before and after recruitment maneuver in either position. A double-lumen venous catheter was inserted into internal jugular vein or subclavian vein, and a pulse index contour cardiac output (PiCCO) catheter was introduced into femoral artery. Cardiac index (CI), stroke volume index (SVI), systemic vascular resistance index (SVRI), intra-thoracic blood volume index (ITBVI), extra vascular lung water index (EVLWI), global end-diastolic volume index (GEDVI), global ejection fraction (GEF), stroke volume variation (SVV) and central vein pressure (CVP) were monitored. (1) Compared with data before recruitment maneuver, there were no significant differences in HR and MAP after supine position and prone position recruitment maneuver, but significant differences in SpO(2) were found between before and after recruitment maneuver when patients' position was changed (supine position: 0.954 ± 0.032 vs. 0.917 ± 0.025, P recruitment maneuver (P recruitment maneuver, CI [L×min(-1)×m(-2)], SVI (ml/m(2)), GEDVI (ml/m(2)) and GEF were decreased significantly during recruitment maneuver (supine position: CI 3.2 ± 0.4 vs. 3.8 ± 0.6, SVI 32.4 ± 5.6 vs. 38.8 ± 6.5, GEDVI 689 ± 44 vs. 766 ± 32, GEF 0.267 ± 0

  20. Qualitative analysis of the Dix-Hallpike maneuver in multi-canal BPPV using a biomechanical model: Introduction of an expanded Dix-Hallpike maneuver for enhanced diagnosis of multi-canal BPPV

    Directory of Open Access Journals (Sweden)

    Henri Traboulsi

    2017-09-01

    Conclusion: The Dix–Hallpike maneuver may cause simultaneous movement of otoliths present in multiple canals and create an obstacle to accurate diagnosis in multi-canal BPPV. An expanded Dix-Hallpike maneuver is described which adds intermediate steps with the head positioned to the right and left in the horizontal position before head-hanging. This expanded maneuver has helped to isolate affected semi-circular canals for individual assessment in multiple canal BPPV.

  1. Vzájemný vztah mezi mobilitou a maximálním uzávěrovým tlakem uretry či Valsalva Leak-Point Pressure u žen se stresovým typem inkontince moči

    Czech Academy of Sciences Publication Activity Database

    Martan, A.; Mašata, J.; Švabík, K.; Drahorádová, P.; Hlásenská, Jana; Pavlíková, Markéta

    2005-01-01

    Roč. 70, č. 4 (2005), s. 123-128 ISSN 1210-7832 R&D Projects: GA MZd NH7378 Keywords : inkontinence moči u žen * hypermobilita uretry * maximální uzávěrový tlak uretry * Valsalva leak -point pressure Subject RIV: FK - Gynaecology, Childbirth

  2. Vzájemný vztah maximálního uzávěrového tlaku uretry a Valsalva Leak-Point Pressure u žen se stresovým typem inkontince moči

    Czech Academy of Sciences Publication Activity Database

    Martan, A.; Mašata, J.; Švabík, K.; Drahorádová, P.; Halaška, M.; Voigt, R.; Pavlíková, Markéta

    2004-01-01

    Roč. 69, č. 4 (2004), s. 267-272 ISSN 1210-7832 R&D Projects: GA MZd NH7378 Keywords : inkontinence moči u žen * maximální uzávěrový tlak uretry * Valsalva leak -point pressure Subject RIV: FK - Gynaecology, Childbirth

  3. Prevention of shoulder dystocia: A randomized controlled trial to evaluate an obstetric maneuver.

    Science.gov (United States)

    Poujade, Olivier; Azria, Elie; Ceccaldi, Pierre-François; Davitian, Carine; Khater, Carine; Chatel, Paul; Pernin, Emilie; Aflak, Nizar; Koskas, Martin; Bourgeois-Moine, Agnès; Hamou-Plotkine, Laurence; Valentin, Morgane; Renner, Jean-Paul; Roy, Carine; Estellat, Candice; Luton, Dominique

    2018-08-01

    Shoulder dystocia is a major obstetric emergency defined as a failure of delivery of the fetal shoulder(s). This study evaluated whether an obstetric maneuver, the push back maneuver performed gently on the fetal head during delivery, could reduce the risk of shoulder dystocia. We performed a multicenter, randomized, single-blind trial to compare the push back maneuver with usual care in parturient women at term. The primary outcome, shoulder dystocia, was considered to have occurred if, after delivery of the fetal head, any additional obstetric maneuver, beginning with the McRoberts maneuver, other than gentle downward traction and episiotomy was required. We randomly assigned 522 women to the push back maneuver group (group P) and 523 women to the standard vaginal delivery group (group S). Finally, 473 women assigned to group P and 472 women assigned to group S delivered vaginally. The rate of shoulder dystocia was significantly lower in group P (1·5%) than in group S (3·8%) (odds ratio [OR] 0·38 [0·16-0·92]; P = 0·03). After adjustment for predefined main risk factors, dystocia remained significantly lower in group P than in group S. There were no significant between-group differences in neonatal complications, including brachial plexus injury, clavicle fracture, hematoma and generalized asphyxia. In this trial in 945 women who delivered vaginally, the push back maneuver significantly decreased the risk of shoulder dystocia, as compared with standard vaginal delivery. Copyright © 2018 Elsevier B.V. All rights reserved.

  4. Five surgical maneuvers on nasal mucosa movement in cleft palate repair: A cadaver study.

    Science.gov (United States)

    Nguyen, Dennis C; Patel, Kamlesh B; Parikh, Rajiv P; Skolnick, Gary B; Woo, Albert S

    2016-06-01

    This biomechanical study aims to characterize the nasal mucosa during palatoplasty, thereby describing the soft tissue attachments at different zones and quantifying movement following their release. Palatal nasal mucosa was exposed and divided in the midline in 10 adult cadaver heads. Five consecutive maneuvers were performed: (1) elevation of nasal mucosa off the maxilla, (2) dissection of nasal mucosa from soft palate musculature, (3) separation of nasal mucosa from palatine aponeurosis, (4) release of mucosa at the pterygopalatine junction, and (5) mobilization of vomer flaps. The mucosal movements across the midline at the midpalate (MP) and posterior nasal spine (PNS) following each maneuver were measured. At the MP, maneuvers 1-4 cumulatively provided 3.8 mm (36.9%), 4.9 mm (47.6%), 6.1 mm (59.2%), and 10.3 mm, respectively. Vomer flap (10.5 mm) elevation led to mobility equivalent to that of maneuvers 1-4 (p = 0.72). At the PNS, cumulative measurements after maneuvers 1-4 were 1.3 mm (10%), 2.4 mm (18.6%), 5.7 mm (44.2%), and 12.9 mm. Here, vomer flaps (6.5 mm) provided less movement (p < 0.001). Maneuver 4 yielded the greatest amount of movement of the lateral nasal mucosa at both MP (4.2 mm, 40.8%) and PNS (7.2 mm, 55.8%). At the MP, complete release of the lateral nasal mucosa achieves as much movement as the vomer flap. At the hard-soft palate junction, the maneuvers progressively add to the movement of the lateral nasal mucosa. The most powerful step is release of attachments along the posterior aspect of the medial pterygoid. Published by Elsevier Ltd.

  5. Mechanical Constraints on Flight at High Elevation Decrease Maneuvering Performance of Hummingbirds.

    Science.gov (United States)

    Segre, Paolo S; Dakin, Roslyn; Read, Tyson J G; Straw, Andrew D; Altshuler, Douglas L

    2016-12-19

    High-elevation habitats offer ecological advantages including reduced competition, predation, and parasitism [1]. However, flying organisms at high elevation also face physiological challenges due to lower air density and oxygen availability [2]. These constraints are expected to affect the flight maneuvers that are required to compete with rivals, capture prey, and evade threats [3-5]. To test how individual maneuvering performance is affected by elevation, we measured the free-flight maneuvers of male Anna's hummingbirds in a large chamber translocated to a high-elevation site and then measured their performance at low elevation. We used a multi-camera tracking system to identify thousands of maneuvers based on body position and orientation [6]. At high elevation, the birds' translational velocities, accelerations, and rotational velocities were reduced, and they used less demanding turns. To determine how mechanical and metabolic constraints independently affect performance, we performed a second experiment to evaluate flight maneuvers in an airtight chamber infused with either normoxic heliox, to lower air density, or nitrogen, to lower oxygen availability. The hypodense treatment caused the birds to reduce their accelerations and rotational velocities, whereas the hypoxic treatment had no significant effect on maneuvering performance. Collectively, these experiments reveal how aerial maneuvering performance changes with elevation, demonstrating that as birds move up in elevation, air density constrains their maneuverability prior to any influence of oxygen availability. Our results support the hypothesis that changes in competitive ability at high elevations are the result of mechanical limits to flight performance [7]. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. The economic costs of intrapartum care in Tower Hamlets: A comparison between the cost of birth in a freestanding midwifery unit and hospital for women at low risk of obstetric complications.

    Science.gov (United States)

    Schroeder, Liz; Patel, Nishma; Keeler, Michelle; Rocca-Ihenacho, Lucia; Macfarlane, Alison J

    2017-02-01

    to compare the economic costs of intrapartum maternity care in an inner city area for 'low risk' women opting to give birth in a freestanding midwifery unit compared with those who chose birth in hospital. micro-costing of health service resources used in the intrapartum care of mothers and their babies during the period between admission and discharge, data extracted from clinical notes. the Barkantine Birth Centre, a freestanding midwifery unit and the Royal London Hospital's consultant-led obstetric unit, both run by the former Barts and the London NHS Trust in Tower Hamlets, a deprived inner city borough in east London, England, 2007-2010. maternity records of 333 women who were resident in Tower Hamlets and who satisfied the Trust's eligibility criteria for using the Birth Centre. Of these, 167 women started their intrapartum care at the Birth Centre and 166 started care at the Royal London Hospital. women who planned their birth at the Birth Centre experienced continuous intrapartum midwifery care, higher rates of spontaneous vaginal delivery, greater use of a birth pool, lower rates of epidural use, higher rates of established breastfeeding and a longer post-natal stay, compared with those who planned for care in the hospital. The total average cost per mother-baby dyad for care where mothers started their intrapartum care at the Birth Centre was £1296.23, approximately £850 per patient less than the average cost per mother and baby who received all their care at the Royal London Hospital. These costs reflect intrapartum throughput using bottom up costing per patient, from admission to discharge, including transfer, but excluding occupancy rates and the related running costs of the units. the study showed that intrapartum throughput in the Birth Centre could be considered cost-minimising when compared to hospital. Modelling the financial viability of midwifery units at a local level is important because it can inform the appropriate provision of these

  7. Laqueadura intraparto e de intervalo Intrapartum and interval tubal sterilization: characteristics correlated with the procedure and regret in a sample of women from a public hospital

    Directory of Open Access Journals (Sweden)

    Arlete Maria dos Santos Fernandes

    2006-10-01

    foi cesárea. Não se detectou diferença nas taxas de satisfação e arrependimento após o procedimento entre os grupos.BACKGROUND: Brazil is a country with a high prevalence of tubal ligation, which is frequently performed at the time of delivery. In recent years, an increase in tubal reversal has been noticed, primarily among young women. OBJECTIVES: To study characteristics correlated with the procedure, determine frequency of intrapartum tubal ligation, measure patient satisfaction rates and tubal sterilization regret, in a sample of post-tubal patients. METHODS: Three hundred and thirty-five women underwent tubal ligation. The variables studied were related to the procedure: age at tubal ligation, whether ligation was performed intrapartum (vaginal or cesarean section or after an interval (other than the intrapartum and puerperal period, health service performing the sterilization, medical expenses paid for the procedure, reason stated for choosing the method and causes related to satisfaction/regret: desire to become pregnant after sterilization, search for treatment and performance of tubal ligation reversal. The women were divided into two groups, a group undergoing ligation in the intrapartum period and a second group ligated after an interval, to evaluate the association between variables by using Fisher's exact test and chi-squared calculation with Yates' correction. The study was approved by the Ethics Committee of the institution. RESULTS: There was a predominance of Caucasian women over 35 years of age, married, and with a low level of education of which 43.5% had undergone sterilization before 30 years of age. Two hundred and forty-five women underwent intrapartum tubal ligation, 91.2% of them had cesarean delivery and 44.6% vaginal delivery. In both groups undergoing intrapartum tubal ligation and ligation after an interval, 82.0% and 80.8% reported satisfaction with the method. Although 14.6% expressed a desire to become pregnant at some time after

  8. Computerized intrapartum fetal monitoring

    International Nuclear Information System (INIS)

    Divon, M.Y.

    1986-01-01

    Preliminary clinical evaluation: Twenty healthy women were studied for 40 minutes each. All were at full-term gestation and had taken no medications during pregnancy or labor. The outcome of each of the pregnancies was entirely normal resulting in appropriately grown, non-asphyxiated infants. Results: (1) uterine contractions occupied 34% of the total observation time (mean duration = 67 +- 15 seconds (+- SD)), (2) all fetuses demonstrated FM (mean frequency = 2.5 per 10 minutes; mean duration = 11 seconds). FM were significantly more common during UC., 3) 85% of FHR accelerations were associated with FM as detected by real-time sonography, (4) FHRV rose from 5.1 +- 1.3 (mean +- SD) between UC to 6.0 +- 1.5 during UC, rho < 0.001. This system provides the clinician with clear, objective and concise information which may be useful in early recognition of the compromised fetus

  9. Intrapartum Pubic Symphysis Disruption

    African Journals Online (AJOL)

    Dhar S, Anderton JM. Rupture of the symphysis pubis during labor. Clin Orthop Relat Res 1992;283:252‑7. 6. Putschar WG. The structure of the human symphysis pubis with special consideration of parturition and its sequelae. Am. J Phys Anthropol 1976;45 (3 pt 2):589‑94. 7. Kharrazi FD, Rodgers WB, Kennedy JG, Lhowe ...

  10. Ship operation and failure mode analysis using a maneuver simulator

    Science.gov (United States)

    Cabrerizo-Morales, Miguel Angel; Molina, Rafael; de los Santos, Francisco; Camarero, Alberto

    2013-04-01

    In a ship or floating structure operation the agents that contribute to the systems behaviour are not only those derived from fluid-structure interaction, but also the ones linked to mooring-control line set-up evolution and human interaction. Therefore, the analysis of such systems is affected by boundary conditions that change during a complete operation. Frequently, monitoring techniques in laboratory (model) and field (prototype) are based in different instrumental techniques adding difficulty to data comparison and, in some cases, inducing precision and repeatability errors. For this reason, the main aim of this study is to develop the methods and tools to achieve a deep knowledge of those floating systems and obtain capabilities to optimize their operationally thresholds. This abstract presents a methodology and an instrumental system applicable both in field and laboratory: SRECMOCOS Project (Small scale REal-time Caisson MOnitoring and COntrol System). SRECMOCOS compiles three modules. For the monitoring and control of the structure it has been developed a synchronized open and modular microcontroller-based electronic system that comprises sensors, to monitor agents and reactions, and actuators to perform pertinent actions after processing the sensors' data. A secondary objective has been to design and implement a global scaled simulator (1:22), at the 3D basin of The Harbour Research Lab at Technical University of Madrid, in which climatic agents and those derived from the rig/maneuvering setup and the structural design were included. The particular case of Campamento's drydock, in Algeciras Bay (Spain), has been used to apply and validate the methodology. SRECMOCOS Project conjugates control, monitoring and wireless communication systems in a real time basis, offering the possibility to register and simulate all the parameters involved in port operations. This approach offers a step forward into a monitoring strategy to be included in monitoring

  11. Care during labor and birth for the prevention of intrapartum-related neonatal deaths: a systematic review and Delphi estimation of mortality effect

    Science.gov (United States)

    2011-01-01

    Background Our objective was to estimate the effect of various childbirth care packages on neonatal mortality due to intrapartum-related events (“birth asphyxia”) in term babies for use in the Lives Saved Tool (LiST). Methods We conducted a systematic literature review to identify studies or reviews of childbirth care packages as defined by United Nations norms (basic and comprehensive emergency obstetric care, skilled care at birth). We also reviewed Traditional Birth Attendant (TBA) training. Data were abstracted into standard tables and quality assessed by adapted GRADE criteria. For interventions with low quality evidence, but strong GRADE recommendation for implementation, an expert Delphi consensus process was conducted to estimate cause-specific mortality effects. Results We identified evidence for the effect on perinatal/neonatal mortality of emergency obstetric care packages: 9 studies (8 observational, 1 quasi-experimental), and for skilled childbirth care: 10 studies (8 observational, 2 quasi-experimental). Studies were of low quality, but the GRADE recommendation for implementation is strong. Our Delphi process included 21 experts representing all WHO regions and achieved consensus on the reduction of intrapartum-related neonatal deaths by comprehensive emergency obstetric care (85%), basic emergency obstetric care (40%), and skilled birth care (25%). For TBA training we identified 2 meta-analyses and 9 studies reporting mortality effects (3 cRCT, 1 quasi-experimental, 5 observational). There was substantial between-study heterogeneity and the overall quality of evidence was low. Because the GRADE recommendation for TBA training is conditional on the context and region, the effect was not estimated through a Delphi or included in the LiST tool. Conclusion Evidence quality is rated low, partly because of challenges in undertaking RCTs for obstetric interventions, which are considered standard of care. Additional challenges for evidence interpretation

  12. Care during labor and birth for the prevention of intrapartum-related neonatal deaths: a systematic review and Delphi estimation of mortality effect

    Directory of Open Access Journals (Sweden)

    Moran Neil F

    2011-04-01

    Full Text Available Abstract Background Our objective was to estimate the effect of various childbirth care packages on neonatal mortality due to intrapartum-related events (“birth asphyxia” in term babies for use in the Lives Saved Tool (LiST. Methods We conducted a systematic literature review to identify studies or reviews of childbirth care packages as defined by United Nations norms (basic and comprehensive emergency obstetric care, skilled care at birth. We also reviewed Traditional Birth Attendant (TBA training. Data were abstracted into standard tables and quality assessed by adapted GRADE criteria. For interventions with low quality evidence, but strong GRADE recommendation for implementation, an expert Delphi consensus process was conducted to estimate cause-specific mortality effects. Results We identified evidence for the effect on perinatal/neonatal mortality of emergency obstetric care packages: 9 studies (8 observational, 1 quasi-experimental, and for skilled childbirth care: 10 studies (8 observational, 2 quasi-experimental. Studies were of low quality, but the GRADE recommendation for implementation is strong. Our Delphi process included 21 experts representing all WHO regions and achieved consensus on the reduction of intrapartum-related neonatal deaths by comprehensive emergency obstetric care (85%, basic emergency obstetric care (40%, and skilled birth care (25%. For TBA training we identified 2 meta-analyses and 9 studies reporting mortality effects (3 cRCT, 1 quasi-experimental, 5 observational. There was substantial between-study heterogeneity and the overall quality of evidence was low. Because the GRADE recommendation for TBA training is conditional on the context and region, the effect was not estimated through a Delphi or included in the LiST tool. Conclusion Evidence quality is rated low, partly because of challenges in undertaking RCTs for obstetric interventions, which are considered standard of care. Additional challenges for

  13. The influence of airway supporting maneuvers on glottis view in pediatric fiberoptic bronchoscopy

    Directory of Open Access Journals (Sweden)

    Tarik Umutoglu

    2015-10-01

    Full Text Available ABSTRACTINTRODUCTION:Flexible fiber optic bronchoscopy is a valuable intervention for evaluation and management of respiratory diseases in both infants, pediatric and adult patients. The aim of this study is to investigate the influence of the airway supporting maneuvers on glottis view during pediatric flexible fiberoptic bronchoscopy.MATERIALS AND METHODS:In this randomized, controlled, crossover study; patients aged between 0 and 15 years who underwent flexible fiberoptic bronchoscopy procedure having American Society of Anesthesiologists I---II risk score were included. Patients having risk of difficult intubation, intubated or patients with tracheostomy, and patients with reduced neck mobility or having cautions for neck mobility were excluded from this study. After obtaining best glottic view at the neutral position, patients were positioned jaw trust with open mouth, jaw trust with teeth prottution, head tilt chin lift and triple airway maneuvers and best glottis scores were recorded.RESULTS:Total of 121 pediatric patients, 57 girls and 64 boys, were included in this study. Both jaw trust with open mouth and jaw trust with teeth prottution maneuvers improved the glottis view compared with neutral position (p 0.05. Head tilt chin lift and triple airway maneuvers improved glottis view when compared with both jaw trust with open mouth and jaw trust with teeth prottution maneuvers and neutral position (p 0.05.

  14. Kristeller maneuvers or fundal pressure and maternal/neonatal morbidity: obstetric and judicial literature review.

    Science.gov (United States)

    Malvasi, Antonio; Zaami, Simona; Tinelli, Andrea; Trojano, Giuseppe; Montanari Vergallo, Gianluca; Marinelli, Enrico

    2018-02-21

    A significant amount of data concerning maternal-fetal damage arising from the exertion of Kristeller maneuvers (KMs) or fundal pressure (FP) go unreleased due to medicolegal implications. For this reason, the paper gathers information as to the real magnitude of litigation related to FP-induced damages and injuries. The authors have undertaken a research in order to include general search engines (PubMed-Medline, Cochrane, Embase, Google, GyneWeb) and legal databases (De Jure, Italian database of jurisprudence daily update; Westlaw, Thomson Reuters, American ruling database and Bailii, UK Court Ruling Database). Results confirm said phenomenon to be more wide ranging than it appears through official channels. Several courts of law, both in the United States of America (USA) and in European Union (EU) Member States as well, have ruled against the use of the maneuver itself, assuming a stance conducive to a presumption of guilt against those doctors and healthcare providers who resorted to KMs or FP during deliveries. Given how rife FP is in mainstream obstetric practice, it is as if there were a wide gap between obstetric real-life and what official jurisprudence and healthcare institutions-sanctioned official practices are. The authors think that it would be desirable to draft specifically targeted guidelines or recommendations on maneuvers during vaginal delivery, in which to point out exactly what kinds of maneuvering techniques are to be absolutely banned and what maneuvers are to be allowed, and under what conditions their application can be considered appropriate.

  15. Adaptive ISAR Imaging of Maneuvering Targets Based on a Modified Fourier Transform.

    Science.gov (United States)

    Wang, Binbin; Xu, Shiyou; Wu, Wenzhen; Hu, Pengjiang; Chen, Zengping

    2018-04-27

    Focusing on the inverse synthetic aperture radar (ISAR) imaging of maneuvering targets, this paper presents a new imaging method which works well when the target's maneuvering is not too severe. After translational motion compensation, we describe the equivalent rotation of maneuvering targets by two variables-the relative chirp rate of the linear frequency modulated (LFM) signal and the Doppler focus shift. The first variable indicates the target's motion status, and the second one represents the possible residual error of the translational motion compensation. With them, a modified Fourier transform matrix is constructed and then used for cross-range compression. Consequently, the imaging of maneuvering is converted into a two-dimensional parameter optimization problem in which a stable and clear ISAR image is guaranteed. A gradient descent optimization scheme is employed to obtain the accurate relative chirp rate and Doppler focus shift. Moreover, we designed an efficient and robust initialization process for the gradient descent method, thus, the well-focused ISAR images of maneuvering targets can be achieved adaptively. Human intervention is not needed, and it is quite convenient for practical ISAR imaging systems. Compared to precedent imaging methods, the new method achieves better imaging quality under reasonable computational cost. Simulation results are provided to validate the effectiveness and advantages of the proposed method.

  16. Multiple Maneuvering Target Tracking by Improved Particle Filter Based on Multiscan JPDA

    Directory of Open Access Journals (Sweden)

    Jing Liu

    2012-01-01

    Full Text Available The multiple maneuvering target tracking algorithm based on a particle filter is addressed. The equivalent-noise approach is adopted, which uses a simple dynamic model consisting of target state and equivalent noise which accounts for the combined effects of the process noise and maneuvers. The equivalent-noise approach converts the problem of maneuvering target tracking to that of state estimation in the presence of nonstationary process noise with unknown statistics. A novel method for identifying the nonstationary process noise is proposed in the particle filter framework. Furthermore, a particle filter based multiscan Joint Probability Data Association (JPDA filter is proposed to deal with the data association problem in a multiple maneuvering target tracking. In the proposed multiscan JPDA algorithm, the distributions of interest are the marginal filtering distributions for each of the targets, and these distributions are approximated with particles. The multiscan JPDA algorithm examines the joint association events in a multiscan sliding window and calculates the marginal posterior probability based on the multiscan joint association events. The proposed algorithm is illustrated via an example involving the tracking of two highly maneuvering, at times closely spaced and crossed, targets, based on resolved measurements.

  17. oVEMP as an objective indicator of successful repositioning maneuver.

    Science.gov (United States)

    Asal, Samir; Sobhy, Osama; Balbaa, Amany

    Benign paroxysmal positioning vertigo (BPPV) is the most common peripheral vestibular disorder. Canalolithiasis in the posterior semi-circular canal is the most common underlying pathology that can be treated effectively by repositioning maneuvers. Our hypothesis suggested that successful maneuvers can lead to repositioning of dislodged otoconia to the utricle. Air conducted oVEMP, which is thought to originate from the contra-lateral utricular organ was measured in twenty patients with unilateral BPPV and we compared n1-p1 peak to peak amplitude of the affected ears in 3 separate intervals: on pre-treatment when typical nystagmus was confirmed, immediately after, and 1 week after repositioning maneuvers to assess change, if any, in amplitude. This study showed significant increase of oVEMP amplitude in the affected ears after successful repositioning maneuver that was more significant after 1 week. oVEMP can be used as a reliable objective test for ensuring a successful maneuver rather than subjective dependence on the patient's symptoms, which may be misleading due to a remission. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  18. Multiple Vascular Accidents Including Rupture of a Sinus of Valsalva Aneurysm, a Minor Ischemic Stroke and Intracranial Arterial Anomaly in a Patient with Systemic Congenital Abnormalities: A Case Report

    Directory of Open Access Journals (Sweden)

    Masataka Nakajima

    2013-11-01

    Full Text Available A 39-year-old man with a history of rupture of a sinus of Valsalva aneurysm experienced an ischemic stroke. Although the patient presented left-sided hemiparesis for a week, no abnormal signals were indicated on diffusion-weighted imaging with repeated magnetic resonance scans. Carotid ultrasound and cerebral angiography were conducted, and they revealed hypoplasty of the left internal carotid artery with a low-lying carotid bifurcation at the level of the C6 vertebra. In addition, he was diagnosed with intellectual disabilities, evaluated by the Wechsler Adult Intelligence Scale-III, and congenital velopharyngeal insufficiency. We herein present the first report of a patient with cardio-cerebrovascular abnormalities, intellectual disabilities, and an otorhinolaryngological abnormality.

  19. Congenital high airway obstruction syndrome in the breech presentation managed by ex utero intrapartum treatment procedure after intraoperative external cephalic version.

    Science.gov (United States)

    Miwa, Ichiro; Sase, Masakatsu; Nakamura, Yasuhiko; Hasegawa, Keiko; Kawasaki, Masahiro; Ueda, Kazuyuki

    2012-05-01

    Congenital high airway obstruction syndrome (CHAOS) caused by laryngeal atresia was diagnosed by prenatal ultrasound in a male fetus at 26 weeks of gestation. Findings included massive ascites, subcutaneous edema, enlarged hyperechogenic lungs with diaphragmatic inversion, dilated trachea, polyhydramnios, and breech presentation. Those findings of CHAOS spontaneously returned to normal by 33 weeks of gestation. However, the placenta was localized to the anterior uterine wall. In addition, the fetal position had been breech until delivery. At 36 weeks of gestation, a planned ex utero intrapartum treatment (EXIT) procedure was performed following intraoperative external cephalic version (ECV) in which the fetus was approached from the posterior wall of the uterus. Laryngoscopy revealed the predicted laryngeal obstruction, and tracheostomy was placed. Intraoperative ECV may be a useful technique in breech presentation before EXIT procedure. © 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.

  20. Massive facial teratoma managed with the ex utero intrapartum treatment (EXIT procedure and use of a 3-dimensional printed model for planning of staged debulking

    Directory of Open Access Journals (Sweden)

    Maggie M. Hodges

    2017-02-01

    Full Text Available Teratomas are the most frequent solid tumor found in neonates. However, only 1.5% of neonatal teratomas originate from facial structures. Neonatal facial teratomas are associated with polyhydramnios, preterm birth, pulmonary hypoplasia, cleft palate, cleft lip, and life-threatening airway compromise. The overall survival reported with these lesions has been between 17 and 87.5%; however survival in the setting of antenatally diagnosed facial teratomas has only been described anecdotally. We present a case of an antenatally diagnosed massive facial teratoma originating from the pterygomaxillary fossa, which was associated with polyhydramnios and pre-term birth. We managed this complex tumor with an ex utero intrapartum treatment (EXIT procedure, multidisciplinary medical and surgical team, and staged excision and reconstruction aided by use of a 3-dimensional printed model. Here we review the surgical management of this rare and complex tumor.

  1. The association between a low cerebro-umbilical ratio at 30-34 weeks gestation, increased intrapartum operative intervention and adverse perinatal outcomes.

    Science.gov (United States)

    Twomey, Sarah; Flatley, Christopher; Kumar, Sailesh

    2016-08-01

    The aim of this study was to investigate the relationship between the cerebro-umbilical ratio (CUR), measured at 30-34 weeks, and adverse intrapartum and perinatal outcomes. This was a retrospective cross-sectional cohort study of women delivering at the Mater Mothers' Hospital in Brisbane, Australia. Fetal Doppler indices for 1224 singleton pregnancies were correlated with maternal demographics and intrapartum and perinatal outcomes. Only women who attempted vaginal delivery were included in the study. Infants delivered by emergency cesarean section for fetal compromise had the lowest median CUR, 1.65 (IQR 1.17-2.12), compared to any other delivery group. The proportion of infants with a CUR ≤1 who required emergency cesarean section for fetal compromise was 33.3% compared to 9.3% of infants with a CUR >1 (adjusted OR 6.92 (95% CI 2.04-25.75), p<0.001). However, the detection rate of CUR ≤1 as a predictor for emergency cesarean delivery for fetal compromise was poor (18.9%). Detection rates increased in cohorts of infants born within two weeks of the scan or with birth weights <10th centile or <5th centile. Additionally, a CUR ≤1 was associated with lower median birth weight, higher rates of admission to the neonatal critical care unit and increased neonatal mortality. This study suggests that a CUR ≤1, measured at 30-34 weeks, is associated with a greater risk of emergency cesarean delivery for fetal compromise and a number of other adverse perinatal outcomes. The association was strongest in low birth weight babies. Copyright © 2016. Published by Elsevier Ireland Ltd.

  2. Ground Track Acquisition and Maintenance Maneuver Modeling for Low-Earth Orbit Satellite

    Directory of Open Access Journals (Sweden)

    Byoung-Sun Lee

    1997-12-01

    Full Text Available This paper presents a comprehensive analytical approach for determining key maneuver parameters associated with the acquisition and maintenance of the ground track for a low-earth orbit. A livearized model relating changes in the drift rate of the ground track directly to changes in the orbital semi-major axis is also developed. The effect of terrestrial atmospheric drag on the semi-major axis is also explored, being quantified through an analytical expression for the decay rate as a function of density. The non-singular Lagrange planetary equations, further simplified for nearly circular orbits, provide the desired relationships between the corrective in-plane impulsive velocity increments and the corresponding effects on the orbit elements. The resulting solution strategy offers excellent insight into the dynamics affecting the timing, magnitude, and frequency of these maneuvers. Simulations are executed for the ground track acquisition and maintenance maneuver as a pre-flight planning and analysis.

  3. Associating crash avoidance maneuvers with driver attributes and accident characteristics: a mixed logit model approach

    DEFF Research Database (Denmark)

    Kaplan, Sigal; Prato, Carlo Giacomo

    2012-01-01

    from the key role of proactive and state-aware road users within the concept of sustainable safety systems, as well as from the key role of effective corrective maneuvers in the success of automated in-vehicle warning and driver assistance systems. Methods: The analysis is conducted by means of a mixed...... about the risks of driving under fatigue and distraction being comparable to the risks of driving under the influence of alcohol and drugs. Moreover, the results suggest the need to educate drivers about hazard perception, designing a forgiving infrastructure within a sustainable safety systems......Objective: The current study focuses on the propensity of drivers to engage in crash avoidance maneuvers in relation to driver attributes, critical events, crash characteristics, vehicles involved, road characteristics, and environmental conditions. The importance of avoidance maneuvers derives...

  4. Effect of Conflict Resolution Maneuver Execution Delay on Losses of Separation

    Science.gov (United States)

    Cone, Andrew C.

    2010-01-01

    This paper examines uncertainty in the maneuver execution delay for data linked conflict resolution maneuvers. This uncertainty could cause the previously cleared primary conflict to reoccur or a secondary conflict to appear. Results show that the likelihood of a primary conflict reoccurring during a horizontal conflict resolution maneuver increases with larger initial turn-out angles and with shorter times until loss of separation. There is also a significant increase in the probability of a primary conflict reoccurring when the time until loss falls under three minutes. Increasing horizontal separation by an additional 1.5 nmi lowers the risk, but does not completely eliminate it. Secondary conflicts were shown to have a small probability of occurring in all tested configurations.

  5. Contingency Trajectory Design for a Lunar Orbit Insertion Maneuver Failure by the LADEE Spacecraft

    Science.gov (United States)

    Genova, A. L.

    2014-01-01

    This paper presents results from a contingency trajectory analysis performed for the Lunar Atmosphere & Dust Environment Explorer (LADEE) mission in the event of a missed lunar-orbit insertion (LOI) maneuver by the LADEE spacecraft. The effects of varying solar perturbations in the vicinity of the weak stability boundary (WSB) in the Sun-Earth system on the trajectory design are analyzed and discussed. It is shown that geocentric recovery trajectory options existed for the LADEE spacecraft, depending on the spacecraft's recovery time to perform an Earth escape-prevention maneuver after the hypothetical LOI maneuver failure and subsequent path traveled through the Sun-Earth WSB. If Earth-escape occurred, a heliocentric recovery option existed, but with reduced science capacapability for the spacecraft in an eccentric, not circular near-equatorial retrograde lunar orbit.

  6. Maneuver Analysis and Targeting Strategy for the Stardust Re-Entry Capsule

    Science.gov (United States)

    Helfrich, Cliff; Bhat, Ramachand S.; Kangas, Julie A.; Wilson, Roby S.; Wong, Mau C.; Potts, Christopher L.; Williams, Kenneth E.

    2006-01-01

    The Stardust Sample Return Capsule (SRC) returned to Earth on January 15, 2006 after seven years of collecting interstellar and comet particles over three heliocentric revolutions, as shown in Figure 1. The SRC was carried on board the Stardust spacecraft, as shown in Figure 2. Because the spacecraft was built with unbalanced thrusters, turns and attitude control maintenance resulted in undesirable delta-v being imparted to the trajectory. As a result, a carefully planned maneuver strategy was devised to accurately target the Stardust capsule to the Utah Test and Training Range (UTTR). This paper provides an overview of the Stardust spacecraft and mission and describes the maneuver strategy that was employed to achieve the stringent targeting requirements for landing in Utah. In addition, an overview of Stardust maneuver analysis tools and techniques will also be presented.

  7. Tracking Maneuvering Group Target with Extension Predicted and Best Model Augmentation Method Adapted

    Directory of Open Access Journals (Sweden)

    Linhai Gan

    2017-01-01

    Full Text Available The random matrix (RM method is widely applied for group target tracking. The assumption that the group extension keeps invariant in conventional RM method is not yet valid, as the orientation of the group varies rapidly while it is maneuvering; thus, a new approach with group extension predicted is derived here. To match the group maneuvering, a best model augmentation (BMA method is introduced. The existing BMA method uses a fixed basic model set, which may lead to a poor performance when it could not ensure basic coverage of true motion modes. Here, a maneuvering group target tracking algorithm is proposed, where the group extension prediction and the BMA adaption are exploited. The performance of the proposed algorithm will be illustrated by simulation.

  8. Analysis of effects of manhole covers on motorcycle driver maneuvers: a nonparametric classification tree approach.

    Science.gov (United States)

    Chang, Li-Yen

    2014-01-01

    A manhole cover is a removable plate forming the lid over the opening of a manhole to allow traffic to pass over the manhole and to prevent people from falling in. Because most manhole covers are placed in roadway traffic lanes, if these manhole covers are not appropriately installed or maintained, they can represent unexpected hazards on the road, especially for motorcycle drivers. The objective of this study is to identify the effects of manhole cover characteristics as well as driver factors and traffic and roadway conditions on motorcycle driver maneuvers. A video camera was used to record motorcycle drivers' maneuvers when they encountered an inappropriately installed or maintained manhole cover. Information on 3059 drivers' maneuver decisions was recorded. Classification and regression tree (CART) models were applied to explore factors that can significantly affect motorcycle driver maneuvers when passing a manhole cover. Nearly 50 percent of the motorcycle drivers decelerated or changed their driving path to reduce the effects of the manhole cover. The manhole cover characteristics including the level difference between manhole cover and pavement, the pavement condition over the manhole cover, and the size of the manhole cover can significantly affect motorcycle driver maneuvers. Other factors, including traffic conditions, lane width, motorcycle speed, and loading conditions, also have significant effects on motorcycle driver maneuvers. To reduce the effects and potential risks from the manhole covers, highway authorities not only need to make sure that any newly installed manhole covers are as level as possible but also need to regularly maintain all the manhole covers to ensure that they are in good condition. In the long run, the size of manhole covers should be kept as small as possible so that the impact of manhole covers on motorcycle drivers can be effectively reduced. Supplemental materials are available for this article. Go to the publisher

  9. Effect of a hybrid maneuver in treating posterior canal benign paroxysmal positional vertigo.

    Science.gov (United States)

    Badawy, Wanees M A; Gad El-Mawla, Ebtessam K; Chedid, Ahmed E F; Mustafa, Ahmed H A

    2015-02-01

    Benign paroxysmal positional vertigo (BPPV) is the most common disorder of the vestibular system of the inner ear, which is a vital part of maintaining balance. Although the efficacy of the Epley maneuver-also known as the canalith repositioning maneuver (CRM)-is well established, data comparing CRM versus a hybrid treatment are lacking. The purpose of this study was to determine the effect of a hybrid treatment, the Gans repositioning maneuver (GRM) either with or without postmaneuver restrictions, compared with CRM on treatment of posterior canal BPPV (PC-BPPV). Study design was a randomized controlled trial. A total of 45 patients (30 males and 15 females) with unilateral PC-BPPV were randomly allocated to one of three equal groups on the basis of the date of the first visit with matched assignment for gender: a GRMR group (GRM with postmaneuver restrictions), a GRM group, and a CRM group. Patients received weekly administration of the maneuver until resolution of symptoms. The Dix-Hallpike test was performed before treatment at every appointment, and finally after 1 mo from the last maneuver. Nystagmus duration and vertigo intensity were recorded. The supine roll test was performed in case the Dix-Hallpike test was negative to test otoconial migration. Data were analyzed with repeated-measures analysis of variance, paired t-tests with a Bonferroni correction, and the Spearman rank correlation coefficient. All patients showed improvement within the groups, and PC-BPPV symptoms were resolved by an average of 2, 1.7, and 1.6 maneuvers for GRMR, GRM, and CRM, respectively, with no statistical differences among the three groups (p > 0.05). Only two patients had recurrence, and one patient had horizontal BPPV at 1 mo follow-up. We demonstrated that the GRM as a new treatment is effective in treating PC-BPPV with no benefits to postmaneuver restrictions. American Academy of Audiology.

  10. Maneuver Acoustic Flight Test of the Bell 430 Helicopter Data Report

    Science.gov (United States)

    Watts, Michael E.; Greenwood, Eric; Smith, Charles D.; Snider, Royce; Conner, David A.

    2014-01-01

    A cooperative ight test by NASA, Bell Helicopter and the U.S. Army to characterize the steady state acoustics and measure the maneuver noise of a Bell Helicopter 430 aircraft was accomplished. The test occurred during June/July 2011 at Eglin Air Force Base, Florida. This test gathered a total of 410 test points over 10 test days and compiled an extensive database of dynamic maneuver measurements. Three microphone arrays with up to 31 microphon. es in each were used to acquire acoustic data. Aircraft data included Differential Global Positioning System, aircraft state and rotor state information. This paper provides an overview of the test and documents the data acquired.

  11. Catheter Entrapment During Posterior Mitral Leaflet Pushing Maneuver for MitraClip Implantation.

    Science.gov (United States)

    Castrodeza, Javier; Amat-Santos, Ignacio J; Tobar, Javier; Varela-Falcón, Luis H

    2016-06-01

    MitraClip (Abbott Vascular) therapy has been reported to be an effective procedure for mitral regurgitation, especially in high-risk patients. Recently, the novel pushing maneuver technique has been described for approaching restricted and short posterior leaflets with a pigtail catheter in order to facilitate grasping of the clip. However, complications or unexpected situations may occur. We report the case of an 84-year-old patient who underwent MitraClip implantation wherein the pushing maneuver was complicated by the clip accidentally gripping the pigtail catheter along with the two leaflets.

  12. Effects of the Eccentricity of a Perturbing Third Body on the Orbital Correction Maneuvers of a Spacecraft

    Directory of Open Access Journals (Sweden)

    R. C. Domingos

    2014-01-01

    Full Text Available The fuel consumption required by the orbital maneuvers when correcting perturbations on the orbit of a spacecraft due to a perturbing body was estimated. The main goals are the measurement of the influence of the eccentricity of the perturbing body on the fuel consumption required by the station keeping maneuvers and the validation of the averaged methods when applied to the problem of predicting orbital maneuvers. To study the evolution of the orbits, the restricted elliptic three-body problem and the single- and double-averaged models are used. Maneuvers are made by using impulsive and low thrust maneuvers. The results indicated that the averaged models are good to make predictions for the orbital maneuvers when the spacecraft is in a high inclined orbit. The eccentricity of the perturbing body plays an important role in increasing the effects of the perturbation and the fuel consumption required for the station keeping maneuvers. It is shown that the use of more frequent maneuvers decreases the annual cost of the station keeping to correct the orbit of a spacecraft. An example of an eccentric planetary system of importance to apply the present study is the dwarf planet Haumea and its moons, one of them in an eccentric orbit.

  13. 78 FR 11555 - Special Conditions: Embraer S.A., Model EMB-550 Airplane; Design Roll Maneuver for Electronic...

    Science.gov (United States)

    2013-02-19

    ... Law 92-574, the ``Noise Control Act of 1972.'' The FAA issues special conditions, as defined in 14 CFR...; Design Roll Maneuver for Electronic Flight Controls AGENCY: Federal Aviation Administration (FAA), DOT... design roll maneuver for electronic flight controls, specifically an electronic flight control system...

  14. 77 FR 70384 - Special Conditions: Embraer S.A., Model EMB-550 Airplane; Design Roll Maneuver for Electronic...

    Science.gov (United States)

    2012-11-26

    ... Law 92-574, the ``Noise Control Act of 1972.'' The FAA issues special conditions, as defined in 14 CFR... Maneuver for Electronic Flight Controls AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Notice... design roll maneuver for electronic flight controls, specifically an electronic flight control system...

  15. Pressure applied by the healthcare staff on a cricoids cartilage simulator during Sellick's maneuver in rapid sequence intubation

    NARCIS (Netherlands)

    J.A. Calvache (Jose Andrés); L.C.B. Sandoval (Luz); W.A. Vargas (William Andres)

    2013-01-01

    textabstractBackground: Sellick's maneuver or cricoid pressure is a strategy used to prevent bronchoaspiration during the rapid intubation sequence. Several studies have described that the force required for an adequate maneuver is of 2.5-3.5 kg. The purpose of this paper was to determine the force

  16. Huang's three-step maneuver shortens the learning curve of laparoscopic spleen-preserving splenic hilar lymphadenectomy.

    Science.gov (United States)

    Huang, Chang-Ming; Huang, Ze-Ning; Zheng, Chao-Hui; Li, Ping; Xie, Jian-Wei; Wang, Jia-Bin; Lin, Jian-Xian; Jun, Lu; Chen, Qi-Yue; Cao, Long-Long; Lin, Mi; Tu, Ru-Hong

    2017-12-01

    The goal of this study was to investigate the difference between the learning curves of different maneuvers in laparoscopic spleen-preserving splenic hilar lymphadenectomy for advanced upper gastric cancer. From January 2010 to April 2014, 53 consecutive patients who underwent laparoscopic spleen-preserving splenic hilar lymphadenectomy via the traditional-step maneuver (group A) and 53 consecutive patients via Huang's three-step maneuver (group B) were retrospectively analyzed. No significant difference in patient characteristics were found between the two groups. The learning curves of groups A and B were divided into phase 1 (1-43 cases and 1-30 cases, respectively) and phase 2 (44-53 cases and 31-53 cases, respectively). Compared with group A, the dissection time, bleeding loss and vascular injury were significantly decreased in group B. No significant differences in short-term outcomes were found between the two maneuvers. The multivariate analysis indicated that the body mass index, short gastric vessels, splenic artery type and maneuver were significantly associated with the dissection time in group B. No significant difference in the survival curve was found between the maneuvers. The learning curve of Huang's three-step maneuver was shorter than that of the traditional-step maneuver, and the former represents an ideal maneuver for laparoscopic spleen-preserving splenic hilar lymphadenectomy.To shorten the learning curve at the beginning of laparoscopic spleen-preserving splenic hilar lymphadenectomy, beginners should beneficially use Huang's three-step maneuver and select patients with advanced upper gastric cancer with a body mass index of less than 25 kg/m 2 and the concentrated type of splenic artery. Copyright © 2017. Published by Elsevier Ltd.

  17. Analysis of risk factors influencing the outcome of the Epley maneuver.

    Science.gov (United States)

    Domínguez-Durán, E; Domènech-Vadillo, E; Álvarez-Morujo de Sande, M G; González-Aguado, R; Guerra-Jiménez, G; Ramos-Macías, Á; Morales-Angulo, C; Martín-Mateos, A J; Figuerola-Massana, E; Galera-Ruiz, H

    2017-10-01

    Benign paroxysmal positional vertigo (BPPV) is the most frequent type of vertigo. The treatment of canalithiasis of the posterior semicircular canal consists in performing a particle-repositioning maneuver, such as the Epley maneuver (EM). However, the EM is not effective in all cases. The objective of this study is to identify risk factors, which predict the EM failure, among the clinical variables recorded in anamnesis and patient examination. This is an observational prospective multicentric study. All patients presenting with BPPV were recruited and applied the EM and appointed for a follow-up visit 7 days later. The following variables were recorded: sex, age, arterial hypertension, diabetes, hyperlipidemia, smoking habit, alcohol consumption, migraine, osteoporosis, diseases of the inner ear, previous ipsilateral BPPV, previous traumatic brain injury, previous sudden head deceleration, time of evolution, sulpiride or betahistine treatment, experienced symptoms, outcome of the Halmagyi maneuver, laterality, cephalic hyperextension of the neck, intensity of nystagmus, intensity of vertigo, duration of nystagmus, occurrence of orthotropic nystagmus, symptoms immediately after the EM, postural restrictions, and symptoms 7 days after the EM. Significant differences in the rate of loss of nystagmus were found for six variables: hyperlipidemia, previous ipsilateral BPPV, intensity of nystagmus, duration of nystagmus, post-maneuver sweating, and subjective status. The most useful significant variables in the clinical practice to predict the success of the EM are previous BPPV and intensity of nystagmus. In the other significant variables, no physiopathological hypothesis can be formulated or differences between groups are too small.

  18. Multislice spiral computed tomography to determine the effects of a recruitment maneuver in experimental lung injury

    Energy Technology Data Exchange (ETDEWEB)

    Henzler, Dietrich; Rossaint, Rolf [University Hospital, RWTH Aachen, Anesthesiology Department, Aachen (Germany); Mahnken, Andreas H.; Wildberger, Joachim E.; Guenther, Rolf W. [University Hospital of the RWTH Aachen, Clinic of Diagnostic Radiology, Aachen (Germany); Kuhlen, Ralf [University Hospital of the RWTH Aachen, Operative Intensive Care Department, Aachen (Germany)

    2006-06-15

    Although recruitment of atelectatic lung is a common aim in acute respiratory distress syndrome (ARDS), the effects of a recruitment maneuver have not been assessed quantitatively. By multislice spiral CT (MSCT), we analyzed the changes in lung volumes calculated from the changes in the CT values of hyperinflated (V{sub HYP}), normally (V{sub NORM}), poorly (V{sub POOR}) and nonaerated (V{sub NON}) lung in eight mechanically ventilated pigs with saline lavage-induced acute lung injury before and after a recruitment maneuver. This was compared to single slice analysis near the diaphragm. The increase in aerated lung was mainly for V{sub POOR} and the less in V{sub NORM}. Total lung volume and intrathoracic gas increased. No differences were found for tidal volumes measured by spirometry or determined by CT. The inspiratory-expiratory volume differences were not different after the recruitment maneuver in V{sub NON} (from 62{+-}18 ml to 43{+-}26 ml, P=0.114), and in V{sub NORM} (from 216{+-}51 ml to 251{+-}37 ml, P=0.102). Single slice analysis significantly underestimated the increase in normally and poorly aerated lung. Quantitative analysis of lung volumes by whole lung MSCT revealed the increase of poorly aerated lung as the main mechanism of a standard recruitment maneuver. MSCT can provide additional information as compared to single slice CT. (orig.)

  19. Cooperative maneuvering in close environments among cybercars and dual-mode cars

    NARCIS (Netherlands)

    Milanés, V.; Alonso, J.; Bouraoui, L.; Ploeg, J.

    2011-01-01

    This paper describes the results of vehicle-to-vehicle (V2V) and infrastructure-to-vehicle (I2V) experiments implementing cooperative maneuvering for three different vehicles driving automatically. The cars used were cybercars from the Institut National de Recherche en Informatique et Automatique

  20. The Prospect of Responsive Spacecraft Using Aeroassisted, Trans-Atmospheric Maneuvers

    Science.gov (United States)

    2014-06-19

    99 V. Design of Experiments Approach to Atmospheric Skip Entry Maneuver Optimization .....100 Chapter Overview...Transfer Diagram .................................................................................................11 3.1. Comparison of Geocentric ...Comparison of Geocentric /Geodetic Latitude for Apollo 10 (2-Gravity Model, Fourth-Order Runge-Kutta Solver

  1. Conflict Resolution Performance in an Experimental Study of En Route Free Maneuvering Operations

    Science.gov (United States)

    Doble, Nathan A.; Barhydt, Richard; Hitt, James M., II

    2005-01-01

    NASA has developed a far-term air traffic management concept, termed Distributed Air/Ground Traffic Management (DAG-TM). One component of DAG-TM, En Route Free Maneuvering, allows properly trained flight crews of equipped autonomous aircraft to assume responsibility for separation from other autonomous aircraft and from Instrument Flight Rules (IFR) aircraft. Ground-based air traffic controllers continue to separate IFR traffic and issue flow management constraints to all aircraft. To examine En Route Free Maneuvering operations, a joint human-in-the-loop experiment was conducted in summer 2004 at the NASA Ames and Langley Research Centers. Test subject pilots used desktop flight simulators to resolve traffic conflicts and adhere to air traffic flow constraints issued by subject controllers. The experimental airspace integrated both autonomous and IFR aircraft at varying traffic densities. This paper presents a subset of the En Route Free Maneuvering experimental results, focusing on airborne and ground-based conflict resolution, and the effects of increased traffic levels on the ability of pilots and air traffic controllers to perform this task. The results show that, in general, increases in autonomous traffic do not significantly impact conflict resolution performance. In addition, pilot acceptability of autonomous operations remains high throughout the range of traffic densities studied. Together with previously reported findings, these results continue to support the feasibility of the En Route Free Maneuvering component of DAG-TM.

  2. 46 CFR 35.20-40 - Maneuvering characteristics-T/OC.

    Science.gov (United States)

    2010-10-01

    ... for the normal load and normal ballast condition for: (1) Calm weather—wind 10 knots or less, calm sea... response of the (name of the vessel) may be different from those listed above if any of the following conditions, upon which the maneuvering information is based, are varied: (1) Calm weather—wind 10 knots or...

  3. Linearity of electrical impedance tomography during maximum effort breathing and forced expiration maneuvers.

    Science.gov (United States)

    Ngo, Chuong; Leonhardt, Steffen; Zhang, Tony; Lüken, Markus; Misgeld, Berno; Vollmer, Thomas; Tenbrock, Klaus; Lehmann, Sylvia

    2017-01-01

    Electrical impedance tomography (EIT) provides global and regional information about ventilation by means of relative changes in electrical impedance measured with electrodes placed around the thorax. In combination with lung function tests, e.g. spirometry and body plethysmography, regional information about lung ventilation can be achieved. Impedance changes strictly correlate with lung volume during tidal breathing and mechanical ventilation. Initial studies presumed a correlation also during forced expiration maneuvers. To quantify the validity of this correlation in extreme lung volume changes during forced breathing, a measurement system was set up and applied on seven lung-healthy volunteers. Simultaneous measurements of changes in lung volume using EIT imaging and pneumotachography were obtained with different breathing patterns. Data was divided into a synchronizing phase (spontaneous breathing) and a test phase (maximum effort breathing and forced maneuvers). The EIT impedance changes correlate strictly with spirometric data during slow breathing with increasing and maximum effort ([Formula: see text]) and during forced expiration maneuvers ([Formula: see text]). Strong correlations in spirometric volume parameters [Formula: see text] ([Formula: see text]), [Formula: see text]/FVC ([Formula: see text]), and flow parameters PEF, [Formula: see text], [Formula: see text], [Formula: see text] ([Formula: see text]) were observed. According to the linearity during forced expiration maneuvers, EIT can be used during pulmonary function testing in combination with spirometry for visualisation of regional lung ventilation.

  4. Multislice spiral computed tomography to determine the effects of a recruitment maneuver in experimental lung injury

    International Nuclear Information System (INIS)

    Henzler, Dietrich; Rossaint, Rolf; Mahnken, Andreas H.; Wildberger, Joachim E.; Guenther, Rolf W.; Kuhlen, Ralf

    2006-01-01

    Although recruitment of atelectatic lung is a common aim in acute respiratory distress syndrome (ARDS), the effects of a recruitment maneuver have not been assessed quantitatively. By multislice spiral CT (MSCT), we analyzed the changes in lung volumes calculated from the changes in the CT values of hyperinflated (V HYP ), normally (V NORM ), poorly (V POOR ) and nonaerated (V NON ) lung in eight mechanically ventilated pigs with saline lavage-induced acute lung injury before and after a recruitment maneuver. This was compared to single slice analysis near the diaphragm. The increase in aerated lung was mainly for V POOR and the less in V NORM . Total lung volume and intrathoracic gas increased. No differences were found for tidal volumes measured by spirometry or determined by CT. The inspiratory-expiratory volume differences were not different after the recruitment maneuver in V NON (from 62±18 ml to 43±26 ml, P=0.114), and in V NORM (from 216±51 ml to 251±37 ml, P=0.102). Single slice analysis significantly underestimated the increase in normally and poorly aerated lung. Quantitative analysis of lung volumes by whole lung MSCT revealed the increase of poorly aerated lung as the main mechanism of a standard recruitment maneuver. MSCT can provide additional information as compared to single slice CT. (orig.)

  5. Associating Crash Avoidance Maneuvers with Driver Attributes and Accident Characteristics: A Mixed Logit Model Approach

    DEFF Research Database (Denmark)

    Kaplan, Sigal; Prato, Carlo Giacomo

    2012-01-01

    as from the key role of the ability of drivers to perform effective corrective maneuvers for the success of automated in-vehicle warning and driver assistance systems. The analysis is conducted by means of a mixed logit model that accommodates correlations across alternatives and heteroscedasticity. Data...

  6. Leveraging Manet and Mobile Devices in Ship-to-Objective Maneuver and Expeditionary MAGTF Operations

    Science.gov (United States)

    2014-09-01

    support and firepower. ECO allows for the Marine Corps to deploy a lower- level maneuver unit as an economy of force measure to assert combat power over...to the Global Information Grid ( GIG ) is the course of action the Marine Corps should adopt (Price & McHuen, 2009). My proposed research addresses

  7. Effect of different body postures on the pressures generated during an L-1 maneuver.

    Science.gov (United States)

    Williams, C A; Lind, A R; Wiley, R L; Douglas, J E; Miller, G

    1988-10-01

    Changes in blood pressure, intrathoracic pressure, heart rate and the electromyographic activity of various muscle groups were determined while nine male subjects performed 15-s L-1 straining maneuvers at four spine-to-thigh angles (70, 84, 94, and 105 degrees) and two seatback angles (30 and 60 degrees). There was no significant difference between the changes in these variables due to the different body positions. At the onset of the L-1, arterial pressure immediately increased to 195 +/- 5 mm Hg, but fell progressively during the next 5 s to 160 +/- 5 mm Hg. It remained constant during the next 5 s of the maneuver and then recovered to 180 +/- mm Hg during the last 5 s of the maneuver. Esophageal pressure followed essentially the same pattern of response, but heart rate progressively increased during the entire L-1. No one muscle group was utilized more than another. Inflation of an anti-G suit to 4 PSI had no effect on the variables measured. Generation of high arterial pressures during L-1 maneuvers is transitory and not affected either positively or negatively by altering subject body position.

  8. The Choice of the Maneuver of the Vessel’s Passing Considering the Coordination’s System of the Interactive Vessels and Their Dynamic Characteristics

    Directory of Open Access Journals (Sweden)

    Yevgen Volkov

    2017-03-01

    Full Text Available The maneuver of the altering course of the vessel is a more preferable to avoid a collision. Due to that the calculation of the parameters of the avoidance maneuver should be done considering the dynamic characteristics of the vessel in maneuvering. The paper analyzes the dynamic models of the vessel rotation motion in order to select more appropriate one for the calculation of avoidance maneuver of the vessel applying the altering of the course.

  9. Parameter Identification of Ship Maneuvering Models Using Recursive Least Square Method Based on Support Vector Machines

    Directory of Open Access Journals (Sweden)

    Man Zhu

    2017-03-01

    Full Text Available Determination of ship maneuvering models is a tough task of ship maneuverability prediction. Among several prime approaches of estimating ship maneuvering models, system identification combined with the full-scale or free- running model test is preferred. In this contribution, real-time system identification programs using recursive identification method, such as the recursive least square method (RLS, are exerted for on-line identification of ship maneuvering models. However, this method seriously depends on the objects of study and initial values of identified parameters. To overcome this, an intelligent technology, i.e., support vector machines (SVM, is firstly used to estimate initial values of the identified parameters with finite samples. As real measured motion data of the Mariner class ship always involve noise from sensors and external disturbances, the zigzag simulation test data include a substantial quantity of Gaussian white noise. Wavelet method and empirical mode decomposition (EMD are used to filter the data corrupted by noise, respectively. The choice of the sample number for SVM to decide initial values of identified parameters is extensively discussed and analyzed. With de-noised motion data as input-output training samples, parameters of ship maneuvering models are estimated using RLS and SVM-RLS, respectively. The comparison between identification results and true values of parameters demonstrates that both the identified ship maneuvering models from RLS and SVM-RLS have reasonable agreements with simulated motions of the ship, and the increment of the sample for SVM positively affects the identification results. Furthermore, SVM-RLS using data de-noised by EMD shows the highest accuracy and best convergence.

  10. Does Shoe Collar Height Influence Ankle Joint Kinematics and Kinetics in Sagittal Plane Maneuvers?

    Science.gov (United States)

    Yang, Yang; Fang, Ying; Zhang, Xini; He, Junliang; Fu, Weijie

    2017-01-01

    The Objective of the study is to investigate the effects of basketball shoes with different collar heights on ankle kinematics and kinetics and athletic performance in different sagittal plane maneuvers. Twelve participants who wore high-top and low-top basketball shoes (hereafter, HS and LS, respectively) performed a weight-bearing dorsiflexion (WB-DF) maneuver, drop jumps (DJs), and lay-up jumps (LJs). Their sagittal plane kinematics and ground reaction forces were recorded using the Vicon motion capture system and Kistler force plates simultaneously. Moreover, ankle dorsiflexion and plantarflexion angles, moment, power, stiffness, and jump height were calculated. In the WB-DF test, the peak ankle dorsiflexion angle (p = 0.041) was significantly smaller in HS than in LS. Additionally, the peak ankle plantarflexion moment (p = 0.028) and power (p = 0.022) were significantly lower in HS than in LS during LJs but not during DJs. In both jumping maneuvers, no significant differences were found in the jump height or ankle kinematics between the two shoe types. According to the WB-DF test, increasing shoe collar height can effectively reduce the ankle range of motion in the sagittal plane. Although the HS did not restrict the flexion–extension performance of the ankle joint during two jumping maneuvers, an increased shoe collar height can reduce peak ankle plantarflexion moment and peak power during the push-off phase in LJs. Therefore, a higher shoe collar height should be used to circumvent effects on the partial kinetics of the ankle joint in the sagittal plane. Key points An increased shoe collar height effectively reduced ankle joint ROM in the sagittal plane in weight-bearing dorsiflexion maneuver. Shoe collar height did not affect sagittal plane ankle kinematics and had no effect on performance during realistic jumping. Shoe collar height can affect the ankle plantarflexion torque and peak power during the push-off phase in lay-up jump. PMID:29238255

  11. Correlation between crash avoidance maneuvers and injury severity sustained by motorcyclists in single-vehicle crashes.

    Science.gov (United States)

    Wang, Chen; Lu, Linjun; Lu, Jian; Wang, Tao

    2016-01-01

    In order to improve motorcycle safety, this article examines the correlation between crash avoidance maneuvers and injury severity sustained by motorcyclists, under multiple precrash conditions. Ten-year crash data for single-vehicle motorcycle crashes from the General Estimates Systems (GES) were analyzed, using partial proportional odds models (i.e., generalized ordered logit models). The modeling results show that "braking (no lock-up)" is associated with a higher probability of increased severity, whereas "braking (lock-up)" is associated with a higher probability of decreased severity, under all precrash conditions. "Steering" is associated with a higher probability of reduced injury severity when other vehicles are encroaching, whereas it is correlated with high injury severity under other conditions. "Braking and steering" is significantly associated with a higher probability of low severity under "animal encounter and object presence," whereas it is surprisingly correlated with high injury severity when motorcycles are traveling off the edge of the road. The results also show that a large number of motorcyclists did not perform any crash avoidance maneuvers or conducted crash avoidance maneuvers that are significantly associated with high injury severity. In general, this study suggests that precrash maneuvers are an important factor associated with motorcyclists' injury severity. To improve motorcycle safety, training/educational programs should be considered to improve safety awareness and adjust driving habits of motorcyclists. Antilock brakes and such systems are also promising, because they could effectively prevent brake lock-up and assist motorcyclists in maneuvering during critical conditions. This study also provides valuable information for the design of motorcycle training curriculum.

  12. Concept of a Maneuvering Load Control System and Effect on the Fatigue Life Extension

    Directory of Open Access Journals (Sweden)

    N. Paletta

    Full Text Available Abstract This paper presents a methodology for the conceptual design of a Maneuver Load Control system taking into account the airframe flexibility. The system, when switched on, is able to minimize the bending moment augmentation at a wing station near the wing root during an unsteady longitudinal maneuver. The reduction of the incremental wing bending moment due to maneuvers can lead to benefits such as improved pay-loads/gross weight capabilities and/or extended structural fatigue life. The maneuver is performed by following a desired vertical load factor law with elevators deflections, starting from the trim equilibrium in level flight. The system observes load factor and structural bending through accelerometers and calibrated strain sensors and then sends signals to a computer that symmetrically actuates ailerons for reducing the structural bending and elevators for compensating the perturbation to the longitudinal equilibrium. The major limit of this kind of systems appears when it has to be installed on commercial transport aircraft for reduced OEW or augmented wing aspect-ratio. In this case extensive RAMS analyses and high redundancy of the MLC related sub-systems are required by the Certification Authority. Otherwise the structural design must be performed at system off. Thus the unique actual benefit to be gained from the adoption of a MLC system on a commercial transport is the fatigue life extension. An application to a business aircraft responding to the EASA Certification Specifications, Part 25, has been performed. The aircraft used for the numerical application is considered only as a test case-study. Most of design and analysis considerations are applicable also to other aircraft, such as unmanned or military ones, although some design requirements can be clearly different. The estimation of the fatigue life extension of a structural joint (wing lower skin-stringer, located close to the wing root, has been estimated by showing

  13. Intrapartum translabial ultrasound with pushing used to predict the difficulty in vacuum-assisted delivery of fetuses in non-occiput posterior position.

    Science.gov (United States)

    Antonio Sainz, José; Borrero, Carlota; Aquise, Adriana; García-Mejido, José Antonio; Gutierrez, Laura; Fernández-Palacín, Ana

    2016-10-01

    Our aim is to evaluate the capacity of intrapartum translabial ultrasound (ITU) with pushing in the prediction of difficulty of fetal extraction in vacuum assisted deliveries. Prospective, observational study performed (2/2015-8/2015) on 75 nulliparous women, ≥37 weeks with singleton pregnancies at full dilatation who had ITU-with-pushing performed, previous to vacuum-placement for fetal extraction. Working on the translabial sagittal-plane, we assessed: Angle-Progression (AoP), Progression-Distance (PD) and Head-Direction (HD); in the axial plane we evaluated: Midline-Angle (MLA) and Head-Perineum-Distance (HPD). Vacuum extractions were classified as easy-difficulty (ED) (≤3 vacuum-pulls), difficult-unsuccessful (DD) (>3 vacuum-pulls). We did not assess occipito-posterior-presentations. Seventy nulliparous were studied (44-ED,26-DD). We observed no differences in obstetric, neonatal or intrapartum characteristics between the two study groups, with the following exceptions: newborn weight (3272 ± 438 g versus 3540 ± 372 g; p = 0.011) and number of vacuum-pulls (1.4-ED-vs-4.4-DD; p pushing was 143.9° ± 14.6° in ED and 115.1°± 12.9° in DD (p Pushing was 42.7 ± 11.3 mm versus 30.4 ± 9.8 mm (p Pushing was 27.6°± 26.6° versus 57.5°±26.5°(p=0.025); HPD-Pushing was 40.8 ± 10.0 mm versus 47.4 ± 10.9 mm (p = 0.039). We identified that the presence of an AoP-Pushing > 128° predicts an Easy-Vacuum-Delivery (≤3 Vacuum-Pulls) in  >85% of cases (Sen 80%-FPR 9.3%).

  14. Precision Closed-Loop Orbital Maneuvering System Design and Performance for the Magnetospheric Multi-Scale Mission (MMS) Formation

    Science.gov (United States)

    Chai, Dean; Queen, Steve; Placanica, Sam

    2015-01-01

    NASA's Magnetospheric Multi-Scale (MMS) mission successfully launched on March 13, 2015 (UTC) consists of four identically instrumented spin-stabilized observatories that function as a constellation to study magnetic reconnection in space. The need to maintain sufficiently accurate spatial and temporal formation resolution of the observatories must be balanced against the logistical constraints of executing overly-frequent maneuvers on a small fleet of spacecraft. These two considerations make for an extremely challenging maneuver design problem. This paper focuses on the design elements of a 6-DOF spacecraft attitude control and maneuvering system capable of delivering the high-precision adjustments required by the constellation designers---specifically, the design, implementation, and on-orbit performance of the closed-loop formation-class maneuvers that include initialization, maintenance, and re-sizing. The maneuvering control system flown on MMS utilizes a micro-gravity resolution accelerometer sampled at a high rate in order to achieve closed-loop velocity tracking of an inertial target with arc-minute directional and millimeter-per-second magnitude accuracy. This paper summarizes the techniques used for correcting bias drift, sensor-head offsets, and centripetal aliasing in the acceleration measurements. It also discusses the on-board pre-maneuver calibration and compensation algorithms as well as the implementation of the post-maneuver attitude adjustments.

  15. The Pringle maneuver reduces the infusion rate of rocuronium required to maintain surgical muscle relaxation during hepatectomy.

    Science.gov (United States)

    Kajiura, Akira; Nagata, Osamu; Sanui, Masamitsu

    2018-04-27

    We investigated the continuous infusion rates of rocuronium necessary to obtain the surgical muscle relaxation before, during, and after the Pringle maneuver on patients who underwent hepatectomy. Fifteen patients were induced by total intravenous anesthesia with propofol. After obtaining the calibration of acceleromyography, the patient was intubated with rocuronium 0.6 mg/kg. Fifteen minutes after initial rocuronium injection, the continuous infusion was started at 7.5 µg/kg/min. The infusion rate was adjusted every 15 min so that the first twitch height (% T1) might become from 3 to 10% of control. The infusion rates at the time when the state of surgical muscle relaxation was achieved for more than 15 min were recorded before, during and after the Pringle maneuver. The 25% recovery time was measured after discontinuing the continuous infusion. The infusion rate of rocuronium before, during, and after the Pringle maneuver was 7.2 ± 1.8, 4.2 ± 1.4, and 4.7 ± 1.5 µg/kg/min (mean ± SD), respectively. The rocuronium infusion rate during the Pringle maneuver was decreased about 40% compared to that before this maneuver, and that after completion of the Pringle maneuver was not recovered to that before the Pringle maneuver. The 25% recovery time was 20 ± 7 min. In case of continuous administration of rocuronium during surgery performing the Pringle maneuver, it was considered necessary to regulate the administration of rocuronium using muscle relaxant monitoring in order to deal with the decrease in muscle relaxant requirement by the Pringle maneuver.

  16. Evaluation of lung recruitment maneuvers in acute respiratory distress syndrome using computer simulation.

    Science.gov (United States)

    Das, Anup; Cole, Oana; Chikhani, Marc; Wang, Wenfei; Ali, Tayyba; Haque, Mainul; Bates, Declan G; Hardman, Jonathan G

    2015-01-12

    Direct comparison of the relative efficacy of different recruitment maneuvers (RMs) for patients with acute respiratory distress syndrome (ARDS) via clinical trials is difficult, due to the heterogeneity of patient populations and disease states, as well as a variety of practical issues. There is also significant uncertainty regarding the minimum values of positive end-expiratory pressure (PEEP) required to ensure maintenance of effective lung recruitment using RMs. We used patient-specific computational simulation to analyze how three different RMs act to improve physiological responses, and investigate how different levels of PEEP contribute to maintaining effective lung recruitment. We conducted experiments on five 'virtual' ARDS patients using a computational simulator that reproduces static and dynamic features of a multivariable clinical dataset on the responses of individual ARDS patients to a range of ventilator inputs. Three recruitment maneuvers (sustained inflation (SI), maximal recruitment strategy (MRS) followed by a titrated PEEP, and prolonged recruitment maneuver (PRM)) were implemented and evaluated for a range of different pressure settings. All maneuvers demonstrated improvements in gas exchange, but the extent and duration of improvement varied significantly, as did the observed mechanism of operation. Maintaining adequate post-RM levels of PEEP was seen to be crucial in avoiding cliff-edge type re-collapse of alveolar units for all maneuvers. For all five patients, the MRS exhibited the most prolonged improvement in oxygenation, and we found that a PEEP setting of 35 cm H2O with a fixed driving pressure of 15 cm H2O (above PEEP) was sufficient to achieve 95% recruitment. Subsequently, we found that PEEP titrated to a value of 16 cm H2O was able to maintain 95% recruitment in all five patients. There appears to be significant scope for reducing the peak levels of PEEP originally specified in the MRS and hence to avoid exposing the lung to

  17. Integrated detection, estimation, and guidance in pursuit of a maneuvering target

    Science.gov (United States)

    Dionne, Dany

    The thesis focuses on efficient solutions of non-cooperative pursuit-evasion games with imperfect information on the state of the system. This problem is important in the context of interception of future maneuverable ballistic missiles. However, the theoretical developments are expected to find application to a broad class of hybrid control and estimation problems in industry. The validity of the results is nevertheless confirmed using a benchmark problem in the area of terminal guidance. A specific interception scenario between an incoming target with no information and a single interceptor missile with noisy measurements is analyzed in the form of a linear hybrid system subject to additive abrupt changes. The general research is aimed to achieve improved homing accuracy by integrating ideas from detection theory, state estimation theory and guidance. The results achieved can be summarized as follows. (i) Two novel maneuver detectors are developed to diagnose abrupt changes in a class of hybrid systems (detection and isolation of evasive maneuvers): a new implementation of the GLR detector and the novel adaptive- H0 GLR detector. (ii) Two novel state estimators for target tracking are derived using the novel maneuver detectors. The state estimators employ parameterized family of functions to described possible evasive maneuvers. (iii) A novel adaptive Bayesian multiple model predictor of the ballistic miss is developed which employs semi-Markov models and ideas from detection theory. (iv) A novel integrated estimation and guidance scheme that significantly improves the homing accuracy is also presented. The integrated scheme employs banks of estimators and guidance laws, a maneuver detector, and an on-line governor; the scheme is adaptive with respect to the uncertainty affecting the probability density function of the filtered state. (v) A novel discretization technique for the family of continuous-time, game theoretic, bang-bang guidance laws is introduced. The

  18. Early Mission Maneuver Operations for the Deep Space Climate Observatory Sun-Earth L1 Libration Point Mission

    Science.gov (United States)

    Roberts, Craig; Case, Sara; Reagoso, John; Webster, Cassandra

    2015-01-01

    The Deep Space Climate Observatory mission launched on February 11, 2015, and inserted onto a transfer trajectory toward a Lissajous orbit around the Sun-Earth L1 libration point. This paper presents an overview of the baseline transfer orbit and early mission maneuver operations leading up to the start of nominal science orbit operations. In particular, the analysis and performance of the spacecraft insertion, mid-course correction maneuvers, and the deep-space Lissajous orbit insertion maneuvers are discussed, com-paring the baseline orbit with actual mission results and highlighting mission and operations constraints..

  19. A multinomial-logit ordered-probit model for jointly analyzing crash avoidance maneuvers and crash severity

    DEFF Research Database (Denmark)

    Kaplan, Sigal; Prato, Carlo Giacomo

    ' propensity to engage in various corrective maneuvers in the case of the critical event of vehicle travelling. Five lateral and speed control maneuvers are considered: “braking”, “steering”, “braking & steering”, and “other maneuvers”, in addition to a “no action” option. The analyzed data are retrieved from...... the United States National Automotive Sampling System General Estimates System (GES) crash database for the years 2005-2009. Results show (i) the correlation between crash avoidance maneuvers and crash severity, and (ii) the link between drivers' attributes, risky driving behavior, road characteristics...

  20. Effects of intrapartum epidural analgesia at high altitudes: maternal, fetal, and neonatal outcomes. A randomized controlled trial of two formulations of analgesics.

    Science.gov (United States)

    Shokry, Mahmoud; Manaa, Essam M; Shoukry, Randa Ali; Shokeir, Mohamed Hossam; Elsedfy, Ghada O; Abd El-Aziz, Abd El-Salam

    2010-07-01

    To investigate whether intrapartum epidural analgesics (bupivacaine or ropivacaine) have an influence (safety and efficacy) on mothers, fetuses, or newborns at high altitudes (2,200 m above the sea level). Prospective randomized trial. A tertiary referral hospital in Aseer region, Saudi Arabia. Eighty parturient women with normal full term pregnancy (37-40 weeks) were randomly allocated to a group receiving epidural bupivacaine 0.125% and the other receiving ropivacaine 0.2%, with fentanyl 100 microg given to both groups. Intra- and postpartum clinical management of the pregnant women and newborns and fetal Doppler assessments were performed. Severity of pain, onset and duration of analgesia, and occurrence of motor blockade were primary outcomes. Progress of labor, need for oxytocin augmentation, mode of delivery, and neonatal condition were secondary outcomes. Demographic, labor characteristics, and neonatal outcomes of the two groups were comparable. The onset of analgesia was relatively more rapid for ropivacaine group (p = 0.067). Duration of analgesia after the first bolus dose was longer and the need for supplemental epidural analgesic doses was lesser in the bupivacaine group (p = 0.041 and 0.045, respectively). In both groups, the fetal umbilical and middle cerebral artery pulsatility indices showed significant change when compared to the baseline of the same group. At high altitudes, no major advantage was found for epidural ropivacaine over bupivacaine in addition to fentanyl for labor analgesia and no harmful effects of the medications were found on mothers, fetuses, or newborns.

  1. Evaluation of the Trade Space Between UAS Maneuver Performance and SAA System Performance Requirements

    Science.gov (United States)

    Jack, Devin P.; Hoffler, Keith D.; Johnson, Sally C.

    2014-01-01

    A need exists to safely integrate Unmanned Aircraft Systems (UAS) into the National Airspace System. Replacing manned aircraft's see-and-avoid capability in the absence of an onboard pilot is one of the key challenges associated with safe integration. Sense-and-avoid (SAA) systems will have to achieve yet-to-be-determined required separation distances for a wide range of encounters. They will also need to account for the maneuver performance of the UAS they are paired with. The work described in this paper is aimed at developing an understanding of the trade space between UAS maneuver performance and SAA system performance requirements. An assessment of current manned and unmanned aircraft performance was used to establish potential UAS performance test matrix bounds. Then, nearterm UAS integration work was used to narrow down the scope. A simulator was developed with sufficient fidelity to assess SAA system performance requirements for a wide range of encounters. The simulator generates closest-point-of-approach (CPA) data from the wide range of UAS performance models maneuvering against a single intruder with various encounter geometries. The simulator is described herein and has both a graphical user interface and batch interface to support detailed analysis of individual UAS encounters and macro analysis of a very large set of UAS and encounter models, respectively. Results from the simulator using approximate performance data from a well-known manned aircraft is presented to provide insight into the problem and as verification and validation of the simulator. Analysis of climb, descent, and level turn maneuvers to avoid a collision is presented. Noting the diversity of backgrounds in the UAS community, a description of the UAS aerodynamic and propulsive design and performance parameters is included. Initial attempts to model the results made it clear that developing maneuver performance groups is required. Discussion of the performance groups developed and how

  2. Slewing maneuvers and vibration control of space structures by feedforward/feedback moment-gyro controls

    Science.gov (United States)

    Yang, Li-Farn; Mikulas, Martin M., Jr.; Park, K. C.; Su, Renjeng

    1993-01-01

    This paper presents a moment-gyro control approach to the maneuver and vibration suppression of a flexible truss arm undergoing a constant slewing motion. The overall slewing motion is triggered by a feedforward input, and a companion feedback controller is employed to augment the feedforward input and subsequently to control vibrations. The feedforward input for the given motion requirement is determined from the combined CMG (Control Momentum Gyro) devices and the desired rigid-body motion. The rigid-body dynamic model has enabled us to identify the attendant CMG momentum saturation constraints. The task for vibration control is carried out in two stages; first in the search of a suitable CMG placement along the beam span for various slewing maneuvers, and subsequently in the development of Liapunov-based control algorithms for CMG spin-stabilization. Both analytical and numerical results are presented to show the effectiveness of the present approach.

  3. Conflict resolution maneuvers during near miss encounters with cockpit traffic displays

    Science.gov (United States)

    Palmer, E.

    1983-01-01

    The benefits and liabilities associated with pilots' use of a cockpit traffic display to assess the threat posed by air traffic and to make small maneuvers to avoid situations which would result in collision avoidance advisories are experimentally studied. The crew's task was to fly a simulated wide-body aircraft along a straight course at constant altitude while intruder aircraft appeared on a variety of converging trajectories. The main experimental variables were the amount and quality of the information displayed on the intruder aircraft's estimated future position. Pilots were to maintain a horizontal separation of at least 1.5 nautical miles or a vertical separation of 500 ft, so that collision avoidance advisories would not be triggered. The results show that pilots could usually maneuver to provide the specified separation but often made course deviations greater than 1.5 nm or 500 ft.

  4. Horizontal Conflict Resolution Maneuvers with a Cockpit Display of Traffic Information

    Science.gov (United States)

    Palmer, E.; Jago, S.; Dubord, M.

    1981-01-01

    Pilot resolution of potential conflicts in the horizontal plane when the only information available on the other aircraft was presented on a Cockpit Display of Traffic Information (CDTI) is investigated. The pilot's task was to assess the situation and if necessary maneuver so as to avoid the other aircraft. No instructions were given on evasive strategy or on what was considered to be an acceptable minimum separation. The results indicate that pilots had a strong bias of turning toward the intruder aircraft in order to pass behind it. In more than 50% of the encounters with a 90 degree crossing angle in which the intruder aircraft was programmed to pass behind the aircraft, the pilots maneuvered so as to pass behind the intruder. This bias was not as strong with the display which showed a prediction of the intruder's relative velocity. The average miss distance for all encounters was about 4500 feet.

  5. Optimization model of conventional missile maneuvering route based on improved Floyd algorithm

    Science.gov (United States)

    Wu, Runping; Liu, Weidong

    2018-04-01

    Missile combat plays a crucial role in the victory of war under high-tech conditions. According to the characteristics of maneuver tasks of conventional missile units in combat operations, the factors influencing road maneuvering are analyzed. Based on road distance, road conflicts, launching device speed, position requirements, launch device deployment, Concealment and so on. The shortest time optimization model was built to discuss the situation of road conflict and the strategy of conflict resolution. The results suggest that in the process of solving road conflict, the effect of node waiting is better than detour to another way. In this study, we analyzed the deficiency of the traditional Floyd algorithm which may limit the optimal way of solving road conflict, and put forward the improved Floyd algorithm, meanwhile, we designed the algorithm flow which would be better than traditional Floyd algorithm. Finally, throgh a numerical example, the model and the algorithm were proved to be reliable and effective.

  6. Quadcopter Aggressive Maneuvers along Singular Configurations: An Energy-Quaternion Based Approach

    Directory of Open Access Journals (Sweden)

    Ayman A. El-Badawy

    2016-01-01

    Full Text Available Automatic aggressive maneuvers with quadcopters are regarded as a highly challenging control problem. The aim is to tackle the singularities that exist in a vertical looping maneuver. Modeling singularities are resolved by writing the equations-of-motion of the quadcopter in quaternion form. Physical singularities due to underactuation are resolved by using an energy-based control. Energy-based control is utilized to overcome the uncontrollability of the quadcopter at physical singular configurations, for instance, when commanding the quadcopter to gain altitude while pitched at 90∘. Three looping strategies (circular, clothoidal, and newly developed constant thrust are implemented on a nonlinear model of the quadcopter. The three looping strategies are discussed along with their advantages and limitations.

  7. Hybrid Switching Controller Design for the Maneuvering and Transit of a Training Ship

    Directory of Open Access Journals (Sweden)

    Tomera Mirosław

    2017-03-01

    Full Text Available The paper presents the design of a hybrid controller used to control the movement of a ship in different operating modes, thereby improving the performance of basic maneuvers. This task requires integrating several operating modes, such as maneuvering the ship at low speeds, steering the ship at different speeds in the course or along the trajectory, and stopping the ship on the route. These modes are executed by five component controllers switched on and off by the supervisor depending on the type of operation performed. The desired route, containing the coordinates of waypoints and tasks performed along consecutive segments of the reference trajectory, is obtained by the supervisory system from the system operator. The former supports switching between component controllers and provides them with new set-points after each change in the reference trajectory segment, thereby ensuring stable operation of the entire hybrid switching controller.

  8. Implementation of the Orbital Maneuvering Systems Engine and Thrust Vector Control for the European Service Module

    Science.gov (United States)

    Millard, Jon

    2014-01-01

    The European Space Agency (ESA) has entered into a partnership with the National Aeronautics and Space Administration (NASA) to develop and provide the Service Module (SM) for the Orion Multipurpose Crew Vehicle (MPCV) Program. The European Service Module (ESM) will provide main engine thrust by utilizing the Space Shuttle Program Orbital Maneuvering System Engine (OMS-E). Thrust Vector Control (TVC) of the OMS-E will be provided by the Orbital Maneuvering System (OMS) TVC, also used during the Space Shuttle Program. NASA will be providing the OMS-E and OMS TVC to ESA as Government Furnished Equipment (GFE) to integrate into the ESM. This presentation will describe the OMS-E and OMS TVC and discuss the implementation of the hardware for the ESM.

  9. Virtual maneuvering test in CFD media in presence of free surface

    Directory of Open Access Journals (Sweden)

    Ahmad Hajivand

    2015-05-01

    Full Text Available Maneuvering oblique towing test is simulated in a Computational Fluid Dynamic (CFD environment to obtain the linear and nonlinear velocity dependent damping coefficients for a DTMB 5512 model ship. The simulations are carried out in freely accessible OpenFOAM library with three different solvers, rasInterFoam, LTSInterFoam and interDyMFoam, and two turbulence models, k-ε and SST k-ω in presence of free surface. Turning and zig-zag maneuvers are simulated for the DTMB 5512 model ship using the calculated damping coefficients with CFD. The comparison of simulated results with the available experimental shows a very good agreement among them.

  10. Analysis of LFM-waveform Libraries for Cognitive Tracking Maneuvering Targets

    Directory of Open Access Journals (Sweden)

    Wang Hongyan

    2016-01-01

    Full Text Available Based on the idea of the waveform agility in cognitive radars,the waveform libraries for maneuvering target tracking are discussed. LFM-waveform libraries are designed according to different combinations of chirp parameters and FrFT rotation angles. By applying the interact multiple model (IMM algorithm in tracking maneuvering targets, transmitted waveform is called real time from the LFM-waveform libraries. The waveforms are selected from the library according to the criterion of maximum mutual information between the current state of knowledge of the model and the measurement. Simulation results show that waveform library containing certain amount LFM-waveforms can improve the performance of cognitive tracking radar.

  11. A Novel Guidance Law with Line-of-Sight Acceleration Feedback for Missiles against Maneuvering Targets

    Directory of Open Access Journals (Sweden)

    Kemao Ma

    2014-01-01

    Full Text Available Terminal guidance law design and its implementation are considered for homing missiles against maneuvering targets. The lateral acceleration dynamics are taken into account in the design. In the guidance law design, the line-of-sight acceleration signals are incorporated into the acceleration reference signals to compensate for the targets’ maneuvers. Then the commanded accelerations are designed and the convergent tracking of the lateral accelerations to these signals is proven theoretically. In the guidance implementation, a linear high-gain differentiator is used to estimate the line-of-sight rates and the line-of-sight acceleration signals. To avoid the magnifying effects of higher order differentiation, a practical design of commanded accelerations is given to realize approximate tracking of the lateral accelerations to the given reference signals. Simulation is conducted for both cases with and without measurement noises. The simulation results justify the feasibility of the design and the implementation.

  12. Cerebral near-infrared spectroscopy to evaluate anti-G straining maneuvers in centrifuge training.

    Science.gov (United States)

    Kobayashi, Asao; Kikukawa, Azusa; Kimura, Mikihiko; Inui, Takuo; Miyamoto, Yoshinori

    2012-08-01

    Over the past decade, near-infrared spectroscopy (NIRS) has emerged as an easily manageable noninvasive method for the continuous monitoring of cerebral cortical oxygenation during +Gz exposure. NIRS is also used to evaluate pilot trainees' ability to adequately perform anti-G straining maneuvers in the course of centrifuge training. This study aimed to determine the general patterns and individual differences in NIRS recordings during +Gz exposure. There were 22 healthy male cadets who participated in the study. The centrifuge training profiles included a gradual onset run (GOR, onset rate of 0.1 Gz x s(-1)) and short-term repeated exposures, with Gz levels from 4 to 7 Gz at an onset rate of 1.0 Gz x s(-1) (rapid onset run, ROR). Cortical tissue hemoglobin saturation (tissue oxygenation index, TOI) and changes in the concentration of oxygenated hemoglobin (O2Hb) were recorded from the right forehead during the period of Gz exposure. Most of the subjects successfully performed an anti-G straining maneuver and maintained or increased the cerebral oxygenation level during Gz exposure. In four subjects, however, oxygenation decline was observed at levels over 4 Gz, even though their anti-G systems were functioning. In contrast to the O2Hb response, TOI, which reflects intracranial oxygenation changes, was decreased during the anti-G straining maneuver at Gz onset or during the countdown to a ROR exposure. Although NIRS is an effective tool for monitoring anti-G straining maneuver performance, it should be carefully evaluated in terms of intracranial oxygenation results.

  13. Does Shoe Collar Height Influence Ankle Joint Kinematics and Kinetics in Sagittal Plane Maneuvers?

    Directory of Open Access Journals (Sweden)

    Yang Yang, Ying Fang, Xini Zhang, Junliang He, Weijie Fu

    2017-12-01

    Full Text Available The Objective of the study is to investigate the effects of basketball shoes with different collar heights on ankle kinematics and kinetics and athletic performance in different sagittal plane maneuvers. Twelve participants who wore high-top and low-top basketball shoes (hereafter, HS and LS, respectively performed a weight-bearing dorsiflexion (WB-DF maneuver, drop jumps (DJs, and lay-up jumps (LJs. Their sagittal plane kinematics and ground reaction forces were recorded using the Vicon motion capture system and Kistler force plates simultaneously. Moreover, ankle dorsiflexion and plantarflexion angles, moment, power, stiffness, and jump height were calculated. In the WB-DF test, the peak ankle dorsiflexion angle (p = 0.041 was significantly smaller in HS than in LS. Additionally, the peak ankle plantarflexion moment (p = 0.028 and power (p = 0.022 were significantly lower in HS than in LS during LJs but not during DJs. In both jumping maneuvers, no significant differences were found in the jump height or ankle kinematics between the two shoe types. According to the WB-DF test, increasing shoe collar height can effectively reduce the ankle range of motion in the sagittal plane. Although the HS did not restrict the flexion–extension performance of the ankle joint during two jumping maneuvers, an increased shoe collar height can reduce peak ankle plantarflexion moment and peak power during the push-off phase in LJs. Therefore, a higher shoe collar height should be used to circumvent effects on the partial kinetics of the ankle joint in the sagittal plane.

  14. Stroke Volume during Mueller Maneuver Measured by Impedance Cardiography in Patients with Mitral Regurgitation

    Czech Academy of Sciences Publication Activity Database

    Viščor, Ivo; Jurák, Pavel; Vondra, Vlastimil; Halámek, Josef; Leinveber, Pavel

    2009-01-01

    Roč. 36, - (2009), s. 749-751 ISSN 0276-6574 R&D Projects: GA AV ČR IAA200650801; GA ČR GP102/07/P425 Institutional research plan: CEZ:AV0Z20650511 Keywords : Mueller maneuver * impedance cardiography * congestive heart failure Subject RIV: JA - Electronics ; Optoelectronics, Electrical Engineering http://cinc.mit.edu/archives/2009/pdf/0749.pdf

  15. Liver hanging maneuver for right hemiliver in situ donation – anatomical considerations

    OpenAIRE

    Trotovšek, B.; Gadžijev, E.M.; Ravnik, D.; Hribernik, M.

    2006-01-01

    Background. An anatomical study was carried out to evaluate the safety of the liver hanging maneuver for the right hemiliver in living donor and in situ splitting transplantation. During this procedure a 4–6 cm blind dissection is performed between the inferior vena cava and the liver. Short subhepatic veins entering the inferior vena cava from segments 1 and 9 could be torn with consequent hemorrhage. Materials and methods. One hundred corrosive casts of livers were evaluated to establish th...

  16. Optimal Braking Patterns and Forces in Autonomous Safety-Critical Maneuvers

    OpenAIRE

    Fors, Victor

    2018-01-01

    The trend of more advanced driver-assistance features and the development toward autonomous vehicles enable new possibilities in the area of active safety. With more information available in the vehicle about the surrounding traffic and the road ahead, there is the possibility of improved active-safety systems that make use of this information for stability control in safety-critical maneuvers. Such a system could adaptively make a trade-off between controlling the longitudinal, lateral, and ...

  17. The balance and harmony of control power for a combat aircraft in tactical maneuvering

    Science.gov (United States)

    Bocvarov, Spiro; Cliff, Eugene M.; Lutze, Frederick H.

    1992-01-01

    An analysis is presented for a family of regular extremal attitude-maneuvers for the High Angle-of-Attack Research Vehicle that has thrust-vectoring capability. Different levels of dynamic coupling are identified in the combat aircraft attitude model, and the characteristic extremal-family motion is explained. It is shown why the extremal-family trajectories develop small sideslip-angles, a highly desirable feature from a practical viewpoint.

  18. Effects of Climate Change and Urban Development on Army Training Capabilities: Firing Ranges and Maneuver Areas

    Science.gov (United States)

    2016-08-01

    investments in the development of off-post housing, shopping facilities, dining facilities ( restaurants ), and other busi- nesses that provide...Regional Urban Growth model (RUG) (Westervelt 2011), the ERDC TR-16-1 35 Landuse Evolution and Impact Assessment Model (LEAM) (Deal 2004), and the U.S...Land Use Scenarios JCSG Joint Cross-Service Group KBDI Keetch-Byram Drought Index LEAM Land-use Evolution and impact Assessment Model MAC Maneuver

  19. Designing a Fuzzy Logic Controller to Enhance Directional Stability of Vehicles under Difficult Maneuvers

    OpenAIRE

    Mehrdad N. Khajavi; Golamhassan Paygane; Ali Hakima

    2009-01-01

    Vehicle which are turning or maneuvering at high speeds are susceptible to sliding and subsequently deviate from desired path. In this paper the dynamics governing the Yaw/Roll behavior of a vehicle has been simulated. Two different simulations have been used one for the real vehicle, for which a fuzzy controller is designed to increase its directional stability property. The other simulation is for a hypothetical vehicle with much higher tire cornering stiffness which is ca...

  20. Performance evaluation of control strategies for power maneuvering event of the KALIMER-600

    International Nuclear Information System (INIS)

    Seong, Seong-Hwan; Kim, Seong-O

    2012-01-01

    Highlights: ► The performance of three power control strategies of the KALIMER-600 was evaluated. ► There are turbine-, reactor- and feedwater-leading strategies in this study. ► For this, a performance analysis code was developed in this study. ► Simulation results show the turbine-leading is the best alternative. ► The feedwater-leading seems to be the second option. - Abstract: A sodium-cooled fast reactor named KALIMER-600 has been under development at KAERI. It is a pool-type reactor with the intermediate loops filled with sodium and has a superheated steam cycle with the once-through steam generators. Since the characteristic of the power control of the KALIMER-600 is expected to be different with that of a conventional power plant, the performance of the turbine-leading, reactor-leading and feedwater-leading control strategies for a power maneuvering event of the KALIMER-600 was evaluated in this study. The turbine-leading and reactor-leading strategies are very similar to those of a conventional water reactor but the feedwater-leading strategy is very similar to that of a fossil plant. Also, a performance analysis code which can analyze the plant dynamics of the KALIMER-600 and simulate the control actions during a power maneuvering event was developed. To evaluate the performance of control strategies, a simple power maneuvering event including a 10% step change and a ramp change with a rate of 5%/min was assumed and simulated. Through the simulation results, the turbine-leading strategy is proven to be very suitable for the KALIMER-600 and the feedwater-leading strategy for power maneuvering seems to be a good alternative for the power control. In further studies, various performance-related events such as the reactor power cutback, turbine runback and some transients will be evaluated and the best control strategy will be suggested.

  1. Does Shoe Collar Height Influence Ankle Joint Kinematics and Kinetics in Sagittal Plane Maneuvers?

    Science.gov (United States)

    Yang, Yang; Fang, Ying; Zhang, Xini; He, Junliang; Fu, Weijie

    2017-12-01

    The Objective of the study is to investigate the effects of basketball shoes with different collar heights on ankle kinematics and kinetics and athletic performance in different sagittal plane maneuvers. Twelve participants who wore high-top and low-top basketball shoes (hereafter, HS and LS, respectively) performed a weight-bearing dorsiflexion (WB-DF) maneuver, drop jumps (DJs), and lay-up jumps (LJs). Their sagittal plane kinematics and ground reaction forces were recorded using the Vicon motion capture system and Kistler force plates simultaneously. Moreover, ankle dorsiflexion and plantarflexion angles, moment, power, stiffness, and jump height were calculated. In the WB-DF test, the peak ankle dorsiflexion angle (p = 0.041) was significantly smaller in HS than in LS. Additionally, the peak ankle plantarflexion moment (p = 0.028) and power (p = 0.022) were significantly lower in HS than in LS during LJs but not during DJs. In both jumping maneuvers, no significant differences were found in the jump height or ankle kinematics between the two shoe types. According to the WB-DF test, increasing shoe collar height can effectively reduce the ankle range of motion in the sagittal plane. Although the HS did not restrict the flexion-extension performance of the ankle joint during two jumping maneuvers, an increased shoe collar height can reduce peak ankle plantarflexion moment and peak power during the push-off phase in LJs. Therefore, a higher shoe collar height should be used to circumvent effects on the partial kinetics of the ankle joint in the sagittal plane.

  2. Home particle repositioning maneuver to prevent the recurrence of posterior canal BPPV.

    Science.gov (United States)

    Ismail, Elshahat Ibrahem; Morgan, Ashraf Elsayed; Abdeltawwab, Mohamed Moustafa

    2018-03-08

    To check the value of home particle repositioning maneuver in the prevention of the recurrence of posterior canal benign paroxysmal positional vertigo (pc-BPPV). In this study, patients diagnosed as unilateral posterior canal BPPV were selected following an accurate evaluation using video goggle VNG system. All patients were managed by particle repositioning maneuver (PRM). Patients were instructed to do home PRM once weekly for five years. Then, they were divided into two groups (according to choice of patient to do PRM). The first group (control group) consisted of 144 patients who did not do home PRM; whereas the second group (study group) included 165 patients who performed home PRM. All patients (control & study groups) were followed up every four months for five years. The study found out that the recurrence rate of pc-BPPV in control group was 33 patients in the first year (27.2%), 11 patients in second year (9%), 5 patients in third year (4%), 3 patients in fourth year (2.5%) and 3 patients in fifth year (2.5%). The recurrence of pc-BPPV in the treated side (study group) of patients was reported as 5 patients in the first year (3.5%), 3 patients in the second year (2%), 2 patients in the third year (1.4%), 2 patients in the fourth year (1.4%), and 1 patient in the fifth year (0.7%). There was statistically significant difference between the control and the study groups regarding the recurrence rates in the first year follow up which was the highest in first four months. Home particle repositioning maneuver has the capacity to prevent the recurrence of pc-BPPV. It proved to be more successful and functional in minimizing the recurrence of the disease in the study than in the control group. Hence, home particle repositioning maneuver is highly recommended for one year at least in pc-BPPV. Copyright © 2018 Elsevier B.V. All rights reserved.

  3. In-shoe plantar tri-axial stress profiles during maximum-effort cutting maneuvers.

    Science.gov (United States)

    Cong, Yan; Lam, Wing Kai; Cheung, Jason Tak-Man; Zhang, Ming

    2014-12-18

    Soft tissue injuries, such as anterior cruciate ligament rupture, ankle sprain and foot skin problems, frequently occur during cutting maneuvers. These injuries are often regarded as associated with abnormal joint torque and interfacial friction caused by excessive external and in-shoe shear forces. This study simultaneously investigated the dynamic in-shoe localized plantar pressure and shear stress during lateral shuffling and 45° sidestep cutting maneuvers. Tri-axial force transducers were affixed at the first and second metatarsal heads, lateral forefoot, and heel regions in the midsole of a basketball shoe. Seventeen basketball players executed both cutting maneuvers with maximum efforts. Lateral shuffling cutting had a larger mediolateral braking force than 45° sidestep cutting. This large braking force was concentrated at the first metatarsal head, as indicated by its maximum medial shear stress (312.2 ± 157.0 kPa). During propulsion phase, peak shear stress occurred at the second metatarsal head (271.3 ± 124.3 kPa). Compared with lateral shuffling cutting, 45° sidestep cutting produced larger peak propulsion shear stress (463.0 ± 272.6 kPa) but smaller peak braking shear stress (184.8 ± 181.7 kPa), of which both were found at the first metatarsal head. During both cutting maneuvers, maximum medial and posterior shear stress occurred at the first metatarsal head, whereas maximum pressure occurred at the second metatarsal head. The first and second metatarsal heads sustained relatively high pressure and shear stress and were expected to be susceptible to plantar tissue discomfort or injury. Due to different stress distribution, distinct pressure and shear cushioning mechanisms in basketball footwear might be considered over different foot regions. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Archaeological Sites Inventory in the Black Hills of the Pinon Canyon Maneuver Site, Las Animas County, Colorado

    National Research Council Canada - National Science Library

    Owens, Mark

    2000-01-01

    .... These tree-covered areas located adjacent to open plains, appear black on the horizon. This setting of open steppes and juxtaposed hills is found along the eastern portion of the Pinon Canyon Maneuver Site (PCMS), a U.S...

  5. Adjuvant Maneuvers for Residual Curvature Correction During Penile Prosthesis Implantation in Men with Peyronie's Disease.

    Science.gov (United States)

    Berookhim, Boback M; Karpman, Edward; Carrion, Rafael

    2015-11-01

    The surgical treatment of comorbid erectile dysfunction and Peyronie's disease has long included the implantation of an inflatable penile prosthesis as well as a number of adjuvant maneuvers to address residual curvature after prosthesis placement. To review the various surgical options for addressing curvature after prosthesis placement, with specific attention paid to an original article by Wilson et al. reporting on modeling over a penile prosthesis for the management of Peyronie's disease. A literature review was performed analyzing articles reporting the management of penile curvature in patients undergoing implantation of an inflatable penile prosthesis. Reported improvement in Peyronie's deformity as well as the complication rate associated with the various surgical techniques described. Modeling is a well-established treatment modality among patients with Peyronie's disease undergoing penile prosthesis implantation. A variety of other adjuvant maneuvers to address residual curvature when modeling alone is insufficient has been presented in the literature. Over 20 years of experience with modeling over a penile prosthesis have proven the efficacy and safety of this treatment option, providing the surgeon a simple initial step for the management of residual curvature after penile implantation which allows for the use of additional adjuvant maneuvers in those with significant deformities. © 2015 International Society for Sexual Medicine.

  6. Mueller-Hillis maneuver and angle of progression: Are they correlated?

    Directory of Open Access Journals (Sweden)

    Sofia Mendes

    Full Text Available Summary Objective: Mueller-Hillis maneuver (MHM and angle of progression (AOP measured by transperineal ultrasound have been used to assess fetal head descent during the second stage of labor. We aimed to assess whether AOP correlates with MHM in the second stage of labor. Method: A prospective observational study including women with singleton pregnancy in the second stage of labor was performed. The AOP was measured immediately after the Mueller-Hillis maneuver. A receiver-operating characteristics (ROC curve analysis was performed to determine the best discriminatory AOP cut-off for the identification of a positive MHM. A p-value less than 0.05 was considered statistically significant. Results: One hundred and sixty-six (166 women were enrolled in the study and 81.3% (n=135 had a positive MHM. The median AOP was 143º (106º to 210º. The area under the curve for the prediction of a positive maneuver was 0.619 (p=0.040. Derived from the ROC curve, an AOP of 138.5º had the best diagnostic performance for the identification of a positive MHM (specificity of 65% and a sensitivity of 67%. Conclusion: An AOP of 138º seems to be associated with a positive MHM in the second stage of labor.

  7. Effects of the Mueller maneuver on functional mitral regurgitation and implications for obstructive sleep apnea.

    Science.gov (United States)

    Pressman, Gregg S; Orban, Marek; Leinveber, Pavel; Parekh, Kunal; Singh, Manmeet; Kara, Tomas; Somers, Virend K

    2015-06-01

    Obstructive sleep apnea is prevalent and adversely affects cardiovascular health. However, little is known of the acute effects of an obstructive apnea on cardiovascular physiology. We hypothesized that pre-existing functional mitral regurgitation (MR) would worsen during performance of a Mueller maneuver (MM) used to simulate an obstructive apnea; 15 subjects with an ejection fraction ≤35% and pre-existing functional MR were studied with Doppler echocardiography. The radius of the proximal flow convergence was used as a measure of mitral regurgitant flow. Measurements were made at baseline, during the MM, and post-MM. Areas of all 4 chambers were also measured at these time points, both in systole and diastole. Mean flow convergence radius for the group decreased significantly during the transition from the late-MM to post-MM (0.65 → 0.57 mm, p = 0.001), implying increased MR during the MM. In addition, in 3 subjects, duration of MR increased during the MM. Right atrial (RA) areas, both systolic and diastolic, increased during the maneuver, whereas RA fractional area change decreased, indicating reduced RA emptying. Left ventricular emptying decreased early in the maneuver, probably because of the increased afterload burden, and then recovered. In conclusion, high negative intrathoracic pressure produces changes that, repeated hundreds of times per night in patients with obstructive sleep apnea, have the potential to worsen heart failure and predispose affected subjects to atrial fibrillation. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Maintaining Aura's Orbit Requirements While Performing Orbit Maintenance Maneuvers Containing an Orbit Normal Delta-V Component

    Science.gov (United States)

    Johnson, Megan R.; Petersen, Jeremy D.

    2014-01-01

    The Earth Observing System (EOS) Afternoon Constellation consists of five member missions (GCOM-W1, Aqua, CALIPSO, CloudSat, and Aura), each of which maintain a frozen, sun-synchronous orbit with a 16-day repeating ground track that follows the Worldwide Reference System-2 (WRS-2). Under nominal science operations for Aura, the propulsion system is oriented such that the resultant thrust vector is aligned 13.493 degrees away from the velocity vector along the yaw axis. When performing orbit maintenance maneuvers, the spacecraft performs a yaw slew to align the thrust vector in the appropriate direction. A new Drag Make Up (DMU) maneuver operations scheme has been implemented for Aura alleviating the need for the 13.493 degree yaw slew. The focus of this investigation is to assess the impact that no-slew DMU maneuver operations will have on Aura's Mean Local Time (MLT) which drives the required along track separation between Aura and the constellation members, as well as Aura's frozen orbit properties, eccentricity and argument of perigee. Seven maneuver strategies were analyzed to determine the best operational approach. A mirror pole strategy, with maneuvers alternating at the North and South poles, was implemented operationally to minimize impact to the MLT. Additional analysis determined that the mirror pole strategy could be further modified to include frozen orbit maneuvers and thus maintain both MLT and the frozen orbit properties under noslew operations.

  9. ABDOMINAL DRAWING IN MANEUVER: EFFECT ON GAIT PARAMETERS AND PAIN REDUCTION IN PATIENTS WITH CHRONIC LOW BACK PAIN

    Directory of Open Access Journals (Sweden)

    Paramasivan Mani

    2016-08-01

    Full Text Available Background: Back pain is the common musculoskeletal condition with a high prevalence of up to 80% among the general and work force population at some times in their lives.Muscular injury, fatigue, or facet or disc degeneration can compromise the stabilizing effects resulting in shearing forces that cause pain.Abdominal drawing in maneuver is used to facilitate the re-education of neuromuscular control mechanisms provided by local stabilizing muscles. Objective of the study is to measure the gait parameters and pain control before and after abdominal drawing in maneuver in patient with chronic mechanical low back pain. Methods: Total number of 30 consecutive patients and they were divided into two groups by purposive sampling. Group A is subjects with low back pain and Group B is subjects without low back pain. Outcome measures were average step cycle, average step length, coefficient of variation, time on each foot, Ambulation index measured with Biodex gait trainer. Pain is measured with Revised-Oswestry low back pain questionnaire. Results: Significant difference between gait parameters were observed in both low back pain group and the group without low back pain group with abdominal drawing in maneuver and the changes without abdominal drawing in maneuver was minimal. There was no significant difference found between both groups with or without abdominal drawing in maneuver. Conclusion: Gait parameters and Pain control can be improved by training with abdominal drawing in maneuver thereby it reduces pain and improves gait symmetry in subjects with low back pain.

  10. A randomised clinical trial on cardiotocography plus fetal blood sampling versus cardiotocography plus ST-analysis of the fetal electrocardiogram (STAN® for intrapartum monitoring

    Directory of Open Access Journals (Sweden)

    Rijnders Robbert JP

    2007-07-01

    . Assuming a reduction of metabolic acidosis from 3.5% to 2.1 %, using a two-sided test with an alpha of 0.05 and a power of 0.80, in favour of CTG plus ST-analysis, about 5100 women have to be randomised. Furthermore, the cost-effectiveness of CTG and ST-analysis as compared to CTG and FBS will be studied. Discussion This study will provide data about the use of intrapartum ST-analysis with a strict protocol for performance of FBS to limit its incidence. We aim to clarify to what extent intrapartum ST-analysis can be used without the performance of FBS and in which cases FBS is still needed. Trial Registration Number ISRCTN95732366

  11. Effectiveness of Otolith Repositioning Maneuvers and Vestibular Rehabilitation exercises in elderly people with Benign Paroxysmal Positional Vertigo: a systematic review.

    Science.gov (United States)

    Ribeiro, Karyna Figueiredo; Oliveira, Bruna Steffeni; Freitas, Raysa V; Ferreira, Lidiane M; Deshpande, Nandini; Guerra, Ricardo O

    2017-06-29

    Benign Paroxysmal Positional Vertigo is highly prevalent in elderly people. This condition is related to vertigo, hearing loss, tinnitus, poor balance, gait disturbance, and an increase in risk of falls, leading to postural changes and quality of life decreasing. To evaluate the outcomes obtained by clinical trials on the effectiveness of Otolith Repositioning Maneuver and Vestibular Rehabilitation exercises in the treatment of Benign Paroxysmal Positional Vertigo in elderly. The literature research was performed using PubMed, Scopus, Web of Science and PEDro databases, and included randomized controlled clinical trials in English, Spanish and Portuguese, published during January 2000 to August 2016. The methodological quality of the studies was assessed by PEDro score and the outcomes analysis was done by critical revision of content. Six studies were fully reviewed. The average age of participants ranged between 67.2 and 74.5 years. The articles were classified from 2 to 7/10 through the PEDro score. The main outcome measures analyzed were vertigo, positional nystagmus and postural balance. Additionally, the number of maneuvers necessary for remission of the symptoms, the quality of life, and the functionality were also assessed. The majority of the clinical trials used Otolith Repositioning Maneuver (n=5) and 3 articles performed Vestibular Rehabilitation exercises in addition to Otolith Repositioning Maneuver or pharmacotherapy. One study showed that the addition of movement restrictions after maneuver did not influence the outcomes. There was a trend of improvement in Benign Paroxysmal Positional Vertigo symptomatology in elderly patients who underwent Otolith Repositioning Maneuver. There is sparse evidence from methodologically robust clinical trials that examined the effects of Otolith Repositioning Maneuver and Vestibular Rehabilitation exercises for treating Benign Paroxysmal Positional Vertigo in the elderly. Randomized controlled clinical trials with

  12. Effectiveness of Otolith Repositioning Maneuvers and Vestibular Rehabilitation exercises in elderly people with Benign Paroxysmal Positional Vertigo: a systematic review

    Directory of Open Access Journals (Sweden)

    Karyna Figueiredo Ribeiro

    Full Text Available Abstract Introduction Benign Paroxysmal Positional Vertigo is highly prevalent in elderly people. This condition is related to vertigo, hearing loss, tinnitus, poor balance, gait disturbance, and an increase in risk of falls, leading to postural changes and quality of life decreasing. Objective To evaluate the outcomes obtained by clinical trials on the effectiveness of Otolith Repositioning Maneuver and Vestibular Rehabilitation exercises in the treatment of Benign Paroxysmal Positional Vertigo in elderly. Methods The literature research was performed using PubMed, Scopus, Web of Science and PEDro databases, and included randomized controlled clinical trials in English, Spanish and Portuguese, published during January 2000 to August 2016. The methodological quality of the studies was assessed by PEDro score and the outcomes analysis was done by critical revision of content. Results Six studies were fully reviewed. The average age of participants ranged between 67.2 and 74.5 years. The articles were classified from 2 to 7/10 through the PEDro score. The main outcome measures analyzed were vertigo, positional nystagmus and postural balance. Additionally, the number of maneuvers necessary for remission of the symptoms, the quality of life, and the functionality were also assessed. The majority of the clinical trials used Otolith Repositioning Maneuver (n = 5 and 3 articles performed Vestibular Rehabilitation exercises in addition to Otolith Repositioning Maneuver or pharmacotherapy. One study showed that the addition of movement restrictions after maneuver did not influence the outcomes. Conclusion There was a trend of improvement in Benign Paroxysmal Positional Vertigo symptomatology in elderly patients who underwent Otolith Repositioning Maneuver. There is sparse evidence from methodologically robust clinical trials that examined the effects of Otolith Repositioning Maneuver and Vestibular Rehabilitation exercises for treating Benign Paroxysmal

  13. Uncertainty Requirement Analysis for the Orbit, Attitude, and Burn Performance of the 1st Lunar Orbit Insertion Maneuver

    Directory of Open Access Journals (Sweden)

    Young-Joo Song

    2016-12-01

    Full Text Available In this study, the uncertainty requirements for orbit, attitude, and burn performance were estimated and analyzed for the execution of the 1st lunar orbit insertion (LOI maneuver of the Korea Pathfinder Lunar Orbiter (KPLO mission. During the early design phase of the system, associate analysis is an essential design factor as the 1st LOI maneuver is the largest burn that utilizes the onboard propulsion system; the success of the lunar capture is directly affected by the performance achieved. For the analysis, the spacecraft is assumed to have already approached the periselene with a hyperbolic arrival trajectory around the moon. In addition, diverse arrival conditions and mission constraints were considered, such as varying periselene approach velocity, altitude, and orbital period of the capture orbit after execution of the 1st LOI maneuver. The current analysis assumed an impulsive LOI maneuver, and two-body equations of motion were adapted to simplify the problem for a preliminary analysis. Monte Carlo simulations were performed for the statistical analysis to analyze diverse uncertainties that might arise at the moment when the maneuver is executed. As a result, three major requirements were analyzed and estimated for the early design phase. First, the minimum requirements were estimated for the burn performance to be captured around the moon. Second, the requirements for orbit, attitude, and maneuver burn performances were simultaneously estimated and analyzed to maintain the 1st elliptical orbit achieved around the moon within the specified orbital period. Finally, the dispersion requirements on the B-plane aiming at target points to meet the target insertion goal were analyzed and can be utilized as reference target guidelines for a mid-course correction (MCC maneuver during the transfer. More detailed system requirements for the KPLO mission, particularly for the spacecraft bus itself and for the flight dynamics subsystem at the ground

  14. Analysis of Driver Evasive Maneuvering Prior to Intersection Crashes Using Event Data Recorders.

    Science.gov (United States)

    Scanlon, John M; Kusano, Kristofer D; Gabler, Hampton C

    2015-01-01

    Intersection crashes account for over 4,500 fatalities in the United States each year. Intersection Advanced Driver Assistance Systems (I-ADAS) are emerging vehicle-based active safety systems that have the potential to help drivers safely navigate across intersections and prevent intersection crashes and injuries. The performance of an I-ADAS is expected to be highly dependent upon driver evasive maneuvering prior to an intersection crash. Little has been published, however, on the detailed evasive kinematics followed by drivers prior to real-world intersection crashes. The objective of this study was to characterize the frequency, timing, and kinematics of driver evasive maneuvers prior to intersection crashes. Event data recorders (EDRs) downloaded from vehicles involved in intersection crashes were investigated as part of NASS-CDS years 2001 to 2013. A total of 135 EDRs with precrash vehicle speed and braking application were downloaded to investigate evasive braking. A smaller subset of 59 EDRs that collected vehicle yaw rate was additionally analyzed to investigate evasive steering. Each vehicle was assigned to one of 3 precrash movement classifiers (traveling through the intersection, completely stopped, or rolling stop) based on the vehicle's calculated acceleration and observed velocity profile. To ensure that any significant steering input observed was an attempted evasive maneuver, the analysis excluded vehicles at intersections that were turning, driving on a curved road, or performing a lane change. Braking application at the last EDR-recorded time point was assumed to indicate evasive braking. A vehicle yaw rate greater than 4° per second was assumed to indicate an evasive steering maneuver. Drivers executed crash avoidance maneuvers in four-fifths of intersection crashes. A more detailed analysis of evasive braking frequency by precrash maneuver revealed that drivers performing complete or rolling stops (61.3%) braked less often than drivers

  15. How Lovebirds Maneuver Rapidly Using Super-Fast Head Saccades and Image Feature Stabilization.

    Directory of Open Access Journals (Sweden)

    Daniel Kress

    Full Text Available Diurnal flying animals such as birds depend primarily on vision to coordinate their flight path during goal-directed flight tasks. To extract the spatial structure of the surrounding environment, birds are thought to use retinal image motion (optical flow that is primarily induced by motion of their head. It is unclear what gaze behaviors birds perform to support visuomotor control during rapid maneuvering flight in which they continuously switch between flight modes. To analyze this, we measured the gaze behavior of rapidly turning lovebirds in a goal-directed task: take-off and fly away from a perch, turn on a dime, and fly back and land on the same perch. High-speed flight recordings revealed that rapidly turning lovebirds perform a remarkable stereotypical gaze behavior with peak saccadic head turns up to 2700 degrees per second, as fast as insects, enabled by fast neck muscles. In between saccades, gaze orientation is held constant. By comparing saccade and wingbeat phase, we find that these super-fast saccades are coordinated with the downstroke when the lateral visual field is occluded by the wings. Lovebirds thus maximize visual perception by overlying behaviors that impair vision, which helps coordinate maneuvers. Before the turn, lovebirds keep a high contrast edge in their visual midline. Similarly, before landing, the lovebirds stabilize the center of the perch in their visual midline. The perch on which the birds land swings, like a branch in the wind, and we find that retinal size of the perch is the most parsimonious visual cue to initiate landing. Our observations show that rapidly maneuvering birds use precisely timed stereotypic gaze behaviors consisting of rapid head turns and frontal feature stabilization, which facilitates optical flow based flight control. Similar gaze behaviors have been reported for visually navigating humans. This finding can inspire more effective vision-based autopilots for drones.

  16. Psychophysiological Assessment in Pilots Performing Challenging Simulated and Real Flight Maneuvers.

    Science.gov (United States)

    Johannes, Bernd; Rothe, Stefanie; Gens, André; Westphal, Soeren; Birkenfeld, Katja; Mulder, Edwin; Rittweger, Jörn; Ledderhos, Carla

    2017-09-01

    The objective assessment of psychophysiological arousal during challenging flight maneuvers is of great interest to aerospace medicine, but remains a challenging task. In the study presented here, a vector-methodological approach was used which integrates different psychophysiological variables, yielding an integral arousal index called the Psychophysiological Arousal Value (PAV). The arousal levels of 15 male pilots were assessed during predetermined, well-defined flight maneuvers performed under simulated and real flight conditions. The physiological data, as expected, revealed inter- and intra-individual differences for the various measurement conditions. As indicated by the PAV, air-to-air refueling (AAR) turned out to be the most challenging task. In general, arousal levels were comparable between simulator and real flight conditions. However, a distinct difference was observed when the pilots were divided by instructors into two groups based on their proficiency in AAR with AWACS (AAR-Novices vs. AAR-Professionals). AAR-Novices had on average more than 2000 flight hours on other aircrafts. They showed higher arousal reactions to AAR in real flight (contact: PAV score 8.4 ± 0.37) than under simulator conditions (7.1 ± 0.30), whereas AAR-Professionals did not (8.5 ± 0.46 vs. 8.8 ± 0.80). The psychophysiological arousal value assessment was tested in field measurements, yielding quantifiable arousal differences between proficiency groups of pilots during simulated and real flight conditions. The method used in this study allows an evaluation of the psychophysiological cost during a certain flying performance and thus is possibly a valuable tool for objectively evaluating the actual skill status of pilots.Johannes B, Rothe S, Gens A, Westphal S, Birkenfeld K, Mulder E, Rittweger J, Ledderhos C. Psychophysiological assessment in pilots performing challenging simulated and real flight maneuvers. Aerosp Med Hum Perform. 2017; 88(9):834-840.

  17. Neonatal Pneumothorax Pressures Surpass Higher Threshold in Lung Recruitment Maneuvers: An In Vivo Interventional Study.

    Science.gov (United States)

    González-Pizarro, Patricio; García-Fernández, Javier; Canfrán, Susana; Gilsanz, Fernando

    2016-02-01

    Causing pneumothorax is one of the main concerns of lung recruitment maneuvers in pediatric patients, especially newborns. Therefore, these maneuvers are not performed routinely during anesthesia. Our objective was to determine the pressures that cause pneumothorax in healthy newborns by a prospective experimental study of 10 newborn piglets (pneumothorax. Animals under anesthesia and bilateral chest tube catheterization were randomly allocated to 2 groups: one with PEEP and fixed inspiratory driving pressure of 15 cm H2O (PEEP group) and the second one with PEEP = 0 cm H2O and non-fixed inspiratory driving pressure (zero PEEP group). In both groups, the ventilation mode was pressure-controlled, and PIP was raised at 2-min intervals, with steps of 5 cm H2O until air leak was observed through the chest tubes. The PEEP group raised PIP through 5-cm H2O PEEP increments, and the zero PEEP group raised PIP through 5-cm H2O inspiratory driving pressure increments. Pneumothorax was observed with a PIP of 90.5 ± 15.7 cm H2O with no statistically significant differences between the PEEP group (92 ± 14.8 cm H2O) and the zero PEEP group (89 ± 18.2 cm H2O). The zero PEEP group had hypotension, with a PIP of 35 cm H2O; the PEEP group had hypotension, with a PIP of 60 cm H2O (P = .01). The zero PEEP group presented bradycardia, with PIP of 40 cm H2O; the PEEP group presented bradycardia, with PIP of 70 cm H2O (P = .002). Performing recruitment maneuvers in newborns without lung disease is a safe procedure in terms of pneumothorax. Pneumothorax does not seem to occur in the clinically relevant PIPs of pneumothorax PIP in poorly compliant lungs. Copyright © 2016 by Daedalus Enterprises.

  18. A Patient-Invented Maneuver to Alleviate Freezing of Gait Using a Foot Loop Band

    Directory of Open Access Journals (Sweden)

    Yasuyuki Okuma

    2014-11-01

    Full Text Available Freezing of gait (FOG is a disabling gait disorder in parkinsonian patients characterized by the inability to initiate or continue locomotion. I herein present a 65-year-old man with Parkinson's disease who invented a unique method (foot loop band to alleviate FOG, which has not been previously described in the literature. The mechanisms to alleviate FOG include not only facilitating mechanical weight shift, but also restoring internal cueing and driving motor commands for gait initiation. This patient-invented maneuver may be recommended for patients having intractable FOG, because it is portable, cheap and safe.

  19. Advanced fighter technology integration (AFTI)/F-16 Automated Maneuvering Attack System final flight test results

    Science.gov (United States)

    Dowden, Donald J.; Bessette, Denis E.

    1987-01-01

    The AFTI F-16 Automated Maneuvering Attack System has undergone developmental and demonstration flight testing over a total of 347.3 flying hours in 237 sorties. The emphasis of this phase of the flight test program was on the development of automated guidance and control systems for air-to-air and air-to-ground weapons delivery, using a digital flight control system, dual avionics multiplex buses, an advanced FLIR sensor with laser ranger, integrated flight/fire-control software, advanced cockpit display and controls, and modified core Multinational Stage Improvement Program avionics.

  20. Driver Behavior During Overtaking Maneuvers from the 100-Car Naturalistic Driving Study.

    Science.gov (United States)

    Chen, Rong; Kusano, Kristofer D; Gabler, Hampton C

    2015-01-01

    Lane changes with the intention to overtake the vehicle in front are especially challenging scenarios for forward collision warning (FCW) designs. These overtaking maneuvers can occur at high relative vehicle speeds and often involve no brake and/or turn signal application. Therefore, overtaking presents the potential of erroneously triggering the FCW. A better understanding of driver behavior during lane change events can improve designs of this human-machine interface and increase driver acceptance of FCW. The objective of this study was to aid FCW design by characterizing driver behavior during lane change events using naturalistic driving study data. The analysis was based on data from the 100-Car Naturalistic Driving Study, collected by the Virginia Tech Transportation Institute. The 100-Car study contains approximately 1.2 million vehicle miles of driving and 43,000 h of data collected from 108 primary drivers. In order to identify overtaking maneuvers from a large sample of driving data, an algorithm to automatically identify overtaking events was developed. The lead vehicle and minimum time to collision (TTC) at the start of lane change events was identified using radar processing techniques developed in a previous study. The lane change identification algorithm was validated against video analysis, which manually identified 1,425 lane change events from approximately 126 full trips. Forty-five drivers with valid time series data were selected from the 100-Car study. From the sample of drivers, our algorithm identified 326,238 lane change events. A total of 90,639 lane change events were found to involve a closing lead vehicle. Lane change events were evenly distributed between left side and right side lane changes. The characterization of lane change frequency and minimum TTC was divided into 10 mph speed bins for vehicle travel speeds between 10 and 90 mph. For all lane change events with a closing lead vehicle, the results showed that drivers change

  1. Nonlinear Aerodynamic Modeling From Flight Data Using Advanced Piloted Maneuvers and Fuzzy Logic

    Science.gov (United States)

    Brandon, Jay M.; Morelli, Eugene A.

    2012-01-01

    Results of the Aeronautics Research Mission Directorate Seedling Project Phase I research project entitled "Nonlinear Aerodynamics Modeling using Fuzzy Logic" are presented. Efficient and rapid flight test capabilities were developed for estimating highly nonlinear models of airplane aerodynamics over a large flight envelope. Results showed that the flight maneuvers developed, used in conjunction with the fuzzy-logic system identification algorithms, produced very good model fits of the data, with no model structure inputs required, for flight conditions ranging from cruise to departure and spin conditions.

  2. On Motion Planning for Point-to-Point Maneuvers for a Class of Sailing Vehicles

    DEFF Research Database (Denmark)

    Xiao, Lin; Jouffroy, Jerome

    2011-01-01

    Despite their interesting dynamic and controllability properties, sailing vehicles have not been much studied in the control community. In this paper, we investigate motion planning of such vehicles. Starting from a simple dynamic model of sailing vessels in one dimension, this paper first...... considers their associated controllability issues, with the so-called no-sailing zone as a starting point, and it links them with a motion planning strategy using two-point boundary value problems as the main mathematical tool. This perspective is then expanded to do point-to-point maneuvers of sailing...

  3. Dynamics and Control of Three-Dimensional Perching Maneuver under Dynamic Stall Influence

    Science.gov (United States)

    Feroskhan, Mir Alikhan Bin Mohammad

    Perching is a type of aggressive maneuver performed by the class 'Aves' species to attain precision point landing with a generally short landing distance. Perching capability is desirable on unmanned aerial vehicles (UAVs) due to its efficient deceleration process that potentially expands the functionality and flight envelope of the aircraft. This dissertation extends the previous works on perching, which is mostly limited to two-dimensional (2D) cases, to its state-of-the-art threedimensional (3D) variety. This dissertation presents the aerodynamic modeling and optimization framework adopted to generate unprecedented variants of the 3D perching maneuver that include the sideslip perching trajectory, which ameliorates the existing 2D perching concept by eliminating the undesirable undershoot and reliance on gravity. The sideslip perching technique methodically utilizes the lateral and longitudinal drag mechanisms through consecutive phases of yawing and pitching-up motion. Since perching maneuver involves high rates of change in the angles of attack and large turn rates, introduction of three internal variables thus becomes necessary for addressing the influence of dynamic stall delay on the UAV's transient post-stall behavior. These variables are then integrated into a static nonlinear aerodynamic model, developed using empirical and analytical methods, and into an optimization framework that generates a trajectory of sideslip perching maneuver, acquiring over 70% velocity reduction. An impact study of the dynamic stall influence on the optimal perching trajectories suggests that consideration of dynamic stall delay is essential due to the significant discrepancies in the corresponding control inputs required. A comparative study between 2D and 3D perching is also conducted to examine the different drag mechanisms employed by 2D and 3D perching respectively. 3D perching is presented as a more efficient deceleration technique with respect to spatial costs and

  4. An Adaptive Nonlinear Aircraft Maneuvering Envelope Estimation Approach for Online Applications

    Science.gov (United States)

    Schuet, Stefan R.; Lombaerts, Thomas Jan; Acosta, Diana; Wheeler, Kevin; Kaneshige, John

    2014-01-01

    A nonlinear aircraft model is presented and used to develop an overall unified robust and adaptive approach to passive trim and maneuverability envelope estimation with uncertainty quantification. The concept of time scale separation makes this method suitable for the online characterization of altered safe maneuvering limitations after impairment. The results can be used to provide pilot feedback and/or be combined with flight planning, trajectory generation, and guidance algorithms to help maintain safe aircraft operations in both nominal and off-nominal scenarios.

  5. Satellite formation flying relative dynamics, formation design, fuel optimal maneuvers and formation maintenance

    CERN Document Server

    Wang, Danwei; Poh, Eng Kee

    2017-01-01

    This book systematically describes the concepts and principles for multi-satellite relative motion, passive and near passive formation designs, trajectory planning and control for fuel optimal formation maneuvers, and formation flying maintenance control design. As such, it provides a sound foundation for researchers and engineers in this field to develop further theories and pursue their implementations. Though satellite formation flying is widely considered to be a major advance in space technology, there are few systematic treatments of the topic in the literature. Addressing that gap, the book offers a valuable resource for academics, researchers, postgraduate students and practitioners in the field of satellite science and engineering.

  6. Study of a very low cost air combat maneuvering trainer aircraft

    Science.gov (United States)

    Hill, G. C.; Bowles, J. V.

    1976-01-01

    A very low cost aircraft for performing Air Combat Maneuvering (ACM) training was studied using the BD-5J sport plane as a point of departure. The installation of a larger engine and increased fuel capacity were required to meet the performance and mission objectives. Reduced wing area increased the simulation of the ACM engagement, and a comparison with current tactical aircraft is presented. Other factors affecting the training transfer are considered analytically, but a flight evaluation is recommended to determine the concept utility.

  7. Exploration of the Trade Space Between Unmanned Aircraft Systems Descent Maneuver Performance and Sense-and-Avoid System Performance Requirements

    Science.gov (United States)

    Jack, Devin P.; Hoffler, Keith D.; Johnson, Sally C.

    2014-01-01

    A need exists to safely integrate Unmanned Aircraft Systems (UAS) into the United States' National Airspace System. Replacing manned aircraft's see-and-avoid capability in the absence of an onboard pilot is one of the key challenges associated with safe integration. Sense-and-avoid (SAA) systems will have to achieve yet-to-be-determined required separation distances for a wide range of encounters. They will also need to account for the maneuver performance of the UAS they are paired with. The work described in this paper is aimed at developing an understanding of the trade space between UAS maneuver performance and SAA system performance requirements, focusing on a descent avoidance maneuver. An assessment of current manned and unmanned aircraft performance was used to establish potential UAS performance test matrix bounds. Then, near-term UAS integration work was used to narrow down the scope. A simulator was developed with sufficient fidelity to assess SAA system performance requirements. The simulator generates closest-point-of-approach (CPA) data from the wide range of UAS performance models maneuvering against a single intruder with various encounter geometries. Initial attempts to model the results made it clear that developing maneuver performance groups is required. Discussion of the performance groups developed and how to know in which group an aircraft belongs for a given flight condition and encounter is included. The groups are airplane, flight condition, and encounter specific, rather than airplane-only specific. Results and methodology for developing UAS maneuver performance requirements are presented for a descent avoidance maneuver. Results for the descent maneuver indicate that a minimum specific excess power magnitude can assure a minimum CPA for a given time-to-go prediction. However, smaller amounts of specific excess power may achieve or exceed the same CPA if the UAS has sufficient speed to trade for altitude. The results of this study will

  8. F-18 High Alpha Research Vehicle (HARV) parameter identification flight test maneuvers for optimal input design validation and lateral control effectiveness

    Science.gov (United States)

    Morelli, Eugene A.

    1995-01-01

    Flight test maneuvers are specified for the F-18 High Alpha Research Vehicle (HARV). The maneuvers were designed for open loop parameter identification purposes, specifically for optimal input design validation at 5 degrees angle of attack, identification of individual strake effectiveness at 40 and 50 degrees angle of attack, and study of lateral dynamics and lateral control effectiveness at 40 and 50 degrees angle of attack. Each maneuver is to be realized by applying square wave inputs to specific control effectors using the On-Board Excitation System (OBES). Maneuver descriptions and complete specifications of the time/amplitude points define each input are included, along with plots of the input time histories.

  9. Transcatheter closure of large atrial septal defects with deficient aortic or posterior rims using the "Greek maneuver". A multicenter study.

    Science.gov (United States)

    Thanopoulos, Basil D; Dardas, Petros; Ninios, Vlasis; Eleftherakis, Nicholaos; Karanasios, Evangelos

    2013-10-09

    We report a modification ("Greek maneuver") of the standard atrial septal defect (ASD) closure technique using the Amplatzer septal occluder (ASO) to facilitate closure of large ASDs with deficient aortic or posterior rims. 185 patients (median 10.8, range 3 to 52 years) with large ASDs (mean diameter 26±7 mm, range 20-40 mm) with a deficient aortic (134 patients) or posterior (51 patients) rim underwent catheter closure with the ASO using the "Greek maneuver" under transesophageal guidance. The Greek maneuver is applied when protrusion of the aortic edge of the deployed left disk of the device in to the right atrium is detected by echo. To circumvent this left disk is recaptured and the whole delivery system is pushed inward and leftward into the left atrium where the left disk and the 2/3 of right disk are simultaneously released. This maneuver forces the left disk to become parallel to the septum preventing the protrusion of the device into the right atrium. The ASO was successfully implanted and was associated with complete closure in 175/185 (95%) of the patients. There were no early or late complications related to the procedure during a follow-up period ranging from 6 months to 7 years. The "Greek maneuver" is a simple quite useful trick that facilitates closure of large ASDs associated with or without deficient aortic or posterior rims. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  10. Ocular VEMPs indicate repositioning of otoconia to the utricle after successful liberatory maneuvers in benign paroxysmal positioning vertigo

    Science.gov (United States)

    BREMOVA, TATIANA; BAYER, OTMAR; AGRAWAL, YURI; KREMMYDA, OLYMPIA; BRANDT, THOMAS; TEUFEL, JULIAN; STRUPP, MICHAEL

    2014-01-01

    Conclusions This study showed a transient increase of ocular vestibular evoked myogenic potential (oVEMP) amplitudes in the affected ear after successful liberatory maneuvers and no changes in cervical VEMP (cVEMP) amplitudes. These findings support the hypothesis that successful liberatory maneuvers can lead to a repositioning of otoconia to the utricle. Objectives To evaluate whether oVEMP amplitudes increase after successful liberatory maneuvers in patients with posterior semicircular canal benign paroxysmal positioning vertigo (pc-BPPV), while cVEMP amplitudes do not change. These findings may indicate a successful repositioning of dislodged otoconia to the utricular macula, but not to the saccular macula. Methods Thirty patients with unilateral pc-BPPV were prospectively examined with bone-conducted oVEMP and air-conducted cVEMP at four time points: before, after, 1 week after, and 1 month after the liberatory maneuvers (Sémont maneuvers). Results At the 1-week follow-up, 20 of 30 patients were asymptomatic (responders); BPPV could still be induced in the other 10 (non-responders). In responders the mean n10 amplitude on the affected side increased from 12 ± 6.5 μV at baseline (before the treatment) to 15.9 ± 7.1 μV at 1 week after treatment; this increase was significantly (p = 0.001) higher in responders than in non-responders. cVEMP did not differ significantly. PMID:24245699

  11. Effect of Repositioning Maneuver Type and Postmaneuver Restrictions on Vertigo and Dizziness in Benign Positional Paroxysmal Vertigo

    Science.gov (United States)

    Toupet, Michel; Ferrary, Evelyne; Bozorg Grayeli, Alexis

    2012-01-01

    Introduction. To compare the efficiency of Epley (Ep) and Sémont-Toupet (ST) repositioning maneuvers and to evaluate postmaneuver restriction effect on short-term vertigo and dizziness after repositioning maneuvers by an analog visual scale (VAS) in benign positional paroxysmal vertigo (BPPV). Material and Methods. 226 consecutive adult patients with posterior canal BPPV were included. Patients were randomized into 2 different maneuver sequence groups (n = 113): 2 ST then 1 Ep or 2 Ep then 1 ST. Each group of sequence was randomized into 2 subgroups: with or without postmaneuver restrictions. Vertigo and dizziness were assessed from days 0 to 5 by VAS. Results. There was no difference between vertigo scores between Ep and ST groups. Dizziness scores were higher in Ep group during the first 3 days but became similar to those of ST group at days 4 and 5. ST maneuvers induced liberatory signs more frequently than Ep (58% versus 42% resp., P < 0.01, Fisher's test). After repositioning maneuvers, VAS scores decreased similarly in patients with and without liberatory signs. Postmaneuver restrictions did not influence VAS scores. Conclusion. Even if ST showed a higher rate of liberatory signs than Ep in this series, VAS scores were not influenced by these signs. PMID:22973168

  12. Ultra-fast escape maneuver of an octopus-inspired robot

    International Nuclear Information System (INIS)

    Weymouth, G D; Subramaniam, V; Triantafyllou, M S

    2015-01-01

    We design and test an octopus-inspired flexible hull robot that demonstrates outstanding fast-starting performance. The robot is hyper-inflated with water, and then rapidly deflates to expel the fluid so as to power the escape maneuver. Using this robot we verify for the first time in laboratory testing that rapid size-change can substantially reduce separation in bluff bodies traveling several body lengths, and recover fluid energy which can be employed to improve the propulsive performance. The robot is found to experience speeds over ten body lengths per second, exceeding that of a similarly propelled optimally streamlined rigid rocket. The peak net thrust force on the robot is more than 2.6 times that on an optimal rigid body performing the same maneuver, experimentally demonstrating large energy recovery and enabling acceleration greater than 14 body lengths per second squared. Finally, over 53% of the available energy is converted into payload kinetic energy, a performance that exceeds the estimated energy conversion efficiency of fast-starting fish. The Reynolds number based on final speed and robot length is Re≈700 000. We use the experimental data to establish a fundamental deflation scaling parameter σ∗ which characterizes the mechanisms of flow control via shape change. Based on this scaling parameter, we find that the fast-starting performance improves with increasing size. (paper)

  13. An Analysis Nomoto Gain and Norbin Parameter on Ship Turning Maneuver

    Directory of Open Access Journals (Sweden)

    Aulia Siti Aisjah

    2010-05-01

    Full Text Available First order approach of maneuvering ship model developed by Nomoto, that has commonly underpinned researchers on mathematical models of ship maneuvering, is employed by the present research in order to describe the results of Nomoto validation gain value from some type of ships. In this present study, the controls are designated using FLC, while the rules are derived from FLC; furthermore, the reference is the LQG/LTR. On the other pole, Norbin parameters are obtained under the bases of the gain and time constant output control response. Validation of Nomoto gain value is obtained through the calculation of the value of a constant gain, settling time of the first order response, and approach value toward damping ratio and natural frequency response of the system used to control the output of the second order pattern. Validation is employed on 20 types of ships with a length between 40-350 meters; as a result, it is figured out that at the Low Speed General Cargo ship, Mariner, RO/RO, and Barge Carrier have good maneuverability compared to the other 17 types of ships.

  14. Estimation of left-turning vehicle maneuvers for the assessment of pedestrian safety at intersections

    Directory of Open Access Journals (Sweden)

    Wael K.M. Alhajyaseen

    2012-07-01

    Full Text Available Improving pedestrian safety at intersections remains a critical issue. Although several types of safety countermeasures, such as reforming intersection layouts, have been implemented, methods have not yet been established to quantitatively evaluate the effects of these countermeasures before installation. One of the main issues in pedestrian safety is conflicts with turning vehicles. This study aims to develop an integrated model to represent the variations in the maneuvers of left-turners (left-hand traffic at signalized intersections that dynamically considers the vehicle reaction to intersection geometry and crossing pedestrians. The proposed method consists of four empirically developed stochastic sub-models, including a path model, free-flow speed profile model, lag/gap acceptance model, and stopping/clearing speed profile model. Since safety assessment is the main objective driving the development of the proposed model, this study uses post-encroachment time (PET and vehicle speed at the crosswalk as validation parameters. Preliminary validation results obtained by Monte Carlo simulation show that the proposed integrated model can realistically represent the variations in vehicle maneuvers as well as the distribution of PET and vehicle speeds at the crosswalk.

  15. Independent Orbiter Assessment (IOA): Assessment of the orbital maneuvering system FMEA/CIL, volume 1

    Science.gov (United States)

    Prust, Chet D.; Haufler, W. A.; Marino, A. J.

    1988-01-01

    The results of the Independent Orbiter Assessment (IOA) of the Failure Modes and Effects Analysis (FMEA) and Critical Items List (CIL) are presented. The IOA effort first completed an analysis of the Orbital Maneuvering System (OMS) hardware and Electrical Power Distribution and Control (EPD and C), generating draft failure modes and potential critical items. To preserve independence, this analysis was accomplished without reliance upon the results contained within the NASA FMEA/CIL documentation. The IOA results were then compared to the proposed Post 51-L NASA FMEA/CIL baseline. This report documents the results of that comparison for the Orbiter OMS hardware. The IOA analysis defined the OMS as being comprised of the following subsystems: helium pressurization, propellant storage and distribution, Orbital Maneuvering Engine, and EPD and C. The IOA product for the OMS analysis consisted of 284 hardware and 667 EPD and C failure mode worksheets that resulted in 160 hardware and 216 EPD and C potential critical items (PCIs) being identified. A comparison was made of the IOA product to the NASA FMEA/CIL baseline which consisted of 101 hardware and 142 EPD and C CIL items.

  16. Spacecraft attitude maneuver control using two parallel mounted 3-DOF spherical actuators

    Directory of Open Access Journals (Sweden)

    Guidan Li

    2017-02-01

    Full Text Available A parallel configuration using two 3-degree-of-freedom (3-DOF spherical electromagnetic momentum exchange actuators is investigated for large angle spacecraft attitude maneuvers. First, the full dynamic equations of motion for the spacecraft system are derived by the Newton-Euler method. To facilitate computation, virtual gimbal coordinate frames are established. Second, a nonlinear control law in terms of quaternions is developed via backstepping method. The proposed control law compensates the coupling torques arising from the spacecraft rotation, and is robust against the external disturbances. Then, the singularity problem is analyzed. To avoid singularities, a modified weighed Moore-Pseudo inverse velocity steering law based on null motion is proposed. The weighted matrices are carefully designed to switch the actuators and redistribute the control torques. The null motion is used to reorient the rotor away from the tilt angle saturation state. Finally, numerical simulations of rest-to-rest maneuvers are performed to validate the effectiveness of the proposed method.

  17. Analysis of Loss of Control Parameters for Aircraft Maneuvering in General Aviation

    Directory of Open Access Journals (Sweden)

    Sameer Ud-Din

    2018-01-01

    Full Text Available A rapid increase in the occurrence of loss of control in general aviation has raised concern in recent years. Loss of control (LOC pertains to unique characteristics in which external and internal events act in conjunction. The Federal Aviation Administration (FAA has approved an Integrated Safety Assessment Model (ISAM for evaluating safety in the National Airspace System (NAS. ISAM consists of an event sequence diagram (ESD with fault trees containing numerous parameters, which is recognized as casual risk model. In this paper, we outline an integrated risk assessment framework to model maneuvering through cross-examining external and internal events. The maneuvering is in the critical flight phase with a high number of LOC occurrences in general aviation, where highly trained and qualified pilots failed to maintain aircraft control irrespective of the preventive nature of the events. Various metrics have been presented for evaluating the significance of these parameters to identify the most important ones. The proposed sensitivity analysis considers the accident, fatality, and risk reduction frequencies that assist in the decision-making process and foresees future risks from a general aviation perspective.

  18. Low-Thrust Out-of-Plane Orbital Station-Keeping Maneuvers for Satellites

    Directory of Open Access Journals (Sweden)

    Vivian M. Gomes

    2012-01-01

    Full Text Available This paper considers the problem of out of plane orbital maneuvers for station keeping of satellites. The main idea is to consider that a satellite is in an orbit around the Earth and that it has its orbit is disturbed by one or more forces. Then, it is necessary to perform a small amplitude orbital correction to return the satellite to its original orbit, to keep it performing its mission. A low thrust propulsion is used to complete this task. It is important to search for solutions that minimize the fuel consumption to increase the lifetime of the satellite. To solve this problem a hybrid optimal control approach is used. The accuracy of the satisfaction of the constraints is considered, in order to try to decrease the fuel expenditure by taking advantage of this freedom. This type of problem presents numerical difficulties and it is necessary to adjust parameters, as well as details of the algorithm, to get convergence. In this versions of the algorithm that works well for planar maneuvers are usually not adequate for the out of plane orbital corrections. In order to illustrate the method, some numerical results are presented.

  19. Operational maneuvers and pipelines activities repairs for the 32 inches scraper tool recovering

    Energy Technology Data Exchange (ETDEWEB)

    Valdivia, Jose; Salguero, Luis; Villanueva, Pedro [Compania Operadora del Gas Amazonas, Lima (Peru)

    2009-07-01

    Transportadora de Gas del Peru and the Compania Operadora de Gas del Amazonas, responsible companies of the transport, operation and maintenance of the pipelines who transport natural gas and natural gas liquids respectively of the Camisea Project - Peru, following the internal policies and the maintenance plan of the pipeline transportation system was planned the activities for the internal pipeline inspection of these activities for 729.3 Km of natural gas pipeline covering diameters of 32 inches, 24 inches and 18 inches. After the first run of the cleaning tool, was scheduled the launch of the dummy scraper (scraper tool) along to the first 210 Km of the 32 inches natural gas pipeline , given changes in elevation along the trace and the low flow of transport. This scraper tool could not reach the final destination. After many series operational maneuvers as venting, creation of differential pressure in valves, the scraper tool only reach the first 75 Km of the trace. After an exhaustive analysis of trending pressure variations, it was concluded that this scraper showed intermittent progress of short durations, concluding that this scraper had not reach the next check point. In this way was decided to conduct operational maneuvers in order to locate, relocated and retrieve the scrapper tool from de 32 inches natural gas pipeline. (author)

  20. Liver hanging maneuver for right hemiliver in situ donation--anatomical considerations.

    Science.gov (United States)

    Trotovsek, B; Gadzijev, E M; Ravnik, D; Hribernik, M

    2006-01-01

    An anatomical study was carried out to evaluate the safety of the liver hanging maneuver for the right hemiliver in living donor and in situ splitting transplantation. During this procedure a 4-6 cm blind dissection is performed between the inferior vena cava and the liver. Short subhepatic veins entering the inferior vena cava from segments 1 and 9 could be torn with consequent hemorrhage. One hundred corrosive casts of livers were evaluated to establish the position and diameter of short subhepatic veins and the inferior right hepatic vein. The average distance from the right border of the inferior vena cava to the opening of segment 1 veins was 16.7+/-3.4 mm and to the entrance of segment 9 veins was 5.0+/-0.5 mm. The width of the narrowest point on the route of blind dissection was determined, with the average value being 8.7+/-2.3 mm (range 2-15 mm). The results show that the liver hanging maneuver is a safe procedure. A proposed route of dissection minimizes the risk of disrupting short subhepatic veins (7%).

  1. Effects of the Tongue-in-Groove Maneuver on Nasal Tip Rotation.

    Science.gov (United States)

    Antunes, Marcelo B; Quatela, Vito C

    2018-03-27

    Changes in nasal tip rotation is a very common maneuver performed during rhinoplasty. Among the many techniques used to achieve this goal is the tongue-in-groove (TIG). This study addresses the long-term effect of the TIG on the nasal tip rotation 1 year after rhinoplasty. The authors prospectively identified patients who were submitted to a rhinoplasty with a TIG maneuver over a period of 1 year. The angle of rotation was measured along the nostril axis angle. The data was analyzed using the t-test and a linear regression model. Seventeen patients were included. The average preoperative tip rotation was 93.95° (SD, 3.12°). Immediate postoperative tip rotation averaged 114.47° (SD, 3.79°). At the 1-year follow-up appointment, the tip rotation averaged 106.55° (SD, 3.54°). There was a significant loss of rotation at the 1-year postoperative visit (pTIG is a more dependable technique than the ones that rely on healing and contraction to obtain rotation. Our data demonstrated a significant loss of rotation during the first year. This suggests that the surgeon needs to slightly overcorrect the tip rotation to account for this loss.

  2. Ultra-fast escape maneuver of an octopus-inspired robot.

    Science.gov (United States)

    Weymouth, G D; Subramaniam, V; Triantafyllou, M S

    2015-02-02

    We design and test an octopus-inspired flexible hull robot that demonstrates outstanding fast-starting performance. The robot is hyper-inflated with water, and then rapidly deflates to expel the fluid so as to power the escape maneuver. Using this robot we verify for the first time in laboratory testing that rapid size-change can substantially reduce separation in bluff bodies traveling several body lengths, and recover fluid energy which can be employed to improve the propulsive performance. The robot is found to experience speeds over ten body lengths per second, exceeding that of a similarly propelled optimally streamlined rigid rocket. The peak net thrust force on the robot is more than 2.6 times that on an optimal rigid body performing the same maneuver, experimentally demonstrating large energy recovery and enabling acceleration greater than 14 body lengths per second squared. Finally, over 53% of the available energy is converted into payload kinetic energy, a performance that exceeds the estimated energy conversion efficiency of fast-starting fish. The Reynolds number based on final speed and robot length is [Formula: see text]. We use the experimental data to establish a fundamental deflation scaling parameter [Formula: see text] which characterizes the mechanisms of flow control via shape change. Based on this scaling parameter, we find that the fast-starting performance improves with increasing size.

  3. Understanding successful and unsuccessful landings of aerial maneuver variations in professional surfing.

    Science.gov (United States)

    Forsyth, J R; Riddiford-Harland, D L; Whitting, J W; Sheppard, J M; Steele, J R

    2018-05-01

    Although performing aerial maneuvers can increase wave score and winning potential in competitive surfing, the critical features underlying successful aerial performance have not been systematically investigated. This study aimed to analyze highly skilled aerial maneuver performance and to identify the critical features associated with successful or unsuccessful landing. Using video recordings of the World Surf League's Championship Tour, every aerial performed during the quarterfinal, semifinal, and final heats from the 11 events in the 2015 season was viewed. From this, 121 aerials were identified with the Frontside Air (n = 15) and Frontside Air Reverse (n = 67) being selected to be qualitatively assessed. Using chi-squared analyses, a series of key critical features, including landing over the center of the surfboard (FS Air χ 2  = 14.00, FS Air Reverse χ 2  = 26.61; P < .001) and landing with the lead ankle in dorsiflexion (FS Air χ 2  = 3.90, FS Air Reverse χ 2  = 13.64; P < .05), were found to be associated with successful landings. These critical features help surfers land in a stable position, while maintaining contact with the surfboard. The results of this study provide coaches with evidence to adjust the technique of their athletes to improve their winning potential. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. Modeling of driver's collision avoidance maneuver based on controller switching model.

    Science.gov (United States)

    Kim, Jong-Hae; Hayakawa, Soichiro; Suzuki, Tatsuya; Hayashi, Koji; Okuma, Shigeru; Tsuchida, Nuio; Shimizu, Masayuki; Kido, Shigeyuki

    2005-12-01

    This paper presents a modeling strategy of human driving behavior based on the controller switching model focusing on the driver's collision avoidance maneuver. The driving data are collected by using the three-dimensional (3-D) driving simulator based on the CAVE Automatic Virtual Environment (CAVE), which provides stereoscopic immersive virtual environment. In our modeling, the control scenario of the human driver, that is, the mapping from the driver's sensory information to the operation of the driver such as acceleration, braking, and steering, is expressed by Piecewise Polynomial (PWP) model. Since the PWP model includes both continuous behaviors given by polynomials and discrete logical conditions, it can be regarded as a class of Hybrid Dynamical System (HDS). The identification problem for the PWP model is formulated as the Mixed Integer Linear Programming (MILP) by transforming the switching conditions into binary variables. From the obtained results, it is found that the driver appropriately switches the "control law" according to the sensory information. In addition, the driving characteristics of the beginner driver and the expert driver are compared and discussed. These results enable us to capture not only the physical meaning of the driving skill but the decision-making aspect (switching conditions) in the driver's collision avoidance maneuver as well.

  5. A Sampling Based Approach to Spacecraft Autonomous Maneuvering with Safety Specifications

    Science.gov (United States)

    Starek, Joseph A.; Barbee, Brent W.; Pavone, Marco

    2015-01-01

    This paper presents a methods for safe spacecraft autonomous maneuvering that leverages robotic motion-planning techniques to spacecraft control. Specifically the scenario we consider is an in-plan rendezvous of a chaser spacecraft in proximity to a target spacecraft at the origin of the Clohessy Wiltshire Hill frame. The trajectory for the chaser spacecraft is generated in a receding horizon fashion by executing a sampling based robotic motion planning algorithm name Fast Marching Trees (FMT) which efficiently grows a tree of trajectories over a set of probabillistically drawn samples in the state space. To enforce safety the tree is only grown over actively safe samples for which there exists a one-burn collision avoidance maneuver that circularizes the spacecraft orbit along a collision-free coasting arc and that can be executed under potential thrusters failures. The overall approach establishes a provably correct framework for the systematic encoding of safety specifications into the spacecraft trajectory generations process and appears amenable to real time implementation on orbit. Simulation results are presented for a two-fault tolerant spacecraft during autonomous approach to a single client in Low Earth Orbit.

  6. Contingency Trajectory Design for a Lunar Orbit Insertion Maneuver Failure by the Lunar Atmosphere Dust Environment Explorer (LADEE) Spacecraft

    Science.gov (United States)

    Genova, Anthony L.; Loucks, Michael; Carrico, John

    2014-01-01

    The purpose of this extended abstract is to present results from a failed lunar-orbit insertion (LOI) maneuver contingency analysis for the Lunar Atmosphere Dust Environment Explorer (LADEE) mission, managed and operated by NASA Ames Research Center in Moffett Field, CA. The LADEE spacecrafts nominal trajectory implemented multiple sub-lunar phasing orbits centered at Earth before eventually reaching the Moon (Fig. 1) where a critical LOI maneuver was to be performed [1,2,3]. If this LOI was missed, the LADEE spacecraft would be on an Earth-escape trajectory, bound for heliocentric space. Although a partial mission recovery is possible from a heliocentric orbit (to be discussed in the full paper), it was found that an escape-prevention maneuver could be performed several days after a hypothetical LOI-miss, allowing a return to the desired science orbit around the Moon without leaving the Earths sphere-of-influence (SOI).

  7. A Minimum Fuel Based Estimator for Maneuver and Natrual Dynamics Reconstruction

    Science.gov (United States)

    Lubey, D.; Scheeres, D.

    2013-09-01

    The vast and growing population of objects in Earth orbit (active and defunct spacecraft, orbital debris, etc.) offers many unique challenges when it comes to tracking these objects and associating the resulting observations. Complicating these challenges are the inaccurate natural dynamical models of these objects, the active maneuvers of spacecraft that deviate them from their ballistic trajectories, and the fact that spacecraft are tracked and operated by separate agencies. Maneuver detection and reconstruction algorithms can help with each of these issues by estimating mismodeled and unmodeled dynamics through indirect observation of spacecraft. It also helps to verify the associations made by an object correlation algorithm or aid in making those associations, which is essential when tracking objects in orbit. The algorithm developed in this study applies an Optimal Control Problem (OCP) Distance Metric approach to the problems of Maneuver Reconstruction and Dynamics Estimation. This was first developed by Holzinger, Scheeres, and Alfriend (2011), with a subsequent study by Singh, Horwood, and Poore (2012). This method estimates the minimum fuel control policy rather than the state as a typical Kalman Filter would. This difference ensures that the states are connected through a given dynamical model and allows for automatic covariance manipulation, which can help to prevent filter saturation. Using a string of measurements (either verified or hypothesized to correlate with one another), the algorithm outputs a corresponding string of adjoint and state estimates with associated noise. Post-processing techniques are implemented, which when applied to the adjoint estimates can remove noise and expose unmodeled maneuvers and mismodeled natural dynamics. Specifically, the estimated controls are used to determine spacecraft dependent accelerations (atmospheric drag and solar radiation pressure) using an adapted form of the Optimal Control based natural dynamics

  8. An estimation of intrapartum-related perinatal mortality rates for booked home births in England and Wales between 1994 and 2003.

    Science.gov (United States)

    Mori, R; Dougherty, M; Whittle, M

    2008-04-01

    The objective of this study was to obtain the best estimate of intrapartum-related perinatal mortality (IPPM) rates for booked home births. A population-based cross-sectional study. England and Wales. All births in England and Wales, including home births (intended or unintended) occurring between 1994 and 2003. All IPPM data were derived from the Confidential Enquiry into Maternal and Child Health. Denominators were derived by using unintended home births and transfer rates from home to hospital, from previous studies, with sensitivity analyses. IPPM rates were calculated for the three following subgroups: (a) the completed home birth group, (b) the transferred group and (c) the unintended home birth group. IPPM rate. The overall IPPM rate for England and Wales improved between 1994 and 2003. However, data to obtain a precise estimate of IPPM rate for booked home birth were not available. The average IPPM rate for all births in the study period was 0.79 per 1000 births (95% CI 0.77-0.81), and the estimated IPPM rate for booked home births was 1.28 or 0.74 per 1000 births, depending on the method of calculation (range 0.49-1.47). The IPPM rates for the completed home birth group appeared to be lower throughout the study period compared with the unintended home birth groups. Those women who had booked for a home birth, but later needed to transfer their care for a hospital birth, appeared to have the highest risk of IPPM in the study period. The results of this study need to be interpreted with caution due to inconsistencies occurring in the recorded data. However, the data do highlight two important features. First, they suggest that IPPM rates for home births do not appear to have improved over the study period examined, even though rates did so overall. Second, although the women who booked for home births and had their babies at home seemed to have a generally low IPPM rate, those who required their care to be transferred to hospital did not. Women who book for

  9. Promising adoption of an electronic clinical decision support system for antenatal and intrapartum care in rural primary healthcare facilities in sub-Saharan Africa: The QUALMAT experience.

    Science.gov (United States)

    Sukums, Felix; Mensah, Nathan; Mpembeni, Rose; Massawe, Siriel; Duysburgh, Els; Williams, Afua; Kaltschmidt, Jens; Loukanova, Svetla; Haefeli, Walter E; Blank, Antje

    2015-09-01

    The QUALMAT project has successfully implemented an electronic clinical decision support system (eCDSS) for antenatal and intrapartum care in two sub-Saharan African countries. The system was introduced to facilitate adherence to clinical practice guidelines and to support decision making during client encounter to bridge the know-do gap of health workers. This study aimed to describe health workers' acceptance and use of the eCDSS for maternal care in rural primary health care (PHC) facilities of Ghana and Tanzania and to identify factors affecting successful adoption of such a system. This longitudinal study was conducted in Lindi rural district in Tanzania and Kassena-Nankana district in Ghana between October 2011 and December 2013 employing mixed methods. The study population included healthcare workers who were involved in the provision of maternal care in six rural PHC facilities from one district in each country where the eCDSS was implemented. All eCDSS users participated in the study with 61 and 56 participants at the midterm and final assessment, respectively. After several rounds of user training and support the eCDSS has been successfully adopted and constantly used during patient care in antenatal clinics and maternity wards. The eCDSS was used in 71% (2703/3798) and 59% (14,189/24,204) of all ANC clients in Tanzania and Ghana respectively, while it was also used in 83% (1185/1427) and 67% (1435/2144) of all deliveries in Tanzania and in Ghana, respectively. Several barriers reported to hinder eCDSS use were related to individual users, tasks, technology, and organization attributes. Implementation of an eCDSS in resource-constrained PHC facilities in sub-Saharan Africa was successful and the health workers accepted and continuously used the system for maternal care. Facilitators for eCDSS use included sufficient training and regular support whereas the challenges to sustained use were unreliable power supply and perceived high workload. However our

  10. Effects of an alveolar recruitment maneuver on subdural pressure, brain swelling, and mean arterial pressure in patients undergoing supratentorial tumour resection: a randomized crossover study.

    Science.gov (United States)

    Flexman, Alana M; Gooderham, Peter A; Griesdale, Donald E; Argue, Ruth; Toyota, Brian

    2017-06-01

    Although recruitment maneuvers have been advocated as part of a lung protective ventilation strategy, their effects on cerebral physiology during elective neurosurgery are unknown. Our objectives were to determine the effects of an alveolar recruitment maneuver on subdural pressure (SDP), brain relaxation score (BRS), and cerebral perfusion pressure among patients undergoing supratentorial tumour resection. In this prospective crossover study, patients scheduled for resection of a supratentorial brain tumour were randomized to undergo either a recruitment maneuver (30 cm of water for 30 sec) or a "sham" maneuver (5 cm of water for 30 sec), followed by the alternative intervention after a 90-sec equilibration period. Subdural pressure was measured through a dural perforation following opening of the cranium. Subdural pressure and mean arterial pressure (MAP) were recorded continuously. The blinded neurosurgeon provided a BRS at baseline and at the end of each intervention. During each treatment, the changes in SDP, BRS, and MAP were compared. Twenty-one patients underwent the study procedure. The increase in SDP was higher during the recruitment maneuver than during the sham maneuver (difference, 3.9 mmHg; 95% confidence interval [CI], 2.2 to 5.6; P < 0.001). Mean arterial pressure decreased further in the recruitment maneuver than in the sham maneuver (difference, -9.0 mmHg; 95% CI, -12.5 to -5.6; P < 0.001). Cerebral perfusion pressure decreased 14 mmHg (95% CI, 4 to 24) during the recruitment maneuver. The BRS did not change with either maneuver. Our results suggest that recruitment maneuvers increase subdural pressure and reduce cerebral perfusion pressure, although the clinical importance of these findings is thus far unknown. This trial was registered with ClinicalTrials.gov, NCT02093117.

  11. Dynamic ankle control in athletes with ankle instability during sports maneuvers.

    Science.gov (United States)

    Lin, Cheng-Feng; Chen, Chin-Yang; Lin, Chia-Wei

    2011-09-01

    Ankle sprain is a common sports injury. While the effects of static constraints in stabilizing the ankle joint are relatively well understood, those of dynamic constraints are less clear and require further investigation. This study was undertaken to evaluate the dynamic stability of the ankle joint during the landing phase of running and stop-jump maneuvers in athletes with and without chronic ankle instability (CAI). Controlled laboratory study. Fifteen athletes with CAI and 15 age-matched athletes without CAI performed running and stop-jump landing tasks. The dynamic ankle joint stiffness, tibialis anterior (TA)/peroneus longus (PL) and TA/gastrocnemius lateralis (GL) co-contraction indices, ankle joint angle, and root-mean-square (RMS) of the TA, PL, and GL electromyographic signals were measured during each task. During running, the CAI group exhibited a greater ankle inversion angle than the control group in the pre-landing phase (P = .012-.042) and a lower dynamic ankle joint stiffness in the post-landing phase (CAI: 0.109 ± 0.039 N·m/deg; control: 0.150 ± 0.068 N·m/deg; P = .048). In the stop-jump landing task, athletes with CAI had a significantly lower TA/PL co-contraction index during the pre-landing phase (CAI: 49.1 ± 19; control: 64.8 ± 16; P = .009). In addition, the CAI group exhibited a greater ankle inversion (P = .049), a lower peak eversion (P = .04), and a smaller RMS of the PL electromyographic signal in the post-landing phase (CAI: 0.73 ± 0.32; control: 0.51 ± 0.22; P = .04). Athletes with CAI had a relatively inverted ankle, reduced muscle co-contraction, and a lower dynamic stiffness in the ankle joint during the landing phase of sports maneuvers and this may jeopardize the stability of the ankle. Sports training or rehabilitation programs should differentiate between the pre-landing and post-landing phases of sports maneuvers, and should educate athletes to land with an appropriate ankle position and muscle recruitment.

  12. Leukemia among participants in military maneuvers at a nuclear bomb test

    International Nuclear Information System (INIS)

    Caldwell, G.G.; Kelley, D.B.; Heath, C.W. Jr.

    1980-01-01

    Preliminary studies indicate that nine cases of leukemia have occurred among 3224 men who participated in military maneuvers during the 1957 nuclear test explosion Smoky. This represents a significant increase over the expected incidence of 3.5 cases. They included four cases of acute myelocytic leukemia, three of chronic myelocytic leukemia, and one each of hairy cell and acute lymphocytic leukemia. At time of diagnosis, patient ages ranged from 21 to 60 years (mean, 41.8 years) and the interval from time of nuclear test to diagnosis from two to 19 years (mean, 14.2 years). Film-badge records, which are available for eight of the nine men, indicated gamma radiation exposure levels ranging from 0 to 2977 mrem (mean, 1033 mrem). Mean film-badge gamma dose for the entire Smoky cohort was 466.2 mrem

  13. Trajectory optimization for lunar rover performing vertical takeoff vertical landing maneuvers in the presence of terrain

    Science.gov (United States)

    Ma, Lin; Wang, Kexin; Xu, Zuhua; Shao, Zhijiang; Song, Zhengyu; Biegler, Lorenz T.

    2018-05-01

    This study presents a trajectory optimization framework for lunar rover performing vertical takeoff vertical landing (VTVL) maneuvers in the presence of terrain using variable-thrust propulsion. First, a VTVL trajectory optimization problem with three-dimensional kinematics and dynamics model, boundary conditions, and path constraints is formulated. Then, a finite-element approach transcribes the formulated trajectory optimization problem into a nonlinear programming (NLP) problem solved by a highly efficient NLP solver. A homotopy-based backtracking strategy is applied to enhance the convergence in solving the formulated VTVL trajectory optimization problem. The optimal thrust solution typically has a "bang-bang" profile considering that bounds are imposed on the magnitude of engine thrust. An adaptive mesh refinement strategy based on a constant Hamiltonian profile is designed to address the difficulty in locating the breakpoints in the thrust profile. Four scenarios are simulated. Simulation results indicate that the proposed trajectory optimization framework has sufficient adaptability to handle VTVL missions efficiently.

  14. A maneuver for improved positioning of a tourniquet in the obese patient.

    Science.gov (United States)

    Krackow, K A

    1982-08-01

    Proximal positioning of an arterial tourniquet will be greatly facilitated by having an assistant firmly draw the skin and subcutaneous tissue distally prior to positioning the cast padding and tourniquet. This simple maneuver is clearly not part of current practice or training, despite the simplicity and effectiveness. Excessive tourniquet tightening should be avoided prior to fixing the Velcro fasteners, a practice which is commonly employed and is not only ineffective in maintaining proximal tourniquet positioning, but also deleterious in that it creates a "venous tourniquet" effect. Loosening of the restraining adhesive tapes and unnecessary traction of adhesive tape on sensitive skin can be avoided by bringing the extremity to its resting position before fastening the tape proximal to the tourniquet.

  15. Student teams maneuver robots in qualifying match at regional robotic competition at KSC

    Science.gov (United States)

    1999-01-01

    All four robots, maneuvered by student teams behind protective walls, converge on a corner of the playing field during qualifying matches of the 1999 Southeastern Regional robotic competition at Kennedy Space Center Visitor Complex . Thirty schools from around the country have converged at KSC for the event that pits gladiator robots against each other in an athletic-style competition. The robots have to retrieve pillow- like disks from the floor, as well as climb onto the platform (with flags) and raise the cache of pillows to a height of eight feet. KSC is hosting the event being sponsored by the nonprofit organization For Inspiration and Recognition of Science and Technology, known as FIRST. The FIRST robotics competition is designed to provide students with a hands-on, inside look at engineering and other professional careers.

  16. Slew Maneuver Control for Spacecraft Equipped with Star Camera and Reaction Wheels

    DEFF Research Database (Denmark)

    Wisniewski, Rafal; Kulczycki, P.

    2005-01-01

    A configuration consisting of a star camera, four reaction wheels and magnetorquers for momentum unloading has become standard for many spacecraft missions. This popularity has motivated numerous agencies and private companies to initiate work on the design of an imbedded attitude control system...... realized on an integrated circuit. This paper provides an easily implementable control algorithm for this type of configuration. The paper considers two issues: slew maneuver with a feature of avoiding direct exposure of the camera's CCD chip to the Sun %, three-axis attitude control and optimal control...... torque distribution in a reaction wheel assembly. The attitude controller is synthesized applying the energy shaping technique, where the desired potential function is carefully designed using a physical insight into the nature of the problem. The system stability is thoroughly analyzed and the control...

  17. Hip Dislocation and Dystocia in Early Medieval Times: Possible Evidence of Labor Maneuver.

    Science.gov (United States)

    Malgosa, Assumpció; Carrascal, Susana; Piga, Giampaolo; Isidro, Albert

    2016-12-01

    In ancient times, maternal mortality would occur frequently, particularly during labor. Evidence of dystocia resulting in the death of a pregnant woman is very infrequent in paleopathologic literature, with only a few cases being demonstrated. In the early medieval site of Casserres, the skeleton of a young woman with a fetus in the pelvic region was found. Some abnormal findings of the maternal skeleton were evaluated, including a sacral anomaly, femoral head wound, the rare position of the lower left limb with the femoral head dislodged anteriorly and cephalad from the socket, and a fibular fracture. Examining the anomalies all together, a case of anterior hip dislocation related to a McRoberts-like maneuver performed during labor is a plausible explanation of the findings.

  18. Firms’ maneuvering between institutional logics in the public sector for commercializing welfare innovations

    DEFF Research Database (Denmark)

    Nissen, Helle Aarøe; Clarke, Ann Højbjerg; Evald, Majbritt Rostgaard

    The article aims to explore, through a micro level focus, how individual private firm actors maneuver between institutional logics embedded in different individual public actors operating at various levels in the public sector, when making efforts towards commercializing innovative welfare...... in commercializing interact with public actors operating at various levels in the public sector using a top-down, bottom-up or mixed approach. The top-down approach shows that private firms handle institutional logics embedded in political and managerial actors by creating legitimacy and accept from above concerning...... approach demonstrates that private firms handle institutional logics by combining interaction with actors across levels in the public sector, thereby mixing top-down and bottom-up approaches. As such, the three approaches point out that private firms, when handling institutional logics, can do...

  19. Control of ZrH reactor reactivity perturbations during orbital maneuvers

    International Nuclear Information System (INIS)

    Audette, R.F.

    1970-01-01

    Scheduled and inadvertent vehicle maneuvers in manned and unmanned space missions may result in reactivity perturbations to the ZrH reactor due to fuel and control drum motion from acceleration forces. Potential power and outlet coolant temperature excursions could result in interruptions of PCS power generation, or excessive coolant temperatures if uncontrolled. This analysis compares potential uncontrolled reactor transients with allowable transients for uninterrupted electrical power generation from a Brayton system, and presents a control scheme to limit transient reactor outlet temperatures to 1250 0 F for a system designed to operate at a nominal 1200 0 F reactor outlet. Potential uncontrolled transients could result in a reactor outlet temperature swing of +-77 0 F about a nominal 1200 0 F and a reactor power swing of +92 Kwt and -67 Kwt about a nominal 130 Kwt for the Brayton System. (U.S.)

  20. Possible Periodic Orbit Control Maneuvers for an eLISA Mission

    Science.gov (United States)

    Bender, Peter L.; Welter, Gary L.

    2012-01-01

    This paper investigates the possible application of periodic orbit control maneuvers for so-called evolved-LISA (eLISA) missions, i.e., missions for which the constellation arm lengths and mean distance from the Earth are substantially reduced. We find that for missions with arm lengths of 106 km and Earth-trailing distance ranging from approx. 12deg to 20deg over the science lifetime, the occasional use of the spacecraft micro-Newton thrusters for constellation configuration maintenance should be able to essentially eliminate constellation distortion caused by Earth-induced tidal forces at a cost to science time of only a few percent. With interior angle variation kept to approx. +/-0:1deg, the required changes in the angles between the laser beam pointing directions for the two arms from any spacecraft could be kept quite small. This would considerably simplify the apparatus necessary for changing the transmitted beam directions.

  1. ISAR Imaging of Maneuvering Targets Based on the Modified Discrete Polynomial-Phase Transform

    Directory of Open Access Journals (Sweden)

    Yong Wang

    2015-09-01

    Full Text Available Inverse synthetic aperture radar (ISAR imaging of a maneuvering target is a challenging task in the field of radar signal processing. The azimuth echo can be characterized as a multi-component polynomial phase signal (PPS after the translational compensation, and the high quality ISAR images can be obtained by the parameters estimation of it combined with the Range-Instantaneous-Doppler (RID technique. In this paper, a novel parameters estimation algorithm of the multi-component PPS with order three (cubic phase signal-CPS based on the modified discrete polynomial-phase transform (MDPT is proposed, and the corresponding new ISAR imaging algorithm is presented consequently. This algorithm is efficient and accurate to generate a focused ISAR image, and the results of real data demonstrate the effectiveness of it.

  2. A robust direct-integration method for rotorcraft maneuver and periodic response

    Science.gov (United States)

    Panda, Brahmananda

    1992-01-01

    The Newmark-Beta method and the Newton-Raphson iteration scheme are combined to develop a direct-integration method for evaluating the maneuver and periodic-response expressions for rotorcraft. The method requires the generation of Jacobians and includes higher derivatives in the formulation of the geometric stiffness matrix to enhance the convergence of the system. The method leads to effective convergence with nonlinear structural dynamics and aerodynamic terms. Singularities in the matrices can be addressed with the method as they arise from a Lagrange multiplier approach for coupling equations with nonlinear constraints. The method is also shown to be general enough to handle singularities from quasisteady control-system models. The method is shown to be more general and robust than the similar 2GCHAS method for analyzing rotorcraft dynamics.

  3. Impact Angle and Time Control Guidance Under Field-of-View Constraints and Maneuver Limits

    Science.gov (United States)

    Shim, Sang-Wook; Hong, Seong-Min; Moon, Gun-Hee; Tahk, Min-Jea

    2018-04-01

    This paper proposes a guidance law which considers the constraints of seeker field-of-view (FOV) as well as the requirements on impact angle and time. The proposed guidance law is designed for a constant speed missile against a stationary target. The guidance law consists of two terms of acceleration commands. The first one is to achieve zero-miss distance and the desired impact angle, while the second is to meet the desired impact time. To consider the limits of FOV and lateral maneuver capability, a varying-gain approach is applied on the second term. Reduction of realizable impact times due to these limits is then analyzed by finding the longest course among the feasible ones. The performance of the proposed guidance law is demonstrated by numerical simulation for various engagement conditions.

  4. Unusual inferior dislocation of shoulder: reduction by two-step maneuver: a case report

    Directory of Open Access Journals (Sweden)

    Patro Dilip K

    2009-11-01

    Full Text Available Abstract Dislocation of the shoulder is the commonest of all large joint dislocations. Inferior dislocation constitutes 0.5% of all shoulder dislocations. It characteristically presents with overhead abduction of the arm, the humerus being parallel to the spine of scapula. We present an unusual case of recurrent luxatio erecta in which the arm transformed later into an adducted position resembling the more common anterior shoulder dislocation. Such a case has not been described before in English literature. Closed reduction by the two-step maneuver was successful with a single attempt. MRI revealed posterior labral tear and a Hill-Sachs variant lesion on the superolateral aspect of humeral head. Immobilisation in a chest-arm bandage followed by physiotherapy yielded excellent results. The case is first of its kind; the unusual mechanism, unique radiological findings and alternate method of treatment are discussed.

  5. MAXIMAL HIP AND KNEE MUSCLE STRENGTH ARE NOT RELATED TO NEUROMUSCULAR PRE-ACTIVITY DURING SIDECUTTING MANEUVER

    DEFF Research Database (Denmark)

    Husted, Rasmus S; Bencke, Jesper; Hölmich, Per

    2018-01-01

    recorded during a sidecutting maneuver (high-risk movement) in adolescent female soccer and handball athletes. Study design: Cross-sectional study. Methods: Eighty-five adolescent (age 16.9 ± 1.2 years) female elite handball and soccer athletes were assessed for maximal hip extensor, hip abductor and knee...

  6. 76 FR 41045 - Special Conditions; Gulfstream Aerospace LP (GALP) Model G250 Airplane, Design Roll-Maneuver...

    Science.gov (United States)

    2011-07-13

    ... issue a finding of regulatory adequacy under Sec. 611 of Public Law 92-574, the ``Noise Control Act of... with electronic flight controls as they relate to design roll-maneuver requirements. The applicable... G250 airplane is equipped with an electronic flight control system that provides control through the...

  7. Determination of the SNPP VIIRS SDSM Screen Relative Transmittance From Both Yaw Maneuver and Regular On-Orbit Data

    Science.gov (United States)

    Lei, Ning; Chen, Xuexia; Xiong, Xiaoxiong

    2015-01-01

    The Visible Infrared Imaging Radiometer Suiteaboard the Suomi National Polar-orbiting Partnership (SNPP) satellite performs radiometric calibration of its reflective solar bands primarily through observing a sunlit onboard solar diffuser (SD). The SD bidirectional reflectance distribution function(BRDF) degradation factor is determined by an onboard SD stability monitor (SDSM), which observes the Sun through a pinhole screen and the sunlit SD. The transmittance of the SDSM pinhole screen over a range of solar angles was determined prelaunch and used initially to determine the BRDF degradation factor.The degradation-factor-versus-time curves were found to have a number of very large unphysical undulations likely due to the inaccuracy in the prelaunch determined SDSM screen transmittance.To refine the SDSM screen transmittance, satellite yaw maneuvers were carried out. With the SDSM screen relative transmittance determined from the yaw maneuver data, the computed BRDFdegradation factor curves still have large unphysical ripples, indicating that the projected solar horizontal angular step size in the yaw maneuver data is too large to resolve the transmittance at a fine angular scale. We develop a methodology to use both the yaw maneuver and a small portion of regular on-orbit data to determine the SDSM screen relative transmittance at a fine angular scale. We determine that the error standard deviation of the calculated relative transmittance ranges from 0.00030 (672 nm) to 0.00092 (926 nm). With the newly determined SDSM screen relative transmittance, the computed BRDF degradation factor behaves much more smoothly over time.

  8. The Assessment of Airway Maneuvers and Interventions in University Canadian Football, Ice Hockey, and Soccer Players

    Science.gov (United States)

    Delaney, J. Scott; Al-Kashmiri, Ammar; Baylis, Penny-Jane; Troutman, Tracy; Aljufaili, Mahmood; Correa, José A.

    2011-01-01

    Abstract Context: Managing an airway in an unconscious athlete is a lifesaving skill that may be made more difficult by the recent changes in protective equipment. Different airway maneuvers and techniques may be required to help ventilate an unconscious athlete who is wearing full protective equipment. Objective: To assess the effectiveness of different airway maneuvers with football, ice hockey, and soccer players wearing full protective equipment. Design: Crossover study. Setting: University sports medicine clinic. Patients or Other Participants: A total of 146 university varsity athletes, consisting of 62 football, 45 ice hockey, and 39 soccer players. Intervention(s): Athletes were assessed for different airway and physical characteristics. Three investigators then evaluated the effectiveness of different bag-valve-mask (BVM) ventilation techniques in supine athletes who were wearing protective equipment while inline cervical spine immobilization was maintained. Main Outcome Measure(s): The effectiveness of 1-person BVM ventilation (1-BVM), 2-person BVM ventilation (2-BVM), and inline immobilization and ventilation (IIV) was judged by each investigator for each athlete using a 4-point rating scale. Results: All forms of ventilation were least difficult in soccer players and most difficult in football players. When compared with 1-BVM, both 2-BVM and IIV were deemed more effective by all investigators for all athletes. Interference from the helmet and stabilizer were common reasons for difficult ventilation in football and ice hockey players. Conclusions: Sports medicine professionals should practice and be comfortable with different ventilation techniques for athletes wearing full equipment. The use of a new ventilation technique, termed inline immobilization and ventilation, may be beneficial, especially when the number of responders is limited. PMID:21391796

  9. The investigation of ship maneuvering with hydrodynamic effects between ships in curved narrow channel

    Directory of Open Access Journals (Sweden)

    Chun-Ki Lee

    2016-01-01

    Full Text Available The hydrodynamic interaction between two large vessels can't be neglected when two large vessels are closed to each other in restricted waterways such as in a harbor or narrow channel. This paper is mainly concerned with the ship maneuvering motion based on the hydrodynamic interaction effects between two large vessels moving each other in curved narrow channel. In this research, the characteristic features of the hydrodynamic interaction forces between two large vessels are described and illustrated, and the effects of velocity ratio and the spacing between two vessels are summarized and discussed. Also, the Inchon outer harbor area through the PALMI island channel in Korea was selected, and the ship maneuvering simulation was carried out to propose an appropriate safe speed and distance between two ships, which is required to avoid sea accident in confined waters. From the inspection of this investigation, it indicates the following result. Under the condition of SP12≤0.5L, it may encounter a dangerous tendency of grounding or collision due to the combined effect of the interaction between ships and external forces. Also considering the interaction and wind effect as a parameter, an overtaken and overtaking vessel in narrow channel can navigate while keeping its own original course under the following conditions; the lateral separation between two ships is about kept at 0.6 times of ship length and 15 degrees of range in maximum rudder angle. On the other hand, two ships while overtaking in curved narrow channel such as Inchon outer harbor in Korea should be navigated under the following conditions; SP12 is about kept at 1.0 times of ship length and the wind velocity should not be stronger than 10 m/s.

  10. Optimizing Mars Sphere of Influence Maneuvers for NASA's Evolvable Mars Campaign

    Science.gov (United States)

    Merrill, Raymond G.; Komar, D. R.; Chai, Patrick; Qu, Min

    2016-01-01

    NASA's Human Spaceflight Architecture Team is refining human exploration architectures that will extend human presence to the Martian surface. For both Mars orbital and surface missions, NASA's Evolvable Mars Campaign assumes that cargo and crew can be delivered repeatedly to the same destination. Up to this point, interplanetary trajectories have been optimized to minimize the total propulsive requirements of the in-space transportation systems, while the pre-deployed assets and surface systems are optimized to minimize their respective propulsive requirements separate from the in-space transportation system. There is a need to investigate the coupled problem of optimizing the interplanetary trajectory and optimizing the maneuvers within Mars's sphere of influence. This paper provides a description of the ongoing method development, analysis and initial results of the effort to resolve the discontinuity between the interplanetary trajectory and the Mars sphere of influence trajectories. Assessment of Phobos and Deimos orbital missions shows the in-space transportation and crew taxi allocations are adequate for missions in the 2030s. Because the surface site has yet to be selected, the transportation elements must be sized to provide enough capability to provide surface access to all landing sites under consideration. Analysis shows access to sites from elliptical parking orbits with a lander that is designed for sub-periapsis landing location is either infeasible or requires expensive orbital maneuvers for many latitude ranges. In this case the locus of potential arrival perigee vectors identifies the potential maximum north or south latitudes accessible. Higher arrival velocities can decrease reorientation costs and increase landing site availability. Utilizing hyperbolic arrival and departure vectors in the optimization scheme will increase transportation site accessibility and provide more optimal solutions.

  11. Cardiopulmonary Re-Immonation (CPR: How Long Should A Person Insist On Performing The Maneuvers?

    Directory of Open Access Journals (Sweden)

    Henrique José Bandeira Formiga

    2017-04-01

    Full Text Available Objetive: The study had the aim to describe the exact moment of interrupting CPR maneuvers in patients in CRP situations. Method: This is an exploratory and descriptive research, with quantitative character and approach. It was performed with 67 (seventy-seven nurses from a Regional Hospital, who were informed about the objectives of the same. There were included those who act in direct patient care; of effective position and contracted in the service; And with more than one (1 year of training. The instrument used for data collection was a questionnaire, previously elaborated, containing objective, subjective and non-inductive questions, which allowed the informant to answer the data pertinent to the study. It was found that the majority of the interviewees were women, aged between 31 and 35 years, specialists, with more than 4 years of training and 3 years of service, medical / surgical clinic attendees, and without reports of training. Results: They demonstrated they know the exact timing of CPR maneuvers but reported that they would not apply CPR in situations in which the patient had cadaveric stiffness, decomposition, crushing of the skull and thorax, or a CPA report of more than 20 minutes. Faced with conditions in which the team could decide not to perform CPR, they reported not applying CPR in the vegetative state, in terminal or chronic patients. Conclusion: Therefore, they conclude that the said moment of interrupting the protocol is determined in a personal and ethical way, that is, by the individuality of each situation. Keywords: Nurses. Cardiovascular Stop. Cardiopulmonary resuscitation.

  12. [Efficacy of quick repositioning maneuver for posterior semicircular canal benign paroxysmal positional vertigo in different age groups].

    Science.gov (United States)

    Zhang, Hao; Li, Jinrang; Guo, Pengfei; Tian, Shiyu; Li, Keliang

    2015-12-01

    To observe the short and long-term efficacy of quick repositioning maneuver for posterior semicircular canal benign paroxysmal positional vertigo (PC-BPPV) in different age groups. The clinical data of 113 adult patients with single PC-BPPV who underwent quick repositioning maneuver from July 2009 to February 2015 were retrospectively analyzed. The quick repositioning maneuver was to roll the patient from involved side to healthy side in the coronal plane for 180° as quickly as possible. The patients were divided into 3 groups according to different ages: young group (age group (45 ≤ age group (≥ 60 years). The short and long term outcomes of the three groups were observed. The left ear was involved in 58 cases (51.3%) and the right ear in 55 cases (48.7%). The short term improvement rates of the young, middle-age and the old groups were 92.5%, 93.6% and 92.3% respectively, and the long term improvement rate was 90.0%, 85.1% and 73.1% respectively. There was no significant difference among the three groups in short and long term outcomes (P > 0.05). The recurrence rate of the three groups was 5.0%, 6.4% and 15.4% respectively, also no significant difference (P > 0.05). The quick repositioning maneuver along the coronal plane for PC-BPPV has a definite effect for every age groups. The method is simple, rapid and easy to master, and the patients are tolerated the maneuver well without evident side effect.

  13. Effects of positive end-expiratory pressure and recruitment maneuvers in a ventilator-induced injury mouse model.

    Directory of Open Access Journals (Sweden)

    Laura A Cagle

    Full Text Available Positive-pressure mechanical ventilation is an essential therapeutic intervention, yet it causes the clinical syndrome known as ventilator-induced lung injury. Various lung protective mechanical ventilation strategies have attempted to reduce or prevent ventilator-induced lung injury but few modalities have proven effective. A model that isolates the contribution of mechanical ventilation on the development of acute lung injury is needed to better understand biologic mechanisms that lead to ventilator-induced lung injury.To evaluate the effects of positive end-expiratory pressure and recruitment maneuvers in reducing lung injury in a ventilator-induced lung injury murine model in short- and longer-term ventilation.5-12 week-old female BALB/c mice (n = 85 were anesthetized, placed on mechanical ventilation for either 2 hrs or 4 hrs with either low tidal volume (8 ml/kg or high tidal volume (15 ml/kg with or without positive end-expiratory pressure and recruitment maneuvers.Alteration of the alveolar-capillary barrier was noted at 2 hrs of high tidal volume ventilation. Standardized histology scores, influx of bronchoalveolar lavage albumin, proinflammatory cytokines, and absolute neutrophils were significantly higher in the high-tidal volume ventilation group at 4 hours of ventilation. Application of positive end-expiratory pressure resulted in significantly decreased standardized histology scores and bronchoalveolar absolute neutrophil counts at low- and high-tidal volume ventilation, respectively. Recruitment maneuvers were essential to maintain pulmonary compliance at both 2 and 4 hrs of ventilation.Signs of ventilator-induced lung injury are evident soon after high tidal volume ventilation (as early as 2 hours and lung injury worsens with longer-term ventilation (4 hrs. Application of positive end-expiratory pressure and recruitment maneuvers are protective against worsening VILI across all time points. Dynamic compliance can be used guide

  14. Effects of positive end-expiratory pressure and recruitment maneuvers in a ventilator-induced injury mouse model

    Science.gov (United States)

    Franzi, Lisa M.; Linderholm, Angela L.; Last, Jerold A.; Adams, Jason Y.; Harper, Richart W.

    2017-01-01

    Background Positive-pressure mechanical ventilation is an essential therapeutic intervention, yet it causes the clinical syndrome known as ventilator-induced lung injury. Various lung protective mechanical ventilation strategies have attempted to reduce or prevent ventilator-induced lung injury but few modalities have proven effective. A model that isolates the contribution of mechanical ventilation on the development of acute lung injury is needed to better understand biologic mechanisms that lead to ventilator-induced lung injury. Objectives To evaluate the effects of positive end-expiratory pressure and recruitment maneuvers in reducing lung injury in a ventilator-induced lung injury murine model in short- and longer-term ventilation. Methods 5–12 week-old female BALB/c mice (n = 85) were anesthetized, placed on mechanical ventilation for either 2 hrs or 4 hrs with either low tidal volume (8 ml/kg) or high tidal volume (15 ml/kg) with or without positive end-expiratory pressure and recruitment maneuvers. Results Alteration of the alveolar-capillary barrier was noted at 2 hrs of high tidal volume ventilation. Standardized histology scores, influx of bronchoalveolar lavage albumin, proinflammatory cytokines, and absolute neutrophils were significantly higher in the high-tidal volume ventilation group at 4 hours of ventilation. Application of positive end-expiratory pressure resulted in significantly decreased standardized histology scores and bronchoalveolar absolute neutrophil counts at low- and high-tidal volume ventilation, respectively. Recruitment maneuvers were essential to maintain pulmonary compliance at both 2 and 4 hrs of ventilation. Conclusions Signs of ventilator-induced lung injury are evident soon after high tidal volume ventilation (as early as 2 hours) and lung injury worsens with longer-term ventilation (4 hrs). Application of positive end-expiratory pressure and recruitment maneuvers are protective against worsening VILI across all time points

  15. Effects of positive end-expiratory pressure and recruitment maneuvers in a ventilator-induced injury mouse model.

    Science.gov (United States)

    Cagle, Laura A; Franzi, Lisa M; Linderholm, Angela L; Last, Jerold A; Adams, Jason Y; Harper, Richart W; Kenyon, Nicholas J

    2017-01-01

    Positive-pressure mechanical ventilation is an essential therapeutic intervention, yet it causes the clinical syndrome known as ventilator-induced lung injury. Various lung protective mechanical ventilation strategies have attempted to reduce or prevent ventilator-induced lung injury but few modalities have proven effective. A model that isolates the contribution of mechanical ventilation on the development of acute lung injury is needed to better understand biologic mechanisms that lead to ventilator-induced lung injury. To evaluate the effects of positive end-expiratory pressure and recruitment maneuvers in reducing lung injury in a ventilator-induced lung injury murine model in short- and longer-term ventilation. 5-12 week-old female BALB/c mice (n = 85) were anesthetized, placed on mechanical ventilation for either 2 hrs or 4 hrs with either low tidal volume (8 ml/kg) or high tidal volume (15 ml/kg) with or without positive end-expiratory pressure and recruitment maneuvers. Alteration of the alveolar-capillary barrier was noted at 2 hrs of high tidal volume ventilation. Standardized histology scores, influx of bronchoalveolar lavage albumin, proinflammatory cytokines, and absolute neutrophils were significantly higher in the high-tidal volume ventilation group at 4 hours of ventilation. Application of positive end-expiratory pressure resulted in significantly decreased standardized histology scores and bronchoalveolar absolute neutrophil counts at low- and high-tidal volume ventilation, respectively. Recruitment maneuvers were essential to maintain pulmonary compliance at both 2 and 4 hrs of ventilation. Signs of ventilator-induced lung injury are evident soon after high tidal volume ventilation (as early as 2 hours) and lung injury worsens with longer-term ventilation (4 hrs). Application of positive end-expiratory pressure and recruitment maneuvers are protective against worsening VILI across all time points. Dynamic compliance can be used guide the frequency

  16. An Echodensity in the Sinus of Valsalva

    NARCIS (Netherlands)

    Amir, Rabia; Yeh, Lu; Matyal, Robina; Mahmood, Feroze

    2016-01-01

    A 60-YEAR-OLD woman was referred to the authors’ institution for surgical treatment of severe aortic valve stenosis with progressive exertional dyspnea. A few months before the current admission, she had been treated in an outside hospital for congestive heart failure. Cardiac catheterization

  17. Valsalva Retinopathy Associated with Sexual Activity

    Directory of Open Access Journals (Sweden)

    Khalid Al Rubaie

    2014-01-01

    Full Text Available A 54-year-old healthy male presented complaining of sudden loss of vision in the right eye. Initial visual acuity was counting fingers. The patient’s acute vision loss developed after sexual activity. Color fundus photos and fluorescein angiography were performed showing a large subinternal limiting membrane hemorrhage in the macular area. A 23-gauge sutureless pars plana vitrectomy with brilliant blue assisted internal limiting membrane peeling was performed with best-corrected visual acuity recovery to 20/50 at 6 months of followup.

  18. In utero and intra-partum HIV-1 transmission and acute HIV-1 infection during pregnancy: using the BED capture enzyme-immunoassay as a surrogate marker for acute infection.

    Science.gov (United States)

    Marinda, Edmore T; Moulton, Lawrence H; Humphrey, Jean H; Hargrove, John W; Ntozini, Robert; Mutasa, Kuda; Levin, Jonathan

    2011-08-01

    The BED assay was developed to estimate the proportion of recent HIV infections in a population. We used the BED assay as a proxy for acute infection to quantify the associated risk of mother-to-child-transmission (MTCT) during pregnancy and delivery. Design A total of 3773 HIV-1 sero-positive women were tested within 96 h of delivery using the BED assay, and CD4 cell count measurements were taken. Mothers were classified according to their likelihood of having recently seroconverted. The risk of MTCT in utero and intra-partum was assessed comparing different groups defined by BED and CD4 cell count, adjusting for background factors using multinomial logistic models. Compared with women with BED ≥ 0.8/CD4 ≥ 350 (typical of HIV-1 chronic patients) there was insufficient evidence to conclude that women presenting with BED pregnancy.

  19. Effects of maneuver dynamics on drag polars of the X-29A forward-swept-wing aircraft with automatic wing camber control

    Science.gov (United States)

    Hicks, John W.; Moulton, Bryan J.

    1988-01-01

    The camber control loop of the X-29A FSW aircraft was designed to furnish the optimum L/D for trimmed, stabilized flight. A marked difference was noted between automatic wing camber control loop behavior in dynamic maneuvers and in stabilized flight conditions, which in turn affected subsonic aerodynamic performance. The degree of drag level increase was a direct function of maneuver rate. Attention is given to the aircraft flight drag polar effects of maneuver dynamics in light of wing camber control loop schedule. The effect of changing camber scheduling to better track the optimum automatic camber control L/D schedule is discussed.

  20. An adaptive maneuvering logic computer program for the simulation of one-on-one air-to-air combat. Volume 1: General description

    Science.gov (United States)

    Burgin, G. H.; Fogel, L. J.; Phelps, J. P.

    1975-01-01

    A technique for computer simulation of air combat is described. Volume 1 decribes the computer program and its development in general terms. Two versions of the program exist. Both incorporate a logic for selecting and executing air combat maneuvers with performance models of specific fighter aircraft. In the batch processing version the flight paths of two aircraft engaged in interactive aerial combat and controlled by the same logic are computed. The realtime version permits human pilots to fly air-to-air combat against the adaptive maneuvering logic (AML) in Langley Differential Maneuvering Simulator (DMS). Volume 2 consists of a detailed description of the computer programs.

  1. Optimal Control of Hypersonic Planning Maneuvers Based on Pontryagin’s Maximum Principle

    Directory of Open Access Journals (Sweden)

    A. Yu. Melnikov

    2015-01-01

    Full Text Available The work objective is the synthesis of simple analytical formula of the optimal roll angle of hypersonic gliding vehicles for conditions of quasi-horizontal motion, allowing its practical implementation in onboard control algorithms.The introduction justifies relevance, formulates basic control tasks, and describes a history of scientific research and achievements in the field concerned. The author reveals a common disadvantage of the other authors’ methods, i.e. the problem of practical implementation in onboard control algorithms.The similar tasks of hypersonic maneuvers are systemized according to the type of maneuver, control parameters and limitations.In the statement of the problem the glider launched horizontally with a suborbital speed glides passive in the static Atmosphere on a spherical surface of constant radius in the Central field of gravitation.The work specifies a system of equations of motion in the inertial spherical coordinate system, sets the limits on the roll angle and optimization criteria at the end of the flight: high speed or azimuth and the minimum distances to the specified geocentric points.The solution.1 A system of equations of motion is transformed by replacing the time argument with another independent argument – the normal equilibrium overload. The Hamiltonian and the equations of mated parameters are obtained using the Pontryagin’s maximum principle. The number of equations of motion and mated vector is reduced.2 The mated parameters were expressed by formulas using current movement parameters. The formulas are proved through differentiation and substitution in the equations of motion.3 The Formula of optimal roll-position control by condition of maximum is obtained. After substitution of mated parameters, the insertion of constants, and trigonometric transformations the Formula of the optimal roll angle is obtained as functions of the current parameters of motion.The roll angle is expressed as the ratio

  2. A Recruiting Maneuver Algorithm in Patients with Early Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    D. I. Levikov

    2011-01-01

    Full Text Available Objective: to evaluate the efficiency of a recruiting maneuver (RM and adjustment of positive end-expiratory pressure (PEEP in patients with early acute respiratory distress syndrome (ARDS. Subjects and methods. The study enrolled 16 patients (14 men and 2 women aged 46 to 78 years (range 62±5.6 years with ARDS of various genesis. RM was made, by stepwisely increasing PEEP and inspiratory pressure under the control of dynamic lung compliance and hemodynamic parameters. The values of blood gas composition and hemodynamics were determined during the study. Results. RM caused an increase in oxygenation index (OI from 153.5±48.3 to 348.5±53.2 mm Hg. Oxygenation values returned to the baseline levels 30—40 min after the PEEP was set at the closure point of +2 cm H2O. If the set PEEP was 8—10 cm H2O higher than the objective, the effect of RM was retained for as long as 24 hours. When RM was performed using the maximum pressure of 50—60 cm H2O, the cardiac index (CI was lower in all the patients and 30—50% of the baseline values were achieved in all cases, which required the optimization of cardiotonic therapy. The time of this pronounced reduction in cardiac output with RM was not longer than 5 min. After RM, during mechanical ventilation with 18—26 cm H2O PEEP, the CI did not practically differ from the baseline values (3.31±0.41 and 3.37±0.36 l/min/m2, respectively, though the dopamine dose required to maintain normal hemodynamics was somewhat higher (7.5±2.3 and 6.3±2.6 ^g/kg/min. Conclusion. Analysis of the given cases suggests that RM is highly effective in patients at the early stages of acute lung injury. The duration of RM effects may depend on the set PEEP level in individual cases. Setting PEEP at a level of +2—4 cm H2O fails to prevent repeated alveolar derecruitment in a number of patients. In these cases, it is expedient to individually adjust PEEP levels, by taking into account the long-term changes in OI and Cdyn. In

  3. The impact of diabetes on mobility, balance, and recovery after repositioning maneuvers in individuals with benign paroxysmal positional vertigo.

    Science.gov (United States)

    D'Silva, Linda J; Whitney, Susan L; Santos, Marcio; Dai, Hongying; Kluding, Patricia M

    2017-06-01

    The prevalence of benign paroxysmal positional vertigo (BPPV) is higher in people with type 2 diabetes (DM). The impact of DM on mobility, balance, and management of BPPV is unknown. This prospective study compared symptom severity, mobility and balance before and after the canalith repositioning maneuver (CRM) in people with posterior canal BPPV canalithiasis, with and without DM. Fifty participants, BPPV (n=34) and BPPV+DM (n=16) were examined for symptom severity (dizziness handicap inventory, DHI), mobility (functional gait assessment, FGA), and postural sway (using an accelerometer in five conditions) before and after the CRM. The number of maneuvers required for symptom resolution was recorded. At baseline, no differences in DHI or FGA scores were seen between groups, however, people with BPPV+DM had higher sway velocity in the medio-lateral direction in tandem stance (pdiabetes, as well as the influence of diabetic peripheral neuropathy on functional performance are essential. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Maintain and Regain Well Clear: Maneuver Guidance Designs for Pilots Performing the Detect-and-Avoid Task

    Science.gov (United States)

    Monk, Kevin J.; Roberts, Zachary

    2017-01-01

    In order to support the future expansion and integration of Unmanned Aircraft Systems (UAS), ongoing research efforts have sought to produce findings that inform the minimum display information elements required for acceptable UAS pilot response times and traffic avoidance. Previous simulations have revealed performance benefits associated with DAA displays containing predictive information and suggestive maneuver guidance tools in the form of banding. The present study investigated the impact of various maneuver guidance display configurations on detect-and-avoid (DAA) task performance in a simulated airspace environment. UAS pilots ability to maintain DAA well clear was compared between displays with either the presence or absence of green DAA bands, which indicated conflict-free flight regions. Additional display comparisons assessed pilots ability to regain DAA well clear with two different guidance presentations designed to aid in DAA well clear recovery during critical encounters. Performance implications and display considerations for future UAS DAA systems are discussed.

  5. Modified unscented Kalman filter using modified filter gain and variance scale factor for highly maneuvering target tracking

    Institute of Scientific and Technical Information of China (English)

    Changyun Liu; Penglang Shui; Gang Wei; Song Li

    2014-01-01

    To improve the low tracking precision caused by lagged filter gain or imprecise state noise when the target highly maneu-vers, a modified unscented Kalman filter algorithm based on the improved filter gain and adaptive scale factor of state noise is pre-sented. In every filter process, the estimated scale factor is used to update the state noise covariance Qk, and the improved filter gain is obtained in the filter process of unscented Kalman filter (UKF) via predicted variance Pk|k-1, which is similar to the standard Kalman filter. Simulation results show that the proposed algorithm provides better accuracy and ability to adapt to the highly maneu-vering target compared with the standard UKF.

  6. Experimental Analysis of Steady-State Maneuvering Effects on Transmission Vibration Patterns Recorded in an AH-1 Cobra Helicopter

    Science.gov (United States)

    Huff, Edward M.; Dzwonczyk, Mark; Norvig, Peter (Technical Monitor)

    2000-01-01

    Flight experiment was designed primarily to determine the extent to which steady-state maneuvers influence characteristic vibration patterns measured at the input pinion and output annulus gear locations of the main transmission. If results were to indicate that maneuvers systematically influence vibration patterns, more extensive studies would be planned to explore the response surface. It was also designed to collect baseline data for comparison with experimental data to be recorded at a later date from test stands at Glenn Research Center. Finally, because this was the first vibration flight study on the Cobra aircraft, considerable energy was invested in developing an in-flight recording apparatus, as well as exploring acceleration mounting methods, and generally learning about the overall vibratory characteristics of the aircraft itself.

  7. Development and experimentation of LQR/APF guidance and control for autonomous proximity maneuvers of multiple spacecraft

    Science.gov (United States)

    Bevilacqua, R.; Lehmann, T.; Romano, M.

    2011-04-01

    This work introduces a novel control algorithm for close proximity multiple spacecraft autonomous maneuvers, based on hybrid linear quadratic regulator/artificial potential function (LQR/APF), for applications including autonomous docking, on-orbit assembly and spacecraft servicing. Both theoretical developments and experimental validation of the proposed approach are presented. Fuel consumption is sub-optimized in real-time through re-computation of the LQR at each sample time, while performing collision avoidance through the APF and a high level decisional logic. The underlying LQR/APF controller is integrated with a customized wall-following technique and a decisional logic, overcoming problems such as local minima. The algorithm is experimentally tested on a four spacecraft simulators test bed at the Spacecraft Robotics Laboratory of the Naval Postgraduate School. The metrics to evaluate the control algorithm are: autonomy of the system in making decisions, successful completion of the maneuver, required time, and propellant consumption.

  8. Electronic data collection for the analysis of surgical maneuvers on patients submitted to rhinoplasty

    Science.gov (United States)

    Berger, Cezar; Freitas, Renato; Malafaia, Osvaldo; Pinto, José Simão de Paula; Mocellin, Marcos; Macedo, Evaldo; Fagundes, Marina Serrato Coelho

    2012-01-01

    Summary Introduction: In the health field, computerization has become increasingly necessary in professional practice, since it facilitates data recovery and assists in the development of research with greater scientific rigor. Objective: the present work aimed to develop, apply, and validate specific electronic protocols for patients referred for rhinoplasty. Methods: The prospective research had 3 stages: (1) preparation of theoretical data bases; (2) creation of a master protocol using Integrated System of Electronic Protocol (SINPE©); and (3) elaboration, application, and validation of a specific protocol for the nose and sinuses regarding rhinoplasty. Results: After the preparation of the master protocol, which dealt with the entire field of otorhinolaryngology, we idealized a specific protocol containing all matters related to the patient. In particular, the aesthetic and functional nasal complaints referred for surgical treatment (i.e., rhinoplasty) were organized into 6 main hierarchical categories: anamnesis, physical examination, complementary exams, diagnosis, treatment, and outcome. This protocol utilized these categories and their sub-items: finality; access; surgical maneuvers on the nasal dorsum, tip, and base; clinical evolution after 3, 6, and 12 months; revisional surgery; and quantitative and qualitative evaluations. Conclusion: The developed electronic-specific protocol is feasible and important for information registration from patients referred to rhinoplasty. PMID:25991979

  9. Electronic data collection for the analysis of surgical maneuvers on patients submitted to rhinoplasty

    Directory of Open Access Journals (Sweden)

    Berger, Cezar

    2012-01-01

    Full Text Available Introduction: In the health field, computerization has become increasingly necessary in professional practice, since it facilitates data recovery and assists in the development of research with greater scientific rigor. Objective: the present work aimed to develop, apply, and validate specific electronic protocols for patients referred for rhinoplasty. Methods: The prospective research had 3 stages: (1 preparation of theoretical data bases; (2 creation of a master protocol using Integrated System of Electronic Protocol (SINPE©; and (3 elaboration, application, and validation of a specific protocol for the nose and sinuses regarding rhinoplasty. Results: After the preparation of the master protocol, which dealt with the entire field of otorhinolaryngology, we idealized a specific protocol containing all matters related to the patient. In particular, the aesthetic and functional nasal complaints referred for surgical treatment (i.e., rhinoplasty were organized into 6 main hierarchical categories: anamnesis, physical examination, complementary exams, diagnosis, treatment, and outcome. This protocol utilized these categories and their sub-items: finality; access; surgical maneuvers on the nasal dorsum, tip, and base; clinical evolution after 3, 6, and 12 months; revisional surgery; and quantitative and qualitative evaluations. Conclusion: The developed electronic-specific protocol is feasible and important for information registration from patients referred to rhinoplasty.

  10. Environmental effects of fog oil and CS usage at the Combat Maneuver Training Center, Hohenfels, Germany

    Energy Technology Data Exchange (ETDEWEB)

    Brubaker, K.L.; Rosenblatt, D.H.; Snyder, C.T.

    1992-03-01

    In response to environmental concerns at the Combat Maneuver Training Center (CMTC), Hohenfels, Germany, the US Army 7th Army Training Command commissioned a scientific study by Argonne National Laboratory to investigate specific issues. The study involved three parts: (1) a field study to determine if fog oil and CS (a compound named after its discoverers, B.B. Carson and R.W. Stoughton) were accumulating in the CMTC environment, (2) a screening of selected soil samples for the presence of US Environmental Protection Agency priority pollutants, and (3) a literature review of the health effects of fog oil and CS, as well as a review of training practices at CMTC. No fog oil or fog oil degradation products were detected in any soil, sediment, or vegetation sample collected at CMTC. Trace quantities of one or more priority pollutants were tentatively detected in three of eight soil and sediment samples. However, the priority pollutant concentrations are so low that they pose no environmental or health hazards. No evidence of widespread or significant contamination in the training areas was found. Crucial data needed to fully evaluate both acute and chronic health effects of civilian exposures to CS at CMTC are not available. On the basis of the available literature, long-ten-n health effects in the civilian population near CMTC that could result from the use of fog oil and CS during training activities are believed to be negligible.

  11. A low-complexity interacting multiple model filter for maneuvering target tracking

    KAUST Repository

    Khalid, Syed Safwan

    2017-01-22

    In this work, we address the target tracking problem for a coordinate-decoupled Markovian jump-mean-acceleration based maneuvering mobility model. A novel low-complexity alternative to the conventional interacting multiple model (IMM) filter is proposed for this class of mobility models. The proposed tracking algorithm utilizes a bank of interacting filters where the interactions are limited to the mixing of the mean estimates, and it exploits a fixed off-line computed Kalman gain matrix for the entire filter bank. Consequently, the proposed filter does not require matrix inversions during on-line operation which significantly reduces its complexity. Simulation results show that the performance of the low-complexity proposed scheme remains comparable to that of the traditional (highly-complex) IMM filter. Furthermore, we derive analytical expressions that iteratively evaluate the transient and steady-state performance of the proposed scheme, and establish the conditions that ensure the stability of the proposed filter. The analytical findings are in close accordance with the simulated results.

  12. Maneuvering control and configuration adaptation of a biologically inspired morphing aircraft

    Science.gov (United States)

    Abdulrahim, Mujahid

    Natural flight as a source of inspiration for aircraft design was prominent with early aircraft but became marginalized as aircraft became larger and faster. With recent interest in small unmanned air vehicles, biological inspiration is a possible technology to enhance mission performance of aircraft that are dimensionally similar to gliding birds. Serial wing joints, loosely modeling the avian skeletal structure, are used in the current study to allow significant reconfiguration of the wing shape. The wings are reconfigured to optimize aerodynamic performance and maneuvering metrics related to specific mission tasks. Wing shapes for each mission are determined and related to the seagulls, falcons, albatrosses, and non-migratory African swallows on which the aircraft are based. Variable wing geometry changes the vehicle dynamics, affording versatility in flight behavior but also requiring appropriate compensation to maintain stability and controllability. Time-varying compensation is in the form of a baseline controller which adapts to both the variable vehicle dynamics and to the changing mission requirements. Wing shape is adapted in flight to minimize a cost function which represents energy, temporal, and spatial efficiency. An optimal control architecture unifies the control and adaptation tasks.

  13. A low-complexity interacting multiple model filter for maneuvering target tracking

    KAUST Repository

    Khalid, Syed Safwan; Abrar, Shafayat

    2017-01-01

    In this work, we address the target tracking problem for a coordinate-decoupled Markovian jump-mean-acceleration based maneuvering mobility model. A novel low-complexity alternative to the conventional interacting multiple model (IMM) filter is proposed for this class of mobility models. The proposed tracking algorithm utilizes a bank of interacting filters where the interactions are limited to the mixing of the mean estimates, and it exploits a fixed off-line computed Kalman gain matrix for the entire filter bank. Consequently, the proposed filter does not require matrix inversions during on-line operation which significantly reduces its complexity. Simulation results show that the performance of the low-complexity proposed scheme remains comparable to that of the traditional (highly-complex) IMM filter. Furthermore, we derive analytical expressions that iteratively evaluate the transient and steady-state performance of the proposed scheme, and establish the conditions that ensure the stability of the proposed filter. The analytical findings are in close accordance with the simulated results.

  14. Applications for General Purpose Command Buffers: The Emergency Conjunction Avoidance Maneuver

    Science.gov (United States)

    Scheid, Robert J; England, Martin

    2016-01-01

    A case study is presented for the use of Relative Operation Sequence (ROS) command buffers to quickly execute a propulsive maneuver to avoid a collision with space debris. In this process, a ROS is custom-built with a burn time and magnitude, uplinked to the spacecraft, and executed in 15 percent of the time of the previous method. This new process provides three primary benefits. First, the planning cycle can be delayed until it is certain a burn must be performed, reducing team workload. Second, changes can be made to the burn parameters almost up to the point of execution while still allowing the normal uplink product review process, reducing the risk of leaving the operational orbit because of outdated burn parameters, and minimizing the chance of accidents from human error, such as missed commands, in a high-stress situation. Third, the science impacts can be customized and minimized around the burn, and in the event of an abort can be eliminated entirely in some circumstances. The result is a compact burn process that can be executed in as few as four hours and can be aborted seconds before execution. Operational, engineering, planning, and flight dynamics perspectives are presented, as well as a functional overview of the code and workflow required to implement the process. Future expansions and capabilities are also discussed.

  15. A Novel Loss Recovery and Tracking Scheme for Maneuvering Target in Hybrid WSNs.

    Science.gov (United States)

    Qian, Hanwang; Fu, Pengcheng; Li, Baoqing; Liu, Jianpo; Yuan, Xiaobing

    2018-01-25

    Tracking a mobile target, which aims to timely monitor the invasion of specific target, is one of the most prominent applications in wireless sensor networks (WSNs). Traditional tracking methods in WSNs only based on static sensor nodes (SNs) have several critical problems. For example, to void the loss of mobile target, many SNs must be active to track the target in all possible directions, resulting in excessive energy consumption. Additionally, when entering coverage holes in the monitoring area, the mobile target may be missing and then its state is unknown during this period. To tackle these problems, in this paper, a few mobile sensor nodes (MNs) are introduced to cooperate with SNs to form a hybrid WSN due to their stronger abilities and less constrained energy. Then, we propose a valid target tracking scheme for hybrid WSNs to dynamically schedule the MNs and SNs. Moreover, a novel loss recovery mechanism is proposed to find the lost target and recover the tracking with fewer SNs awakened. Furthermore, to improve the robustness and accuracy of the recovery mechanism, an adaptive unscented Kalman filter (AUKF) algorithm is raised to dynamically adjust the process noise covariance. Simulation results demonstrate that our tracking scheme for maneuvering target in hybrid WSNs can not only track the target effectively even if the target is lost but also maintain an excellent accuracy and robustness with fewer activated nodes.

  16. Observability Analysis of DVL/PS Aided INS for a Maneuvering AUV

    Directory of Open Access Journals (Sweden)

    Itzik Klein

    2015-10-01

    Full Text Available Recently, ocean exploration has increased considerably through the use of autonomous underwater vehicles (AUV. A key enabling technology is the precision of the AUV navigation capability. In this paper, we focus on understanding the limitation of the AUV navigation system. That is, what are the observable error-states for different maneuvering types of the AUV? Since analyzing the performance of an underwater navigation system is highly complex, to answer the above question, current approaches use simulations. This, of course, limits the conclusions to the emulated type of vehicle used and to the simulation setup. For this reason, we take a different approach and analyze the system observability for different types of vehicle dynamics by finding the set of observable and unobservable states. To that end, we apply the observability Gramian approach, previously used only for terrestrial applications. We demonstrate our analysis for an underwater inertial navigation system aided by a Doppler velocity logger or by a pressure sensor. The result is a first prediction of the performance of an AUV standing, rotating at a position and turning at a constant speed. Our conclusions of the observable and unobservable navigation error states for different dynamics are supported by extensive numerical simulation.

  17. Determination of baroreflex sensitivity during the modified Oxford maneuver by trigonometric regressive spectral analysis.

    Directory of Open Access Journals (Sweden)

    Julia Gasch

    Full Text Available BACKGROUND: Differences in spontaneous and drug-induced baroreflex sensitivity (BRS have been attributed to its different operating ranges. The current study attempted to compare BRS estimates during cardiovascular steady-state and pharmacologically stimulation using an innovative algorithm for dynamic determination of baroreflex gain. METHODOLOGY/PRINCIPAL FINDINGS: Forty-five volunteers underwent the modified Oxford maneuver in supine and 60° tilted position with blood pressure and heart rate being continuously recorded. Drug-induced BRS-estimates were calculated from data obtained by bolus injections of nitroprusside and phenylephrine. Spontaneous indices were derived from data obtained during rest (stationary and under pharmacological stimulation (non-stationary using the algorithm of trigonometric regressive spectral analysis (TRS. Spontaneous and drug-induced BRS values were significantly correlated and display directionally similar changes under different situations. Using the Bland-Altman method, systematic differences between spontaneous and drug-induced estimates were found and revealed that the discrepancy can be as large as the gain itself. Fixed bias was not evident with ordinary least products regression. The correlation and agreement between the estimates increased significantly when BRS was calculated by TRS in non-stationary mode during the drug injection period. TRS-BRS significantly increased during phenylephrine and decreased under nitroprusside. CONCLUSIONS/SIGNIFICANCE: The TRS analysis provides a reliable, non-invasive assessment of human BRS not only under static steady state conditions, but also during pharmacological perturbation of the cardiovascular system.

  18. Intercept Algorithm for Maneuvering Targets Based on Differential Geometry and Lyapunov Theory

    Directory of Open Access Journals (Sweden)

    Yunes Sh. ALQUDSI

    2018-03-01

    Full Text Available Nowadays, the homing guidance is utilized in the existed and under development air defense systems (ADS to effectively intercept the targets. The targets became smarter and capable to fly and maneuver professionally and the tendency to design missile with a small warhead became greater, then there is a pressure to produce a more precise and accurate missile guidance system based on intelligent algorithms to ensure effective interception of highly maneuverable targets. The aim of this paper is to present an intelligent guidance algorithm that effectively and precisely intercept the maneuverable and smart targets by virtue of the differential geometry (DG concepts. The intercept geometry and engagement kinematics, in addition to the direct intercept condition are developed and expressed in DG terms. The guidance algorithm is then developed by virtue of DG and Lyapunov theory. The study terminates with 2D engagement simulation with illustrative examples, to demonstrate that, the derived DG guidance algorithm is a generalized guidance approach and the well-known proportional navigation (PN guidance law is a subset of this approach.

  19. The Function and Organization of the Motor System Controlling Flight Maneuvers in Flies.

    Science.gov (United States)

    Lindsay, Theodore; Sustar, Anne; Dickinson, Michael

    2017-02-06

    Animals face the daunting task of controlling their limbs using a small set of highly constrained actuators. This problem is particularly demanding for insects such as Drosophila, which must adjust wing motion for both quick voluntary maneuvers and slow compensatory reflexes using only a dozen pairs of muscles. To identify strategies by which animals execute precise actions using sparse motor networks, we imaged the activity of a complete ensemble of wing control muscles in intact, flying flies. Our experiments uncovered a remarkably efficient logic in which each of the four skeletal elements at the base of the wing are equipped with both large phasically active muscles capable of executing large changes and smaller tonically active muscles specialized for continuous fine-scaled adjustments. Based on the responses to a broad panel of visual motion stimuli, we have developed a model by which the motor array regulates aerodynamically functional features of wing motion. VIDEO ABSTRACT. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Influences of Athletic Footwear on Ground Reaction Forces During A Sidestep Cutting Maneuver on Artificial Turf

    Directory of Open Access Journals (Sweden)

    Jacob R. Gdovin

    2018-04-01

    Full Text Available Background: Recreational athletes can select their desired footwear based on personal preferences of shoe properties such as comfort and weight. Commonly worn running shoes and cleated footwear with similar stud geometry and distribution are worn when performing sport-specific tasks such as a side-step cutting maneuver (SCM in soccer and American football (hereafter, referred to as football. The effects of such footwear on injury mechanics have been documented with less being known regarding their effect on performance. Objective: The purpose of this study was to examine performance differences including peak ground reaction forces (pGRF, time-to-peak ground reaction forces (tpGRF and the rate of force development (RFD between football cleats (FB, soccer cleats (SOC, and traditional running sneakers (RUN during the braking and propulsive phases of a SCM. Methodology: Eleven recreationally active males who participated in football and/or soccer-related activities at the time of testing completed the study. A 1 x 3 [1 Condition (SCM x 3 Footwear (RUN, FB, SOC] repeated measures ANOVA was utilized to analyze the aforementioned variables. Results: There were no significant differences (p > 0.05 between footwear conditions when comparing pGRF, tpGRF, or RFD in either the braking or propulsive phases. Conclusion: The results suggest that the studded and non-studded footwear allowed athletes to generate similar forces over a given time frame when performing a SCM.