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Sample records for perioperative transoesophageal echo

  1. Modelling transoesophageal echo

    Directory of Open Access Journals (Sweden)

    Susan Wright

    2011-04-01

    Full Text Available Background: Achieving competence in transoesophageal echocardiography (TOE requires a clear understanding of cardiac anatomy as well as an ability to correlate two-dimensional (2D echocardiographic images with the three-dimensional (3D structures which they represent. Training in the technique is a long process, which may also be hampered by insufficient access to teaching in the clinical environment. These challenges would be met by a simulator which demonstrates detailed cardiac anatomy with a previously unavailable degree of accuracy. Methods: A TOE simulator system was created by collaboration with a wide range of clinical specialists and a post-production company skilled in the generation of computer graphics and special effects for the film industry. The core of the system is an animated, accurate and detailed virtual heart. Echocardiographic simulation was developed to provide a real-time display of ultrasound images alongside the 3D anatomical correlate of the imaging plane. Results: A freely interactive animated model of the heart was created as the basis for ultrasound simulation. Creation of a mannequin simulator which drives the software allowed reproduction of the practical experience of the TOE procedure. Conclusions: Partnership with groups with a wide diversity of skills can result in a simulator teaching tool of high fidelity.

  2. Transoesophageal echocardiography: What a neuroanaesthesiologist should know?

    Directory of Open Access Journals (Sweden)

    Minati Choudhury

    2015-01-01

    Full Text Available Transoesophageal echocardiography (TEE is a semi invasive imaging modality rapidly gained credence and popularity in the cardiothoracic centers worldwide by mid 1990s. It has also been found to be useful in some noncardiac surgical procedures, in particular in the management of neurosurgical patients and haemodynamically unstable patients in intensive care units (ICUs. The principal goal of basic transoesophageal echocardiographic examination encompass a broad range of anatomic imaging including the diagnosis of air embolism, causes of haemodynamic instability, ventricular size and function, volume status, and complications from invasive procedures, as well as the clinical impact or etiology of pulmonary dysfunction in ICU. TEE is relatively cheap and semi-invasive, but it should not be used as a stand-alone device but as a tool which provides data in addition to the data acquired from other forms of monitoring. The establishment of TEE in perioperative neuro anaesthetic care though recent, may result in a significant change in the role of the anaesthetsiologist who, using TEE can provide new information which may change the course and the outcome of surgical procedures.

  3. Echo

    Energy Technology Data Exchange (ETDEWEB)

    Harvey, Dustin Yewell [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-01-25

    This document is a white paper marketing proposal for Echo™ is a data analysis platform designed for efficient, robust, and scalable creation and execution of complex workflows. Echo’s analysis management system refers to the ability to track, understand, and reproduce workflows used for arriving at results and decisions. Echo improves on traditional scripted data analysis in MATLAB, Python, R, and other languages to allow analysts to make better use of their time. Additionally, the Echo platform provides a powerful data management and curation solution allowing analysts to quickly find, access, and consume datasets. After two years of development and a first release in early 2016, Echo is now available for use with many data types in a wide range of application domains. Echo provides tools that allow users to focus on data analysis and decisions with confidence that results are reported accurately.

  4. Perioperative anaphylaxis

    Directory of Open Access Journals (Sweden)

    Marta Inés Berrío Valencia

    2015-08-01

    Full Text Available BACKGROUND AND OBJECTIVE: Anaphylaxis remains one of the potential causes of perioperative death, being generally unanticipated and quickly progress to a life threatening situation. A narrative review of perioperative anaphylaxis is performed.CONTENT: The diagnostic tests are primarily to avoid further major events. The mainstays of treatment are adrenaline and intravenous fluids.CONCLUSION: The anesthesiologist should be familiar with the proper diagnosis, management and monitoring of perioperative anaphylaxis.

  5. ECHO virus

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/001340.htm ECHO virus To use the sharing features on this page, please enable JavaScript. Enteric cytopathic human orphan (ECHO) viruses are a group of viruses that can lead ...

  6. Ultrasound cylindrical phased array for transoesophageal thermal therapy: initial studies

    International Nuclear Information System (INIS)

    Melodelima, David; Lafon, Cyril; Prat, Frederic; Birer, Alain; Cathignol, Dominique

    2002-01-01

    This work was undertaken to investigate the feasibility of constructing a cylindrical phased array composed of 64 elements spread around the periphery (OD 10.6 mm) for transoesophageal ultrasound thermotherapy. The underlying operating principle of this applicator is to rotate a plane ultrasound beam electronically. For this purpose, eight adjacent transducers were successively excited with appropriate delay times so as to generate a plane wave. The exposure direction was changed by exciting a different set of eight elements. For these feasibility studies, we used a cylindrical prototype (OD 10.6 mm) composed of 16 elementary transducers distributed over a quarter of the cylinder, all operating at 4.55 MHz. The active part was mechanically reinforced by a rigid damper structure behind the transducers. It was shown that an ultrasound field similar to that emitted by a plane transducer could be generated. Ex vivo experiments on pig's liver demonstrated that the ultrasound beam could be accurately rotated to generate sector-based lesions to a suitable depth (up to 19 mm). Throughout these experiments, exposures lasting 20 s were delivered at an acoustic intensity of 17 W cm -2 . By varying the power from exposure to exposure, the depth of the lesion at different angles could be controlled

  7. How to misuse echo contrast

    Directory of Open Access Journals (Sweden)

    Missios Anna

    2009-01-01

    Full Text Available Abstract Background Primary intracardiac tumours are rare, there are however several entities that can mimic tumours. Contrast echocardiography has been suggested to aid the differentiation of various suspected masses. We present a case where transthoracic echocardiography completely misdiagnosed a left atrial mass, partly due to use of echo contrast. Case presentation An 80 year-old woman was referred for transthoracic echocardiography because of one-month duration of worsening of dyspnoea. Transthoracic echocardiography displayed a large echodense mass in the left atrium. Intravenous injection of contrast (SonoVue, Bracco Inc., It indicated contrast-enhancement of the structure, suggesting tumour. Transesophageal echocardiography revealed, however, a completely normal finding in the left atrium. Subsequent gastroscopy examination showed a hiatal hernia. Conclusion It is noteworthy that the transthoracic echocardiographic exam completely misdiagnosed what seemed like a left atrial mass, which in part was an effect of the use of echo contrast. This example highlights that liberal use of transoesophageal echocardiography is often warranted if optimal display of cardiac structures is desired.

  8. Influence of transoesophageal echocardiography on therapy and prognosis in young patients with TIA or ischaemic stroke

    NARCIS (Netherlands)

    Rettig, T. C. D.; Bouma, B. J.; van den Brink, R. B. A.

    2009-01-01

    Objective. To determine the influence of transoesophageal echocardiography (TEE) on therapy and prognosis in patients with cryptogenic transient ischaemic attack (TIA) or ischaemic stroke under the age of 50 years.Methods and results. We evaluated all patients aged 50 and under who were referred to

  9. Temporo-mandibular joint dislocation: an unusual complication of transoesophageal echocardiography.

    Science.gov (United States)

    Anantharam, Brijesh; Chahal, Navtej; Stephens, Nigel; Senior, Roxy

    2010-03-01

    Temporo-mandibular joint (TMJ) dislocation is an unusual complication of transoesophageal echocardiography (TEE). We report a rare case of bilateral TMJ dislocation in an 84-year-old man prior to DC cardioversion (DCCV) for atrial flutter. Shortly after TEE and DCCV, the patient complained of bilateral facial pain. An orthopantomogram revealed bilateral TMJ dislocation. A closed reduction was performed by maxillo-facial surgeons under intravenous anaesthesia. Although very uncommon, the physician should be aware of the complication and its management.

  10. Echo project

    DEFF Research Database (Denmark)

    Gfader, Verina; Carson, Rebecca; Kraus, Chris

    2016-01-01

    team to both present the printed matter in the format of running a book stall, and stage a discursive event at the Classroom. Echo reverberates some of the encounters and debates there, with new commissioned chapters propelling a ongoing correspondence across urban environs: An essay on the General...... mothers and demonology (Kathy Acker’s property deals in the UK), and more; and future materials formalized as poster texts . . ....

  11. An investigation into the causes of unexpected intra-operative transoesophageal echocardiography findings.

    Science.gov (United States)

    Skinner, H J; Mahmoud, A; Uddin, A; Mathew, T

    2012-04-01

    There is uncertainty regarding echocardiography before cardiac surgery, especially with regard to timing and disease progression as well as potential errors. We investigated the causes of unexpected intra-operative transoesophageal echocardiography findings by performing a 33-month audit. We found that there were 50/797 (6%) unexpected findings that led to an alteration in surgical strategy in 34 (4%) patients. Of the unexpected findings, 25 (50%) were unrelated to pre-operative pathology. After reviewing pre-operative studies and reports, unexpected findings were found to be due to: reporting errors in 20 patients (44%); limitations in transthoracic compared to transoesophageal echocardiography in 14 patients (30%); disease progression in 10 patients (22%); and inter-observer variability in two patients (4%). We identified six reports out of 797 (0.8%) that contained potentially serious errors. Surgical management changed in 18/20 (90%) patients in whom the unexpected change was due to reporting error, compared to 16/30 (53%) patients whose pre-operative echocardiogram was correctly reported (p = 0.006). Our study suggests that pre-operative echocardiography reporting errors are common and important. Anaesthesia © 2012 The Association of Anaesthetists of Great Britain and Ireland.

  12. The modern role of transoesophageal echocardiography in the assessment of valvular pathologies

    Science.gov (United States)

    Bull, Sacha; Newton, James

    2017-01-01

    Despite significant advancements in the field of cardiovascular imaging, transoesophageal echocardiography remains the key imaging modality in the management of valvular pathologies. This paper provides echocardiographers with an overview of the modern role of TOE in the diagnosis and management of valvular disease. We describe how the introduction of 3D techniques has changed the detection and grading of valvular pathologies and concentrate on its role as a monitoring tool in interventional cardiology. In addition, we focus on the echocardiographic and Doppler techniques used in the assessment of prosthetic valves and provide guidance for the evaluation of prosthetic valves. Finally, we summarise quantitative methods used for the assessment of valvular stenosis and regurgitation and highlight the key areas where echocardiography remains superior over other novel imaging modalities. PMID:28096184

  13. The modern role of transoesophageal echocardiography in the assessment of valvular pathologies

    Directory of Open Access Journals (Sweden)

    Malgorzata Wamil MD PhD

    2017-03-01

    Full Text Available Despite significant advancements in the field of cardiovascular imaging, transoesophageal echocardiography remains the key imaging modality in the management of valvular pathologies. This paper provides echocardiographers with an overview of the modern role of TOE in the diagnosis and management of valvular disease. We describe how the introduction of 3D techniques has changed the detection and grading of valvular pathologies and concentrate on its role as a monitoring tool in interventional cardiology. In addition, we focus on the echocardiographic and Doppler techniques used in the assessment of prosthetic valves and provide guidance for the evaluation of prosthetic valves. Finally, we summarise quantitative methods used for the assessment of valvular stenosis and regurgitation and highlight the key areas where echocardiography remains superior over other novel imaging modalities.

  14. Guidelines for transoesophageal echocardiographic probe cleaning and disinfection from the British Society of Echocardiography.

    Science.gov (United States)

    Kanagala, P; Bradley, C; Hoffman, P; Steeds, R P

    2011-10-01

    The clinical utility of transoesophageal echocardiography (TOE) is well established. Being a semi-invasive procedure, however, the potential for transmission of infection between sequential patients exists. This has implications for the protection of both patients and medical staff. Guidelines for disinfection during gastrointestinal endoscopy (GIE) have been in place for many years.(1,2) Unfortunately, similar guidance is lacking with respect to TOE. Although traversing the same body cavities and sharing many similarities with upper GIE, there are fundamental structural and procedural differences with TOE which merit special consideration in establishing a decontamination protocol. This document provides recommendations for TOE probe decontamination based on the available evidence, expert opinion, and modification of the current British Society of Gastroenterology guidelines.

  15. Danish Perioperative Nurses' Documentation

    DEFF Research Database (Denmark)

    Søndergaard, Susanne Friis; Lorentzen, Vibeke; Sørensen, Erik E

    2017-01-01

    of 2015 to 2016, six participants tested an EHR containing a Danish edition of a selected section of the Perioperative Nursing Data Set. This study relied on realistic evaluation and participant observations to generate data. We found that nursing leadership was essential for improving perioperative...

  16. ECHO Gov Login | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  17. Automatic Adjustments of a Trans-oesophageal Ultrasound Robot for Monitoring Intra-operative Catheters

    Science.gov (United States)

    Wang, Shuangyi; Housden, James; Singh, Davinder; Rhode, Kawal

    2017-12-01

    3D trans-oesophageal echocardiography (TOE) has become a powerful tool for monitoring intra-operative catheters used during cardiac procedures in recent years. However, the control of the TOE probe remains as a manual task and therefore the operator has to hold the probe for a long period of time and sometimes in a radiation environment. To solve this problem, an add-on robotic system has been developed for holding and manipulating a commercial TOE probe. This paper focuses on the application of making automatic adjustments to the probe pose in order to accurately monitor the moving catheters. The positioning strategy is divided into an initialization step based on a pre-planning method and a localized adjustments step based on the robotic differential kinematics and related image servoing techniques. Both steps are described in the paper along with simulation experiments performed to validate the concept. The results indicate an error less than 0.5 mm for the initialization step and an error less than 2 mm for the localized adjustments step. Compared to the much bigger live 3D image volume, it is concluded that the methods are promising. Future work will focus on evaluating the method in the real TOE scanning scenario.

  18. Grating stimulated echo

    International Nuclear Information System (INIS)

    Dubetsky, B.; Berman, P.R.; Sleator, T.

    1992-01-01

    A theory of a grating simulated echo (GTE) is developed. The GSE involves the sequential excitation of atoms by two counterpropagating traveling waves, a standing wave, and a third traveling wave. It is shown that the echo signal is very sensitive to small changes in atomic velocity, much more sensitive than the normal stimulated echo. Use of the GSE as a collisional probe or accelerometer is discussed

  19. Demonstration of infective endocarditis by cardiac CT and transoesophageal echocardiography: comparison with intra-operative findings.

    Science.gov (United States)

    Koo, Hyun Jung; Yang, Dong Hyun; Kang, Joon-Won; Lee, Joo Yeon; Kim, Dae-Hee; Song, Jong-Min; Kang, Duk-Hyun; Song, Jae-Kwan; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae-Won; Lim, Tae-Hwan

    2018-02-01

    We aimed to compare imaging findings of infective endocarditis between computed tomography (CT) and transoesophageal echocardiography (TEE) using surgical inspection as a reference standard. Forty-nine patients (aged 54 ± 17 years, 69% men) who underwent pre-operative CT and TEE for infective endocarditis were included. Twelve of these patients had prosthetic valve endocarditis. Imaging findings of infective endocarditis were classified as vegetation, leaflet perforation, abscess/pseudoaneurysm, and paravalvular leakage. Diagnostic performances of CT and TEE were evaluated using surgical inspection as a reference standard. Interobserver agreements for CT findings were obtained using Cohen's κ test. The detection rates of infective endocarditis per patient with CT and TEE were 93.9% (46/49) and 95.9% (47/49), respectively. In per-imaging analysis, the sensitivities of CT and TEE were not significantly different for both native and prosthetic valve infective endocarditis (sensitivity: vegetation, 100% in TEE and 90.9% in CT; leaflet perforation, 87.5% in TEE and 50.0% in CT; abscess/pseudoaneurysm, 40.0% in TEE and 60.0% in CT; paravalvular leakage, 100% in TEE and 50.0% in CT). Interobserver agreements for CT findings were substantial or excellent (0.79-0.88). Cardiac CT can accurately demonstrate infective endocarditis in pre-operative patients with a similar diagnostic accuracy to TEE. The interobserver agreements for the CT findings of infective endocarditis were excellent. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

  20. Assessment of atrial septal defects in adults comparing cardiovascular magnetic resonance with transoesophageal echocardiography

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    Brown Michael A

    2010-07-01

    Full Text Available Abstract Background Many adult patients with secundum-type atrial septal defects (ASDs are able to have these defects fixed percutaneously. Traditionally, this has involved an assessment of ASD size, geometry and atrial septal margins by transoesophageal echocardiography (TOE prior to percutaneous closure. This is a semi-invasive technique, and all of the information obtained could potentially be obtained by non-invasive cardiovascular magnetic resonance (CMR. We compared the assessment of ASDs in consecutive patients being considered for percutaneous ASD closure using CMR and TOE. Methods Consecutive patients with ASDs diagnosed on transthoracic echocardiography (TTE were invited to undergo both CMR and TOE. Assessment of atrial septal margins, maximal and minimal defect dimensions was performed with both techniques. Analyses between CMR and TOE were made using simple linear regression and Bland Altman Analyses. Results Total CMR scan time was 20 minutes, and comparable to the TOE examination time. A total of 20 patients (M:F = 5:15, mean age 42.8 years ± 15.7 were included in the analyses. There was an excellent agreement between CMR and TOE for estimation of maximum defect size (R = 0.87. The anterior inferior, anterior superior and posterior inferior margins could be assessed in all patients with CMR. The posterior superior margin could not be assessed in only one patient. Furthermore, in 1 patient in whom TOE was unable to be performed, CMR was used to successfully direct percutaneous ASD closure. Conclusions CMR agrees with TOE assessment of ASDs in the work-up for percutaneous closure. Potentially CMR could be used instead of TOE for this purpose.

  1. Perioperative nutritional support.

    Science.gov (United States)

    Morán López, Jesús Manuel; Piedra León, María; García Unzueta, María Teresa; Ortiz Espejo, María; Hernández González, Miriam; Morán López, Ruth; Amado Señaris, José Antonio

    2014-01-01

    The relationship between preoperative malnutrition and morbi-mortality has been documented for years. Despite the existence of tools that allow its detection, and therefore treat this entity, their introduction into clinical practice is not wide-spread. Both perioperative insulin resistance and hyperglycemia are associated with increased perioperative morbidity and length of hospital stay. The intake of carbohydrate-rich drinks 2-4h prior to surgery reduces insulin resistance. In the immediate postoperative period, the enteral route is safe and well tolerated and its early use reduces hospital stay and postoperative complications compared with parenteral nutritional support. Inmunonutrition has been proven effective to decrease postoperative complications and hospital stay. In view of these data we opted for the adoption of these measures replacing bowel rest and the indiscriminate use of postoperative parenteral nutrition. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

  2. Burnout in perioperative context

    OpenAIRE

    Galvão, Ana Maria; Gonçalves, Ana Rita Veloso; Certo, Ana

    2014-01-01

    Companies in a global context are going through moments of great development of information and technologies. In these environments Burnout is highly prevalent, this syndrome is considered as one of physical and emotional stress that leads to a lack of motivation to work, leading to a progressive sense of inadequacy and failure. Objectives: What level of stress Perioperative nurses for nurses in the Region of Tras-os-Montes and Alto Douro. Methods: Non-experimental study,...

  3. Peri-operative care.

    Science.gov (United States)

    Baston, Helen

    2004-05-01

    This is the third 'midwifery basics' series aimed at student midwives, and focuses on midwifery care during labour. This article provides a summary of peri-operative care for women who experience caesarean birth. Students are encouraged to seek further information through a series of activities, and to link theory with practice by considering the issues relating to the care of the woman described in the short vignette.

  4. Happy birthday Echo!

    CERN Document Server

    Staff Association

    2010-01-01

    You are reading the number hundred and one (no. 101) edition of our bulletin Echo. Just over four years ago, on 27th March 2006, the first untitled edition was published (Fig. 1 on the left). The title Echo appeared on the second edition on 10th April 2006 (Fig. 1 in the centre). Today (see Fig. 1 on the right), the layout is slightly different, but the structure of each edition has remained more or less the same: an editorial informing you of the important issues, followed by articles on club life, cultural activities (exhibitions and conferences), information from GAC-EPA, and special offers for our members.     Fig. 1 : Nos. 1, 2 and 100 of our twice-monthly publication Echo Echo was created in March 2006 when, much to our regret, CERN official communication and that of your representatives were separated. November 2009 saw a return to normal practice, and since then the CERN st...

  5. Perioperative Management of Neurological Conditions

    Directory of Open Access Journals (Sweden)

    Manjeet Singh Dhallu

    2017-06-01

    Full Text Available Perioperative care of the patients with neurological diseases can be challenging. Most important consideration is the management and understanding of pathophysiology of these disorders and evaluation of new neurological changes that occur perioperatively. Perioperative generally refers to 3 phases of surgery: preoperative, intraoperative, and postoperative. We have tried to address few commonly encountered neurological conditions in clinical practice, such as delirium, stroke, epilepsy, myasthenia gravis, and Parkinson disease. In this article, we emphasize on early diagnosis and management strategies of neurological disorders in the perioperative period to minimize morbidity and mortality of patients.

  6. Rotary spin echoes

    Energy Technology Data Exchange (ETDEWEB)

    Solomon, I. [Commissariat a l' energie atomique et aux energies alternatives - CEA, Centre d' Etudes Nucleaires de Saclay, BP2, Gif-sur-Yvette (France)

    1959-07-01

    Torrey has observed the free precession of nuclear spins around an r-f field H{sub 1}, fixed in a frame rotating at the Larmor frequency ω{sub 0} = γH{sub 0} around a large d-c magnetic field H{sub 0}. He showed that for an H{sub 1}, much larger than inhomogeneity of H{sub 0}, the latter has a negligible effect on the decay of the spin magnetization which is mainly due to the inhomogeneity of H{sub 1}. We report here on a method of overcoming the inhomogeneity of H{sub 1}, by production of echoes in the rotating frame ('rotary echoes'). These echoes are obtained by a 180 deg. phase shift at t = τ on the r-f field so that H{sub 1}, is suddenly reversed, producing a re-focussing of the magnetization vectors at the time t = 2 τ. The rotary echoes so obtained are very similar to the usual spin-echoes with, however some specific features that make them particularly suitable for the measurement of long relaxation times. Reprint of a paper published in Physical Review Letters, vol. 2, no. 7, Apr 1959, p. 301-302.

  7. Rotary spin echoes

    International Nuclear Information System (INIS)

    Solomon, I.

    1959-01-01

    Torrey has observed the free precession of nuclear spins around an r-f field H 1 , fixed in a frame rotating at the Larmor frequency ω 0 = γH 0 around a large d-c magnetic field H 0 . He showed that for an H 1 , much larger than inhomogeneity of H 0 , the latter has a negligible effect on the decay of the spin magnetization which is mainly due to the inhomogeneity of H 1 . We report here on a method of overcoming the inhomogeneity of H 1 , by production of echoes in the rotating frame ('rotary echoes'). These echoes are obtained by a 180 deg. phase shift at t = τ on the r-f field so that H 1 , is suddenly reversed, producing a re-focussing of the magnetization vectors at the time t = 2 τ. The rotary echoes so obtained are very similar to the usual spin-echoes with, however some specific features that make them particularly suitable for the measurement of long relaxation times. Reprint of a paper published in Physical Review Letters, vol. 2, no. 7, Apr 1959, p. 301-302

  8. Fast spin-echo imaging

    International Nuclear Information System (INIS)

    Mackey, K.; Zoarski, G.; Bentson, J.R.; Lufkin, R.B.; Melki, P.; Jolesz, F.

    1991-01-01

    This paper reports on a partial radio-frequency (RF) echo-planar pulse sequence called contiguous slice fast spin echo (CSFSE) which is undergoing clinical trials for spine MR imaging. In this variation of rapid acquisition relaxation enhanced (RARE) spin-echo imaging, rapid 180 degrees RF pulse generated refocused echoes, producing T2-weighted images in about one-third the time of conventional double-echo technique. Forty patients with suspected pathology of the spine were imaged with conventional double-echo and closely matched CSFSE techniques on a GE Signa 1.5-T Advantage system. Cases were reviewed by two board-certified neuroradiologists. In all cases the CSFSE images were of equal or superior quality compared with those obtained with the conventional double-echo technique. Pathologic processes that were imaged consisted of inflammatory, neoplastic, posttraumatic, and degenerative conditions

  9. Management of severe perioperative bleeding

    DEFF Research Database (Denmark)

    Kozek-Langenecker, Sibylle A; Ahmed, Aamer B; Afshari, Arash

    2017-01-01

    : The management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. Initially, it is important to identify those patients with an increased risk of perioperative bleeding. Next, strategies should be employed to correct preoperative anaemia...... and to stabilise macrocirculation and microcirculation to optimise the patient's tolerance to bleeding. Finally, targeted interventions should be used to reduce intraoperative and postoperative bleeding, and so prevent subsequent morbidity and mortality. The objective of these updated guidelines is to provide...

  10. Perioperative acute renal failure.

    LENUS (Irish Health Repository)

    Mahon, Padraig

    2012-02-03

    PURPOSE OF REVIEW: Recent biochemical evidence increasingly implicates inflammatory mechanisms as precipitants of acute renal failure. In this review, we detail some of these pathways together with potential new therapeutic targets. RECENT FINDINGS: Neutrophil gelatinase-associated lipocalin appears to be a sensitive, specific and reliable biomarker of renal injury, which may be predictive of renal outcome in the perioperative setting. For estimation of glomerular filtration rate, cystatin C is superior to creatinine. No drug is definitively effective at preventing postoperative renal failure. Clinical trials of fenoldopam and atrial natriuretic peptide are, at best, equivocal. As with pharmacological preconditioning of the heart, volatile anaesthetic agents appear to offer a protective effect to the subsequently ischaemic kidney. SUMMARY: Although a greatly improved understanding of the pathophysiology of acute renal failure has offered even more therapeutic targets, the maintenance of intravascular euvolaemia and perfusion pressure is most effective at preventing new postoperative acute renal failure. In the future, strategies targeting renal regeneration after injury will use bone marrow-derived stem cells and growth factors such as insulin-like growth factor-1.

  11. Dissecting a Light Echo

    Science.gov (United States)

    2008-01-01

    [figure removed for brevity, see original site] Click on image for audio animation This animation illustrates how a light echo works, and how an optical illusion of material moving outward is created. A light echo occurs when a star explodes, acting like a cosmic flashbulb. The light from this explosion zips through nearby dust clumps, illuminating and heating them up slightly. This brief period of warming causes them to glow in infrared, like a chain of Christmas bulbs lighting up one by one. The animation starts by showing the explosion of a star, which results in a flash of light that moves outward in all directions. The direction of our line of sight from Earth is indicated by the blue arrow. When the light flash reaches surrounding dust, shown here as three dark clouds, the dust is heated up, creating infrared light that begins to travel toward Earth (indicated by the red arrows). Dust closest to the explosion lights up first, while the explosion's shock wave takes longer to reach more distant material. This results in light from different parts of the cloud reaching Earth at different times, creating the illusion of motion over time. As the animation shows, the inclination of the cloud toward our line of sight can result in the material seeming to move both away from and toward the central star.

  12. Habits in perioperative nursing culture.

    Science.gov (United States)

    Lindwall, Lillemor; von Post, Iréne

    2008-09-01

    This study focuses on investigating habits in perioperative nursing culture, which are often simply accepted and not normally considered or discussed. A hermeneutical approach was chosen as the means of understanding perioperative nurses' experiences of and reflections on operating theatre culture. Focus group discussions were used to collect data, which was analysed using hermeneutical text analysis. The results revealed three main categories of habits present in perioperative nursing culture: habits that promote ethical values (by temporary friendship with patients, showing respect for each other, and spending time on reflection on ethics and caring); habits that hinder progress (by seeing the patient as a surgical case, not acknowledging colleagues, and not talking about ethics); and habits that set the cultural tone (the hidden power structure and achieving more in less time).

  13. Implementing a Perioperative Nursing Student Summer Internship.

    Science.gov (United States)

    Nash, Janice; Kamel, Teya C; Sherer, Joanne; Nauer, Kathleen

    2018-01-01

    Using qualitative research and a collaborative academic service partnership, we created an innovative 120-hour perioperative nursing summer internship for eight undergraduate nursing students in 2016. Recognizing that perioperative exposure is limited in the traditional baccalaureate program, this unpaid internship served to clarify student perceptions of perioperative nursing care and encourage graduates to meet perioperative workforce demands. We based the theoretical and practical student learning experiences on the AORN Periop 101 learning modules and included faculty-led discussions, student journaling, and onsite precepted clinical activities. Evaluation data revealed that students achieved an enhanced awareness of perioperative nursing, and a majority of the participants expressed a desire to enter the perioperative field after graduation. We suggest that stakeholders continue to strategize ways to maximize educational preparation to address the evolving health care market supply and demand. © AORN, Inc, 2018.

  14. Help Content for ECHO Reports | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  15. ECHO-UseFY17.png | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  16. Transitioning From Perioperative Staff Nurse to Perioperative Educator.

    Science.gov (United States)

    Mower, Juliana

    2017-08-01

    Perioperative nurses who enjoy teaching may wish to become staff development educators. The shift to this new role requires a transition period during which the new educator acquires the knowledge, skills, and attitudes integral to mastering the job. A systematic approach to achieving baseline competencies in the educator role helps to ensure a successful conversion from providing direct patient care to supporting the educational needs of staff members. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  17. Custom Search | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  18. Watershed Statistics | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  19. Perioperative Rosuvastatin in Cardiac Surgery.

    Science.gov (United States)

    Zheng, Zhe; Jayaram, Raja; Jiang, Lixin; Emberson, Jonathan; Zhao, Yan; Li, Qi; Du, Juan; Guarguagli, Silvia; Hill, Michael; Chen, Zhengming; Collins, Rory; Casadei, Barbara

    2016-05-05

    Complications after cardiac surgery are common and lead to substantial increases in morbidity and mortality. Meta-analyses of small randomized trials have suggested that perioperative statin therapy can prevent some of these complications. We randomly assigned 1922 patients in sinus rhythm who were scheduled for elective cardiac surgery to receive perioperative rosuvastatin (at a dose of 20 mg daily) or placebo. The primary outcomes were postoperative atrial fibrillation within 5 days after surgery, as assessed by Holter electrocardiographic monitoring, and myocardial injury within 120 hours after surgery, as assessed by serial measurements of the cardiac troponin I concentration. Secondary outcomes included major in-hospital adverse events, duration of stay in the hospital and intensive care unit, left ventricular and renal function, and blood biomarkers. The concentrations of low-density lipoprotein cholesterol and C-reactive protein after surgery were lower in patients assigned to rosuvastatin than in those assigned to placebo (PSTICS ClinicalTrials.gov number, NCT01573143.).

  20. Rapid Gradient-Echo Imaging

    Science.gov (United States)

    Hargreaves, Brian

    2012-01-01

    Gradient echo sequences are widely used in magnetic resonance imaging (MRI) for numerous applications ranging from angiography to perfusion to functional MRI. Compared with spin-echo techniques, the very short repetition times of gradient-echo methods enable very rapid 2D and 3D imaging, but also lead to complicated “steady states.” Signal and contrast behavior can be described graphically and mathematically, and depends strongly on the type of spoiling: fully balanced (no spoiling), gradient spoiling, or RF-spoiling. These spoiling options trade off between high signal and pure T1 contrast while the flip angle also affects image contrast in all cases, both of which can be demonstrated theoretically and in image examples. As with spin-echo sequences, magnetization preparation can be added to gradient-echo sequences to alter image contrast. Gradient echo sequences are widely used for numerous applications such as 3D perfusion imaging, functional MRI, cardiac imaging and MR angiography. PMID:23097185

  1. Vasopressin in perioperative management of congenital ...

    African Journals Online (AJOL)

    Annals of Pediatric Surgery ... Oxygenation failure, pulmonary hypertension and refractory systemic hypotension in infants with ... managing pulmonary and systemic perioperative haemodynamic instability in infants with diaphragmatic hernia.

  2. Universal definition of perioperative bleeding in adult cardiac surgery

    NARCIS (Netherlands)

    Dyke, Cornelius; Aronson, Solomon; Dietrich, Wulf; Hofmann, Axel; Karkouti, Keyvan; Levi, Marcel; Murphy, Gavin J.; Sellke, Frank W.; Shore-Lesserson, Linda; von Heymann, Christian; Ranucci, Marco

    2014-01-01

    Perioperative bleeding is common among patients undergoing cardiac surgery; however, the definition of perioperative bleeding is variable and lacks standardization. We propose a universal definition for perioperative bleeding (UDPB) in adult cardiac surgery in an attempt to precisely describe and

  3. Echo phenomena in a plasma

    International Nuclear Information System (INIS)

    Pavlenko, V.N.

    1983-01-01

    The mechanism of echo phenomenon in different plasma media: laboratory and cosmic plasma, metals and semiconductors is analyzed to get a more comprehensive idea on collective processes in a plasma and for practical applications in radiophysics and plasma diagnostics. The echo phenomenon permitted to confirm a reversible nature of the Landau damping, to prove the fact that the information on perturbation is conserved in a plasma (as non-damping oscillations of the distribution function) even after disappearing of the macroscopic field. The dependence of the diffusion coefficient on the velocity is measured, microturbulences in a plasma are investigated. New ways of the plasma wave conversion are suggested, as well as ''lightning'' of super-critical plasma layers and regions of plasma non-transparency. Prospective advantages of using echo for studying the mechanisms of charged particle interaction with the surface bounding a plasma are revealed

  4. Technetium 99m SESTAMIBI myocardial perfusion imaging: Comparison between treadmill, dipyridamole and trans-oesophageal atrial pacing 'stress' tests in normal subjects

    International Nuclear Information System (INIS)

    Primeau, M.; Taillefer, R.; Lambert, R.; Essiambre, R.; Honos, G.

    1991-01-01

    The purpose of this study was to determine the blood clearance, myocardial uptake and heart/lung and heart/liver ratios of technetium 99m methoxyisobutylisonitrile ( 99m Tc-SESTAMIBI) following 3 different types of cardiac stimulation in normal subjects: Treadmill stress (STRESS), intravenous administration of dipyridamole (DIP) and trans-oesophageal atrial pacing (TAP). Ten normal volunteers were submitted to 3 injections of 99m Tc-SESTAMIBI (10 mCi/70 kg, separated by an interval of 7 days) following STRESS (standard Bruce protocol), DIP (0.142 mg/kg.min during 4 min) and TAP procedures. Blood samples were collected from 1 to 60 min after each 99m Tc-SESTAMIBI injection. Planar imaging was performed at 5, 30 and 60 min. Blood retention (percentage of injected dose at 1 min) was 56%±4%, 24%±4% and 38%±6% for STRESS, DIP and TAP, respectively (P 99m Tc-SESTAMIBI. (orig.)

  5. Perioperative corticosteroids for intermittent and mild persistent asthma

    Directory of Open Access Journals (Sweden)

    Hiroto Matsuse

    2002-01-01

    Conclusions: Our results suggest that perioperative corticosteroids are effective in preventing perioperative bronchospasm in stable asthmatics during surgery under general anesthesia by suppressing airway hyperresponsiveness.

  6. Statins and perioperative myocardial infarction. | Levin | Southern ...

    African Journals Online (AJOL)

    The growing prevalence of atherosclerosis means that perioperative myocardial infarction (PMI) is of significant concern to anesthesiologists. Perioperative revascularization (if indicated medically), beta blockade (in high risk patients) and statin therapy are therapeutic modalities that are currently employed to reduce PMI.

  7. Nitrous oxide and perioperative outcomes.

    Science.gov (United States)

    Ko, Hanjo; Kaye, Alan David; Urman, Richard D

    2014-06-01

    There is emerging evidence related to the effects of nitrous oxide on important perioperative patient outcomes. Proposed mechanisms include metabolic effects linked to elevated homocysteine levels and endothelial dysfunction, inhibition of deoxyribonucleic acid and protein formation, and depression of chemotactic migration by monocytes. Newer large studies point to possible risks associated with the use of nitrous oxide, although data are often equivocal and inconclusive. Cardiovascular outcomes such as stroke or myocardial infarction were shown to be unchanged in previous studies, but the more recent Evaluation of Nitrous Oxide in the Gas Mixture for Anesthesia I trial shows possible associations between nitrous oxide and increased cardiovascular and pulmonary complications. There are also possible effects on postoperative wound infections and neuropsychological function, although the multifactorial nature of these complications should be considered. Teratogenicity linked to nitrous oxide use has not been firmly established. The use of nitrous oxide for routine anesthetic care may be associated with significant costs if complications such as nausea, vomiting, and wound infections are taken into consideration. Overall, definitive data regarding the effect of nitrous oxide on major perioperative outcomes are lacking. There are ongoing prospective studies that may further elucidate its role. The use of nitrous oxide in daily practice should be individualized to each patient's medical conditions and risk factors.

  8. Comparison of third-order plasma wave echoes with ballistic second-order plasma wave echoes

    International Nuclear Information System (INIS)

    Leppert, H.D.; Schuelter, H.; Wiesemann, K.

    1982-01-01

    The apparent dispersion of third-order plasma wave echoes observed in a high frequency plasma is compared with that of simultaneously observed ballistic second-order echoes. Amplitude and wavelength of third-order echoes are found to be always smaller than those of second-order echoes, however, the dispersion curves of both types of echoes are very similar. These observations are in qualitative agreement with calculations of special ballistic third-order echoes. The ballistic nature of the observed third-order echoes may, therefore, be concluded from these measurements. (author)

  9. Risk reduction: perioperative smoking intervention

    DEFF Research Database (Denmark)

    Møller, Ann; Tønnesen, Hanne

    2006-01-01

    Smoking is a well-known risk factor for perioperative complications. Smokers experience an increased incidence of respiratory complications during anaesthesia and an increased risk of postoperative cardiopulmonary complications, infections and impaired wound healing. Smokers have a greater risk...... of postoperative intensive care admission. Even passive smoking is associated with increased risk at operation. Preoperative smoking intervention 6-8 weeks before surgery can reduce the complications risk significantly. Four weeks of abstinence from smoking seems to improve wound healing. An intensive, individual...... approach to smoking intervention results in a significantly better postoperative outcome. Future research should focus upon the effect of a shorter period of preoperative smoking cessation. All smokers admitted for surgery should be informed of the increased risk, recommended preoperative smoking cessation...

  10. Digital health and perioperative care.

    Science.gov (United States)

    Fotis, Theofanis

    2017-06-01

    According to the U.S. Food and Drug Administration 'the broad scope of digital health includes categories such as mobile health (mHealth), health information technology (IT), wearable devices, telehealth and telemedicine, and personalised medicine, and is used by providers and other stakeholders in their efforts to reduce inefficiencies, improve access, reduce costs, increase quality, and make medicine more personalised for patients (FDA 2016). More recently, Paul Sonier, a digital health strategist and founder of the Linkedin digital health group with more than 40,000 members, defined digital health as 'the convergence of the digital and genomic revolutions with health, healthcare, living, and society' (storyofdigitalhealth.com 2016). Copyright the Association for Perioperative Practice.

  11. Short echo time, fast gradient-echo imaging

    International Nuclear Information System (INIS)

    Haacke, E.M.; Lenz, G.W.

    1987-01-01

    Present fast-gradient-echoes schemes can acquire volume data rapidly and are flexible in T1 or T1/T2 contrast behavior. However, sequences used to date employ echo time (TE) values of about 15 ms +- 5 and, because of in vivo field inhomogeneities (short T2), they suffer badly from signal loss near sinuses and tissue boundaries. The authors implemented sequences with TE = 4-6 ms and found significant improvement in image quality, especially at high fields. Examples with long TEs vs. short TEs are given in the knee, spine, head, and orbits. Further advantages include (1) faster repetition times (15 ms), (2) higher-quality spin-density or T1-weighted images, and (3) reduction of blood motion artifacts

  12. Optimal glucose management in the perioperative period.

    Science.gov (United States)

    Evans, Charity H; Lee, Jane; Ruhlman, Melissa K

    2015-04-01

    Hyperglycemia is a common finding in surgical patients during the perioperative period. Factors contributing to poor glycemic control include counterregulatory hormones, hepatic insulin resistance, decreased insulin-stimulated glucose uptake, use of dextrose-containing intravenous fluids, and enteral and parenteral nutrition. Hyperglycemia in the perioperative period is associated with increased morbidity, decreased survival, and increased resource utilization. Optimal glucose management in the perioperative period contributes to reduced morbidity and mortality. To readily identify hyperglycemia, blood glucose monitoring should be instituted for all hospitalized patients. Published by Elsevier Inc.

  13. Longitudinal collective echoes in coasting particle beams

    Directory of Open Access Journals (Sweden)

    Ahmed Al-Khateeb

    2003-01-01

    Full Text Available Longitudinal ballistic and collective beam echoes with diffusion effects are investigated theoretically. In the presence of the space-charge impedance, the collective echo amplitude is obtained as a closed form expression. In contrast to the ballistic case, the collective echo amplitude consists of one maximum at time t_{echo}. The echo amplitude grows up and damps down with a rate proportional to the Landau damping rate of space-charge waves. The effect of weak diffusion is found to modify the ballistic and the collective echo amplitudes in the same manner. This effect of diffusion was confirmed using a “noiseless,” grid-based simulation code. As a first application the amount of numerical diffusion in our simulation code was determined using the echo effect.

  14. Focused Review of Perioperative Care of Patients with Pulmonary Hypertension and Proposal of a Perioperative Pathway.

    Science.gov (United States)

    Steppan, Jochen; Diaz-Rodriguez, Natalia; Barodka, Viachaslau M; Nyhan, Daniel; Pullins, Erica; Housten, Traci; Damico, Rachel L; Mathai, Stephen C; Hassoun, Paul M; Berkowitz, Dan E; Maxwell, Bryan G; Kolb, Todd M

    2018-01-15

    Morbidity and mortality risk increase considerably for patients with pulmonary hypertension (PH) undergoing non-cardiac surgery. Unfortunately, there are no comprehensive, evidence-based guidelines for perioperative evaluation and management of these patients. We present a brief review of the literature on perioperative outcomes for patients with PH and describe the implementation of a collaborative perioperative management program for these high-risk patients at a tertiary academic center.

  15. Perioperative lung protective ventilation in obese patients

    NARCIS (Netherlands)

    Fernandez-Bustamante, Ana; Hashimoto, Soshi; Serpa Neto, Ary; Moine, Pierre; Vidal Melo, Marcos F.; Repine, John E.

    2015-01-01

    The perioperative use and relevance of protective ventilation in surgical patients is being increasingly recognized. Obesity poses particular challenges to adequate mechanical ventilation in addition to surgical constraints, primarily by restricted lung mechanics due to excessive adiposity, frequent

  16. Independence of echo-threshold and echo-delay in the barn owl.

    Directory of Open Access Journals (Sweden)

    Brian S Nelson

    Full Text Available Despite their prevalence in nature, echoes are not perceived as events separate from the sounds arriving directly from an active source, until the echo's delay is long. We measured the head-saccades of barn owls and the responses of neurons in their auditory space-maps while presenting a long duration noise-burst and a simulated echo. Under this paradigm, there were two possible stimulus segments that could potentially signal the location of the echo. One was at the onset of the echo; the other, after the offset of the direct (leading sound, when only the echo was present. By lengthening the echo's duration, independently of its delay, spikes and saccades were evoked by the source of the echo even at delays that normally evoked saccades to only the direct source. An echo's location thus appears to be signaled by the neural response evoked after the offset of the direct sound.

  17. Classification of radar echoes using fractal geometry

    International Nuclear Information System (INIS)

    Azzaz, Nafissa; Haddad, Boualem

    2017-01-01

    Highlights: • Implementation of two concepts of fractal geometry to classify two types of meteorological radar echoes. • A new approach, called a multi-scale fractal dimension is used for classification between fixed echoes and rain echoes. • An Automatic identification system of meteorological radar echoes was proposed using fractal geometry. - Abstract: This paper deals with the discrimination between the precipitation echoes and the ground echoes in meteorological radar images using fractal geometry. This study aims to improve the measurement of precipitations by weather radars. For this, we considered three radar sites: Bordeaux (France), Dakar (Senegal) and Me lbourne (USA). We showed that the fractal dimension based on contourlet and the fractal lacunarity are pertinent to discriminate between ground and precipitation echoes. We also demonstrated that the ground echoes have a multifractal structure but the precipitations are more homogeneous than ground echoes whatever the prevailing climate. Thereby, we developed an automatic classification system of radar using a graphic interface. This interface, based on the fractal geometry makes possible the identification of radar echoes type in real time. This system can be inserted in weather radar for the improvement of precipitation estimations.

  18. A radar-echo model for Mars

    International Nuclear Information System (INIS)

    Thompson, T.W.; Moore, H.J.

    1990-01-01

    Researchers developed a radar-echo model for Mars based on 12.6 cm continuous wave radio transmissions backscattered from the planet. The model broadly matches the variations in depolarized and polarized total radar cross sections with longitude observed by Goldstone in 1986 along 7 degrees S. and yields echo spectra that are generally similiar to the observed spectra. Radar map units in the model include an extensive cratered uplands unit with weak depolarized echo cross sections, average thermal inertias, moderate normal refelectivities, and moderate rms slopes; the volcanic units of Tharsis, Elysium, and Amazonis regions with strong depolarized echo cross sections, low thermal inertia, low normal reflectivities, and large rms slopes; and the northern planes units with moderate to strong depolarized echo cross sections, moderate to very high thermal inertias, moderate to large normal reflectivities, and moderate rms slopes. The relevance of the model to the interpretation of radar echoes from Mars is discussed

  19. The acoustics of the echo cornet

    Science.gov (United States)

    Pyle, Robert W., Jr.; Klaus, Sabine K.

    2002-11-01

    The echo cornet was an instrument produced by a number of makers in several countries from about the middle of the nineteenth to the early twentieth centuries. It consists of an ordinary three-valve cornet to which a fourth valve has been added, downstream of the three normal valves. The extra valve diverts the airstream from the normal bell to an ''echo'' bell that gives a muted tone quality. Although the air column through the echo bell is typically 15 cm longer than the path through the normal bell, there is no appreciable change of playing pitch when the echo bell is in use. Acoustic input impedance and impulse response measurements and consideration of the standing-wave pattern within the echo bell show how this can be so. Acoustically, the echo bell is more closely related to hand-stopping on the French horn than to the mutes commonly used on the trumpet and cornet.

  20. Beam echoes in the presence of coupling

    Energy Technology Data Exchange (ETDEWEB)

    Gross, Axel [Case Western Reserve U.

    2017-10-03

    Transverse beam echoes could provide a new technique of measuring diusion characteristics orders of magnitude faster than the current methods; however, their interaction with many accelerator parameters is poorly understood. Using a program written in C, we explored the relationship between coupling and echo strength. We found that echoes could be generated in both dimensions, even with a dipole kick in only one dimension. We found that the echo eects are not destroyed even when there is strong coupling, falling o only at extremely high coupling values. We found that at intermediate values of skew quadrupole strength, the decoherence time of the beam is greatly increased, causing a destruction of the echo eects. We found that this is caused by a narrowing of the tune width of the particles. Results from this study will help to provide recommendations to IOTA (Integrable Optics Test Accelerator) for their upcoming echo experiment.

  1. Perioperative anaesthetic adverse events in Thailand (PAAd THAI) study: Incident report of perioperative convulsion.

    Science.gov (United States)

    Eiamcharoenwit, Jatuporn; Akavipat, Phuping; Ariyanuchitkul, Thidarat; Wirachpisit, Nichawan; Pulnitiporn, Aksorn; Pongraweewan, Orawan

    2018-01-01

    The aim of this study was to identify the characteristics of perioperative convulsion and to suggest possible correcting strategies. The multi-centre study was conducted prospectively in 22 hospitals across Thailand in 2015. The occurrences of perioperative adverse events were collected. The data was collated by site manager and forwarded to the data management unit. All perioperative convulsion incidences were enrolled and analysed. The consensus was documented for the relevant factors and the corrective strategies. Descriptive statistics were used. From 2,000 incident reports, perioperative convulsions were found in 16 patients. Six episodes (37.5%) were related to anaesthesia, 31.3% to patients, 18.8% to surgery, and 12.5% to systemic processes. The contributing factor was an inexperienced anaesthesia performer (25%), while the corrective strategy was improvements to supervision (43.8%). Incidents of perioperative convulsion were found to be higher than during the last decade. The initiation and maintenance of safe anaesthesia should be continued.

  2. Detection of left atrial thrombus in patients with mitral stenosis and atrial fibrillation: retrospective comparison of two-phase computed tomography, transoesophageal echocardiography and surgical findings

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Bo Hwa; Ko, Sung Min [Konkuk University Medical Center, Konkuk University School of Medicine, Department of Radiology, Research Institute of Medical Science, Seoul (Korea, Republic of); Hwang, Hweung Kon [Konkuk University Medical Center, Konkuk University School of Medicine, Department of Cardiology, Seoul (Korea, Republic of); Song, Meong Gun; Shin, Je Kyoun [Konkuk University Medical Center, Konkuk University School of Medicine, Department of Thoracic surgery, Seoul (Korea, Republic of); Kang, Woon Seok; Kim, Tae-Yop [Konkuk University Medical Center, Konkuk University School of Medicine, Department of Anesthesiology, Seoul (Korea, Republic of)

    2013-11-15

    This retrospective study aims to assess the accuracy of two-phase computed tomography (CT) and transoesophageal echocardiography (TEE) for the detection of left atrial (LA) thrombus in patients with mitral stenosis (MS) and atrial fibrillation (AF), by using intraoperative findings as the reference standard. Preoperative two-phase CT and intraoperative TEE were performed in 106 patients with MS and AF. The ratio (LAA/AA{sub L}) of Hounsfield units (HU) in the LA appendage (LAA) to the ascending aorta (AA) was calculated on the late-phase CT image. LA echodense masses on TEE and LA filling defects on two-phase CT were observed in 29 and 39 patients, respectively. Thirty-five LA thrombi were identified at surgery in 27 patients. Compared with the intraoperative findings, per-patient sensitivity, specificity, positive and negative predictive values of two-phase CT were 100 %, 85 %, 69 % and 100 %, and those by using TEE were 93 %, 95 %, 86 % and 97 % in detecting LAA thrombus. After adopting the cut-off value of 0.5 for the LAA/AA{sub L} HU ratio, the specificity and positive predictive value of two-phase CT were increased to 96 % and 90 %, respectively. Two-phase CT with a cut-off value of LAA/AA{sub L} HU ratio of 0.5 provides high performance for the detection of LAA thrombus. (orig.)

  3. Use of the CHA2DS2VASc score to reduce utilisation of transoesophageal echocardiography prior to ablation for atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Charlotte Atkinson

    2017-10-01

    Full Text Available Transoesophageal echocardiography (TOE is frequently performed prior to atrial fibrillation (AF ablation to exclude left atrial appendage (LAA thrombus. However, patients undergoing AF ablation are usually anticoagulated, thus making the presence of thrombus unlikely in most cases. This study aimed to determine whether the CHA2DS2VASc scoring system can be used to identify patients that do not require TOE prior to AF ablation. In this single-centre retrospective study, local institutional and primary care databases and electronic patient records were searched to identify patients that had undergone TOE prior to AF ablation. Patient demographics, CHA2DS2VASc score, TOE findings and anticoagulation status were collected for analysis. Over a 7-year period (2008–2014, 332 patients (age 57 ± 10 years; 74% male underwent TOE prior to proposed AF ablation. CHA2DS2VASc scores of 0, 1, 2 and >2 were found in 39, 34, 15 and 12% of patients, respectively. The prevalence of LAA thrombus was 0.6% (2 patients and these 2 patients had risk scores of 2 and 4. No patients with a score of 0 or 1 had LAA thrombus. Patients that are classed as low risk by the CHA2DS2VASc score do not require a pre-ablation TOE to screen for LAA thrombus provided they are adequately anticoagulated. This would lead to a significant reduction in health care expenditures by reducing unnecessary TOE requests and thereby improve patient experience.

  4. Light echoes - Type II supernovae

    International Nuclear Information System (INIS)

    Schaefer, B.E.

    1987-01-01

    Type II supernovae (SNs) light curves show a remarkable range of shapes. Data have been collected for the 12 Type II SNs that have light curve information for more than four months past maximum. Contrary to previous reports, it is found that (1) the decay rate after 100 days past maximum varies by almost an order of magnitude and (2) the light curve shapes are not bimodally distributed, but actually form a continuum. In addition, it is found that the extinctions to the SNs are related to the light curve shapes. This implies that the absorbing dust is local to the SNs. The dust is likely to be part of a circumstellar shell emitted by the SN progenitor that Dwek (1983) has used to explain infrared echoes. The optical depth of the shell can get quite large. In such cases, it is found that the photons scattered and delayed by reflection off dust grains will dominate the light curve several months after peak brightness. This light echo offers a straightforward explanation of the diversity of Type II SN light curves. 22 references

  5. Perioperative Management of Patients with Rheumatic Diseases

    Science.gov (United States)

    Bissar, Lina; Almoallim, Hani; Albazli, Khaled; Alotaibi, Manal; Alwafi, Samar

    2013-01-01

    This paper aims to explore the assessment of patients with rheumatologic diseases, especially rheumatoid arthritis (RA), before undergoing orthopedic surgery. Perioperative assessment ensures an early diagnosis of the patient's medical condition, overall health, medical co-morbidities, and the assessment of the risk factors associated with the proposed procedures. Perioperative assessment allows for proper postoperative management of complications and of the management of drugs such as disease-modifying anti-rheumatic drugs (DMARD) and anti-platelets, and corticosteroids. The assessment also supports follow up plans, and patient education. Perioperative assessment enables the discussion of the proposed treatment plans and the factors associated with them in each case among the different specialists involved to facilitate an appropriate early decision-making about the assessment and treatment of patients with rheumatologic diseases. It also enables the discussion of both condition and procedure with the patient to ensure a good postoperative care. The article identifies the components of perioperative medical evaluation, discusses perioperative management of co-morbidities and the management of specific clinical problems related to RA, systemic lupus erythematosus, the management of DMARDs, like methotrexate (MTX) and biologic therapies, prophylactic antibiotics, and postoperative follow up, including patient education and rehabilitation PMID:24062860

  6. Perioperative death: Its implications and management

    Directory of Open Access Journals (Sweden)

    J P Attri

    2016-01-01

    Full Text Available Death to most people is a major life event. Nothing in this world prepares us to face and manage the perioperative death although the majority of anesthesiologists will be involved in an intraoperative death during the course of their careers. Whether death on the table was expected or occurred when least expected or may be even later, the anesthesiologist is most likely to be affected emotionally, physically in his personal life, and as well as will have an influence on his professional career. Anesthesiologists as perioperative physicians are likely to experience death on the operating table at some time in their careers. In case of perioperative death, meticulous record keeping including time of occurrence of event and methods and medications used during resuscitation, nature of the problem, and all sequence of events should be adopted to breaking bad news with relatives and blame game should be avoided. The anesthesiologist and the relatives of the patient should also be given emotional support to come out of this untoward event. In this article, we have highlighted the various factors and causes leading on to perioperative death and if in case such an event occurs, what are the protocols to be followed, including medicolegal aspects, giving emotional support to the concerned anesthesiologist, dealing with the relatives of the patient sympathetically, etc. We have also enumerated the various precautions to be taken to prevent perioperative mortality in this article.

  7. Perioperative nursing in public university hospitals

    DEFF Research Database (Denmark)

    Sørensen, Erik Elgaard; Olsen, Ida Østrup; Tewes, Marianne

    2014-01-01

    BACKGROUND: In recent years, perioperative nursing has received ongoing attention as part of an interprofessional collaboration. Perioperative nursing is constantly faced with new challenges and opportunities that necessitate continual updates of nursing knowledge and technical skills. In light...... of the longstanding relationship between nursing and technology, it is interesting that few studies with this focus have been performed. Therefore, our research question was: What is the content of perioperative nursing and how do nurses facilitate the interaction between nursing care and technology in highly...... specialized operating rooms in public university hospitals? METHODS: An ethnography involving participant observations and interviews was conducted during a 9-month study period. The participants comprised 24 nurses from 9 different operating wards at 2 university hospitals in different regions of Denmark...

  8. Hip Resurfacing Arthroplasty and Perioperative Blood Testing

    Directory of Open Access Journals (Sweden)

    Andrew Cook

    2014-01-01

    Full Text Available It is standard practice in many institutions to routinely perform preoperative and postoperative haemoglobin level testing in association with hip joint arthroplasty procedures. It is our observation, however, that blood transfusion after uncomplicated primary hip arthroplasty in healthy patients is uncommon and that the decision to proceed with blood transfusion is typically made on clinical grounds. We therefore question the necessity and clinical value of routine perioperative blood testing about the time of hip resurfacing arthroplasty. We present analysis of perioperative blood tests and transfusion rates in 107 patients undertaking unilateral hybrid hip resurfacing arthroplasty by the senior author at a single institution over a three-year period. We conclude that routine perioperative testing of haemoglobin levels for hip resurfacing arthroplasty procedures does not assist in clinical management. We recommend that postoperative blood testing only be considered should the patient demonstrate clinical signs of symptomatic anaemia or if particular clinical circumstances necessitate.

  9. Perioperative outcomes of pancreaticoduodenectomy: Nepalese experience.

    Science.gov (United States)

    Lakhey, Paleswan Joshi; Bhandari, Ramesh Singh; Ghimire, Bikal; Khakurel, Mahesh

    2010-08-01

    Pancreaticodudenectomy (PD) is a high-risk, technically demanding operation associated with substantial perioperative morbidity and mortality. This review is intended to evaluate the perioperative outcomes of PD done in a single gastrointestinal surgery unit of a university teaching hospital. A retrospective review of medical records of patients who underwent PD from April 2005 through May 2009 was done. Perioperative morbidity was defined according to the standard of the International Study Group for Pancreatic Fistula (ISGPF). The patient demographics, type of surgery, and perioperative morbidity and mortality were evaluated. The factors associated with increased morbidity were analyzed. Twenty-four patients underwent PD, and there were no perioperative deaths. The overall morbidity was 58%, with a pancreatic fistula rate of 13%. None of the associated parameters, like increasing age, the presence of co-morbidity, preoperative biliary drainage, and duration of surgery, were found to increase the morbidity. These results of PD, though a small case series, are comparable to the international standard. Better outcomes can be achieved even in low- to medium-volume centers in developing countries where a dedicated team with special interest in pancreatic surgery is in place. Although there were no deaths after PD in our series, the morbidity was higher than that observed in other high-volume centers. To decrease the morbidity associated with PD, various factors must be streamlined, among them, the operative technique and the intensive perioperative management of the patient, as well as uniform definition of complications, use of a multidisciplinary approach, and identification of associated risk factors.

  10. Service Dogs in the Perioperative Setting.

    Science.gov (United States)

    Levey, Janet A; Chappy, Sharon L

    2017-04-01

    Service dogs are critical for the independence of individuals with disabilities because they assist with daily living activities and help these individuals navigate society. Perioperative nurses need a working knowledge of disability laws pertaining to service dogs to provide patient-centered care for individuals using service dogs. This article provides information on the Americans With Disabilities Act regulations regarding service dogs, makes recommendations for the care of patients with service dogs across the perioperative continuum, and offers policy directives to ensure that safe, high-quality care is delivered to patients using service dogs. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  11. Ethics in perioperative practice--patient advocacy.

    Science.gov (United States)

    Schroeter, Kathryn

    2002-05-01

    Though often difficult, ethical decision making is necessary when caring for surgical patients. Perioperative nurses have to recognize ethical dilemmas and be prepared to take action based on the ethical code outlined in the American Nurses Association's (ANA's) Code of Ethics for Nurses with Interpretive Statements. In this second of a nine-part series that will help perioperative nurses relate the ANA code to their own area of practice, the author looks at the third provision statement, which addresses nurses' position as patient advocates.

  12. Perioperative beta blockers in patients having non-cardiac surgery

    DEFF Research Database (Denmark)

    Bangalore, Sripal; Wetterslev, Jørn; Pranesh, Shruthi

    2008-01-01

    American College of Cardiology and American Heart Association (ACC/AHA) guidelines on perioperative assessment recommend perioperative beta blockers for non-cardiac surgery, although results of some clinical trials seem not to support this recommendation. We aimed to critically review the evidence...... to assess the use of perioperative beta blockers in patients having non-cardiac surgery....

  13. anaesthetic registrars' experiences of perioperative death

    African Journals Online (AJOL)

    Death on the table: anaesthetic registrars' experiences of perioperative ... aDepartment of Anaesthesiology and Critical Care, University of KwaZulu-Natal, Durban, South Africa ... Results: Themes expressed by participants fell into three broad categories: ... number (up to 70%) of anaesthetists report experiencing adverse.

  14. Patient Education May Improve Perioperative Safety.

    NARCIS (Netherlands)

    de Haan, L.S.; Calsbeek, H; Wolff, André

    2016-01-01

    Importance: There is a growing interest in enabling ways for patients to participate in their own care to improve perioperative safety, but little is known about the effectiveness of interventions enhancing an active patient role. Objective: To evaluate the effect of patient participation on

  15. Perioperative care of the older patient

    NARCIS (Netherlands)

    E. Blommers; M. Klimek (Markus); K.A. Hartholt (Klaas); T.J.M. van der Cammen (Tischa); J. Klein (Jan); P. Noordzij (Peter)

    2011-01-01

    textabstractNearly 60% of the Dutch population undergoing surgery is aged 65 years and over. Older patients are at increased risk of developing perioperative complications (e.g., myocardial infarction, pneumonia, or delirium), which may lead to a prolonged hospital stay or death. Preoperative risk

  16. The treatment of perioperative myocardial infarctions following ...

    African Journals Online (AJOL)

    Background: Perioperative myocardial infarction (PMI) is a common complication following noncardiac surgery, with a 30-day mortality of 10-20%. Effective therapeutic interventions are of public health importance. Method: This is a systematic review, aimed to determine the evidence for therapies following PMI. Results: A ...

  17. Vasopressin in perioperative management of congenital ...

    African Journals Online (AJOL)

    Perioperative care of infants with diaphragmatic hernias can be a challenge because of pulmonary hypertension and systemic hypotension. The objective of this study was to report the usefulness of vasopressin infusion in improving pulmonary and systemic haemodynamics in an infant with congenital diaphragmatic hernia.

  18. Gravitational wave sources: reflections and echoes

    Science.gov (United States)

    Price, Richard H.; Khanna, Gaurav

    2017-11-01

    The recent detection of gravitational waves has generated interest in alternatives to the black hole interpretation of sources. A subset of such alternatives involves a prediction of gravitational wave ‘echoes’. We consider two aspects of possible echoes: first, general features of echoes coming from spacetime reflecting conditions. We find that the detailed nature of such echoes does not bear any clear relationship to quasi-normal frequencies. Second, we point out the pitfalls in the analysis of local reflecting ‘walls’ near the horizon of rapidly rotating black holes.

  19. Gravitational wave sources: reflections and echoes

    International Nuclear Information System (INIS)

    Price, Richard H; Khanna, Gaurav

    2017-01-01

    The recent detection of gravitational waves has generated interest in alternatives to the black hole interpretation of sources. A subset of such alternatives involves a prediction of gravitational wave ‘echoes’. We consider two aspects of possible echoes: first, general features of echoes coming from spacetime reflecting conditions. We find that the detailed nature of such echoes does not bear any clear relationship to quasi-normal frequencies. Second, we point out the pitfalls in the analysis of local reflecting ‘walls’ near the horizon of rapidly rotating black holes. (paper)

  20. Sparse adaptive filters for echo cancellation

    CERN Document Server

    Paleologu, Constantin

    2011-01-01

    Adaptive filters with a large number of coefficients are usually involved in both network and acoustic echo cancellation. Consequently, it is important to improve the convergence rate and tracking of the conventional algorithms used for these applications. This can be achieved by exploiting the sparseness character of the echo paths. Identification of sparse impulse responses was addressed mainly in the last decade with the development of the so-called ``proportionate''-type algorithms. The goal of this book is to present the most important sparse adaptive filters developed for echo cancellati

  1. Echoes in correlated neural systems

    International Nuclear Information System (INIS)

    Helias, M; Tetzlaff, T; Diesmann, M

    2013-01-01

    Correlations are employed in modern physics to explain microscopic and macroscopic phenomena, like the fractional quantum Hall effect and the Mott insulator state in high temperature superconductors and ultracold atoms. Simultaneously probed neurons in the intact brain reveal correlations between their activity, an important measure to study information processing in the brain that also influences the macroscopic signals of neural activity, like the electroencephalogram (EEG). Networks of spiking neurons differ from most physical systems: the interaction between elements is directed, time delayed, mediated by short pulses and each neuron receives events from thousands of neurons. Even the stationary state of the network cannot be described by equilibrium statistical mechanics. Here we develop a quantitative theory of pairwise correlations in finite-sized random networks of spiking neurons. We derive explicit analytic expressions for the population-averaged cross correlation functions. Our theory explains why the intuitive mean field description fails, how the echo of single action potentials causes an apparent lag of inhibition with respect to excitation and how the size of the network can be scaled while maintaining its dynamical state. Finally, we derive a new criterion for the emergence of collective oscillations from the spectrum of the time-evolution propagator. (paper)

  2. Wind yield forecast with Echo State Networks; Windertragsprognose mit Echo State Networks

    Energy Technology Data Exchange (ETDEWEB)

    Kobialka, Hans-Ulrich [Fraunhofer IAIS, Sankt Augustin (Germany)

    2012-07-01

    Statistical methods are able to create models of complex system dynamics which are difficult to capture analytically. This paper describes a wind energy prediction system based on a machine learning method, called Echo State Networks. Echo State Networks enable the training of large recurrent neural networks which are able to model and predict highly non-linear system dynamics. This paper gives a short description of Echo State Networks and the realization of the wind energy prediction system. (orig.)

  3. Hazardous Waste Dashboard Help | ECHO | US EPA

    Science.gov (United States)

    The dashboards found on the Enforcement and Compliance History Online (ECHO) website are specialized to track both facility and agency performance as they relate to compliance with and enforcement of environmental standards under the Resource Conservation and Recovery Act (RCRA).

  4. Air Dashboard Help | ECHO | US EPA

    Science.gov (United States)

    The dashboards found on the Enforcement and Compliance History Online (ECHO) website are specialized to track both facility and agency performance as they relate to compliance with and enforcement of environmental standards under the Clean Air Act (CAA).

  5. MEASUREMENT OF TRANSVERSE ECHOES IN RHIC

    International Nuclear Information System (INIS)

    FISCHER, W.; SATOGATA, T.; TOMAS, R.

    2005-01-01

    Beam echoes are a very sensitive method to measure diffusion, and longitudinal echo measurements were performed in a number of machines. In RHIC, for the first time, a transverse beam echo was observed after applying a dipole kick followed by a quadrupole .kick. After application of the dipole kick, the dipole moment decohered completely due to lattice nonlinearities. When a quadrupole kick is applied at time τ after the dipole kick, the beam re-cohered at time 2τ thus showing an echo response. We describe the experimental setup and measurement results. In the measurements the dipole and quadrupole kick amplitudes, amplitude dependent tune shift, and the time between dipole and quadrupole kick were varied. In addition, measurements were taken with gold bunches of different intensities. These should exhibit different transverse diffusion rates due to intra-beam scattering

  6. Water Dashboard Help | ECHO | US EPA

    Science.gov (United States)

    The dashboards on the ECHO website are specialized to track both facility and agency performance as they relate to compliance with and enforcement of environmental standards under the Clean Water Act (CWA).

  7. Stellar Echo Imaging of Exoplanets, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — All stars exhibit intensity fluctuations over several time scales, from nanoseconds to days; these intensity fluctuations echo off planetary bodies in the star...

  8. Stellar Echo Imaging of Exoplanets, Phase II

    Data.gov (United States)

    National Aeronautics and Space Administration — All stars exhibit intensity fluctuations over several time scales, from nanoseconds to days; these intensity fluctuations echo off planetary bodies in the star...

  9. Time Delay Estimation Algoritms for Echo Cancellation

    Directory of Open Access Journals (Sweden)

    Kirill Sakhnov

    2011-01-01

    Full Text Available The following case study describes how to eliminate echo in a VoIP network using delay estimation algorithms. It is known that echo with long transmission delays becomes more noticeable to users. Thus, time delay estimation, as a part of echo cancellation, is an important topic during transmission of voice signals over packetswitching telecommunication systems. An echo delay problem associated with IP-based transport networks is discussed in the following text. The paper introduces the comparative study of time delay estimation algorithm, used for estimation of the true time delay between two speech signals. Experimental results of MATLab simulations that describe the performance of several methods based on cross-correlation, normalized crosscorrelation and generalized cross-correlation are also presented in the paper.

  10. Enforcement and Compliance History Online (ECHO) Facilities

    Data.gov (United States)

    U.S. Environmental Protection Agency — ECHO provides integrated compliance and enforcement information for about 800,000 regulated facilities nationwide. Its features range from simple to advanced,...

  11. Report Environmental Violations | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  12. Denuncie violaciones ambientales | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  13. Analyze Trends: State Hazardous Waste Dashboard | ECHO ...

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  14. DWDashboard_Year.png | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  15. summarytable.PNG | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  16. dashboard_3.PNG | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  17. ExampleDFR.PNG | ECHO | US EPA

    Science.gov (United States)

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    Science.gov (United States)

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    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  20. Resources.PNG | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  1. Dischargers_Example.png | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  2. dashboard_1.PNG | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  3. dashboard_2.PNG | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  4. monperload_3.PNG | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  5. Hierarchy of Loading Calculations | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  6. Mobile Bay.pdf | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  7. Custom Search Help | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  8. Custom Search Results Help | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  9. Watershed Statistics Help | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  10. Water Pollution Search | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  11. Electric Dipole Echoes in Rydberg Atoms

    International Nuclear Information System (INIS)

    Yoshida, S.; Reinhold, C. O.; Burgdoerfer, J.; Zhao, W.; Mestayer, J. J.; Lancaster, J. C.; Dunning, F. B.

    2007-01-01

    We report the first observation of echoes in the electric dipole moment of an ensemble of Rydberg atoms precessing in an external electric field F. Rapid reversal of the field direction is shown to play a role similar to that of a π pulse in NMR in rephasing a dephased ensemble of electric dipoles resulting in the buildup of an echo. The mechanisms responsible for this are discussed with the aid of classical trajectory Monte Carlo simulations

  12. Technical Users Background Document | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  13. Time-resolved Femtosecond Photon Echo Probes Bimodal Solvent Dynamics

    NARCIS (Netherlands)

    Pshenichnikov, M.S; Duppen, K.; Wiersma, D. A.

    1995-01-01

    We report on time-resolved femtosecond photon echo experiments of a dye molecule in a polar solution. The photon echo is time resolved by mixing the echo with a femtosecond gate pulse in a nonlinear crystal. It is shown that the temporal profile of the photon echo allows separation of the

  14. Perioperative Vision Loss in Cervical Spinal Surgery.

    Science.gov (United States)

    Gabel, Brandon C; Lam, Arthur; Chapman, Jens R; Oskouian, Rod J; Nassr, Ahmad; Currier, Bradford L; Sebastian, Arjun S; Arnold, Paul M; Hamilton, Steven R; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

    2017-04-01

    Retrospective multicenter case series. To assess the rate of perioperative vision loss following cervical spinal surgery. Medical records for 17 625 patients from 21 high-volume surgical centers from the AOSpine North America Clinical Research Network who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, inclusive, were reviewed to identify occurrences of vision loss following surgery. Of the 17 625 patients in the registry, there were 13 946 patients assessed for the complication of blindness. There were 9591 cases that involved only anterior surgical approaches; the remaining 4355 cases were posterior and/or circumferential fusions. There were no cases of blindness or vision loss in the postoperative period reported during the sampling period. Perioperative vision loss following cervical spinal surgery is exceedingly rare.

  15. Perioperative complications in endovascular neurosurgery: Anesthesiologist's perspective

    Science.gov (United States)

    Sharma, Megha U.; Ganjoo, Pragati; Singh, Daljit; Tandon, Monica S.; Agarwal, Jyotsna; Sharma, Durga P.; Jagetia, Anita

    2017-01-01

    Background: Endovascular neurosurgery is known to be associated with potentially serious perioperative complications that can impact the course and outcome of anesthesia. We present here our institutional experience in the anesthetic management of various endovascular neurosurgical procedures and their related complications over a 10-year period. Methods: Data was obtained in 240 patients pertaining to their preoperative status, details of anesthesia and surgery, perioperative course and surgery-related complications. Information regarding hemodynamic alterations, temperature variability, fluid-electrolyte imbalance, coagulation abnormalities and alterations in the anesthesia course was specifically noted. Results: Among the important complications observed were aneurysm rupture (2.5%), vasospasm (6.67%), thromboembolism (4.16%), contrast reactions, hemodynamic alterations, electrolyte abnormalities, hypothermia, delayed emergence from anesthesia, groin hematomas and early postoperative mortality (5.14%). Conclusion: Awareness of the unique challenges of endovascular neurosurgery and prompt and appropriate management of the associated complications by an experienced neuroanesthesiologist is vital to the outcome of these procedures. PMID:28413524

  16. Detrimental effects of perioperative blood transfusion

    DEFF Research Database (Denmark)

    Nielsen, Hans Jørgen

    1995-01-01

    Evidence suggests that perioperative allogeneic blood transfusion increases the risk of infectious complications after major surgery and of cancer recurrence after curative operation. This has been attributed to immunosuppression. Several authors have suggested that filtered whole blood and/or red...... cell concentrate, or leucocyte- and buffy coat-reduced red cells in artificial medium or their own plasma, may reduce postoperative immunosuppression. It was also anticipated that the use of autologous blood might minimize the risk of perioperative transfusion, but studies have unexpectedly shown...... similar postoperative infectious complications and cancer recurrence and/or survival rates in patients receiving autologous blood donated before operation and those receiving allogeneic blood. Future studies should identify common risk factors associated with blood storage....

  17. Using games to provide interactive perioperative education.

    Science.gov (United States)

    Carifa, Linda; Janiszewski Goodin, Heather

    2011-10-01

    Perioperative nurses must use critical thinking and sound clinical judgment to meet their patients' needs safely and effectively. This requires the integration and continual updating of large amounts of detailed clinical information. Innovative education strategies are designed to make teaching and learning more interesting and interactive, especially for the presentation of complex subject material. One interactive educational strategy is the use of games. Educational games can foster collaboration and critical thinking among peers and associates. An example of this was the Perioperative QuizBowl: Evidence-Based Practice presented at the annual AORN Congress from 2003 to 2010, which was used to teach and reinforce evidence-based practice in a fun, competitive way. Although AORN no longer presents this offering, the QuizBowl format demonstrates how educational games can support clinical practice. Copyright © 2011 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  18. Echoes from a Dying Star

    Science.gov (United States)

    Kohler, Susanna

    2017-06-01

    When a passing star is torn apart by a supermassive black hole, it emits a flare of X-ray, ultraviolet, and optical light. What can we learn from the infrared echo of a violent disruption like this one?Stellar DestructionOptical (black triangles) and infrared (blue circles and red squares) observations of F010042237. Day 0 marks the day the optical emission peaked. The infrared emission rises steadily through the end of the data. [Dou et al. 2017]Tidal disruption events occur when a star passes within the tidal radius of a supermassive black hole. After tidal forces pull the star apart, much of the stellar matter falls onto the black hole, radiating briefly in X-ray, ultraviolet and optical as it accretes. This signature rise and gradual fall of emission has allowed us to detect dozens of tidal disruption events thus far.One of the recently discovered candidate events is a little puzzling. Not only does the candidate in ultraluminous infrared galaxy F010042237 have an unusual host most disruptions occur in galaxies that are no longer star-forming, in contrast to this one but its optical light curve also shows an unusually long decay time.Now mid-infrared observations of this event have beenpresented by a team of scientists led by Liming Dou (Guangzhou University and Department of Education, Guangdong Province, China), revealing why this disruption is behaving unusually.Schematic of a convex dusty ring (red bows) that absorbs UV photons and re-emits in the infrared. It simultaneously scatters UV and optical photons into our line of sight. The dashed lines illustrate the delays at lags of 60 days, 1, 2, 3, 4, and 5 years. [Adapted from Dou et al. 2017]A Dusty Solution?The optical flare from F010042237s nucleus peaked in 2010, so Dou and collaborators obtained archival mid-infrared data from the WISE and NEOWISE missions from 2010 to 2016. The data show that the galaxy is quiescent in mid-infrared in 2010 but in data from three years later, the infrared emission has

  19. Perioperative registered nurses knowledge, attitudes, behaviors, and barriers regarding pressure ulcer prevention in perioperative patients.

    Science.gov (United States)

    Tallier, Peggy C; Reineke, Patricia R; Asadoorian, Kathy; Choonoo, John G; Campo, Marc; Malmgreen-Wallen, Christine

    2017-08-01

    Hospital acquired pressure ulcers have a detrimental effect on patient quality of life, morbidity, mortality, and cost to the healthcare industry. Little is known about pressure ulcer prevention in perioperative services. The objectives of this study were to describe perioperative registered nurses (RNs) knowledge, attitudes, behaviors, and barriers about pressure ulcer prevention and to determine if knowledge and the availability of a pressure ulcer staging tool are predictors of pressure ulcer prevention behavior. A cross-sectional descriptive pilot study was conducted. Sixty-two perioperative RNs from 10 acute care hospitals participated. Perioperative nurses believed carrying out pressure ulcer prevention strategies is essential to nursing practice but only two-thirds reported conducting pressure ulcer risk assessment on all patients and daily assessment on at risk patients. Results indicated a knowledge deficit regarding assessment and prevention of pressure ulcers as performance on the PUKT (72%) fell below the recommended score of 90%. Results of binary logistic regression indicated that knowledge as measured by the PUKT and availability of a pressure ulcer staging tool were statistically significant (p=0.03) predictors of pressure ulcer prevention behavior. The initial model without the predictor variables, indicated an overall success rate of correct predictions of 64% which increase to 73% when the predictor variables were added to the initial model. Although perioperative nurses believe that pressure ulcer prevention is important, a knowledge deficit exists and there is a need for pressure ulcer prevention education. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Perioperative lung protective ventilation in obese patients

    OpenAIRE

    Fernandez-Bustamante, Ana; Hashimoto, Soshi; Serpa Neto, Ary; Moine, Pierre; Vidal Melo, Marcos F; Repine, John E

    2015-01-01

    The perioperative use and relevance of protective ventilation in surgical patients is being increasingly recognized. Obesity poses particular challenges to adequate mechanical ventilation in addition to surgical constraints, primarily by restricted lung mechanics due to excessive adiposity, frequent respiratory comorbidities (i.e. sleep apnea, asthma), and concerns of postoperative respiratory depression and other pulmonary complications. The number of surgical patients with obesity is increa...

  1. Optimizing Perioperative Nutrition in Pediatric Populations.

    Science.gov (United States)

    Canada, Nicki L; Mullins, Lucille; Pearo, Brittany; Spoede, Elizabeth

    2016-02-01

    Nutrition status prior to surgery and nutrition rehabilitation after surgery can affect the morbidity and mortality of pediatric patients. A comprehensive approach to nutrition in pediatric surgical patients is important and includes preoperative assessment, perioperative nutrition considerations, and postoperative recovery. A thorough nutrition assessment to identify patients who are at nutrition risk prior to surgery is important so that the nutrition status can be optimized prior to the procedure to minimize suboptimal outcomes. Preoperative malnutrition is associated with increased complications and mean hospital days following surgery. Enteral and parenteral nutrition can be used in cases where food intake is inadequate to maintain and possibly improve nutrition status, especially in the 7-10 days prior to surgery. In the perioperative period, fasting should be limited to restricting solid foods and non-human milk 6 hours prior to the procedure and allowing clear liquids until 2 hours prior to the procedure. Postoperatively, early feeding has been shown to resolve postoperative ileus earlier, decrease infection rates, promote wound healing, and reduce length of hospital stay. If nutrition cannot be provided orally, then nutrition through either enteral or parenteral means should be initiated within 24-48 hours of surgery. Practitioners should identify those patients who are at the highest nutrition risk for postsurgical complications and provide guidance for optimal nutrition during the perioperative and postoperative period. © 2015 American Society for Parenteral and Enteral Nutrition.

  2. Perioperative Management of Diabetes: A Review

    Directory of Open Access Journals (Sweden)

    Md Nazmul Kayes

    2014-07-01

    Full Text Available Diabetes increases the requirements of surgery as well as perioperative morbidity and mortality. Careful preoperative evaluation and treatment of cardiac and renal diseases, intensive intraoperative and postoperative management are essential to optimize the best outcome. Stress hyperglycemia in response to surgery, osmotic diuresis and hypoinsulinemia can lead to life threatening complications like ketoacidosis or hyperglycemic hyperosmolar syndrome. Wound healing is impaired by hyperglycemia and chance of postoperative wound infection is more in diabetics. Therefore aseptic precautions must be taken. Adequate insulin, glucose, fluid and electrolytes should be provided for good metabolic control. Though some current study reveals that oral hypoglycemic agents can be used for the effective management of perioperative diabetes; the adverse effects of newly introduced agents need more clinical observations. Subcutaneous administration of insulin as in Sliding Scale may be a less preferable method, because of unreliable absorption and unpredictable blood glucose. Intravenous administration of rapid onset soluble (short acting insulin as in Alberti (GIK regimen, is safe and effective method controlling perioperative hyperglycemia. Patient with type 1 diabetes needs frequent monitoring of glucose, electrolytes and acid-base balance as chance of high hyperglycemia and ketoacidosis is more. In case of emergency surgery assessment for diabetic ketoacidosis (DKA and meticulous management is essential. Postoperative pain and hyperglycemia should be treated carefully to avoid complications.

  3. [Perioperative management of long-term medication].

    Science.gov (United States)

    Vogel Kahmann, I; Ruppen, W; Lurati Buse, G; Tsakiris, D A; Bruggisser, M

    2011-01-01

    Anesthesiologists and surgeons are increasingly faced with patients who are under long-term medication. Some of these drugs can interact with anaesthetics or anaesthesia and/or surgical interventions. As a result, patients may experience complications such as bleeding, ischemia, infection or severe circulatory reactions. On the other hand, perioperative discontinuation of medication is often more dangerous. The proportion of outpatient operations has increased dramatically in recent years and will probably continue to increase. Since the implementation of DRGs (pending in Switzerland, introduced in Germany for some time), the patient enters the hospital the day before operation. This means that the referring physician as well as anesthesiologists and surgeons at an early stage must deal with issues of perioperative pharmacotherapy. This review article is about the management of the major drug classes during the perioperative period. In addition to cardiac and centrally acting drugs and drugs that act on hemostasis and the endocrine system, special cases such as immunosuppressants and herbal remedies are mentioned.

  4. [Perioperative managment of laparoscopic sleeve gastrectomy].

    Science.gov (United States)

    Chang, Xu-sheng; Yin, Kai; Wang, Xin; Zhuo, Guang-zuan; Ding, Dan; Guo, Xiang; Zheng, Cheng-zhu

    2013-10-01

    To summarize the surgical technique and perioperative management of laparoscopic sleeve gastrectomy (LSG). A total of 57 morbid obesity patients undergoing LSG surgery from May 2010 to December 2012 were enrolled in the study, whose clinical data in perioperative period were analyzed retrospectively. These patients had more than 1 year of follow-up. All the patients received preoperative preparation and postoperative management, and postoperative excess weight loss(EWL%) and improvement of preoperative complications was evaluated. All the cases completed the operation under laparoscopy, except 1 case because of the abdominal extensive adhesion. The average operation time was(102.0±15.2) min and the mean intraoperative blood loss (132.3±45.6) ml. Of 2 postoperative hemorrhage patients, 1 case received conservative treatment, and another one underwent laparoscopic exploration. The EWL% at 3 months, 6 months and 1 year after procedure was (54.9±13.8)%, (79.0±23.6)% and (106.9±25.1)% respectively. The preoperative complications were improved in some degree. There were no operative death, and anastomotic leak, anastomotic stenosis, or surgical site infection occurred. LSG is a safe and effective surgical technique, whose safety and efficacy may be increased by improving the perioperative management.

  5. Evidence for the perioperative care of mastectomized women

    Directory of Open Access Journals (Sweden)

    Carla Monique Lopes Mourão

    2014-01-01

    Full Text Available This study aimed to evaluate the evidence available in the literature about the perioperative care provided to women submitted to mastectomy. An integrative review of scientific literature conducted in MEDLINE, CINAHL, LILACS, and SciELO databases, published from 2000 to 2011, using the controlled descriptors: preoperative care; preoperative period; intraoperative care; intraoperative period; postoperative care; postoperative period; perioperative care; perioperative period; and mastectomy. The sample of this review consisted of seven articles. The evidence pointed as perioperative care of mastectomy the pharmacological management of pain in different surgical periods. Despite the difficulty in presenting a consensus of evidence for perioperative care of mastectomy, there was concern on the part of professionals to minimize/prevent pre-, intra- and post-operative pain. Nursing should be aware, both of the update of pharmacological treatments in pain management and the development of future research related to nursing care in the perioperative period of mastectomy.

  6. Echo-Interleaved-Spiral MR Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Rosenthal, Shirrie; Azhari, Haim [Department of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa 32000 (Israel); Montag, Avram [Elscint Ltd., MRI division, Haifa (Israel)

    1999-12-31

    Interleaved-Spiral imaging is an efficient method for MRI fast scans. However, images suffer from blurring and artifacts due to field inhomogeneities and the long readout times. In this paper, we combine interleaved-spirals with spin-echo for 3D scans. The refocusing RF-pulses (echoes) refocus off-resonance spins, thus allowing longer acquisition times per excitation, by limiting inhomogeneity effects. The total number of excitations for a 3D scan is reduced by half. The 3D Fourier transform of an object is divided into pairs of slices, one slice is scanned in an outgoing interleaved-spiral, initiated after a 90 degree pulse has been applied. The second slice is scanned in an ingoing interleaved-spiral, after a 180 degree pulse has been applied, thus reaching the slice origin at the echo time. (authors) 4 refs., 3 figs.

  7. Echo-Interleaved-Spiral MR Imaging

    International Nuclear Information System (INIS)

    Rosenthal, Shirrie; Azhari, Haim; Montag, Avram

    1998-01-01

    Interleaved-Spiral imaging is an efficient method for MRI fast scans. However, images suffer from blurring and artifacts due to field inhomogeneities and the long readout times. In this paper, we combine interleaved-spirals with spin-echo for 3D scans. The refocusing RF-pulses (echoes) refocus off-resonance spins, thus allowing longer acquisition times per excitation, by limiting inhomogeneity effects. The total number of excitations for a 3D scan is reduced by half. The 3D Fourier transform of an object is divided into pairs of slices, one slice is scanned in an outgoing interleaved-spiral, initiated after a 90 degree pulse has been applied. The second slice is scanned in an ingoing interleaved-spiral, after a 180 degree pulse has been applied, thus reaching the slice origin at the echo time. (authors)

  8. Meteor head echoes - observations and models

    Directory of Open Access Journals (Sweden)

    A. Pellinen-Wannberg

    2005-01-01

    Full Text Available Meteor head echoes - instantaneous echoes moving with the velocities of the meteors - have been recorded since 1947. Despite many attempts, this phenomenon did not receive a comprehensive theory for over 4 decades. The High Power and Large Aperture (HPLA features, combined with present signal processing and data storage capabilities of incoherent scatter radars, may give an explanation for the old riddle. The meteoroid passage through the radar beam can be followed with simultaneous spatial-time resolution of about 100m-ms class. The current views of the meteor head echo process will be presented and discussed. These will be related to various EISCAT observations, such as dual-frequency target sizes, altitude distributions and vector velocities.

  9. J-NSE: Neutron spin echo spectrometer

    Directory of Open Access Journals (Sweden)

    Olaf Holderer

    2015-08-01

    Full Text Available Neutron Spin-Echo (NSE spectroscopy is well known as the only neutron scattering technique that achieves energy resolution of several neV. By using the spin precession of polarized neutrons in magnetic field one can measure tiny velocity changes of the individual neutron during the scattering process. Contrary to other inelastic neutron scattering techniques, NSE measures the intermediate scattering function S(Q,t in reciprocal space and time directly. The Neutron Spin-Echo spectrometer J-NSE, operated by JCNS, Forschungszentrum Jülich at the Heinz Maier-Leibnitz Zentrum (MLZ in Garching, covers a time range (2 ps to 200 ns on length scales accessible by small angle scattering technique. Along with conventional NSE spectroscopy that allows bulk measurements in transmission mode, J-NSE offers a new possibility - gracing incidence spin echo spectroscopy (GINSENS, developed to be used as "push-button" option in order to resolve the depth dependent near surface dynamics.

  10. Black hole ringdown echoes and howls

    Science.gov (United States)

    Nakano, Hiroyuki; Sago, Norichika; Tagoshi, Hideyuki; Tanaka, Takahiro

    2017-07-01

    Recently the possibility of detecting echoes of ringdown gravitational waves from binary black hole mergers was shown. The presence of echoes is expected if the black hole is surrounded by a mirror that reflects gravitational waves near the horizon. Here, we present slightly more sophisticated templates motivated by a waveform which is obtained by solving the linear perturbation equation around a Kerr black hole with a complete reflecting boundary condition in the stationary traveling wave approximation. We estimate that the proposed template can bring about a 10% improvement in the signal-to-noise ratio.

  11. Evolution of entanglement under echo dynamics

    International Nuclear Information System (INIS)

    Prosen, Tomaz; Znidaric, Marko; Seligman, Thomas H.

    2003-01-01

    Echo dynamics and fidelity are often used to discuss stability in quantum-information processing and quantum chaos. Yet fidelity yields no information about entanglement, the characteristic property of quantum mechanics. We study the evolution of entanglement in echo dynamics. We find qualitatively different behavior between integrable and chaotic systems on one hand and between random and coherent initial states for integrable systems on the other. For the latter the evolution of entanglement is given by a classical time scale. Analytic results are illustrated numerically in a Jaynes-Cummings model

  12. Short term memory in echo state networks

    OpenAIRE

    Jaeger, H.

    2001-01-01

    The report investigates the short-term memory capacity of echo state recurrent neural networks. A quantitative measure MC of short-term memory capacity is introduced. The main result is that MC 5 N for networks with linear Output units and i.i.d. input, where N is network size. Conditions under which these maximal memory capacities are realized are described. Several theoretical and practical examples demonstrate how the short-term memory capacities of echo state networks can be exploited for...

  13. How can dolphins recognize fish according to their echoes? A statistical analysis of fish echoes.

    Directory of Open Access Journals (Sweden)

    Yossi Yovel

    Full Text Available Echo-based object classification is a fundamental task of animals that use a biosonar system. Dolphins and porpoises should be able to rely on echoes to discriminate a predator from a prey or to select a desired prey from an undesired object. Many studies have shown that dolphins and porpoises can discriminate between objects according to their echoes. All of these studies however, used unnatural objects that can be easily characterized in human terminologies (e.g., metallic spheres, disks, cylinders. In this work, we collected real fish echoes from many angles of acquisition using a sonar system that mimics the emission properties of dolphins and porpoises. We then tested two alternative statistical approaches in classifying these echoes. Our results suggest that fish species can be classified according to echoes returning from porpoise- and dolphin-like signals. These results suggest how dolphins and porpoises can classify fish based on their echoes and provide some insight as to which features might enable the classification.

  14. Perioperative interstitial brachytherapy for recurrent keloid scars

    International Nuclear Information System (INIS)

    Rio, E.; Bardet, E.; Peuvrel, P.; Martinet, L.; Perrot, P.; Baraer, F.; Loirat, Y.; Sartre, J.Y.; Malard, O.; Ferron, C.; Dreno, B.

    2010-01-01

    Purpose: Evaluation of the results of perioperative interstitial brachytherapy with low dose-rate (L.D.R.) Ir-192 in the treatment of keloid scars. Patients and methods: We performed a retrospective analysis of 73 histologically confirmed keloids (from 58 patients) resistant to medico surgical treated by surgical excision plus early perioperative brachytherapy. All lesions were initially symptomatic. Local control was evaluated by clinical evaluation. Functional and cosmetic results were assessed in terms of patient responses to a self-administered questionnaire. Results: Median age was 28 years (range 13-71 years). Scars were located as follows: 37% on the face, 32% on the trunk or abdomen, 16% on the neck, and 15% on the arms or legs. The mean delay before loading was four hours (range, 1-6 h). The median dose was 20 Gy (range, 15-40 Gy). Sixty-four scars (from 53 patients) were evaluated. Local control was 86% (follow-up, 44.5 months; range, 14-150 months). All relapses occurred early within 2 years posttreatment. At 20 months, survival without recurrence was significantly lower when treated lengths were more than 6 cm long. The rate was 100% for treated scars below 4.5 cm in length, 95% (95% CI: 55-96) for those 4.5-6 cm long, and 75% (95% CI: 56-88) beyond 6 cm (p = 0.038). Of the 35 scars (28 patients) whose results were reassessed, six remained symptomatic and the esthetic results were considered to be good in 51% (18/35) and average in 37% (13/35) (median follow-up, 70 months; range, 16-181 months). Conclusion: Early perioperative L.D.R. brachytherapy delivering 20 Gy at 5 mm reduced the rate of recurrent keloids resistant to other treatments and gave good functional results. (authors)

  15. Perioperative lung protective ventilation in obese patients.

    Science.gov (United States)

    Fernandez-Bustamante, Ana; Hashimoto, Soshi; Serpa Neto, Ary; Moine, Pierre; Vidal Melo, Marcos F; Repine, John E

    2015-05-06

    The perioperative use and relevance of protective ventilation in surgical patients is being increasingly recognized. Obesity poses particular challenges to adequate mechanical ventilation in addition to surgical constraints, primarily by restricted lung mechanics due to excessive adiposity, frequent respiratory comorbidities (i.e. sleep apnea, asthma), and concerns of postoperative respiratory depression and other pulmonary complications. The number of surgical patients with obesity is increasing, and facing these challenges is common in the operating rooms and critical care units worldwide. In this review we summarize the existing literature which supports the following recommendations for the perioperative ventilation in obese patients: (1) the use of protective ventilation with low tidal volumes (approximately 8 mL/kg, calculated based on predicted -not actual- body weight) to avoid volutrauma; (2) a focus on lung recruitment by utilizing PEEP (8-15 cmH2O) in addition to recruitment maneuvers during the intraoperative period, as well as incentivized deep breathing and noninvasive ventilation early in the postoperative period, to avoid atelectasis, hypoxemia and atelectrauma; and (3) a judicious oxygen use (ideally less than 0.8) to avoid hypoxemia but also possible reabsorption atelectasis. Obesity poses an additional challenge for achieving adequate protective ventilation during one-lung ventilation, but different lung isolation techniques have been adequately performed in obese patients by experienced providers. Postoperative efforts should be directed to avoid hypoventilation, atelectasis and hypoxemia. Further studies are needed to better define optimum protective ventilation strategies and analyze their impact on the perioperative outcomes of surgical patients with obesity.

  16. Levosimendan for Perioperative Cardioprotection: Myth or Reality?

    Science.gov (United States)

    Santillo, Elpidio; Migale, Monica; Massini, Carlo; Incalzi, Raffaele Antonelli

    2018-03-21

    Levosimendan is a calcium sensitizer drug causing increased contractility in the myocardium and vasodilation in the vascular system. It is mainly used for the therapy of acute decompensated heart failure. Several studies on animals and humans provided evidence of the cardioprotective properties of levosimendan including preconditioning and anti-apoptotic. In view of these favorable effects, levosimendan has been tested in patients undergoing cardiac surgery for the prevention or treatment of low cardiac output syndrome. However, initial positive results from small studies have not been confirmed in three recent large trials. To summarize levosimendan mechanisms of action and clinical use and to review available evidence on its perioperative use in cardiac surgery setting. We searched two electronic medical databases for randomized controlled trials studying levosimendan in cardiac surgery patients, ranging from January 2000 to August 2017. Meta-analyses, consensus documents and retrospective studies were also reviewed. In the selected interval of time, 54 studies on the use of levosimendan in heart surgery have been performed. Early small size studies and meta-analyses have suggested that perioperative levosimendan infusion could diminish mortality and other adverse outcomes (i.e. intensive care unit stay and need for inotropic support). Instead, three recent large randomized controlled trials (LEVO-CTS, CHEETAH and LICORN) showed no significant survival benefits from levosimendan. However, in LEVO-CTS trial, prophylactic levosimendan administration significantly reduced the incidence of low cardiac output syndrome. Based on most recent randomized controlled trials, levosimendan, although effective for the treatment of acute heart failure, can't be recommended as standard therapy for the management of heart surgery patients. Further studies are needed to clarify whether selected subgroups of heart surgery patients may benefit from perioperative levosimendan

  17. Perioperative pharmacokinetics of methadone in adolescents.

    Science.gov (United States)

    Sharma, Anshuman; Tallchief, Danielle; Blood, Jane; Kim, Thomas; London, Amy; Kharasch, Evan D

    2011-12-01

    Methadone is frequently administered to adults experiencing anesthesia and receiving pain treatment. Methadone pharmacokinetics in adults are well characterized, including the perioperative period. Methadone is also used in children. There is, however, no information on methadone pharmacokinetics in children of any age. The purpose of this investigation was to determine the pharmacokinetics of intravenous methadone in children undergoing surgery. Perioperative opioid-sparing effects were also assessed. Eligible subjects were children 5-18 yr undergoing general anesthesia and surgery, with an anticipated postoperative inpatient stay exceeding 3 days. Three groups of 10 to 11 patients each received intravenous methadone hydrochloride after anesthetic induction in ascending dose groups of 0.1, 0.2, and 0.3 mg/kg (up to 20 mg). Anesthetic care was not otherwise changed. Venous blood was obtained for 4 days, for stereoselective determination of methadone and metabolites. Pain assessments were made each morning. Daily and total opioid consumption was determined. Perioperative opioid consumption and pain was determined in a second cohort, which was matched to age, sex, race, ethnicity, surgical procedure, and length of stay, but not receiving methadone. The final methadone study cohort was 31 adolescents (14 ± 2 yr, range 10-18) undergoing major spine surgery for a diagnosis of scoliosis. Methadone pharmacokinetics were linear over the dose range 0.1-0.3 mg/kg. Disposition was stereoselective. Methadone administration did not dose-dependently affect postoperative pain scores, and did not dose-dependently decrease daily or total postoperative opioid consumption in spinal fusion patients. Methadone enantiomer disposition in adolescents undergoing surgery was similar to that in healthy adults.

  18. Perioperative Prophylaxis for Total Artificial Heart Transplantation.

    Science.gov (United States)

    Chambers, H E; Pelish, P; Qiu, F; Florescu, D F

    2017-11-01

    Practice variation regarding perioperative antimicrobial prophylaxis in total artificial heart transplantations (TAH-t) across institutions is unknown. The aim of our survey was to assess the current practices for prevention of infection in TAH-t recipients among different programs. An electronic survey was sent to programs that implant Syncardia TAH (Syncardia Systems, Tuscon, Ariz, USA). Proportions were analyzed for categorical variables; means and SDs were analyzed for continuous variables. The majority of centers (80.8%) had a formal surgical infection prophylaxis protocol. For non-penicillin-allergic patients, five (20.1%) institutions reported using a 4-drug regimen, seven (29.2%) used a 3-drug regimen, five (20.1%) used a 2-drug regimen, and seven (29.2%) used a cephalosporin alone. Similar data was seen in the penicillin-allergic patients. Infections were reported to occur postoperatively in 52.2% centers. During the first month after TAH-t, bacteremia represented 27.3%, driveline infections 27.2%, pulmonary infections 9%, and mediastinal infections 18.2%. The most common organisms seen within the first month were Candida spp., Escherichia coli, and Pseudomonas aeruginosa (21.4%). In 65% of centers, the mean rate of death post-TAH-t due to infection was 14.5% (SD, 22.3%). The mean rate of patients surviving until orthotopic heart transplantation was 58.6% (SD, 27.7%). Preventing infections post-TAH-t is key to decreasing morbidity and mortality. All institutions administered perioperative prophylaxis for TAH-t with significant variation among the centers. The majority of the centers have a formal perioperative prophylactic protocol. Copyright © 2017. Published by Elsevier Inc.

  19. Melatonin in perioperative medicine: Current perspective

    Directory of Open Access Journals (Sweden)

    Souvik Maitra

    2013-01-01

    Full Text Available Melatonin, a new addition to the armamentarium of anesthesiologist, has some unique properties that are highly desirable in routine peri-operative care. Available clinical data show that preoperative melatonin is as effective as benzodiazepines in reducing preoperative anxiety with minimal action on psychomotor performance and sleep wake cycle. It may be considered as a safe and effective alternative of benzodiazepines as preoperative anxiolytic. It may have opioid sparing effect, may reduce intraocular pressure, and have role in prevention of postoperative delirium. The short-term administration of melatonin is free from significant adverse effects also.

  20. Peri-operative cognitive dysfunction and protection

    DEFF Research Database (Denmark)

    Steinmetz, J; Rasmussen, L S

    2016-01-01

    Cognition may decline after surgery. Postoperative delirium, especially when hyperactive, may be easily recognised, whereas cognitive dysfunction is subtle and can only be detected using neuropsychological tests. The causes for these two conditions are largely unknown, although they share risk...... factors, the predominant one being age. Ignorance of the causes for postoperative cognitive dysfunction contributes to the difficulty of conducting interventional studies. Postoperative cognitive disorders are associated with increased mortality and permanent disability. Peri-operative interventions can...... reduce the rate of delirium in the elderly, but in spite of promising findings in animal experiments, no intervention reduces postoperative cognitive dysfunction in humans....

  1. Transcultural nursing in perioperative patient care.

    Directory of Open Access Journals (Sweden)

    Anna Kostka

    2017-06-01

    Full Text Available Jehovah's Witnesses is a religious association, who refuses blood transfusions even in life-threatening conditions. There are several alternative methods, implemented for use with patients that religion, whose task is to reduce the risk of bleeding and hemorrhage in the perioperative period. Good cooperation of the therapeutic team, the selection of appropriate treatment, the use of recommended methods of anesthesia, surgical techniques and proper nursing care with careful monitoring of post-operative complications and quick response if they leave, they contribute to the improvement of health.

  2. Experimental separation of a frequency spin echo signal

    International Nuclear Information System (INIS)

    Bun'kov, Yu.M.; Dmitriev, V.V.

    1981-01-01

    To study systems with bound nuclear-electron precession CsMnF 2 antiferromagnetic light-plane monocrystal was investigated. Crystal orientation was carried out by roentgenoscopy. Measurements were performed at helium temperatures in the 500-700 MHz frequency range. A NMR pulsed spectrometer with generators of both resonance and doubled frequency was used to produce an echo signal (to study by the parametric echo method). It was shown that the theory of the formation of a frequency modulated echo (FM echo) did not fully describe the properties of the echo signals in systems with dynamic frequency shift (DFS). An intense spin echo signal, which formation was apparently connected with other nonlinear properties of the systems with nuclear-electron precession, was observed. The spin echo signal in magnetics with DFS, which properties correspond to notions of the frequency mechanism of echo formation, was experimentally separated. As a result of the investigations it had been possible to settle contradictions between the theory of FM echo formation and the experimental results for the last 9 years. It turned out that the mechanism of FM echo formation in the magnetics with bound nuclear-electron precession was effective only at large delay times between the pulses. In the range of small delays the FM echo is ''jammed'' by a gigantic echo signal of a nature different from that of the traditional FM signal. The constant of gigantic echo intensity drop at increasing delay between the pulses weakly depends on spin-spin relaxation time [ru

  3. Comparison of multi-echo and single-echo gradient-recalled echo sequences for SPIO-enhanced Liver MRI at 3 T

    International Nuclear Information System (INIS)

    Choi, J.S.; Kim, M.-J.; Kim, J.H.; Choi, J.-Y.; Chung, Y.E.; Park, M.-S.; Kim, K.W.

    2010-01-01

    Aim: To assess the utility of a T2*-weighted, multi-echo data imaging combination sequenced on superparamagnetic iron oxide (SPIO)-enhanced liver magnetic resonance imaging (MRI) using a 3 T system. Materials and methods: Fifty patients underwent SPIO-enhanced MRI at 3 T using T2*-weighted, single-echo, gradient-recalled echo (GRE) sequences [fast imaging with steady precession; repetition time (TR)/echo time (TE), 126 ms/9 ms; flip angle, 30 o ] and multi-echo GRE (multi-echo data image combination) sequences (TR/TE, 186 ms/9 ms; flip angle, 30 o ). Three radiologists independently reviewed the images in a random order. The sensitivity and accuracy for the detection of focal hepatic lesions (a total of 76 lesions in 33 patients; 48 solid lesions, 28 non-solid lesions) were compared by analysing the area under the receiver operating characteristic curves. Image artefacts (flow artefacts, susceptibility artefacts, dielectric artefacts, and motion artefacts), lesion conspicuity, and overall image quality were evaluated according to a four-point scale: 1, poor; 2, fair; 3, good; 4, excellent. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the lesions were compared. Results: Image artefacts were more frequent with single-echo GRE (p < 0.05). The mean scale of image quality assessment for flow, susceptibility, dielectric, and motion artefacts were 2.76, 3.13, 3.42, and 2.89 with singe-echo, respectively, compared with 3.47, 3.43, 3.47, and 3.39, respectively, with multi-echo GRE. There was no significant difference in lesion conspicuity between single-echo (3.15) and multi-echo (3.30) GRE sequences. The overall image quality was significantly (p < 0.05) better with multi-echo (3.37) than with single-echo GRE (2.89). The mean SNR and CNR of the lesions were significantly (p < 0.05) higher on multi-echo (79 ± 23 and 128 ± 59, respectively) images than on single-echo (38 ± 11 and 102 ± 44, respectively) images. Lesion detection accuracy and

  4. Critical Elements for the Pediatric Perioperative Anesthesia Environment.

    Science.gov (United States)

    Polaner, David M; Houck, Constance S

    2015-12-01

    The American Academy of Pediatrics proposes guidance for the pediatric perioperative anesthesia environment. Essential components are identified to optimize the perioperative environment for the anesthetic care of infants and children. Such an environment promotes the safety and well-being of infants and children by reducing the risk of adverse events. Copyright © 2015 by the American Academy of Pediatrics.

  5. A systematic review of peri-operative melatonin

    DEFF Research Database (Denmark)

    Andersen, L P H; Werner, M U; Rosenberg, J

    2014-01-01

    We systematically reviewed randomised controlled trials of peri-operative melatonin. We included 24 studies of 1794 participants that reported eight peri-operative outcomes: anxiety; analgesia; sleep quality; oxidative stress; emergence behaviour; anaesthetic requirements; steal induction......%, respectively. Qualitative reviews suggested the melatonin improved sleep quality and emergence behaviour, and might be capable of reducing oxidative stress and anaesthetic requirements....

  6. Perioperative nutrition: what do we know? | Kotze | South African ...

    African Journals Online (AJOL)

    Surgery patients are at risk for iatrogenic malnutrition and subsequent deleterious effects. The benefits of nutrition support on patient outcomes have been demonstrated and the possible benefit of perioperative nutrition support thus implied. Enhanced recovery after surgery (ERAS) protocols, including perioperative nutrition ...

  7. Reduce--recycle--reuse: guidelines for promoting perioperative waste management.

    Science.gov (United States)

    Laustsen, Gary

    2007-04-01

    The perioperative environment generates large amounts of waste, which negatively affects local and global ecosystems. To manage this waste health care facility leaders must focus on identifying correctable issues, work with relevant stakeholders to promote solutions, and adopt systematic procedural changes. Nurses and managers can moderate negative environmental effects by promoting reduction, recycling, and reuse of materials in the perioperative setting.

  8. Effect of perioperative insulin infusion on surgical morbidity and mortality

    DEFF Research Database (Denmark)

    Gandhi, Gunjan Y; Murad, M Hassan; Flynn, Errol David

    2008-01-01

    To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of perioperative insulin infusion on outcomes important to patients.......To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of perioperative insulin infusion on outcomes important to patients....

  9. The impact of acute preoperative beta-blockade on perioperative ...

    African Journals Online (AJOL)

    To determine the impact of acute preoperative β-blockade on the incidence of perioperative cardiovascular morbidity and all- ... Our findings suggest that acute preoperative β-blockade is associated with an increased risk of perioperative cardiac ..... Shammash JB, Trost JC, Gold JM, Berlin JA, Golden MA, Kimmel SE.

  10. Pesticide Dashboard Help | ECHO | US EPA

    Science.gov (United States)

    The dashboards found on the Enforcement and Compliance History Online (ECHO) website are specialized to track both facility and agency performance as they relate to compliance with and enforcement of environmental standards under the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA).

  11. Long range echo classification for minehunting sonars

    NARCIS (Netherlands)

    Theije, P.A.M. de; Groen, J.; Sabel, J.C.

    2006-01-01

    This paper focesus on single-ping classification of sea mines, at a range of about 400 m, and combining a hull mounted sonar (HMS) and a propelled variable-depth sonar (PDVS). The deleoped classifier is trained and tested on a set of simulated realistic echoes of mines and non-mines. As the mines

  12. Electric Dipole Echoes and Noise-Induced Coherence

    International Nuclear Information System (INIS)

    Mestayer, J.J.; Zhao, W.; Lancaster, J.C.; Dunning, F.B.; Yoshida, S.; Reinhold, Carlos O.; Burgdorfer, J.

    2007-01-01

    The generation of echoes in the electric dipole moment of a Rydberg wavepacket precessing in an external electric field by reversal of the field is described. When the wavepacket experiences reversible dephasing, large echoes are observed pointing to strong refocusing of the wavepacket. The presence of irreversible dephasing leads to a reduction in the size of the echoes. The effect of irreversible dynamics on echoes is investigated using artificially synthesized noise. Methods to determine the decoherence rate are discussed

  13. Evolution and revision of the Perioperative Nursing Data Set.

    Science.gov (United States)

    Petersen, Carol; Kleiner, Cathy

    2011-01-01

    The Perioperative Nursing Data Set (PNDS) is a nursing language that provides standardized terminology to support perioperative nursing practice. The PNDS represents perioperative nursing knowledge and comprises data elements and definitions that demonstrate the nurse's influence on patient outcomes. Emerging issues and changes in practice associated with the PNDS standardized terminology require ongoing maintenance and periodic in-depth review of its content. Like each new edition of the Perioperative Nursing Data Set, the third edition, published in 2010, underwent content validation by numerous experts in clinical practice, vocabulary development, and informatics. The goal of this most recent edition is to enable the perioperative nurse to use the PNDS in a meaningful manner, as well as to promote standardization of PNDS implementation in practice, both in written documentation and the electronic health record. Copyright © 2011 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  14. Perioperative management of facial bipartition surgery

    Directory of Open Access Journals (Sweden)

    Caruselli M

    2015-11-01

    Full Text Available Marco Caruselli,1 Michael Tsapis,1,2 Fabrice Ughetto,1 Gregoire Pech-Gourg,3 Dario Galante,4 Olivier Paut1 1Anesthesia and Intensive Care Unit, La Timone Children’s Hospital, 2Pediatric Transport Team, SAMU 13, La Timone Hospital, 3Pediatric Neurosurgery Unit, La Timone Children’s Hospital, Marseille, France; 4Anesthesia and Intensive Care Unit, University Hospital Ospedali Riuniti of Foggia, Foggia, Italy Abstract: Severe craniofacial malformations, such as Crouzon, Apert, Saethre-Chotzen, and Pfeiffer syndromes, are very rare conditions (one in 50,000/100,000 live births that often require corrective surgery. Facial bipartition is the more radical corrective surgery. It is a high-risk intervention and needs complex perioperative management and a multidisciplinary approach. Keywords: craniofacial surgery, facial bipartition surgery, craniofacial malformations, pediatric anesthesia

  15. Perioperative management of patients with pituitary tumours

    Directory of Open Access Journals (Sweden)

    Mary Abraham

    2016-01-01

    Full Text Available Management of pituitary tumours can be very challenging for the anaesthesiologist. These patients require a thorough pre-operative assessment in view of underlying endocrine disturbances, which could cause anatomic and physiological disturbances. This needs to be optimized prior to surgery and the anaesthetic technique planned accordingly. The main intraoperative problems that could be encountered by the anaesthesiologist are airway problems, haemodynamic disturbances and potential for bleeding during surgery. The postoperative concerns are related to the endocrine system and fluid and water balance and this needs to be monitored closely and managed appropriately. The advent of minimally invasive surgery along with neuroimaging has considerably decreased perioperative morbidity and mortality following pituitary surgery. A team approach and close coordination between the endocrinologist, neurosurgeon and anaesthesiologist is imperative for a favourable outcome in patients undergoing pituitary surgery.

  16. Perioperative Management of Sickle Cell Disease.

    Science.gov (United States)

    Adjepong, Kwame Ofori; Otegbeye, Folashade; Adjepong, Yaw Amoateng

    2018-01-01

    Over 30 million people worldwide have sickle cell disease (SCD). Emergent and non-emergent surgical procedures in SCD have been associated with relatively increased risks of peri-operative mortality, vaso-occlusive (painful) crisis, acute chest syndrome, post-operative infections, congestive heart failure, cerebrovascular accident and acute kidney injury. Pre-operative assessment must include a careful review of the patient's known crisis triggers, baseline hematologic profile, usual transfusion requirements, pre-existing organ dysfunction and opioid use. Use of preoperative blood transfusions should be selective and decisions individualized based on the baseline hemoglobin, surgical procedure and anticipated volume of blood loss. Intra- and post-operative management should focus on minimizing hypoxia, hypothermia, acidosis, and intravascular volume depletion. Pre- and post-operative incentive spirometry use should be encouraged.

  17. Supply chain optimization for pediatric perioperative departments.

    Science.gov (United States)

    Davis, Janice L; Doyle, Robert

    2011-09-01

    Economic challenges compel pediatric perioperative departments to reduce nonlabor supply costs while maintaining the quality of patient care. Optimization of the supply chain introduces a framework for decision making that drives fiscally responsible decisions. The cost-effective supply chain is driven by implementing a value analysis process for product selection, being mindful of product sourcing decisions to reduce supply expense, creating logistical efficiency that will eliminate redundant processes, and managing inventory to ensure product availability. The value analysis approach is an analytical methodology for product selection that involves product evaluation and recommendation based on consideration of clinical benefit, overall financial impact, and revenue implications. Copyright © 2011 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  18. Perceptions of perioperative nursing competence: a cross-country comparison.

    Science.gov (United States)

    Gillespie, Brigid M; Harbeck, Emma B; Falk-Brynhildsen, Karin; Nilsson, Ulrica; Jaensson, Maria

    2018-01-01

    Throughout many countries, professional bodies rely on yearly self-assessment of competence for ongoing registration; therefore, nursing competence is pivotal to safe clinical practice. Our aim was to describe and compare perioperative nurses' perceptions of competence in four countries, while examining the effect of specialist education and years of experience in the operating room. We conducted a secondary analysis of cross-sectional surveys from four countries including; Australia, Canada, Scotland, and Sweden. The 40-item Perceived Perioperative Competence Scale-Revised (PPCS-R), was used with a total sample of 768 respondents. We used a factorial design to examine the influence of country, years of experience in the operating room and specialist education on nurses' reported perceived perioperative competence. Regardless of country origin, nurses with specialist qualifications reported higher perceived perioperative competence when compared to nurses without specialist education. However, cross-country differences were dependent on nurses' number of years of experience in the operating room. Nurses from Sweden with 6-10 years of experience in the operating room reported lower perceived perioperative competence when compared to Australian nurses. In comparing nurses with > 10 years of experience, Swedish nurses reported significantly lower perceived perioperative competence when compared to nurses from Australia, Canada and Scotland. Researchers need to consider educational level and years of experience in the perioperative context when examining constructs such as competence.

  19. Workshop on neutron spin-echo

    Energy Technology Data Exchange (ETDEWEB)

    Aynajian, P.; Habicht, K.; Keller, Th.; Keimer, B.; Mezei, F.; Monkenbusch, M.; Allgaier, J.; Richter, D.; Fetters, L.J.; Muller, K.; Kreiling, S.; Dehnicke, K.; Greiner, A.; Ehlers, G.; Arbe, A.; Colmenero, J.; Richter, D.; Farago, B.; Monkenbusch, M.; Ohl, M.; Butzek, M.; Kozielewski, T.; Monkenbusch, M.; Richter, D.; Pappas, C.; Hillier, A.; Manuel, P.; Cywinski, R.; Bentley, P.; Alba, M.; Mezei, F.; Campbell, I.A.; Zimmermann, U.; Ellis, J.; Jobic, H.; Pickup, R.M.; Pappas, C.; Farago, B.; Cywinski, R.; Haussler, W.; Holderer, O.; Frielinghaus, H.; Byelov, D.; Monkenbusch, M.; Allgaier, J.; Richter, D.; Egger, H.; Hellweg, Th.; Malikova, N.; Cadene, A.; Marry, V.; Dubois, E.; Turq, P.; Gardner, J.S.; Ehlers, G.; Bramwell, St.S.; Grigoriev, S.; Kraan, W.; Rekveldt, T.; Bouwman, W.; Van Dijk, N.; Falus, P.; Vorobiev, A.; Major, J.; Felcher, G.P.; Te-velthuis, S.; Dosch, H.; Vorobiev, A.; Dridi, M.H.; Major, J.; Dosch, H.; Falus, P.; Felcher, G.P.; Te Velthuis, S.G.E.; Bleuel, M.; Broell, M.; Lang, E.; Littrell, K.; Gahler, R.; Lal, J.; Lauter, H.; Toperverg, B.; Lauter, V.; Jernenkov, M.; Stueber, S.; Enderle, M.; Janoschek, M.; Keller, Th.; Klimko, S.; Boeni, P.; Nagao, M.; Yamada, N.; Kawabata, Y.; Seto, H.; Takeda, T.; Yoshizawa, H.; Yoshida, K.; Yamaguchi, T.; Bellissent-Funel, M.C.; Longeville, St

    2005-07-01

    This document gathers the abstracts of most papers presented at the workshop. Neutron spin-echo (NSE) spectroscopy is a well established technique with a growing expert user community, the aim of the meeting was to discuss the latest achievements in neutron spin-echo science and instrumentation. One of the applications presented is the investigation on the microscopic scale of the dynamics of water in montmorillonite clays with Na{sup +} and Cs{sup +} ions in monolayer and bilayer states. The NSE technique has been used in the normal and resonance modes. NSE results show consistently slower dynamics (higher relaxation times) than both time-of-flight technique (TOF) and classical molecular dynamics simulations (MD). In the present TOF and NSE experiments, anisotropy of the water motion in the interlayer is almost impossible to detect, due to the use of powder samples and insufficient resolution. (A.C.)

  20. The EChO science case

    DEFF Research Database (Denmark)

    Tinetti, Giovanna; Drossart, Pierre; Eccleston, Paul

    2015-01-01

    in the Solar System. Observations to date have shown that our Solar System is certainly not representative of the general population of planets in our Milky Way. The key science questions that urgently need addressing are therefore: What are exoplanets made of? Why are planets as they are? How do planetary....... The mission can target super-Earths, Neptune-like, and Jupiter-like planets, in the very hot to temperate zones (planet temperatures of 300–3000 K) of F to M-type host stars. The EChO core science would be delivered by a three-tier survey. The EChO Chemical Census: This is a broad survey of a few...

  1. Validation of the TRUST tool in a Greek perioperative setting.

    Science.gov (United States)

    Chatzea, Vasiliki-Eirini; Sifaki-Pistolla, Dimitra; Dey, Nilanjan; Melidoniotis, Evangelos

    2017-06-01

    The aim of this study was to translate, culturally adapt and validate the TRUST questionnaire in a Greek perioperative setting. The TRUST questionnaire assesses the relationship between trust and performance. The study assessed the levels of trust and performance in the surgery and anaesthesiology department during a very stressful period for Greece (economic crisis) and offered a user friendly and robust assessment tool. The study concludes that the Greek version of the TRUST questionnaire is a reliable and valid instrument for measuring team performance among Greek perioperative teams. Copyright the Association for Perioperative Practice.

  2. Introducing a music program in the perioperative area.

    Science.gov (United States)

    Cunningham, M F; Monson, B; Bookbinder, M

    1997-10-01

    Music can touch patients deeply and thus transform their anxiety and stress into relaxation and healing. Patients with cancer who undergo surgical procedures are highly stressed. To help alleviate these patients' stress and improve their comfort, perioperative nurses at Memorial Sloan-Kettering Cancer Center (MSKCC), New York, surveyed surgical patients and staff members about introducing a perioperative music program. This article reviews the literature on the use of music in perioperative care settings and describes MSKCC's decision to evaluate and then implement a music program.

  3. Single-shot echo-planar imaging of multiple sclerosis: effects of varying echo time

    International Nuclear Information System (INIS)

    Wolansky, L.J.; Chong, S.; Liu, W.C.; Kang, E.; Simpson, S.W.; Karimi, S.; Akbari, H.

    1999-01-01

    Our aim was to determine the relative merits of short and long echo times (TE) with single-shot echo-planar imaging for imaging cerebral lesions such as multiple sclerosis. We examined seven patients with clinically definite multiple sclerosis were imaged at 1.5 T. Patients were scanned with spin-echo, single-shot echo-planar imaging, using TEs of 45, 75, 105, and 135 ms. Region of interest (ROI) measurements were performed on 36 lesions at or above the level of the corona radiata. The mean image contrast (IC) was highest (231.1) for a TE of 45 ms, followed by 75 ms (218.9), 105 ms (217.9), and 135 ms (191.6). When mean contrast-to-noise ratios (C/N) were compared, the value was again highest (29.7) for TE 45 ms, followed by 75 ms (28.9), 105 ms (28.5), and 135 ms (26.3). In a lesion-by-lesion comparison, TE 45 ms had the highest IC and C/N in the largest number of cases (50 % and 47.2 %, respectively). IC and C/N for TE 45 ms were superior to those of 75 ms in 64 % and 58 %, respectively. These results support the use of relatively short TEs for single-shot echo-planar imaging in the setting of cerebral lesions such as multiple sclerosis. (orig.) (orig.)

  4. Temperature sheets and aspect sensitive radar echoes

    Directory of Open Access Journals (Sweden)

    H. Luce

    Full Text Available here have been years of discussion and controversy about the existence of very thin and stable temperature sheets and their relationship to the VHF radar aspect sensitivity. It is only recently that very high-resolution in situ temperature observations have brought credence to the reality and ubiquity of these structures in the free atmosphere and to their contribution to radar echo enhancements along the vertical. Indeed, measurements with very high-resolution sensors are still extremely rare and rather difficult to obtain outside of the planetary boundary layer. They have only been carried out up to the lower stratosphere by Service d’A´ eronomie (CNRS, France for about 10 years. The controversy also persisted due to the volume resolution of the (Mesosphere-Stratosphere-Troposphere VHF radars which is coarse with respect to sheet thickness, although widely sufficient for meteorological or mesoscale investigations. The contribution within the range gate of many of these structures, which are advected by the wind, and decay and grow at different instants and could be distorted either by internal gravity waves or turbulence fields, could lead to radar echoes with statistical properties similar to those produced by anisotropic turbulence. Some questions thus remain regarding the manner in which temperature sheets contribute to VHF radar echoes. In particular, the zenithal and azimuthal angular dependence of the echo power may not only be produced by diffuse reflection on stable distorted or corrugated sheets, but also by extra contributions from anisotropic turbulence occurring in the stratified atmosphere. Thus, for several years, efforts have been put forth to improve the radar height resolution in order to better describe thin structures. Frequency interferometric techniques are widely used and have been recently further developed with the implementation of high-resolution data processings. We begin by reviewing briefly some characteristics

  5. Temperature sheets and aspect sensitive radar echoes

    Directory of Open Access Journals (Sweden)

    H. Luce

    2001-08-01

    Full Text Available here have been years of discussion and controversy about the existence of very thin and stable temperature sheets and their relationship to the VHF radar aspect sensitivity. It is only recently that very high-resolution in situ temperature observations have brought credence to the reality and ubiquity of these structures in the free atmosphere and to their contribution to radar echo enhancements along the vertical. Indeed, measurements with very high-resolution sensors are still extremely rare and rather difficult to obtain outside of the planetary boundary layer. They have only been carried out up to the lower stratosphere by Service d’A´ eronomie (CNRS, France for about 10 years. The controversy also persisted due to the volume resolution of the (Mesosphere-Stratosphere-Troposphere VHF radars which is coarse with respect to sheet thickness, although widely sufficient for meteorological or mesoscale investigations. The contribution within the range gate of many of these structures, which are advected by the wind, and decay and grow at different instants and could be distorted either by internal gravity waves or turbulence fields, could lead to radar echoes with statistical properties similar to those produced by anisotropic turbulence. Some questions thus remain regarding the manner in which temperature sheets contribute to VHF radar echoes. In particular, the zenithal and azimuthal angular dependence of the echo power may not only be produced by diffuse reflection on stable distorted or corrugated sheets, but also by extra contributions from anisotropic turbulence occurring in the stratified atmosphere. Thus, for several years, efforts have been put forth to improve the radar height resolution in order to better describe thin structures. Frequency interferometric techniques are widely used and have been recently further developed with the implementation of high-resolution data processings. We begin by reviewing briefly some characteristics

  6. The EChO science case

    Science.gov (United States)

    Tinetti, Giovanna; Drossart, Pierre; Eccleston, Paul; Hartogh, Paul; Isaak, Kate; Linder, Martin; Lovis, Christophe; Micela, Giusi; Ollivier, Marc; Puig, Ludovic; Ribas, Ignasi; Snellen, Ignas; Swinyard, Bruce; Allard, France; Barstow, Joanna; Cho, James; Coustenis, Athena; Cockell, Charles; Correia, Alexandre; Decin, Leen; de Kok, Remco; Deroo, Pieter; Encrenaz, Therese; Forget, Francois; Glasse, Alistair; Griffith, Caitlin; Guillot, Tristan; Koskinen, Tommi; Lammer, Helmut; Leconte, Jeremy; Maxted, Pierre; Mueller-Wodarg, Ingo; Nelson, Richard; North, Chris; Pallé, Enric; Pagano, Isabella; Piccioni, Guseppe; Pinfield, David; Selsis, Franck; Sozzetti, Alessandro; Stixrude, Lars; Tennyson, Jonathan; Turrini, Diego; Zapatero-Osorio, Mariarosa; Beaulieu, Jean-Philippe; Grodent, Denis; Guedel, Manuel; Luz, David; Nørgaard-Nielsen, Hans Ulrik; Ray, Tom; Rickman, Hans; Selig, Avri; Swain, Mark; Banaszkiewicz, Marek; Barlow, Mike; Bowles, Neil; Branduardi-Raymont, Graziella; du Foresto, Vincent Coudé; Gerard, Jean-Claude; Gizon, Laurent; Hornstrup, Allan; Jarchow, Christopher; Kerschbaum, Franz; Kovacs, Géza; Lagage, Pierre-Olivier; Lim, Tanya; Lopez-Morales, Mercedes; Malaguti, Giuseppe; Pace, Emanuele; Pascale, Enzo; Vandenbussche, Bart; Wright, Gillian; Ramos Zapata, Gonzalo; Adriani, Alberto; Azzollini, Ruymán; Balado, Ana; Bryson, Ian; Burston, Raymond; Colomé, Josep; Crook, Martin; Di Giorgio, Anna; Griffin, Matt; Hoogeveen, Ruud; Ottensamer, Roland; Irshad, Ranah; Middleton, Kevin; Morgante, Gianluca; Pinsard, Frederic; Rataj, Mirek; Reess, Jean-Michel; Savini, Giorgio; Schrader, Jan-Rutger; Stamper, Richard; Winter, Berend; Abe, L.; Abreu, M.; Achilleos, N.; Ade, P.; Adybekian, V.; Affer, L.; Agnor, C.; Agundez, M.; Alard, C.; Alcala, J.; Allende Prieto, C.; Alonso Floriano, F. J.; Altieri, F.; Alvarez Iglesias, C. A.; Amado, P.; Andersen, A.; Aylward, A.; Baffa, C.; Bakos, G.; Ballerini, P.; Banaszkiewicz, M.; Barber, R. J.; Barrado, D.; Barton, E. J.; Batista, V.; Bellucci, G.; Belmonte Avilés, J. A.; Berry, D.; Bézard, B.; Biondi, D.; Błęcka, M.; Boisse, I.; Bonfond, B.; Bordé, P.; Börner, P.; Bouy, H.; Brown, L.; Buchhave, L.; Budaj, J.; Bulgarelli, A.; Burleigh, M.; Cabral, A.; Capria, M. T.; Cassan, A.; Cavarroc, C.; Cecchi-Pestellini, C.; Cerulli, R.; Chadney, J.; Chamberlain, S.; Charnoz, S.; Christian Jessen, N.; Ciaravella, A.; Claret, A.; Claudi, R.; Coates, A.; Cole, R.; Collura, A.; Cordier, D.; Covino, E.; Danielski, C.; Damasso, M.; Deeg, H. J.; Delgado-Mena, E.; Del Vecchio, C.; Demangeon, O.; De Sio, A.; De Wit, J.; Dobrijévic, M.; Doel, P.; Dominic, C.; Dorfi, E.; Eales, S.; Eiroa, C.; Espinoza Contreras, M.; Esposito, M.; Eymet, V.; Fabrizio, N.; Fernández, M.; Femenía Castella, B.; Figueira, P.; Filacchione, G.; Fletcher, L.; Focardi, M.; Fossey, S.; Fouqué, P.; Frith, J.; Galand, M.; Gambicorti, L.; Gaulme, P.; García López, R. J.; Garcia-Piquer, A.; Gear, W.; Gerard, J.-C.; Gesa, L.; Giani, E.; Gianotti, F.; Gillon, M.; Giro, E.; Giuranna, M.; Gomez, H.; Gomez-Leal, I.; Gonzalez Hernandez, J.; González Merino, B.; Graczyk, R.; Grassi, D.; Guardia, J.; Guio, P.; Gustin, J.; Hargrave, P.; Haigh, J.; Hébrard, E.; Heiter, U.; Heredero, R. L.; Herrero, E.; Hersant, F.; Heyrovsky, D.; Hollis, M.; Hubert, B.; Hueso, R.; Israelian, G.; Iro, N.; Irwin, P.; Jacquemoud, S.; Jones, G.; Jones, H.; Justtanont, K.; Kehoe, T.; Kerschbaum, F.; Kerins, E.; Kervella, P.; Kipping, D.; Koskinen, T.; Krupp, N.; Lahav, O.; Laken, B.; Lanza, N.; Lellouch, E.; Leto, G.; Licandro Goldaracena, J.; Lithgow-Bertelloni, C.; Liu, S. J.; Lo Cicero, U.; Lodieu, N.; Lognonné, P.; Lopez-Puertas, M.; Lopez-Valverde, M. A.; Lundgaard Rasmussen, I.; Luntzer, A.; Machado, P.; MacTavish, C.; Maggio, A.; Maillard, J.-P.; Magnes, W.; Maldonado, J.; Mall, U.; Marquette, J.-B.; Mauskopf, P.; Massi, F.; Maurin, A.-S.; Medvedev, A.; Michaut, C.; Miles-Paez, P.; Montalto, M.; Montañés Rodríguez, P.; Monteiro, M.; Montes, D.; Morais, H.; Morales, J. C.; Morales-Calderón, M.; Morello, G.; Moro Martín, A.; Moses, J.; Moya Bedon, A.; Murgas Alcaino, F.; Oliva, E.; Orton, G.; Palla, F.; Pancrazzi, M.; Pantin, E.; Parmentier, V.; Parviainen, H.; Peña Ramírez, K. Y.; Peralta, J.; Perez-Hoyos, S.; Petrov, R.; Pezzuto, S.; Pietrzak, R.; Pilat-Lohinger, E.; Piskunov, N.; Prinja, R.; Prisinzano, L.; Polichtchouk, I.; Poretti, E.; Radioti, A.; Ramos, A. A.; Rank-Lüftinger, T.; Read, P.; Readorn, K.; Rebolo López, R.; Rebordão, J.; Rengel, M.; Rezac, L.; Rocchetto, M.; Rodler, F.; Sánchez Béjar, V. J.; Sanchez Lavega, A.; Sanromá, E.; Santos, N.; Sanz Forcada, J.; Scandariato, G.; Schmider, F.-X.; Scholz, A.; Scuderi, S.; Sethenadh, J.; Shore, S.; Showman, A.; Sicardy, B.; Sitek, P.; Smith, A.; Soret, L.; Sousa, S.; Stiepen, A.; Stolarski, M.; Strazzulla, G.; Tabernero, H. M.; Tanga, P.; Tecsa, M.; Temple, J.; Terenzi, L.; Tessenyi, M.; Testi, L.; Thompson, S.; Thrastarson, H.; Tingley, B. W.; Trifoglio, M.; Martín Torres, J.; Tozzi, A.; Turrini, D.; Varley, R.; Vakili, F.; de Val-Borro, M.; Valdivieso, M. L.; Venot, O.; Villaver, E.; Vinatier, S.; Viti, S.; Waldmann, I.; Waltham, D.; Ward-Thompson, D.; Waters, R.; Watkins, C.; Watson, D.; Wawer, P.; Wawrzaszk, A.; White, G.; Widemann, T.; Winek, W.; Wiśniowski, T.; Yelle, R.; Yung, Y.; Yurchenko, S. N.

    2015-12-01

    The discovery of almost two thousand exoplanets has revealed an unexpectedly diverse planet population. We see gas giants in few-day orbits, whole multi-planet systems within the orbit of Mercury, and new populations of planets with masses between that of the Earth and Neptune—all unknown in the Solar System. Observations to date have shown that our Solar System is certainly not representative of the general population of planets in our Milky Way. The key science questions that urgently need addressing are therefore: What are exoplanets made of? Why are planets as they are? How do planetary systems work and what causes the exceptional diversity observed as compared to the Solar System? The EChO (Exoplanet Characterisation Observatory) space mission was conceived to take up the challenge to explain this diversity in terms of formation, evolution, internal structure and planet and atmospheric composition. This requires in-depth spectroscopic knowledge of the atmospheres of a large and well-defined planet sample for which precise physical, chemical and dynamical information can be obtained. In order to fulfil this ambitious scientific program, EChO was designed as a dedicated survey mission for transit and eclipse spectroscopy capable of observing a large, diverse and well-defined planet sample within its 4-year mission lifetime. The transit and eclipse spectroscopy method, whereby the signal from the star and planet are differentiated using knowledge of the planetary ephemerides, allows us to measure atmospheric signals from the planet at levels of at least 10-4 relative to the star. This can only be achieved in conjunction with a carefully designed stable payload and satellite platform. It is also necessary to provide broad instantaneous wavelength coverage to detect as many molecular species as possible, to probe the thermal structure of the planetary atmospheres and to correct for the contaminating effects of the stellar photosphere. This requires wavelength

  7. Perioperative leadership: managing change with insights, priorities, and tools.

    Science.gov (United States)

    Taylor, David L

    2014-07-01

    The personal leadership of the perioperative director is a critical factor in the success of any change management initiative. This article presents an approach to perioperative nursing leadership that addresses obstacles that prevent surgical departments from achieving high performance in clinical and financial outcomes. This leadership approach consists of specific insights, priorities, and tools: key insights include self-understanding of personal barriers to leadership and accuracy at understanding economic and strategic considerations related to the OR environment; key priorities include creating a customer-centered organization, focusing on process improvement, and concentrating on culture change; and key tools include using techniques (e.g., direct engagement, collaborative leadership) to align surgical organizations with leadership priorities and mitigate specific perioperative management risks. Included in this article is a leadership development plan for perioperative directors. Copyright © 2014 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  8. Perioperative care of a pregnant trauma victim: a review of ...

    African Journals Online (AJOL)

    Adele

    2004-05-03

    May 3, 2004 ... (until proven otherwise) in any female trauma patient of child- ... The perioperative management of pregnant trauma victims re- ... trauma, abdominal trauma, head injury, cervical spine injury, fetal injury, gun shot wounds, blunt.

  9. [Aspects of perioperative care in patients with diabetes].

    Science.gov (United States)

    Pestel, G; Closhen, D; Zimmermann, A; Werner, C; Weber, M M

    2013-01-01

    Diabetes is a common disease in Germany. Due to diabetes-associated end-organ disease, such as large and small vessel disease and neuropathy, diabetic patients require more intense anesthesia care during the perioperative phase. An in-depth and comprehensive medical history focusing on hemodynamic alterations, gastroparesis, neuropathy and stiff joint syndrome is a cornerstone of perioperative care and may affect outcome of diabetes patients more than specific anesthetic medications or the anesthetic procedure. Intraoperative anesthetic care needs to focus on preservation of hemodynamic stability, perioperative infection control and maintenance of glucose homeostasis. Whereas some years ago strict glucose control by aggressive insulin therapy was adamantly advocated, the results of recent studies have put the risk of such therapeutic algorithms into perspective. Therefore, optimized perioperative care of diabetic patients consists of setting a predefined targeted blood glucose level, evidence-based therapeutic approaches to reach that goal and finally adequate and continuous monitoring and amendment of the therapeutic approach if required.

  10. Perioperative Evaluation of Pregnant Surgical Patients: A Review

    Directory of Open Access Journals (Sweden)

    Manu Gupta

    2016-06-01

    Full Text Available Pregnant Females require special perioperative consideration as females react differently to treatment from physiologic and behavioural standpoints. Thus a standard perioperative assessment plays a crucial role for successful accomplishment of intraoperative and postoperative phase as well as to resist complications due to pregnancy. Each physiologic system is affected in such a way that may or may not have clinical significance for the surgeons. Thus affect of Pregnancy on cardiovascular, respiratory, gastrointestinal, renal and endocrinal system have been reviewed. Moreover to decrease the hazards to the developing child, impact of surgery/treatment on the fetus has also been discussed. It was concluded that the goal of the perioperative evaluation of pregnant females is to identify its physiological effects on various systems and provide for the best efficacious perioperative treatment algorithm that shall minimize the patient morbidity.

  11. Perioperative Clinical Nurse Specialist Role Delineation: A Systematic Review

    National Research Council Canada - National Science Library

    Cole, Lisa M; Walker, Theodore J; Nader, Kelly C; Glover, Dennis E; Newkirk, Laura E

    2006-01-01

    A clearly defined role of the Perioperative Clinical Nurse Specialist (PONS) is not identified. The purpose of this study was to provide recommendations for a delineated role of the PONS that will provide role clarity and practice guidance...

  12. Perioperative corticosteroids for intermittent and mild persistent asthma

    OpenAIRE

    Hiroto Matsuse; Terufumi Shimoda; Ikuko Machida; Yuki Kondo; Tetsuya Kawano; Sachiko Saeki; Shinya Tomari; Kazuko Mitsuta; Chizu Fukushima; Yasushi Obase; Shigeru Kohno

    2002-01-01

    Objectives: Asthmatics are considered to be at high risk for pulmonary complications during general anesthesia with tracheal intubation. The purpose of the present study was to determine the usefulness of perioperative corticosteroids for mild asthmatics in preventing perioperative exacerbation of asthma. Methods: Airway hyperresponsiveness to inhaled methacholine was determined in patients with intermittent (n = 27) and mild persistent (n = 48) asthma before general anesthesia who underwe...

  13. I need to know! Timely accessing of perioperative user manuals.

    Science.gov (United States)

    Landreneau, Raphael

    2010-12-01

    Ready access to equipment or product information is essential for the safe operation of the many items that a perioperative nurse is asked to use, troubleshoot, or maintain. One institution's solution for making manufacturer information available in the practice setting was to create a facility intranet site dedicated to OR equipment manuals. This site provides information access to perioperative nurses and support staff members and, ultimately, helps improve patient care. Published by Elsevier Inc. All rights reserved.

  14. Novel approaches in management of perioperative coagulopathy.

    Science.gov (United States)

    Tanaka, Kenichi A; Bader, Stephen O; Görlinger, Klaus

    2014-02-01

    The recent advances in hemostatic monitoring, and discussion of the clinical implications of hemostatic therapies based on different blood components and factor concentrates. Implementing suitable laboratory tests and transfusion protocols is highly recommended because the laboratory test guided, protocol-driven transfusion approach reduces blood component utilization, and possibly leads to improved outcomes. Timely assessment of coagulation has been difficult using conventional coagulation tests, but thrombocytopenia, fibrin polymerization defects, and fibrinolysis can be quickly assessed on thromboelastometry. The latter testing can be applied to guide the dosing of fibrinogen and prothrombin complex concentrate, which are selectively used to correct fibrinogen deficiency, and improve thrombin generation in acquired coagulopathy. These therapeutic approaches are novel, and potentially effective in reducing the exposure to allogeneic components (e.g., plasma and platelets) and side-effects of transfusion. Although the accessibility of different therapies among different countries, tranexamic acid is widely available, and is an effective blood conservation measure with a good safety profile in various surgical settings. Our understanding of perioperative coagulopathy, diagnostic tools, and therapeutic approaches has evolved in recent years. Additional multidisciplinary efforts are required to understand the optimal combinations, cost-effectiveness, and safety profiles of allogeneic components, and available factor concentrates.

  15. PERIOPERATIVE MANAGEMENT OF PATIENTS WITH RHEUMATOID ARTHRITIS

    Directory of Open Access Journals (Sweden)

    V. N. Amirdzhanova

    2014-01-01

    Full Text Available The paper considers the joint management of rheumatoid arthritis patients needing endoprosthetic replacement of the large joints of the lower extremities by rheumatologists and orthopedic traumatologists.Due to the fact that there are no conventional standards or guidelines for the perioperative management of patients with rheumatic diseases, adopted by international rheumatology associations, the authors generalize their experience in managing the patients in terms of international approaches and guidelines from different countries. The medical assessment and reduction of cardiovascular risks, the prevention of infectious complications, hemorrhages, and lower extremity deep vein thrombosis, and the specific features of management of patients with osteoporosis are under consideration. The authors' experience in managing the patients receiving antirheumatic therapy with nonsteroidal antiinflammatory and disease-modifying antirheumatic drugs, such as methotrexate, leflunomide, sulfasalazine, and hydroxychloroquine, is detailed. Recommendations for managing patients taking glucocorticoids and biologic agents (tumor necrosis factor-α inhibitors, anti-B-cell therapy, and interleukin-6 receptor inhibitors in the preoperative andpostoperative periods are given.

  16. Diagnosis of partial and complete rotator cuff tears using combined gradient echo and spin echo imaging

    International Nuclear Information System (INIS)

    Tuite, M.J.; Yandow, D.R.; DeSmet, A.A.; Orwin, J.F.; Quintana, F.A.

    1994-01-01

    Most magnetic resonance (MR) studies evaluating the rotator cuff for tears have used T2-weighted imaging in the coronal oblique and sagittal oblique planes. T2 * -weighted gradient echo imaging, however, has advantages over spin echo imaging, including contiguous slices without cross-talk, high contrast around the cuff, and intrinsically shorter imaging times which can be used to increase the number of signals averaged and thus improve the signal-to-noise ratio. We reviewed the shoulder MR scans of 87 consecutive patients who underwent both a MR scan and a shoulder arthroscopy during which the size of tears, if present, was graded. The reviewers were blinded as to the history and arthroscopic results. The MR scans included oblique coronal T2 * -weighted gradient echo and oblique sagittal T2-weighted spin echo images. MR cuff grades were correlated with arthroscopic findings. For complete tears, the sensitivity of MR was 0.91 and the specificity 0.95. For partial tears, the sensitivity was 0.74 and the specificity 0.87. This accuracy is similar to two-plane T2-weighted imaging as previously reported in the literature. There was a statistically significant correlation (p < 0.0005) between the cuff grade as determined by MR and the arthroscopic findings. (orig.)

  17. Diagnosis of partial and complete rotator cuff tears using combined gradient echo and spin echo imaging

    Energy Technology Data Exchange (ETDEWEB)

    Tuite, M J [Dept. of Radiology, Univ. of Wisconsin, Madison, WI (United States); Yandow, D R [Dept. of Radiology, Univ. of Wisconsin, Madison, WI (United States); DeSmet, A A [Dept. of Radiology, Univ. of Wisconsin, Madison, WI (United States); Orwin, J F [Div. of Orthopedic Surgery, Univ. of Wisconsin, Madison, WI (United States); Quintana, F A [Dept. of Biostatistics, Univ. of Wisconsin, Madison, WI (United States)

    1994-10-01

    Most magnetic resonance (MR) studies evaluating the rotator cuff for tears have used T2-weighted imaging in the coronal oblique and sagittal oblique planes. T2{sup *}-weighted gradient echo imaging, however, has advantages over spin echo imaging, including contiguous slices without cross-talk, high contrast around the cuff, and intrinsically shorter imaging times which can be used to increase the number of signals averaged and thus improve the signal-to-noise ratio. We reviewed the shoulder MR scans of 87 consecutive patients who underwent both a MR scan and a shoulder arthroscopy during which the size of tears, if present, was graded. The reviewers were blinded as to the history and arthroscopic results. The MR scans included oblique coronal T2{sup *}-weighted gradient echo and oblique sagittal T2-weighted spin echo images. MR cuff grades were correlated with arthroscopic findings. For complete tears, the sensitivity of MR was 0.91 and the specificity 0.95. For partial tears, the sensitivity was 0.74 and the specificity 0.87. This accuracy is similar to two-plane T2-weighted imaging as previously reported in the literature. There was a statistically significant correlation (p < 0.0005) between the cuff grade as determined by MR and the arthroscopic findings. (orig.)

  18. X-ray echoes from gamma-ray bursts

    International Nuclear Information System (INIS)

    Dermer, C.D.; Hurley, K.C.; Hartmann, D.H.

    1991-01-01

    The identification of an echo of reflected radiation in time histories of gamma-ray burst spectra can provide important information about the existence of binary companions or accretion disks in gamma-ray burst systems. Because of the nature of Compton scattering, the spectrum of the echo will be attenuated at gamma-ray energies compared with the spectrum of the primary burst emission. The expected temporal and spectral signatures of the echo and a search for such echoes are described, and implications for gamma-ray burst models are discussed. 35 refs

  19. Triple echo steady-state (TESS) relaxometry.

    Science.gov (United States)

    Heule, Rahel; Ganter, Carl; Bieri, Oliver

    2014-01-01

    Rapid imaging techniques have attracted increased interest for relaxometry, but none are perfect: they are prone to static (B0 ) and transmit (B1 ) field heterogeneities, and commonly biased by T2 /T1 . The purpose of this study is the development of a rapid T1 and T2 relaxometry method that is completely (T2 ) or partly (T1 ) bias-free. A new method is introduced to simultaneously quantify T1 and T2 within one single scan based on a triple echo steady-state (TESS) approach in combination with an iterative golden section search. TESS relaxometry is optimized and evaluated from simulations, in vitro studies, and in vivo experiments. It is found that relaxometry with TESS is not biased by T2 /T1 , insensitive to B0 heterogeneities, and, surprisingly, that TESS-T2 is not affected by B1 field errors. Consequently, excellent correspondence between TESS and reference spin echo data is observed for T2 in vitro at 1.5 T and in vivo at 3 T. TESS offers rapid T1 and T2 quantification within one single scan, and in particular B1 -insensitive T2 estimation. As a result, the new proposed method is of high interest for fast and reliable high-resolution T2 mapping, especially of the musculoskeletal system at high to ultra-high fields. Copyright © 2013 Wiley Periodicals, Inc.

  20. Neutron spin echo scattering angle measurement (SESAME)

    International Nuclear Information System (INIS)

    Pynn, R.; Fitzsimmons, M.R.; Fritzsche, H.; Gierlings, M.; Major, J.; Jason, A.

    2005-01-01

    We describe experiments in which the neutron spin echo technique is used to measure neutron scattering angles. We have implemented the technique, dubbed spin echo scattering angle measurement (SESAME), using thin films of Permalloy electrodeposited on silicon wafers as sources of the magnetic fields within which neutron spins precess. With 30-μm-thick films we resolve neutron scattering angles to about 0.02 deg. with neutrons of 4.66 A wavelength. This allows us to probe correlation lengths up to 200 nm in an application to small angle neutron scattering. We also demonstrate that SESAME can be used to separate specular and diffuse neutron reflection from surfaces at grazing incidence. In both of these cases, SESAME can make measurements at higher neutron intensity than is available with conventional methods because the angular resolution achieved is independent of the divergence of the neutron beam. Finally, we discuss the conditions under which SESAME might be used to probe in-plane structure in thin films and show that the method has advantages for incident neutron angles close to the critical angle because multiple scattering is automatically accounted for

  1. Respiratory Management of Perioperative Obese Patients.

    Science.gov (United States)

    Imber, David Ae; Pirrone, Massimiliano; Zhang, Changsheng; Fisher, Daniel F; Kacmarek, Robert M; Berra, Lorenzo

    2016-12-01

    With a rising incidence of obesity in the United States, anesthesiologists are faced with a larger volume of obese patients coming to the operating room as well as obese patients with ever-larger body mass indices (BMIs). While there are many cardiovascular and endocrine issues that clinicians must take into account when caring for the obese patient, one of the most prominent concerns of the anesthesiologist in the perioperative setting should be the status of the lung. Because the pathophysiology of reduced lung volumes in the obese patient differs from that of the ARDS patient, the best approach to keeping the obese patient's lung open and adequately ventilated during mechanical ventilation is unique. Although strong evidence and research are lacking regarding how to best ventilate the obese surgical patient, we aim with this review to provide an assessment of the small amount of research that has been conducted and the pathophysiology we believe influences the apparent results. We will provide a basic overview of the anatomy and pathophysiology of the obese respiratory system and review studies concerning pre-, intra-, and postoperative respiratory care. Our focus in this review centers on the best approach to keeping the lung recruited through the prevention of compression atelectasis and the maintaining of physiological lung volumes. We recommend the use of PEEP via noninvasive ventilation (NIV) before induction and endotracheal intubation, the use of both PEEP and periodic recruitment maneuvers during mechanical ventilation, and the use of PEEP via NIV after extubation. It is our hope that by studying the underlying mechanisms that make ventilating obese patients so difficult, future research can be better tailored to address this increasingly important challenge to the field of anesthesia. Copyright © 2016 by Daedalus Enterprises.

  2. Laparoscopic cholecystectomy perioperative management: an update

    Directory of Open Access Journals (Sweden)

    Sellbrant I

    2015-07-01

    Full Text Available Irene Sellbrant,1 Gustaf Ledin,2 Jan G Jakobsson2 1Department of Anaesthesia, Capio Lundby, Gothenburg, 2Department of Anaesthesia and Intensive Care, Institution for Clinical Science, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden Abstract: Laparoscopic cholecystectomy is one of the most common general surgical procedures. The aim of the present paper is to review current evidence and well-established practice for elective laparoscopic perioperative management. There is no firm evidence for best anesthetic technique, further high quality studies assessing short as well as more protracted outcomes are needed. Preventive multi-modal analgesia, combining non-opioid analgesics, paracetamol, nonsteroidal anti-inflammatory drugs or coxib, and local anesthesia, has a long history. Local anesthesia improves postoperative pain and facilitates discharge on the day of surgery. Whether transversus abdominis plane-block has clinically important advantages compared to local infiltration analgesia needs further studies. Single intravenous dose steroid, dexamethasone, reduces postoperative nausea and vomiting, pain, and enhances the recovery process. Multi-modal analgesia is reassuringly safe thus having a positive benefit versus risk profile. Adherence to modern guidelines avoiding prolonged fasting and liberal intravenous fluid regime supports rapid recovery. The effects of CO2 insufflation must be acknowledged and low intra-abdominal pressure should be sought in order to reduce negative cardiovascular/respiratory effects. There is no firm evidence supporting heating and humidification of the insufflated gas. The potential risk for CO2/gas entrainment into vasaculture, gas emboli, or subcutaneous/intra-thoracic into the pleural space must be kept in mind. Laparoscopic cholecystectomy in ASA 1-2 patients following a multi-modal enhanced recovery protocol promotes high success rate for discharge on the day of surgery. Keywords: laparoscopic

  3. Understanding Value as a Key Concept in Sustaining the Perioperative Nursing Workforce.

    Science.gov (United States)

    Kapaale, Chaluza C

    2018-03-01

    Perioperative nursing is faced with a staffing crisis attributed in part to minimal numbers of newly graduated nurses choosing a career in this specialty. This article analyzes and applies the concept of value to explore how to maintain an adequate perioperative nursing workforce; recruit newly graduated nurses; and encourage career professional, nurse educator, and student collaboration to generate meaningful value for perioperative nursing. This analysis revealed that value co-creation for perioperative nursing could lead to newly graduated nurses increasingly choosing perioperative nursing as a career, and enjoying satisfying perioperative nursing careers while providing high-quality patient care. © AORN, Inc, 2018.

  4. Toyota production system quality improvement initiative improves perioperative antibiotic therapy.

    Science.gov (United States)

    Burkitt, Kelly H; Mor, Maria K; Jain, Rajiv; Kruszewski, Matthew S; McCray, Ellesha E; Moreland, Michael E; Muder, Robert R; Obrosky, David Scott; Sevick, Mary Ann; Wilson, Mark A; Fine, Michael J

    2009-09-01

    To assess the role of a Toyota production system (TPS) quality improvement (QI) intervention on appropriateness of perioperative antibiotic therapy and in length of hospital stay (LOS) among surgical patients. Pre-post quasi-experimental study using local and national retrospective cohorts. We used TPS methods to implement a multifaceted intervention to reduce nosocomial methicillin-resistant Staphylococcus aureus infections on a Veterans Affairs surgical unit, which led to a QI intervention targeting appropriate perioperative antibiotic prophylaxis. Appropriate perioperative antibiotic therapy was defined as selection of the recommended antibiotic agents for a duration not exceeding 24 hours from the time of the operation. The local computerized medical record system was used to identify patients undergoing the 25 most common surgical procedures and to examine changes in appropriate antibiotic therapy and LOS over time. Overall, 2550 surgical admissions were identified from the local computerized medical records. The proportion of surgical admissions receiving appropriate perioperative antibiotics was significantly higher (P <.01) in 2004 after initiation of the TPS intervention (44.0%) compared with the previous 4 years (range, 23.4%-29.8%) primarily because of improvements in compliance with antibiotic therapy duration rather than appropriate antibiotic selection. There was no statistically significant decrease in LOS over time. The use of TPS methods resulted in a QI intervention that was associated with an increase in appropriate perioperative antibiotic therapy among surgical patients, without affecting LOS.

  5. Perioperative management of children with obstructive sleep apnea.

    Science.gov (United States)

    Schwengel, Deborah A; Sterni, Laura M; Tunkel, David E; Heitmiller, Eugenie S

    2009-07-01

    Obstructive sleep apnea syndrome (OSA) affects 1%-3% of children. Children with OSA can present for all types of surgical and diagnostic procedures requiring anesthesia, with adenotonsillectomy being the most common surgical treatment for OSA in the pediatric age group. Thus, it is imperative that the anesthesiologist be familiar with the potential anesthetic complications and immediate postoperative problems associated with OSA. The significant implications that the presence of OSA imposes on perioperative care have been recognized by national medical professional societies. The American Academy of Pediatrics published a clinical practice guideline for pediatric OSA in 2002, and cited an increased risk of anesthetic complications, though specific anesthetic issues were not addressed. In 2006, the American Society of Anesthesiologists published a practice guideline for perioperative management of patients with OSA that noted the pediatric-related risk factor of obesity, and the increased perioperative risk associated with adenotonsillectomy in children younger than 3 yr. However, management of OSA in children younger than 1 yr-of-age was excluded from the guideline, as were other issues related specifically to the pediatric patient. Hence, many questions remain regarding the perioperative care of the child with OSA. In this review, we examine the literature on pediatric OSA, discuss its pathophysiology, current treatment options, and recognized approaches to perioperative management of these young and potentially high-risk patients.

  6. The role of perioperative warming in surgery: a systematic review

    Directory of Open Access Journals (Sweden)

    Muhammad Shafique Sajid

    Full Text Available OBJECTIVE: The objective of this review was to systematically analyze the trials on the effectiveness of perioperative warming in surgical patients. METHODS: A systematic review of the literature was undertaken. Clinical trials on perioperative warming were selected according to specific criteria and analyzed to generate summative data expressed as standardized mean difference (SMD. RESULTS: Twenty-five studies encompassing 3,599 patients in various surgical disciplines were retrieved from the electronic databases. Nineteen randomized trials on 1785 patients qualified for this review. The no-warming group developed statistically significant hypothermia. In the fixed effect model, the warming group had significantly less pain and lower incidence of wound infection, compared with the no-warming group. In the random effect model, the warming group was also associated with lower risk of post-anesthetic shivering. Both in the random and the fixed effect models, the warming group was associated with significantly less blood loss. However, there was significant heterogeneity among the trials. CONCLUSION: Perioperative warming of surgical patients is effective in reducing postoperative wound pain, wound infection and shivering. Systemic warming of the surgical patient is also associated with less perioperative blood loss through preventing hypothermia-induced coagulopathy. Perioperative warming may be given routinely to all patients of various surgical disciplines in order to counteract the consequences of hypothermia.

  7. Theory and optical design of x-ray echo spectrometers

    Science.gov (United States)

    Shvyd'ko, Yuri

    2017-08-01

    X-ray echo spectroscopy, a space-domain counterpart of neutron spin echo, is a recently proposed inelastic x-ray scattering (IXS) technique. X-ray echo spectroscopy relies on imaging IXS spectra and does not require x-ray monochromatization. Due to this, the echo-type IXS spectrometers are broadband, and thus have a potential to simultaneously provide dramatically increased signal strength, reduced measurement times, and higher resolution compared to the traditional narrow-band scanning-type IXS spectrometers. The theory of x-ray echo spectrometers presented earlier [Yu. Shvyd'ko, Phys. Rev. Lett. 116, 080801 (2016), 10.1103/PhysRevLett.116.080801] is developed here further with a focus on questions of practical importance, which could facilitate optical design and assessment of the feasibility and performance of the echo spectrometers. Among others, the following questions are addressed: spectral resolution, refocusing condition, echo spectrometer tolerances, refocusing condition adjustment, effective beam size on the sample, spectral window of imaging and scanning range, impact of the secondary source size on the spectral resolution, angular dispersive optics, focusing and collimating optics, and detector's spatial resolution. Examples of optical designs and characteristics of echo spectrometers with 1-meV and 0.1-meV resolutions are presented.

  8. 21 CFR 892.1560 - Ultrasonic pulsed echo imaging system.

    Science.gov (United States)

    2010-04-01

    ... system. (a) Identification. An ultrasonic pulsed echo imaging system is a device intended to project a... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ultrasonic pulsed echo imaging system. 892.1560... receiver. This generic type of device may include signal analysis and display equipment, patient and...

  9. Echo Shaping Using Sums of Damped Complex Sinusoids

    DEFF Research Database (Denmark)

    Putnam, Lance Jonathan

    2015-01-01

    Feedback delay lines are the basis of myriad audio effects and reverberation schemes. The feedback delay line, by itself, is limited to producing an infinite sequence of exponentially decaying echoes. We introduce a new type of linear time-invariant echo effect whose impulse response is a general...

  10. ECHO Data Partners Join Forces to Federate Access to Resources

    Science.gov (United States)

    Kendall, J.; Macie, M.

    2003-12-01

    During the past year the NASA's Earth Science Data and Information System (ESDIS) project has been collaborating with various Earth science data and client providers to design and implement the EOS Clearinghouse (ECHO). ECHO is an open, interoperable metadata clearinghouse and order broker system. ECHO functions as a repository of information intended to streamline access to digital data and services provided by NASA's Earth Science Enterprise and the extended Earth science community. In a unique partnership, ECHO data providers are working to extend their services in the digital era, to reflect current trends in scientific and educational communications. The multi-organization, inter-disciplinary content of ECHO provides a valuable new service to a growing number of Earth science applications and interdisciplinary research efforts. As such, ECHO is expected to attract a wide audience. In this poster, we highlight the contributions of current ECHO data partners and provide information for prospective data partners on how the project supports the incorporation of new collections and effective long-term asset management that is directly under the control of the organizations who contribute resources to ECHO.

  11. Revival of silenced echo and quantum memory for light

    Energy Technology Data Exchange (ETDEWEB)

    Damon, V; Bonarota, M; Louchet-Chauvet, A; Chaneliere, T; Le Gouet, J-L, E-mail: jean-louis.legouet@lac.u-psud.fr [Laboratoire Aime Cotton, CNRS-UPR 3321, Univ. Paris-Sud, Bat. 505, 91405 Orsay cedex (France)

    2011-09-15

    We propose an original quantum memory protocol. It belongs to the class of rephasing processes and is closely related to two-pulse photon echo. It is known that the strong population inversion produced by the rephasing pulse prevents the plain two-pulse photon echo from serving as a quantum memory scheme. Indeed, gain and spontaneous emission generate prohibitive noise. A second {pi}-pulse can be used to simultaneously reverse the atomic phase and bring the atoms back into the ground state. Then a secondary echo is radiated from a non-inverted medium, avoiding contamination by gain and spontaneous emission noise. However, one must kill the primary echo, in order to preserve all the information for the secondary signal. In the present work, spatial phase mismatching is used to silence the standard two-pulse echo. An experimental demonstration is presented.

  12. Tranexamic Acid: From Trauma to Routine Perioperative Use

    Science.gov (United States)

    Simmons, Jeff; Sikorski, Robert A.; Pittet, Jean-Francois

    2015-01-01

    Purpose Of Review Optimizing hemostasis with antifibrinolytics is becoming a common surgical practice. Large clinical studies have demonstrated efficacy and safety of tranexamic acid (TXA) in the trauma population to reduce blood loss and transfusions. Its use in patients without preexisting coagulopathies is debated, as thromboembolic events are a concern. In this review, perioperative administration of TXA is examined in non-trauma surgical populations. Additionally, risk of thromboembolism, dosing regimens, and timing of dosing are assessed. Recent Findings Perioperative use of tranexamic acid is associated with reduced blood loss and transfusions. Thromboembolic effects do not appear to be increased. However, optimal dosing and timing of TXA administration is still under investigation for non-trauma surgical populations. Summary As part of a perioperative blood management program, tranexamic acid can be used to help reduce blood loss and mitigate exposure to blood transfusion. PMID:25635366

  13. Old, new and hidden causes of perioperative hypersensitivity

    DEFF Research Database (Denmark)

    Garvey, Lene Heise

    2016-01-01

    intravenously such as neuromuscular blocking agents (NMBA), induction agents and antibiotics have traditionally been reported to be implicated most commonly. It has recently become apparent that there are geographical differences in sensitization patterns related to variation in exposures, referral patterns...... and performance and interpretation of investigations. Differences in sensitization to NMBAs are partly explained by cross sensitization to pholcodine, an ingredient in cough-medicines available in some countries. While NMBAs are the most common causes of perioperative hypersensitivity in some countries, this may...... in causes of perioperative hypersensitivity emerging over time and to increase awareness about the “hidden allergens” in the perioperative setting. Some practical advice on how to approach the patient testing negative on all initial investigations is also included....

  14. Optimizing perioperative decision making: improved information for clinical workflow planning.

    Science.gov (United States)

    Doebbeling, Bradley N; Burton, Matthew M; Wiebke, Eric A; Miller, Spencer; Baxter, Laurence; Miller, Donald; Alvarez, Jorge; Pekny, Joseph

    2012-01-01

    Perioperative care is complex and involves multiple interconnected subsystems. Delayed starts, prolonged cases and overtime are common. Surgical procedures account for 40-70% of hospital revenues and 30-40% of total costs. Most planning and scheduling in healthcare is done without modern planning tools, which have potential for improving access by assisting in operations planning support. We identified key planning scenarios of interest to perioperative leaders, in order to examine the feasibility of applying combinatorial optimization software solving some of those planning issues in the operative setting. Perioperative leaders desire a broad range of tools for planning and assessing alternate solutions. Our modeled solutions generated feasible solutions that varied as expected, based on resource and policy assumptions and found better utilization of scarce resources. Combinatorial optimization modeling can effectively evaluate alternatives to support key decisions for planning clinical workflow and improving care efficiency and satisfaction.

  15. A Novel Process Audit for Standardized Perioperative Handoff Protocols.

    Science.gov (United States)

    Pallekonda, Vinay; Scholl, Adam T; McKelvey, George M; Amhaz, Hassan; Essa, Deanna; Narreddy, Spurthy; Tan, Jens; Templonuevo, Mark; Ramirez, Sasha; Petrovic, Michelle A

    2017-11-01

    A perioperative handoff protocol provides a standardized delivery of communication during a handoff that occurs from the operating room to the postanestheisa care unit or ICU. The protocol's success is dependent, in part, on its continued proper use over time. A novel process audit was developed to help ensure that a perioperative handoff protocol is used accurately and appropriately over time. The Audit Observation Form is used for the Audit Phase of the process audit, while the Audit Averages Form is used for the Data Analysis Phase. Employing minimal resources and using quantitative methods, the process audit provides the necessary means to evaluate the proper execution of any perioperative handoff protocol. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

  16. Seismic echo character northern Hatteras Abyssal Plain

    International Nuclear Information System (INIS)

    McCreery, C.J.; Laine, E.P.

    1985-01-01

    Latest efforts in echo-character mapping of the northern Hatteras Abyssal Plain have discerned variations in thickness in a near-surface sedimentary sequence which has been designated seismic unit A. This unit probably represents the last episode of progradation of the Hatteras Deep Sea Fan in the southern part of the study area, and has infilled probable paleochannels from the Wilmington Canyon and Sohm Gap in the north. Unit A thins to a minimum in the central part of the plain, where older sediments come within 1 meter of the surface. Variations in the character of the surface reflector probably represent differing degrees of microtopography developed on a Late Pleistocene surface overlain by Holocene sediments. With the exception of one area identified as a relict surface outcropping in the western plain, this microtopography seems related to present-day thalweg locations on the abyssal plain. 11 references, 13 figures

  17. Challenges in neutron spin echo spectroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Pappas, C., E-mail: c.pappas@tudelft.n [Helmholtz-Zentrum Berlin for Materials and Energy, Glienicker Str. 100, 14109 Berlin (Germany); Faculty of Applied Sciences, Delft University of Technology, Mekelweg 15, 2629 JB Delft (Netherlands); Lelievre-Berna, E.; Falus, P.; Farago, B. [Institut Laue Langevin, 6 rue Jules Horowitz, 38042 Grenoble (France); Bentley, P. [Helmholtz-Zentrum Berlin for Materials and Energy, Glienicker Str. 100, 14109 Berlin (Germany); Institut Laue Langevin, 6 rue Jules Horowitz, 38042 Grenoble (France); Moskvin, E. [Helmholtz-Zentrum Berlin for Materials and Energy, Glienicker Str. 100, 14109 Berlin (Germany); PNPI, 188300 Gatchina, Leningrad District (Russian Federation); Krist, Th. [Helmholtz-Zentrum Berlin for Materials and Energy, Glienicker Str. 100, 14109 Berlin (Germany); Grigoriev, S. [PNPI, 188300 Gatchina, Leningrad District (Russian Federation)

    2009-09-01

    With the new brilliant neutron sources and the developments of novel optical elements, neutron spin echo (NSE) spectroscopy evolves to tackle new problems and scientific fields. The new developments pave the way to complex experimental set-ups such as the intensity modulated variant of NSE (IMNSE), a powerful technique which was introduced some 20 years ago but found limited use up to now. With the new compact supermirror or He{sup 3} polarizers IMNSE becomes attractive for a broad range of applications in magnetism, soft matter and biology. A novel development along this line is the polarimetric NSE technique, which combines IMNSE and the zero-field polarimeter Cryopad to access components of the scattered polarization that are transverse to the incoming polarization. Polarimetric NSE is the method of choice for studying chiral fluctuations, as illustrated by new results on the reference helimagnet MnSi.

  18. Theory of electron spin echoes in solids

    CERN Document Server

    Asadullina, N Y; Asadullin, Y Y

    2002-01-01

    We propose modified Bloch equations (MBEs) with specific power-dependent relaxation and dispersion parameters characteristic for two-pulse excitation and when the magnetic dipole-dipole interactions in the electron spin system control the dephasing. We discriminate between the 'active' (excited by both pulses) and 'passive' (excited by the second pulse only) spins: it is shown that the 'active' spins participate in a new effect, an active spin frequency modulation effect giving rise to the power-dependent dispersion and multiple electron spin echoes (ESEs); the 'passive' spins contribute to the power-dependent relaxation. The MBEs are solved and a general expression for the two-pulse ESEs is obtained. Detailed numerical analysis of this expression gives results in good quantitative agreement with the recent experiments on the two-pulse ESEs at conventional low applied fields. The developed theory is applied also to high field ESEs, which are promising for future investigations. On the basis of published resul...

  19. The basics of neutron spin echo

    International Nuclear Information System (INIS)

    Farago, B.

    1999-01-01

    Until 1974 inelastic neutron scattering consisted of producing by some means a neutron beam of known speed and measuring the final speed of the neutrons after the scattering event. The smaller the energy change was, the better the neutron speed had to be defined. As the neutrons come form a reactor with an approximately Maxwell distribution, an infinitely good energy resolution can be achieved only at the expense of infinitely low count rate. This introduces a practical resolution limit around 0.1 μeV on back-scattering instruments. In 1972 F. Mezei discovered the method of Neutron Spin Echo. This method decouples the energy resolution from intensity loss. The basics of this method is presented. (author)

  20. Parallel electric fields detected via conjugate electron echoes during the Echo 7 sounding rocket flight

    Science.gov (United States)

    Nemzek, R. J.; Winckler, J. R.

    1991-01-01

    Electron detectors on the Echo 7 active sounding rocket experiment measured 'conjugate echoes' resulting from artificial electron beam injections. Analysis of the drift motion of the electrons after a complete bounce leads to measurements of the magnetospheric convection electric field mapped to ionospheric altitudes. The magnetospheric field was highly variable, changing by tens of mV/m on time scales of as little as hundreds of millisec. While the smallest-scale magnetospheric field irregularities were mapped out by ionospheric conductivity, larger-scale features were enhanced by up to 50 mV/m in the ionosphere. The mismatch between magnetospheric and ionspheric convection fields indicates a violation of the equipotential field line condition. The parallel fields occurred in regions roughly 10 km across and probably supported a total potential drop of 10-100 V.

  1. Recent Results for the ECHo Experiment

    Science.gov (United States)

    Hassel, C.; Blaum, K.; Goodacre, T. Day; Dorrer, H.; Düllmann, Ch. E.; Eberhardt, K.; Eliseev, S.; Enss, C.; Filianin, P.; Fäßler, A.; Fleischmann, A.; Gastaldo, L.; Goncharov, M.; Hengstler, D.; Jochum, J.; Johnston, K.; Keller, M.; Kempf, S.; Kieck, T.; Köster, U.; Krantz, M.; Marsh, B.; Mokry, C.; Novikov, Yu. N.; Ranitzsch, P. C. O.; Rothe, S.; Rischka, A.; Runke, J.; Saenz, A.; Schneider, F.; Scholl, S.; Schüssler, R. X.; Simkovic, F.; Stora, T.; Thörle-Pospiech, P.; Türler, A.; Veinhard, M.; Wegner, M.; Wendt, K.; Zuber, K.

    2016-08-01

    The Electron Capture in ^{163}Ho experiment, ECHo, is designed to investigate the electron neutrino mass in the sub-eV range by means of the analysis of the calorimetrically measured spectrum following the electron capture (EC) in ^{163}Ho. Arrays of low-temperature metallic magnetic calorimeters (MMCs), read-out by microwave SQUID multiplexing, will be used in this experiment. With a first MMC prototype having the ^{163}Ho source ion-implanted into the absorber, we performed the first high energy resolution measurement of the EC spectrum, which demonstrated the feasibility of such an experiment. In addition to the technological challenges for the development of MMC arrays, which preserve the single pixel performance in terms of energy resolution and bandwidth, the success of the experiment relies on the availability of large ultra-pure ^{163}Ho samples, on the precise description of the expected spectrum, and on the identification and reduction of background. We present preliminary results obtained with standard MMCs developed for soft X-ray spectroscopy, maXs-20, where the ^{163}Ho ion-implantation was performed using a high-purity ^{163}Ho source produced by advanced chemical and mass separation. With these measurements, we aim at determining an upper limit for the background level due to source contamination and provide a refined description of the calorimetrically measured spectrum. We discuss the plan for a medium scale experiment, ECHo-1k, in which about 1000 mathrm {Bq} of high-purity ^{163}Ho will be ion-implanted into detector arrays. With one year of measuring time, we will be able to achieve a sensitivity on the electron neutrino mass below 20 eV/c^2 (90 % C.L.), improving the present limit by more than one order of magnitude. This experiment will guide the necessary developments to reach the sub-eV sensitivity.

  2. Spring and Its Global Echo: Quantitative Analysis

    Directory of Open Access Journals (Sweden)

    A. V. Korotayev

    2017-01-01

    Full Text Available It is shown that the Arab Spring acted as a trigger for a global wave of socio-political destabilization, which signifi cantly exceeded the scale of the Arab Spring itself and affected absolutely all world-system zones. Only in 2011 the growth of the global number of largescale anti-government demonstrations, riots and political strikes was to a high degree (although not entirely due to their growth in the Arab world. In the ensuing years, the Arab countries rather made a negative contribution to a very noticeable further increase in the global number of large-scale anti-government demonstrations, riots and general strikes (the global intensity of all these three important types of socio-political destabilization continued to grow despite the decline in the Arab world. Thus, for all these three important indicators of sociopolitical destabilization, the scale of the global echo of the Arab Spring has overshadowed the scale of the Arab Spring itself. Only as regards the fourth considered indicator (major terrorist attacks / guerrilla warfare the scale of the global echo for the entire period considered did not overshadow the scale of the Arab Spring (and, incidentally, «Winter» - and in 2014-2015 Arab countries continued to make a disproportionate contribution to the historically record global values of this sad indicator – global number of major terrorist attacks/ guerilla warfare. To conclude, triggered by the Arab Spring, the global wave of socio-political destabilization led after 2010 to a very signifi cant growth of socio-political instability in absolutely all World System zones. However, this global destabilization wave manifested itself in different World System zones in different ways and not completely synchronously.

  3. Mock ECHO: A Simulation-Based Medical Education Method.

    Science.gov (United States)

    Fowler, Rebecca C; Katzman, Joanna G; Comerci, George D; Shelley, Brian M; Duhigg, Daniel; Olivas, Cynthia; Arnold, Thomas; Kalishman, Summers; Monnette, Rebecca; Arora, Sanjeev

    2018-04-16

    This study was designed to develop a deeper understanding of the learning and social processes that take place during the simulation-based medical education for practicing providers as part of the Project ECHO® model, known as Mock ECHO training. The ECHO model is utilized to expand access to care of common and complex diseases by supporting the education of primary care providers with an interprofessional team of specialists via videoconferencing networks. Mock ECHO trainings are conducted through a train the trainer model targeted at leaders replicating the ECHO model at their organizations. Trainers conduct simulated teleECHO clinics while participants gain skills to improve communication and self-efficacy. Three focus groups, conducted between May 2015 and January 2016 with a total of 26 participants, were deductively analyzed to identify common themes related to simulation-based medical education and interdisciplinary education. Principal themes generated from the analysis included (a) the role of empathy in community development, (b) the value of training tools as guides for learning, (c) Mock ECHO design components to optimize learning, (d) the role of interdisciplinary education to build community and improve care delivery, (e) improving care integration through collaboration, and (f) development of soft skills to facilitate learning. Mock ECHO trainings offer clinicians the freedom to learn in a noncritical environment while emphasizing real-time multidirectional feedback and encouraging knowledge and skill transfer. The success of the ECHO model depends on training interprofessional healthcare providers in behaviors needed to lead a teleECHO clinic and to collaborate in the educational process. While building a community of practice, Mock ECHO provides a safe opportunity for a diverse group of clinician experts to practice learned skills and receive feedback from coparticipants and facilitators.

  4. Participation in paediatric perioperative care: 'what it means for parents'.

    Science.gov (United States)

    Sjöberg, Carina; Svedberg, Petra; Nygren, Jens M; Carlsson, Ing-Marie

    2017-12-01

    To explore what it means for parents to participate in their children's paediatric perioperative care. Allowing parents to participate in paediatric perioperative care can make a major difference for children in terms of their well-being, a decreased need for painkillers, fewer sleeping disorders and a more positive experience for both parties. The nurse anaesthetist should have a holistic view and develop a shared vision for the child, the parents and for themselves to perform successful paediatric perioperative care. Descriptive qualitative study. The study was conducted in 2014. Data were collected in 20 narrative interviews with 15 mothers and five fathers who had experience of participating in their child's paediatric perioperative day surgery. The analysis was carried out with qualitative content analysis to describe the variations, differences and similarities in the experiences. The analysis revealed a main category that describes that parental participation in the context of paediatric perioperative care in day surgery meant 'having strength to participate despite an increased vulnerability'. Three generic categories with additional subcategories explained what was essential for the parents to be able to preserve this strength and participate in their child's care despite their increased vulnerability. The generic categories were named, 'gaining information about what will happen', 'being seen as a resource' and 'gaining access to the environment'. Efforts should be made to improve parents' roles and opportunities to participate in paediatric perioperative care. Nurse anaesthetists have a crucial role in enabling parents' participation and need knowledge to develop strategies and nursing interventions that meet parents' needs. © 2017 John Wiley & Sons Ltd.

  5. Ultrafast bold fMRI using single-shot spin-echo echo planar imaging

    Directory of Open Access Journals (Sweden)

    Boujraf Said

    2009-01-01

    Full Text Available The choice of imaging parameters for functional MRI can have an impact on the accuracy of functional localization by affecting the image quality and the degree of blood oxygenation-dependent (BOLD contrast achieved. By improving sampling efficiency, parallel acquisition techniques such as sensitivity encoding (SENSE have been used to shorten readout trains in single-shot (SS echo planar imaging (EPI. This has been applied to susceptibility artifact reduction and improving spatial resolution. SENSE together with single-shot spin-echo (SS-SE imaging may also reduce off-resonance artifacts. The goal of this work was to investigate the BOLD response of a SENSE-adapted SE-EPI on a three Tesla scanner. Whole-brain fMRI studies of seven healthy right hand-dominant volunteers were carried out in a three Tesla scanner. fMRI was performed using an SS-SE EPI sequence with SENSE. The data was processed using statistical parametric mapping. Both, group and individual subject data analyses were performed. Individual average percentage and maximal percentage signal changes attributed to the BOLD effect in M1 were calculated for all the subjects as a function of echo time. Corresponding activation maps and the sizes of the activated clusters were also calculated. Our results show that susceptibility artifacts were reduced with the use of SENSE; and the acquired BOLD images were free of the typical quadrature artifacts of SS-EPI. Such measures are crucial at high field strengths. SS SE-EPI with SENSE offers further benefits in this regard and is more specific for oxygenation changes in the microvasculature bed. Functional brain activity can be investigated with the help of single-shot spin echo EPI using SENSE at high magnetic fields.

  6. Liver iron content determined by MRI. Spin-echo vs. gradient-echo

    Energy Technology Data Exchange (ETDEWEB)

    Juchems, M.S.; Wunderlich, A.P. [Universitaetskliniken Ulm (Germany). Klinik fuer Diagnostische und Interventionelle Radiologie; Cario, H. [Universitaetskliniken Ulm (Germany). Klinik fuer Kinder- und Jugendmedizin; Schmid, M. [Stadtspital Triemli, Zuerich (Switzerland). Medizinische Onkologie und Haematologie

    2012-05-15

    Purpose: Liver iron content (LIC) measurement plays a central role in the management of patients with transfusional iron overload. Calculating the LIC with data obtained from standardized MRI sequences represents an attractive alternative diagnostic possibility. The purpose of this study was to compare the LIC measurement obtained with gradient-echo (GRE) sequences to the mean liver proton transverse relaxation (R2) acquired with SE sequences. Materials and Methods: 68 patients with iron overload (median age: 24, range: 3 - 88) underwent 1.5 T MRI for liver iron content measurement. All patients received spin-echo (SE) and gradient-echo (GRE) sequences. Results: The two MRI methods revealed different liver iron content results although a significant correlation was found (r = 0.85, p < 0.001). Values evaluated using GRE sequences (median: 260 {mu}mol/g dry weight [d.w.], range: 6 - 732) were generally higher than those obtained by SE examinations (median: 161 {mu}mol /g d.w., range: 5 - 830). Conclusion: In conclusion, our study revealed different results for both MRI measurements, which could lead to different decisions concerning the management of chelation therapy in individual patients. (orig.)

  7. Perioperative glycemic control in diabetic patients undergoing coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Ehab A. Wahby

    2016-08-01

    Conclusion: Tight glycemic control improved perioperative outcome in diabetic CABG patients. Maintaining perioperative blood glucose level between 110 and 149 mg/dl is safe and should be recommended as a routine practice in diabetic patients undergoing CABG surgery.

  8. Perioperative care of an adolescent with postural orthostatic tachycardia syndrome

    Directory of Open Access Journals (Sweden)

    Kernan Scott

    2010-01-01

    Full Text Available Postural orthostatic tachycardia syndrome (POTS is a disorder characterized by postural tachycardia in combination with orthostatic symptoms without associated hypotension. Symptoms include light-headedness, palpitations, fatigue, confusion, and anxiety, which are brought on by assuming the upright position and usually relieved by sitting or lying down. Given the associated autonomic dysfunction that occurs with POTS, various perioperative concerns must be considered when providing anesthetic care for such patients. We present an adolescent with POTS who required anesthetic care during posterior spinal fusion for the treatment of scoliosis. The potential perioperative implications of this syndrome are discussed.

  9. Strategier til begraensning af det perioperative forbrug af allogent blod

    DEFF Research Database (Denmark)

    Jørgensen, B G; Qvist, N

    2001-01-01

    Allogenic blood transfusion carries the risk of immunological and non-immunological adverse effects. Consequently, blood transfusion should be limited to situations where alternatives are not available. This article reviews current by available alternative strategies that reduce the need...... for perioperative allogenic blood transfusion. The effectiveness of a number of these alternatives needs to be documented and potential adverse effects clarified. The acceptance of a lower haemoglobin level as the transfusion trigger value is perhaps the most important factor in reducing the need for peri......-operative allogenic blood transfusion...

  10. Perioperative Management of a Patient with Cold Urticaria

    Directory of Open Access Journals (Sweden)

    Priscilla Agbenyefia

    2017-12-01

    Full Text Available Cold urticaria consists of an allergic immune response to cold temperatures with symptoms ranging from pruritic wheals to life-threatening angioedema, bronchospasm, or anaphylactic shock. Adequate planning to maintain normothermia perioperatively is vital due to impaired hypothalamic thermoregulation and overall depression of sympathetic outflow during deep sedation and general anesthesia. This case report describes the successful perioperative management of a 45-year-old female with a history of cold urticaria undergoing a laparoscopic Nissen fundoplication for refractory gastroesophageal reflux disease and discusses how to appropriately optimize the care of these patients.

  11. Translation, adaptation and psychometric validation of the Good Perioperative Nursing Care Scale (GPNCS) with surgical patients in perioperative care

    DEFF Research Database (Denmark)

    Hertel-Joergensen, Michala; Abrahamsen, Charlotte; Jensen, Carsten

    2018-01-01

    patients were screened for eligibility; 215 were included. The full-scale model fit estimates were moderate. Factor loadings typically ranged from 0.65 to 0.97, except for the questions concerning Technical Skills (0.38-0.63) and Nursing Process (0.28). The Cronbach's alpha value for the total scale score......AIM: To test the psychometric validity of the Good Perioperative Nursing Care Scale (GPNCS), a self-administered questionnaire, following translation and adaptation. INTRODUCTION: Patients' satisfaction with and experience of nursing care in orthopaedic or perioperative settings are currently...... was 0.92, with subfactors ranging from 0.72 to 0.87. CONCLUSION: Providing evidence for quality, or lack thereof, the Danish version of the GPNCS is a valid tool for measuring surgical patients' experiences with perioperative nursing care. The electronic version proved practical. RELEVANCE TO CLINICAL...

  12. No counterpart of visual perceptual echoes in the auditory system.

    Directory of Open Access Journals (Sweden)

    Barkın İlhan

    Full Text Available It has been previously demonstrated by our group that a visual stimulus made of dynamically changing luminance evokes an echo or reverberation at ~10 Hz, lasting up to a second. In this study we aimed to reveal whether similar echoes also exist in the auditory modality. A dynamically changing auditory stimulus equivalent to the visual stimulus was designed and employed in two separate series of experiments, and the presence of reverberations was analyzed based on reverse correlations between stimulus sequences and EEG epochs. The first experiment directly compared visual and auditory stimuli: while previous findings of ~10 Hz visual echoes were verified, no similar echo was found in the auditory modality regardless of frequency. In the second experiment, we tested if auditory sequences would influence the visual echoes when they were congruent or incongruent with the visual sequences. However, the results in that case similarly did not reveal any auditory echoes, nor any change in the characteristics of visual echoes as a function of audio-visual congruence. The negative findings from these experiments suggest that brain oscillations do not equivalently affect early sensory processes in the visual and auditory modalities, and that alpha (8-13 Hz oscillations play a special role in vision.

  13. Fast spin echo MRI techniques. Contrast characteristics and clinical potential

    International Nuclear Information System (INIS)

    Melki, P.; Mulkern, R.V.; Dacher, J.N.; Helenon, O.; Higuchi, N.; Oshio, K.; Jolesz, F.; Pourcelot, L.; Einstein, S.

    1993-01-01

    Based on partial RF echo planar principles, Fast Spin Echo techniques (FSE) were implemented on high field systems. These methods produce image quality and contrast which resemble to conventional spin echo (SE) techniques. By reducing acquisition times by factors between 1.4 and 16 over SE methods, FSE allows for several imaging options usually prohibitive with conventional spin echo (SE) sequences. These include fast scans (especially breathold acquisitions); improved T2 contrast with longer TR intervals; increased spatial resolution with the use of larger image matrices and/or smaller fields of view; and 3D volume imaging with a 3D multislab FSE technique. Contrast features of FSE techniques are directly comparable to those of multiple echo SE sequences using the same echo spacing than FSE methods. However, essential contrast differences existing between the FSE sequences and their routine asymmetric dual SE counterpart can be identified. Decreased magnetic susceptibility effects and increased fat signal present within T2 weighted images compared to conventional dual SE images are due to the use of shorter echo spacings employed in FSE sequences. Off-resonance irradiation inherent to the use of a large number of radio frequency pulses in shown to results in dramatic magnetization contrast transfer effects in FSE images acquired in multislice mode

  14. Desmopressin use for minimising perioperative blood transfusion

    Science.gov (United States)

    Desborough, Michael J; Oakland, Kathryn; Brierley, Charlotte; Bennett, Sean; Doree, Carolyn; Trivella, Marialena; Hopewell, Sally; Stanworth, Simon J; Estcourt, Lise J

    2017-01-01

    Background Blood transfusion is administered during many types of surgery, but its efficacy and safety are increasingly questioned. Evaluation of the efficacy of agents, such as desmopressin (DDAVP; 1-deamino-8-D-arginine-vasopressin), that may reduce perioperative blood loss is needed. Objectives To examine the evidence for the efficacy of DDAVP in reducing perioperative blood loss and the need for red cell transfusion in people who do not have inherited bleeding disorders. Search methods We searched for randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (2017, issue 3) in the Cochrane Library, MEDLINE (from 1946), Embase (from 1974), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (from 1937), the Transfusion Evidence Library (from 1980), and ongoing trial databases (all searches to 3 April 2017). Selection criteria We included randomised controlled trials comparing DDAVP to placebo or an active comparator (e.g. tranexamic acid, aprotinin) before, during, or immediately after surgery or after invasive procedures in adults or children. Data collection and analysis We used the standard methodological procedures expected by Cochrane. Main results We identified 65 completed trials (3874 participants) and four ongoing trials. Of the 65 completed trials, 39 focused on adult cardiac surgery, three on paediatric cardiac surgery, 12 on orthopaedic surgery, two on plastic surgery, and two on vascular surgery; seven studies were conducted in surgery for other conditions. These trials were conducted between 1986 and 2016, and 11 were funded by pharmaceutical companies or by a party with a commercial interest in the outcome of the trial. The GRADE quality of evidence was very low to moderate across all outcomes. No trial reported quality of life. DDAVP versus placebo or no treatment Trial results showed considerable heterogeneity between surgical settings for total volume of red cells transfused (low

  15. A comparison of multi-echo spin-echo and triple-echo steady-state T2 mapping for in vivo evaluation of articular cartilage

    Energy Technology Data Exchange (ETDEWEB)

    Juras, Vladimir; Szomolanyi, Pavol [Medical University of Vienna, High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Vienna (Austria); Institute of Measurement Science, Department of Imaging Methods, Bratislava (Slovakia); Bohndorf, Klaus; Kronnerwetter, Claudia; Hager, Benedikt; Zbyn, Stefan [Medical University of Vienna, High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Vienna (Austria); Heule, Rahel; Bieri, Oliver [University of Basel Hospital, Division of Radiological Physics, Department of Radiology, Basel (Switzerland); Trattnig, Siegfried [Medical University of Vienna, High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Vienna (Austria); Christian Doppler Laboratory for Clinical Molecular MR Imaging, Vienna (Austria); Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Austrian Cluster for Tissue Regeneration, Vienna (Austria)

    2016-06-15

    To assess the clinical relevance of T{sub 2} relaxation times, measured by 3D triple-echo steady-state (3D-TESS), in knee articular cartilage compared to conventional multi-echo spin-echo T{sub 2}-mapping. Thirteen volunteers and ten patients with focal cartilage lesions were included in this prospective study. All subjects underwent 3-Tesla MRI consisting of a multi-echo multi-slice spin-echo sequence (CPMG) as a reference method for T{sub 2} mapping, and 3D TESS with the same geometry settings, but variable acquisition times: standard (TESSs 4:35min) and quick (TESSq 2:05min). T{sub 2} values were compared in six different regions in the femoral and tibial cartilage using a Wilcoxon signed ranks test and the Pearson correlation coefficient (r). The local ethics committee approved this study, and all participants gave written informed consent. The mean quantitative T{sub 2} values measured by CPMG (mean: 46±9ms) in volunteers were significantly higher compared to those measured with TESS (mean: 31±5ms) in all regions. Both methods performed similarly in patients, but CPMG provided a slightly higher difference between lesions and native cartilage (CPMG: 90ms→61ms [31%],p=0.0125;TESS 32ms→24ms [24%],p=0.0839). 3D-TESS provides results similar to those of a conventional multi-echo spin-echo sequence with many benefits, such as shortening of total acquisition time and insensitivity to B{sub 1} and B{sub 0} changes. (orig.)

  16. A comparison of multi-echo spin-echo and triple-echo steady-state T2 mapping for in vivo evaluation of articular cartilage.

    Science.gov (United States)

    Juras, Vladimir; Bohndorf, Klaus; Heule, Rahel; Kronnerwetter, Claudia; Szomolanyi, Pavol; Hager, Benedikt; Bieri, Oliver; Zbyn, Stefan; Trattnig, Siegfried

    2016-06-01

    To assess the clinical relevance of T2 relaxation times, measured by 3D triple-echo steady-state (3D-TESS), in knee articular cartilage compared to conventional multi-echo spin-echo T2-mapping. Thirteen volunteers and ten patients with focal cartilage lesions were included in this prospective study. All subjects underwent 3-Tesla MRI consisting of a multi-echo multi-slice spin-echo sequence (CPMG) as a reference method for T2 mapping, and 3D TESS with the same geometry settings, but variable acquisition times: standard (TESSs 4:35min) and quick (TESSq 2:05min). T2 values were compared in six different regions in the femoral and tibial cartilage using a Wilcoxon signed ranks test and the Pearson correlation coefficient (r). The local ethics committee approved this study, and all participants gave written informed consent. The mean quantitative T2 values measured by CPMG (mean: 46±9ms) in volunteers were significantly higher compared to those measured with TESS (mean: 31±5ms) in all regions. Both methods performed similarly in patients, but CPMG provided a slightly higher difference between lesions and native cartilage (CPMG: 90ms→61ms [31%],p=0.0125;TESS 32ms→24ms [24%],p=0.0839). 3D-TESS provides results similar to those of a conventional multi-echo spin-echo sequence with many benefits, such as shortening of total acquisition time and insensitivity to B1 and B0 changes. • 3D-TESS T 2 mapping provides clinically comparable results to CPMG in shorter scan-time. • Clinical and investigational studies may benefit from high temporal resolution of 3D-TESS. • 3D-TESS T 2 values are able to differentiate between healthy and damaged cartilage.

  17. A comparison of multi-echo spin-echo and triple-echo steady-state T2 mapping for in vivo evaluation of articular cartilage

    International Nuclear Information System (INIS)

    Juras, Vladimir; Szomolanyi, Pavol; Bohndorf, Klaus; Kronnerwetter, Claudia; Hager, Benedikt; Zbyn, Stefan; Heule, Rahel; Bieri, Oliver; Trattnig, Siegfried

    2016-01-01

    To assess the clinical relevance of T 2 relaxation times, measured by 3D triple-echo steady-state (3D-TESS), in knee articular cartilage compared to conventional multi-echo spin-echo T 2 -mapping. Thirteen volunteers and ten patients with focal cartilage lesions were included in this prospective study. All subjects underwent 3-Tesla MRI consisting of a multi-echo multi-slice spin-echo sequence (CPMG) as a reference method for T 2 mapping, and 3D TESS with the same geometry settings, but variable acquisition times: standard (TESSs 4:35min) and quick (TESSq 2:05min). T 2 values were compared in six different regions in the femoral and tibial cartilage using a Wilcoxon signed ranks test and the Pearson correlation coefficient (r). The local ethics committee approved this study, and all participants gave written informed consent. The mean quantitative T 2 values measured by CPMG (mean: 46±9ms) in volunteers were significantly higher compared to those measured with TESS (mean: 31±5ms) in all regions. Both methods performed similarly in patients, but CPMG provided a slightly higher difference between lesions and native cartilage (CPMG: 90ms→61ms [31%],p=0.0125;TESS 32ms→24ms [24%],p=0.0839). 3D-TESS provides results similar to those of a conventional multi-echo spin-echo sequence with many benefits, such as shortening of total acquisition time and insensitivity to B 1 and B 0 changes. (orig.)

  18. Peri-operative Blood Transfusion in open Suprapubic Transvesical ...

    African Journals Online (AJOL)

    INTRODUCTION: Open simple prostatectomy is the most effective and the most durable method of controlling symptoms associated with benign prostatic hyperplasia, especially in sub- Saharan Africa, where TURP set and expertise are unavailable in most health institutions. The risk of perioperative heterologous blood ...

  19. Pediatric Perioperative Pulmonary Arterial Hypertension: A Case-Based Primer

    Directory of Open Access Journals (Sweden)

    Shilpa Shah

    2017-10-01

    Full Text Available The perioperative period is an extremely tenuous time for the pediatric patient with pulmonary arterial hypertension. This article will discuss a multidisciplinary approach to preoperative planning, the importance of early identification of pulmonary hypertensive crises, and practical strategies for postoperative management for this unique group of children.

  20. Important issues for perioperative systemic antimicrobial prophylaxis in surgery

    NARCIS (Netherlands)

    Sinha, Bhanu; van Assen, Sander; Friedrich, Alexander W.

    PURPOSE OF REVIEW: Prevention of surgical site infections is a key issue to patient safety and the success of surgical interventions. Systemic antimicrobial prophylaxis is one important component of a perioperative infection prevention bundle. This review focuses on selected recent developments and

  1. Optimization of peri-operative care in colorectal surgery

    NARCIS (Netherlands)

    Kornmann, V.N.N.

    2016-01-01

    Colorectal cancer is an important health issue, and colorectal surgery is increasingly being performed. During the last years, quality and safety of care, new surgical techniques and attention for peri-operative risks resulted in reduction of postoperative morbidity and mortality. Despite these

  2. Perioperative adverse airway events in cleft lip and palate repair ...

    African Journals Online (AJOL)

    Background: Airway-related problems account for the majority of anaesthetic morbidity in paediatric anaesthesia, but more so for cleft lip and palate repair. The aim of this study was to assess the frequency, pattern, management and outcome of adverse airway events during the perioperative period in cleft lip and palate ...

  3. Patient satisfaction with the perioperative surgical services and ...

    African Journals Online (AJOL)

    Introduction: Globally, increasing consideration has been given to the assessment of patient satisfaction as a method of monitor of the quality of health care provision in the health institutions. Perioperative patient satisfaction has been contemplated to be related with the level of postoperative pain intensity, patients' ...

  4. [PERIOPERATIVE ANALGESIA INFLUENCE ON MOTHER REHABILITATION PERIOD AFTER CESAREAN SECTION].

    Science.gov (United States)

    Sedykh, S V

    2015-01-01

    Early breast-feeding is a standard of perinatal care currently. After cesarean section it can be possible in case of early mother activation (verticalization). Assessment of perioperative analgesia influence on activation timing was the aim of our research. We included 120 parturient women. It was proved, that local analgesia using in postoperative period promotes early mother verticaliration, and optimal breast-feeding starting.

  5. The need for peri-operative supplemental oxygen | Chikungwa ...

    African Journals Online (AJOL)

    The need for peri-operative supplemental oxygen. M. T. Chikungwa, K. Jonsson. Abstract. (Central African Journal of Medicine: 2002 48 (5-6): 72-73). AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL · AJOL's Partners · Terms and Conditions of Use ...

  6. Neuroanaesthetic and perioperative challenges in the management of giant encephaloceles

    Directory of Open Access Journals (Sweden)

    V Bhatnagar

    2013-01-01

    Full Text Available There are complex issues involved in the surgical management of giant occipital encephaloceles, especially in neonates and young infants. Airway management can cause technical difficulties due to location of lesion, associated abnormalities and the position to be maintained during surgery. We present perioperative challenges we faced in the management of one such case.

  7. Perioperative nurses' attitudes toward the electronic health record.

    Science.gov (United States)

    Yontz, Laura S; Zinn, Jennifer L; Schumacher, Edward J

    2015-02-01

    The adoption of an electronic health record (EHR) is mandated under current health care legislation reform. The EHR provides data that are patient centered and improves patient safety. There are limited data; however, regarding the attitudes of perioperative nurses toward the use of the EHR. The purpose of this project was to identify perioperative nurses' attitudes toward the use of the EHR. Quantitative descriptive survey was used to determine attitudes toward the electronic health record. Perioperative nurses in a southeastern health system completed an online survey to determine their attitudes toward the EHR in providing patient care. Overall, respondents felt the EHR was beneficial, did not add to the workload, improved documentation, and would not eliminate any nursing jobs. Nursing acceptance and the utilization of the EHR are necessary for the successful integration of an EHR and to support the goal of patient-centered care. Identification of attitudes and potential barriers of perioperative nurses in using the EHR will improve patient safety, communication, reduce costs, and empower those who implement an EHR. Copyright © 2015 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  8. Current attitudes regarding the use of perioperative analgesics and ...

    African Journals Online (AJOL)

    A survey was performed in 2017 to evaluate the use of perioperative analgesia and routine anaesthetic management in dogs and cats by Cameroon veterinarians in 19 veterinary clinics, including 7 and 12 in Douala and Yaounde, respectively. The questionnaire consisted of five sections recording demographic data, ...

  9. Current aspects of perioperative fluid handling in vascular surgery

    NARCIS (Netherlands)

    Jacob, Matthias; Chappell, Daniel; Hollmann, Markus W.

    2009-01-01

    Purpose of review Perioperative fluid management influences patient outcome. Vascular surgery unites various surgical procedures, mainly with a high impact on patients who often have relevant preexisting illnesses. There are only scarce data on this specialty, forcing the clinician to extrapolate

  10. An Audit Of Perioperative Cardiac Arrest At Lagos University ...

    African Journals Online (AJOL)

    Objective: Intraoperative cardiac arrests are not uncommon and are related to both surgical and anaesthetic factors. This study aimed to examine the factors which predispose to a periopeartive cardiac arrest, to assess the appropriateness of therapy and the outcome. Materials and Methods: All perioperative cardiac arrests ...

  11. Benefits and harms of perioperative beta-blockade

    DEFF Research Database (Denmark)

    Wetterslev, Jørn; Juul, Anne Benedicte

    2006-01-01

    randomized trials. However, confidence intervals of the intervention effects in the meta-analyses are wide, leaving room for both benefits and harms. The largest observational study performed suggests that perioperative beta-blockade is associated with higher mortality in patients with low cardiac risk...

  12. Nursing reflections from journaling during a perioperative internship.

    Science.gov (United States)

    Kuiper, Ruth Ann

    2004-01-01

    AN IMPORTANT CONCERN in nursing practice and education is the difficulties nurses experience as they transition into a new clinical area. THIS STUDY compared the reflective journals of 26 experienced and inexperienced nurses participating in a nine-week perioperative internship. THE STUDY examined self-regulated learning strategies used to enhance metacognitive critical thinking abilities.

  13. Clinical and diagnostic features of perioperative hypersensitivity to cefuroxime

    DEFF Research Database (Denmark)

    Christiansen, I S; Krøigaard, M; Mosbech, H

    2015-01-01

    of causation in the perioperative setting. Provocations were always positive when carried out in skin test positive patients; however 8 patients had positive provocations only, highlighting the need for provocation in skin test negative patients. This article is protected by copyright. All rights reserved....

  14. Rhinoplasty perioperative database using a personal digital assistant.

    Science.gov (United States)

    Kotler, Howard S

    2004-01-01

    To construct a reliable, accurate, and easy-to-use handheld computer database that facilitates the point-of-care acquisition of perioperative text and image data specific to rhinoplasty. A user-modified database (Pendragon Forms [v.3.2]; Pendragon Software Corporation, Libertyville, Ill) and graphic image program (Tealpaint [v.4.87]; Tealpaint Software, San Rafael, Calif) were used to capture text and image data, respectively, on a Palm OS (v.4.11) handheld operating with 8 megabytes of memory. The handheld and desktop databases were maintained secure using PDASecure (v.2.0) and GoldSecure (v.3.0) (Trust Digital LLC, Fairfax, Va). The handheld data were then uploaded to a desktop database of either FileMaker Pro 5.0 (v.1) (FileMaker Inc, Santa Clara, Calif) or Microsoft Access 2000 (Microsoft Corp, Redmond, Wash). Patient data were collected from 15 patients undergoing rhinoplasty in a private practice outpatient ambulatory setting. Data integrity was assessed after 6 months' disk and hard drive storage. The handheld database was able to facilitate data collection and accurately record, transfer, and reliably maintain perioperative rhinoplasty data. Query capability allowed rapid search using a multitude of keyword search terms specific to the operative maneuvers performed in rhinoplasty. Handheld computer technology provides a method of reliably recording and storing perioperative rhinoplasty information. The handheld computer facilitates the reliable and accurate storage and query of perioperative data, assisting the retrospective review of one's own results and enhancement of surgical skills.

  15. Ambulatory anesthesia: optimal perioperative management of the diabetic patient

    Directory of Open Access Journals (Sweden)

    Polderman JAW

    2016-05-01

    Full Text Available Jorinde AW Polderman, Robert van Wilpe, Jan H Eshuis, Benedikt Preckel, Jeroen Hermanides Department of Anaesthesiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands Abstract: Given the growing number of patients with diabetes mellitus (DM and the growing number of surgical procedures performed in an ambulatory setting, DM is one of the most encountered comorbidities in patients undergoing ambulatory surgery. Perioperative management of ambulatory patients with DM requires a different approach than patients undergoing major surgery, as procedures are shorter and the stress response caused by surgery is minimal. However, DM is a risk factor for postoperative complications in ambulatory surgery, so should be managed carefully. Given the limited time ambulatory patients spend in the hospital, improvement in management has to be gained from the preanesthetic assessment. The purpose of this review is to summarize current literature regarding the anesthesiologic management of patients with DM in the ambulatory setting. We will discuss the risks of perioperative hyperglycemia together with the pre-, intra-, and postoperative considerations for these patients when encountered in an ambulatory setting. Furthermore, we provide recommendations for the optimal perioperative management of the diabetic patient undergoing ambulatory surgery. Keywords: diabetes mellitus, perioperative period, ambulatory surgery, insulin, complications, GLP-1 agonist, DPP-4 inhibitor

  16. The science of EChO

    Science.gov (United States)

    Tinetti, Giovanna; Cho, James Y.-K.; Griffith, Caitlin A.; Grasset, Olivier; Grenfell, Lee; Guillot, Tristan; Koskinen, Tommi T.; Moses, Julianne I.; Pinfield, David; Tennyson, Jonathan; Tessenyi, Marcell; Wordsworth, Robin; Aylward, Alan; van Boekel, Roy; Coradini, Angioletta; Encrenaz, Therese; Snellen, Ignas; Zapatero-Osorio, Maria R.; Bouwman, Jeroen; Coudé du Foresto, Vincent; Lopez-Morales, Mercedes; Mueller-Wodarg, Ingo; Pallé, Enric; Selsis, Franck; Sozzetti, Alessandro; Beaulieu, Jean-Philippe; Henning, Thomas; Meyer, Michael; Micela, Giuseppina; Ribas, Ignasi; Stam, Daphne; Swain, Mark; Krause, Oliver; Ollivier, Marc; Pace, Emanuele; Swinyard, Bruce; Ade, Peter A. R.; Achilleos, Nick; Adriani, Alberto; Agnor, Craig B.; Afonso, Cristina; Allende Prieto, Carlos; Bakos, Gaspar; Barber, Robert J.; Barlow, Michael; Bernath, Peter; Bézard, Bruno; Bordé, Pascal; Brown, Linda R.; Cassan, Arnaud; Cavarroc, Céline; Ciaravella, Angela; Cockell, Charles; Coustenis, Athéna; Danielski, Camilla; Decin, Leen; De Kok, Remco; Demangeon, Olivier; Deroo, Pieter; Doel, Peter; Drossart, Pierre; Fletcher, Leigh N.; Focardi, Matteo; Forget, Francois; Fossey, Steve; Fouqué, Pascal; Frith, James; Galand, Marina; Gaulme, Patrick; González Hernández, Jonay I.; Grassi, Davide; Griffin, Matt J.; Grözinger, Ulrich; Guedel, Manuel; Guio, Pactrick; Hainaut, Olivier; Hargreaves, Robert; Hauschildt, Peter H.; Heng, Kevin; Heyrovsky, David; Hueso, Ricardo; Irwin, Pat; Kaltenegger, Lisa; Kervella, Patrick; Kipping, David; Kovacs, Geza; La Barbera, Antonino; Lammer, Helmut; Lellouch, Emmanuel; Leto, Giuseppe; Lopez Morales, Mercedes; Valverde, Lopez Miguel A.; Lopez-Puertas, Manuel; Lovi, Christophe; Maggio, Antonio; Maillard, Jean-Pierre; Prado, Jesus Maldonado; Marquette, Jean-Baptiste; Martin-Torres, Francisco J.; Maxted, Pierre; Miller, Steve; Molinari, Sergio; Montes, David; Moro-Martin, Amaya; Mousis, Olivier; Tuong, Napoléon Nguyen; Nelson, Richard; Orton, Glenn S.; Pantin, Eric; Pascale, Enzo; Pezzuto, Stefano; Poretti, Ennio; Prinja, Raman; Prisinzano, Loredana; Réess, Jean-Michel; Reiners, Ansgar; Samuel, Benjamin; Sanz Forcada, Jorge; Sasselov, Dimitar; Savini, Giorgio; Sicardy, Bruno; Smith, Alan; Stixrude, Lars; Strazzulla, Giovanni; Vasisht, Gautam; Vinatier, Sandrine; Viti, Serena; Waldmann, Ingo; White, Glenn J.; Widemann, Thomas; Yelle, Roger; Yung, Yuk; Yurchenko, Sergey

    2011-11-01

    The science of extra-solar planets is one of the most rapidly changing areas of astrophysics and since 1995 the number of planets known has increased by almost two orders of magnitude. A combination of ground-based surveys and dedicated space missions has resulted in 560-plus planets being detected, and over 1200 that await confirmation. NASA's Kepler mission has opened up the possibility of discovering Earth-like planets in the habitable zone around some of the 100,000 stars it is surveying during its 3 to 4-year lifetime. The new ESA's Gaia mission is expected to discover thousands of new planets around stars within 200 parsecs of the Sun. The key challenge now is moving on from discovery, important though that remains, to characterisation: what are these planets actually like, and why are they as they are? In the past ten years, we have learned how to obtain the first spectra of exoplanets using transit transmission and emission spectroscopy. With the high stability of Spitzer, Hubble, and large ground-based telescopes the spectra of bright close-in massive planets can be obtained and species like water vapour, methane, carbon monoxide and dioxide have been detected. With transit science came the first tangible remote sensing of these planetary bodies and so one can start to extrapolate from what has been learnt from Solar System probes to what one might plan to learn about their faraway siblings. As we learn more about the atmospheres, surfaces and near-surfaces of these remote bodies, we will begin to build up a clearer picture of their construction, history and suitability for life. The Exoplanet Characterisation Observatory, EChO, will be the first dedicated mission to investigate the physics and chemistry of Exoplanetary Atmospheres. By characterising spectroscopically more bodies in different environments we will take detailed planetology out of the Solar System and into the Galaxy as a whole. EChO has now been selected by the European Space Agency to be

  17. The effect of strong pitch angle scattering on the use of artificial auroral streaks for echo detection - Echo 5

    International Nuclear Information System (INIS)

    Swanson, R.L.; Steffen, J.E.; Winckler, J.R.

    1986-01-01

    During the Echo 5 experiment launched 13 November 1979 from the Poker Flat Research Range (Fairbanks, Alaska), a 0.75 A, 37 keV electron beam was injected both up and down the field line to test the use of optical and X-ray methods to detect the beam as it interacted with the atmosphere below the rocket for both the downward injections (markers) and the upward injected electrons which mirrored at the Southern Hemisphere and returned echoes. The artificial auroral streaks created by the markers were easily visible on the ground TV system but the large intensity of photons produced around the rocket masked any response to the markers by the on-board photometers and X-ray detectors. No echoes were detected with any of the detection systems although the power in some of the upward injections was 7.6 times the power in a detected downward injection thus setting an upper limit on the loss-cone echo flux. The magnitude of the bounce averaged pitch angle diffusion coefficient necessary to explain the lack of observable echoes was found to be 4 x 10 -4 S -1 . It was found that an equatorial wave electric field of 11 mVm -1 would account for the lack of echoes. Such fields should cause strong pitch angle scattering of up to 10 keV natural electrons and thus be consistent with the presence of diffuse aurora on the Echo 5 trajectory. (author)

  18. Perioperative blood loss and diclofenac in major arthroplastic surgery

    Directory of Open Access Journals (Sweden)

    Ljiljana Gvozdenović

    2011-04-01

    Full Text Available Introduction: Contemporary literature indicates precaution over the perioperative use of non-steroidal anti-inflammatory drugs, since they can potentially increase perioperative blood loss related to their mechanism of action. The aim of this study was to assess the influence of non-steroidal anti-inflammatory drugs on perioperative blood loss undergoing hip arthroplasty and its correlation with general and regional anesthesia.Methods: This prospective study included 120 patients who had undergone elective unilateral total hip arthroplasty. Patients were allocated into four groups. Groups 1 and 2 were pretreated with diclofenac and operated in general and regional anesthesia. Group 3 and 4 weren’t pretreated with any non-steroidal anti-inflammatory drug and were, as well, operated in general and regional anesthesia. Diclofenac was administered orally two times a day 75 mg (total 150 mg and also as intramuscular injection (75 mg preoperatively and 12 hours later on a day of surgery.Results: The perioperative blood loss in the rst 24 hours showed an increase of 29.4% in the diclofenac group operated in general anesthesia and increase of 26.8% in patients operated in regional anesthesia (P < 0.05 compared to control group. Statistical data evaluation of patients operated in general anesthesia compared to regional anesthesia, the overall blood loss in the rst 24 h after surgery, showed an increase of 6.4% in the diclofenac group and increase of 3.6% in placebo group. This was not statistically significant.Conclusion: Pretreatment with non-steroidal anti-inflammatory drugs (diclofenac before elective unilateral total hip arthroplasty increases the perioperative blood loss signficantly. Early discontinuation of non-selective non-steroidal anti-inflammatory drugs is advised.

  19. Geomagnetic control of polar mesosphere summer echoes

    Directory of Open Access Journals (Sweden)

    J. Bremer

    2000-02-01

    Full Text Available Using observations with the ALOMAR SOUSY radar near Andenes (69.3°N, 16.0°E from 1994 until 1997 polar mesosphere summer echoes (PMSE have been investigated in dependence on geomagnetic K indices derived at the Auroral Observatory Tromsø (69.66°N, 18.94°E. During night-time and morning hours a significant correlation between the signal-to-noise ratio (SNR of the radar results and the geomagnetic K indices could be detected with a maximum correlation near midnight. The correlation becomes markedly smaller in the afternoon and early evening hours with a minimum near 17 UT. This diurnal variation is in reasonable agreement with riometer absorption at Ivalo (68.55°N, 27.28°E and can be explained by the diurnal variation of ionization due to precipitating high energetic particles. Therefore, a part of the diurnal PMSE variation is caused by this particle precipitation. The variability of the solar EUV variation, however, has no significant influence on the PMSE during the observation period.Keywords: Ionosphere (auroral ionosphere - Magnetospheric physics (energetic particles, precipitating - Radio science (remote sensing

  20. Book review: Musical echoes: South African women thinking in jazz ...

    African Journals Online (AJOL)

    Abstract. Title: Musical echoes: South African women thinking in jazz. Author: Muller, Carol and Sathima, Bea Benjamin. Publisher: Duke University Press. Publication year: 2011. ISBN 978-0-8223-4914-3 ...

  1. Classification of underwater target echoes based on auditory perception characteristics

    Science.gov (United States)

    Li, Xiukun; Meng, Xiangxia; Liu, Hang; Liu, Mingye

    2014-06-01

    In underwater target detection, the bottom reverberation has some of the same properties as the target echo, which has a great impact on the performance. It is essential to study the difference between target echo and reverberation. In this paper, based on the unique advantage of human listening ability on objects distinction, the Gammatone filter is taken as the auditory model. In addition, time-frequency perception features and auditory spectral features are extracted for active sonar target echo and bottom reverberation separation. The features of the experimental data have good concentration characteristics in the same class and have a large amount of differences between different classes, which shows that this method can effectively distinguish between the target echo and reverberation.

  2. Water Pollution Search Results Help - TRI | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  3. Water Pollution Search Criteria Help | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  4. TRI DMR Dashboard Top Industries_Chemicals.png | ECHO ...

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  5. TRI DMR Dashboard Pie Chart.png | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  6. DW_Dashboard_CalendarView.png | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  7. TRI DMR Dashboard Summary Table.png | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  8. TRI DMR Dashboard Top Industries Graph.png | ECHO | US ...

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  9. eff-date-range.png | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  10. PWS_Dashboard_2.png | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  11. eff-hover-chart.png | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  12. PWS_Dashboard_1.png | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  13. eff-toggle-chart.png | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  14. ECHO Services: Foundational Middleware for a Science Cyberinfrastructure

    Science.gov (United States)

    Burnett, Michael

    2005-01-01

    This viewgraph presentation describes ECHO, an interoperability middleware solution. It uses open, XML-based APIs, and supports net-centric architectures and solutions. ECHO has a set of interoperable registries for both data (metadata) and services, and provides user accounts and a common infrastructure for the registries. It is built upon a layered architecture with extensible infrastructure for supporting community unique protocols. It has been operational since November, 2002 and it available as open source.

  15. Puget Sound Watershed.pdf | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  16. Numerical modelling of so-called secondary ultrasonic echoes

    International Nuclear Information System (INIS)

    Langenberg, K.J.; Fellinger, P.; Hofmann, C.

    1994-01-01

    The formation of secondary ultrasonic echoes is discussed for a particularly simple testing situation. This discussion is based upon the intuitive visualization of elastic wave propagation as obtained with the numerical EFIT-Code (Elastodynamic Finite Integration Technique). The resulting travel times for the econdary echoes contain well-defined limits as they originate from the simple model of grazing incidence plane longitudinal wave mode conversion. (orig.) [de

  17. Civil Enforcement Case Report Data Dictionary | ECHO | US ...

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  18. Water Quality Indicators Data Review | ECHO | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  19. The architecture of dynamic reservoir in the echo state network

    Science.gov (United States)

    Cui, Hongyan; Liu, Xiang; Li, Lixiang

    2012-09-01

    Echo state network (ESN) has recently attracted increasing interests because of its superior capability in modeling nonlinear dynamic systems. In the conventional echo state network model, its dynamic reservoir (DR) has a random and sparse topology, which is far from the real biological neural networks from both structural and functional perspectives. We hereby propose three novel types of echo state networks with new dynamic reservoir topologies based on complex network theory, i.e., with a small-world topology, a scale-free topology, and a mixture of small-world and scale-free topologies, respectively. We then analyze the relationship between the dynamic reservoir structure and its prediction capability. We utilize two commonly used time series to evaluate the prediction performance of the three proposed echo state networks and compare them to the conventional model. We also use independent and identically distributed time series to analyze the short-term memory and prediction precision of these echo state networks. Furthermore, we study the ratio of scale-free topology and the small-world topology in the mixed-topology network, and examine its influence on the performance of the echo state networks. Our simulation results show that the proposed echo state network models have better prediction capabilities, a wider spectral radius, but retain almost the same short-term memory capacity as compared to the conventional echo state network model. We also find that the smaller the ratio of the scale-free topology over the small-world topology, the better the memory capacities.

  20. Hypoxia Task Force Scope and Methodology | ECHO | US ...

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  1. Velocities of Auroral Coherent Echoes At 12 and 144 Mhz

    Science.gov (United States)

    Koustov, A. V.; Danskin, D. W.; Makarevitch, R. A.; Uspensky, M. V.; Janhunen, P.; Nishitani, N.; Nozawa, N.; Lester, M.; Milan, S.

    Two Doppler coherent radar systems are currently working at Hankasalmi, Finland, the STARE and CUTLASS radars operating at 144 MHz and 12 MHz, respectively. The STARE beam 3 is nearly co-located with the CUTLASS beam 5 providing an opportunity for echo velocity comparison along the same direction but at significantly different radar frequencies. In this study we consider one event when STARE radar echoes are detected t the same ranges as CUTLASS radar echoes. The observations are complemented by EISCAT measurements of the ionospheric electric field and elec- tron density behavior at one range of 900 km. Two separate situations are studied; for the first one, CUTLASS observed F-region echoes (including the range of the EIS- CAT measurements) while for the second one CUTLASS observed E-region echoes. In both cases STARE E-region measurements were available. We show that F-region CUTLASS velocities agree well with the convection component along the CUTLASS radar beam while STARE velocities are sometimes smaller by a factor of 2-3. For the second case, STARE velocities are found to be either smaller or larger than CUTLASS velocities, depending on range. Plasma physics of E- and F-region irregularities is dis- cussed in attempt to explain inferred relationship between various velocities. Special attention is paid to ionospheric refraction that is important for the detection of 12-MHz echoes.

  2. Wavelet-LMS algorithm-based echo cancellers

    Science.gov (United States)

    Seetharaman, Lalith K.; Rao, Sathyanarayana S.

    2002-12-01

    This paper presents Echo Cancellers based on the Wavelet-LMS Algorithm. The performance of the Least Mean Square Algorithm in Wavelet transform domain is observed and its application in Echo cancellation is analyzed. The Widrow-Hoff Least Mean Square Algorithm is most widely used algorithm for Adaptive filters that function as Echo Cancellers. The present day communication signals are widely non-stationary in nature and some errors crop up when Least Mean Square Algorithm is used for the Echo Cancellers handling such signals. The analysis of non-stationary signals often involves a compromise between how well transitions or discontinuities can be located. The multi-scale or multi-resolution of signal analysis, which is the essence of wavelet transform, makes Wavelets popular in non-stationary signal analysis. In this paper, we present a Wavelet-LMS algorithm wherein the wavelet coefficients of a signal are modified adaptively using the Least Mean Square Algorithm and then reconstructed to give an Echo-free signal. The Echo Canceller based on this Algorithm is found to have a better convergence and a comparatively lesser MSE (Mean Square error).

  3. Imaging of the brain using the fast-spin-echo and gradient-spin-echo techniques

    International Nuclear Information System (INIS)

    Umek, W.; Ba-Ssalamah, A.; Prokesch, R.; Mallek, R.; Heimberger, K.; Hittmair, K.

    1998-01-01

    The aim of our study was to compare gradient-spin-echo (GRASE) to fast-spin-echo (FSE) sequences for fast T2-weighted MR imaging of the brain. Thirty-one patients with high-signal-intensity lesions on T2-weighted images were examined on a 1.5-T MR system. The FSE and GRASE sequences with identical sequence parameters were obtained and compared side by side. Image assessment criteria included lesion conspicuity, contrast between different types of normal tissue, and image artifacts. In addition, signal-to-noise, contrast-to-noise, and contrast ratios and were determined. The FSE technique demonstrated more lesions than GRASE and with generally better conspicuity. Smaller lesions in particular were better demonstrated on FSE because of lower image noise and slightly weaker image artifacts. Gray-white differentiation was better on FSE. Ferritin and hemosiderin depositions appeared darker on GRASE, which resulted in better contrast. Fatty tissue was less bright on GRASE. With current standard hardware equipment, the FSE technique seems preferable to GRASE for fast T2-weighted routine MR imaging of the brain. For the assessment of hemosiderin or ferritin depositions, GRASE might be considered. (orig.)

  4. A protocol for a systematic review for perioperative pregabalin use

    Directory of Open Access Journals (Sweden)

    Eipe Naveen

    2012-09-01

    Full Text Available Abstract Background Perioperative pain management has recently been revolutionized with the recognition of novel mechanisms and introduction of newer drugs. Many randomized trials have studied the use of the gabapentinoid anti-epileptic, pregabalin, in acute pain. Published systematic reviews suggest that using pregabalin for perioperative pain management may decrease analgesic requirements and pain scores, at the expense of troublesome side effects. A major limitation of the extant reviews is the lack of rigorous investigation of clinical characteristics that would maximize the benefit harms ratio in favor of surgical patients. We posit that effects of pregabalin for perioperative pain management vary by the type of surgical pain model and propose this systematic review protocol to update previous systematic reviews and investigate the heterogeneity in findings across subgroups of surgical pain models. Methods/Design Using a peer-reviewed search strategy, we will search key databases for clinical trials on perioperative pregabalin use in adults. The electronic searches will be supplemented by scanning the reference lists of included studies. No limits of language, country or year will be imposed. Outcomes will include pain; use of co-analgesia, particularly opioids; enhanced recovery; and drug-related harms. We will focus on the identification of surgical models and patient characteristics that have shown benefit and adverse effects from pregabalin. Two clinical experts will independently screen the studies for inclusion using eligibility criteria established a priori. Data extracted by the reviewers will then be verified. Publication bias will be assessed, as will risk of bias using the Cochrane Risk of Bias tool. Meta-analysis and meta-regression are planned if the studies are deemed statistically, methodologically and clinically homogenous. Evidence will be graded for its strength for a select number of outcomes. Discussion We will explore

  5. Intravenous sub-anesthetic ketamine for perioperative analgesia

    Directory of Open Access Journals (Sweden)

    Andrew W Gorlin

    2016-01-01

    Full Text Available Ketamine, an N-methyl-d-aspartate antagonist, blunts central pain sensitization at sub-anesthetic doses (0.3 mg/kg or less and has been studied extensively as an adjunct for perioperative analgesia. At sub-anesthetic doses, ketamine has a minimal physiologic impact though it is associated with a low incidence of mild psychomimetic symptoms as well as nystagmus and double vision. Contraindications to its use do exist and due to ketamine′s metabolism, caution should be exercised in patients with renal or hepatic dysfunction. Sub-anesthetic ketamine improves pain scores and reduces perioperative opioid consumption in a broad range of surgical procedures. In addition, there is evidence that ketamine may be useful in patients with opioid tolerance and for preventing chronic postsurgical pain.

  6. Approaches and perioperative management in periacetabular osteotomy surgery

    DEFF Research Database (Denmark)

    Søballe, Kjeld; Troelsen, Anders

    2012-01-01

    .9 to 8.1 years) of 209 PAOs performed using this approach have shown Kaplan-Meier survivorship rates of 94.7% at 5 years and 88.6% at 8.1 years, with conversion to total hip arthroplasty as the end point. Perioperative management includes a patient education program, optimized pain treatment strategies...... (local infiltration analgesia), and a progressive mobilization and exercise program. The transsartorial approach coupled with a specific perioperative management program has proved successful for PAO surgery.......In the early days of periacetabular osteotomy (PAO), surgical approaches were characterized by extensive soft-tissue dissection. The Smith-Petersen approach (and iliofemoral modifications) and the ilioinguinal approach have traditionally been used for PAO. The optimal surgical approach for PAO...

  7. Inhaled therapy for the management of perioperative pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    C A Thunberg

    2015-01-01

    Full Text Available Patients with pulmonary hypertension (PH are at high risk for complications in the perioperative setting and often receive vasodilators to control elevated pulmonary artery pressure (PAP. Administration of vasodilators via inhalation is an effective strategy for reducing PAP while avoiding systemic side effects, chiefly hypotension. The prototypical inhaled pulmonary-specific vasodilator, nitric oxide (NO, has a proven track record but is expensive and cumbersome to implement. Alternatives to NO, including prostanoids (such as epoprostenol, iloprost, and treprostinil, NO-donating drugs (sodium nitroprusside, nitroglycerin, and nitrite, and phosphodiesterase inhibitors (milrinone, sildenafil may be given via inhalation for the purpose of treating elevated PAP. This review will focus on the perioperative therapy of PH using inhaled vasodilators.

  8. Perioperative aspirin and clonidine and risk of acute kidney injury

    DEFF Research Database (Denmark)

    Garg, Amit X; Kurz, Andrea; Sessler, Daniel I

    2014-01-01

    IMPORTANCE: Acute kidney injury, a common complication of surgery, is associated with poor outcomes and high health care costs. Some studies suggest aspirin or clonidine administered during the perioperative period reduces the risk of acute kidney injury; however, these effects are uncertain...... and each intervention has the potential for harm. OBJECTIVE: To determine whether aspirin compared with placebo, and clonidine compared with placebo, alters the risk of perioperative acute kidney injury. DESIGN, SETTING, AND PARTICIPANTS: A 2 × 2 factorial randomized, blinded, clinical trial of 6905...... patients undergoing noncardiac surgery from 88 centers in 22 countries with consecutive patients enrolled between January 2011 and December 2013. INTERVENTIONS: Patients were assigned to take aspirin (200 mg) or placebo 2 to 4 hours before surgery and then aspirin (100 mg) or placebo daily up to 30 days...

  9. Using YouTube in perioperative nursing education.

    Science.gov (United States)

    Logan, Rebecca

    2012-04-01

    Educators today need innovative teaching strategies to meet the learning needs of the multigenerational population of perioperative nurses. Emerging technologies, such as YouTube, the world's largest video-sharing web site, can be used as a component of an active learning strategy that can appeal to a broad group of nurses along the novice-to-expert proficiency continuum. Using video clips can be a useful method to engage learners and promote critical thinking, decision making, and creativity. YouTube videos can be used to teach skills or as a platform for discussion. Learners also can create and upload their own videos to educate others. Increased engagement and active learning can lead the perioperative nurse to a deeper understanding of the educational material. Copyright © 2012 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  10. Emerging Risk Factors and Prevention of Perioperative Pulmonary Complications

    Directory of Open Access Journals (Sweden)

    Priyanka Bhateja

    2014-01-01

    Full Text Available Modern surgery is faced with the emergence of newer “risk factors” and the challenges associated with identifying and managing these risks in the perioperative period. Obstructive sleep apnea and obesity hypoventilation syndrome pose unique challenges in the perioperative setting. Recent studies have identified some of the specific risks arising from caring for such patients in the surgical setting. While all possible postoperative complications are not yet fully established or understood, the prevention and management of these complications pose even greater challenges. Pulmonary hypertension with its changing epidemiology and novel management strategies is another new disease for the surgeon and the anesthesiologist in the noncardiac surgical setting. Traditionally most such patients were not considered surgical candidates for any required elective surgery. Our review discusses these disease entities which are often undiagnosed before elective noncardiac surgery.

  11. Validation of computerized sniffer for monitoring perioperative normothermia.

    Science.gov (United States)

    Giri, Jyothsna; Li, Man; Pickering, Brian; Subramanian, Arun; Kor, Daryl J; Herasevich, Vitaly

    2013-01-01

    The World Health Organization sets a standard to maintain patient core temperature greater than 36°C throughout the perioperative period. Normothermia (defined as >36°C) in the Operating Room (OR) is an important factor to preventing complications in patients (MI, infection, coagulopathy). Randomized studies suggests that maintaining at higher temperatures may further reduce complications in surgery (less complications for group at 36.4°C than the control group at 36.0°C) [1,2]. Perioperative normothermia is an important but often unrecognized element during anesthesia. Early recognition of hypothermia would allow for appropriate interventions and prevent complications. Manual validation of the diagnostic performance a clinical tool (alert) that would automatically measure changes in core temperature to identify patients who fail to be in range of normothermia during surgery. The clinical tool (alert) was found to be 97 % sensitive.

  12. Fluid therapy in the perioperative setting-a clinical review

    DEFF Research Database (Denmark)

    Voldby, Anders Winther; Brandstrup, Birgitte

    2016-01-01

    BACKGROUND: Perioperative hypovolemia and fluid overload have effects on both complications following surgery and on patient survival. Therefore, the administration of intravenous fluids before, during, and after surgery at the right time and in the right amounts is of great importance. This review...... aims to analyze the literature concerning perioperative fluid therapy in abdominal surgery and to provide evidence-based recommendations for clinical practice. RESULTS: Preoperative oral or intravenous administration of carbohydrate containing fluids has been shown to improve postoperative well...... for most patients. It is less expensive and simpler than the zero-balance GDT approach and therefore recommended in this review. In outpatient surgery, 1-2 L of balanced crystalloids reduces postoperative nausea and vomiting and improves well-being....

  13. Technological advances in perioperative monitoring: Current concepts and clinical perspectives.

    Science.gov (United States)

    Chilkoti, Geetanjali; Wadhwa, Rachna; Saxena, Ashok Kumar

    2015-01-01

    Minimal mandatory monitoring in the perioperative period recommended by Association of Anesthetists of Great Britain and Ireland and American Society of Anesthesiologists are universally acknowledged and has become an integral part of the anesthesia practice. The technologies in perioperative monitoring have advanced, and the availability and clinical applications have multiplied exponentially. Newer monitoring techniques include depth of anesthesia monitoring, goal-directed fluid therapy, transesophageal echocardiography, advanced neurological monitoring, improved alarm system and technological advancement in objective pain assessment. Various factors that need to be considered with the use of improved monitoring techniques are their validation data, patient outcome, safety profile, cost-effectiveness, awareness of the possible adverse events, knowledge of technical principle and ability of the convenient routine handling. In this review, we will discuss the new monitoring techniques in anesthesia, their advantages, deficiencies, limitations, their comparison to the conventional methods and their effect on patient outcome, if any.

  14. Perioperative Outcome of Dyssomnia Patients on Chronic Methylphenidate Use

    Directory of Open Access Journals (Sweden)

    Nicoleta Stoicea MD, PhD

    2014-01-01

    Full Text Available Methylphenidate is frequently prescribed for attention deficit hyperactivity disorder, narcolepsy, and other sleep disorders requiring psychostimulants. Our report is based on 2 different clinical experiences of patients with chronic methylphenidate use, undergoing general anesthesia. These cases contrast different strategies of taking versus withholding the drug treatment on the day of surgery. From the standpoint of anesthetic management and patient safety, the concerns for perioperative methylphenidate use are mainly related to cardiovascular stability and possible counteraction of sedatives and anesthetics.

  15. Ontology-based specification, identification and analysis of perioperative risks.

    Science.gov (United States)

    Uciteli, Alexandr; Neumann, Juliane; Tahar, Kais; Saleh, Kutaiba; Stucke, Stephan; Faulbrück-Röhr, Sebastian; Kaeding, André; Specht, Martin; Schmidt, Tobias; Neumuth, Thomas; Besting, Andreas; Stegemann, Dominik; Portheine, Frank; Herre, Heinrich

    2017-09-06

    Medical personnel in hospitals often works under great physical and mental strain. In medical decision-making, errors can never be completely ruled out. Several studies have shown that between 50 and 60% of adverse events could have been avoided through better organization, more attention or more effective security procedures. Critical situations especially arise during interdisciplinary collaboration and the use of complex medical technology, for example during surgical interventions and in perioperative settings (the period of time before, during and after surgical intervention). In this paper, we present an ontology and an ontology-based software system, which can identify risks across medical processes and supports the avoidance of errors in particular in the perioperative setting. We developed a practicable definition of the risk notion, which is easily understandable by the medical staff and is usable for the software tools. Based on this definition, we developed a Risk Identification Ontology (RIO) and used it for the specification and the identification of perioperative risks. An agent system was developed, which gathers risk-relevant data during the whole perioperative treatment process from various sources and provides it for risk identification and analysis in a centralized fashion. The results of such an analysis are provided to the medical personnel in form of context-sensitive hints and alerts. For the identification of the ontologically specified risks, we developed an ontology-based software module, called Ontology-based Risk Detector (OntoRiDe). About 20 risks relating to cochlear implantation (CI) have already been implemented. Comprehensive testing has indicated the correctness of the data acquisition, risk identification and analysis components, as well as the web-based visualization of results.

  16. Anticipatory vigilance: A grounded theory study of minimising risk within the perioperative setting.

    Science.gov (United States)

    O'Brien, Brid; Andrews, Tom; Savage, Eileen

    2018-01-01

    To explore and explain how nurses minimise risk in the perioperative setting. Perioperative nurses care for patients who are having surgery or other invasive explorative procedures. Perioperative care is increasingly focused on how to improve patient safety. Safety and risk management is a global priority for health services in reducing risk. Many studies have explored safety within the healthcare settings. However, little is known about how nurses minimise risk in the perioperative setting. Classic grounded theory. Ethical approval was granted for all aspects of the study. Thirty-seven nurses working in 11 different perioperative settings in Ireland were interviewed and 33 hr of nonparticipant observation was undertaken. Concurrent data collection and analysis was undertaken using theoretical sampling. Constant comparative method, coding and memoing and were used to analyse the data. Participants' main concern was how to minimise risk. Participants resolved this through engaging in anticipatory vigilance (core category). This strategy consisted of orchestrating, routinising and momentary adapting. Understanding the strategies of anticipatory vigilance extends and provides an in-depth explanation of how nurses' behaviour ensures that risk is minimised in a complex high-risk perioperative setting. This is the first theory situated in the perioperative area for nurses. This theory provides a guide and understanding for nurses working in the perioperative setting on how to minimise risk. It makes perioperative nursing visible enabling positive patient outcomes. This research suggests the need for training and education in maintaining safety and minimising risk in the perioperative setting. © 2017 John Wiley & Sons Ltd.

  17. Assessment of diagnosing metastatic bone tumor on T2*-weighted images. Comparison between turbo spin echo (TSE) method and gradient echo (GE) method

    International Nuclear Information System (INIS)

    Hayashi, Takahiko; Sugiyama, Akira; Katayama, Motoyuki

    1996-01-01

    We examined the usefulness of T2 * weighted gradient field echo images for diagnosis for metastatic bone tumors in comparison with T2 weighted turbo spin echo (fast spin echo) images. In T2 * weighted gradient field echo sequence to obtain maximum contrast-to-noise ratio (CNR), we experimentally manipulated flip angle (FA) (5deg-90deg), repetition time (TR) (400, 700 msec), and echo time (TE) (10-50 msec). The best CNR was 16.4 in fast low angle shot (FLASH) (TE: 24 msec, TR: 700 msec, FA: 40deg). Magnetic resonance imaging was carried out in 28 patients with metastatic bone tumors. In addition to conventional T1 weighted spin echo images, T2 weighted turbo spin echo (fast spin echo images) and T2 * weighted gradient field echo images were obtained. T2 * weighted gradient field echo images were superior to T2 weighted turbo spin echo (fast spin echo) images in delineating the tumors, adjacent fat tissues, and bone marrow. (author)

  18. [Croatian guidelines for perioperative enteral nutrition of surgical patients].

    Science.gov (United States)

    Zelić, Marko; Bender, Darija Vranesić; Kelecić, Dina Ljubas; Zupan, Zeljko; Cicvarić, Tedi; Maldini, Branka; Durut, Iva; Rahelić, Velimir; Skegro, Mate; Majerović, Mate; Perko, Zdravko; Sustić, Alan; Madzar, Tomislav; Kovacić, Borna; Kekez, Tihomir; Krznarić, Zeljko

    2014-01-01

    Nutritional status of patients significantly affects the outcome of surgical treatment, whether it's about being obese or malnutrition with loss of muscle mass. Inadequate nutritional support in the perioperative period compromises surgical procedures even in patients who are adequately nourished. In this paper, particular attention was paid to malnourished patients, and their incidence in population hospitalized in surgical wards can be high up to 30%. Special emphasis was paid to the appropriateness of preoperative fasting and to the acceptance of new knowledge in this area of treatment. The aim of this working group was to make guidelines for perioperative nutritional support with different modalities of enteral nutrition. The development of these guidelines was attended by representatives of Croatian Medical Association: Croatian Society for Digestive Surgery, Croatian Society for Clinical Nutrition, Croatian Society of Surgery, Croatian Society for Endoscopic Surgery, Croatian Trauma Society and the Croatian Society of Anesthesiology and Intensive Care. The guidelines are designed as a set of questions that arise daily in clinical practice when preparing patients for surgery and after the surgical treatment, which relate to the assessment of nutritional status, perioperative nutritional support, duration of preoperative fasting period and the selection of food intake route. Assessment of nutritional status and the use of different modes of enteral nutrition should enter into standard protocols of diagnosis and treatment in the Croatian hospitals.

  19. Nutrition in peri-operative esophageal cancer management.

    Science.gov (United States)

    Steenhagen, Elles; van Vulpen, Jonna K; van Hillegersberg, Richard; May, Anne M; Siersema, Peter D

    2017-07-01

    Nutritional status and dietary intake are increasingly recognized as essential areas in esophageal cancer management. Nutritional management of esophageal cancer is a continuously evolving field and comprises an interesting area for scientific research. Areas covered: This review encompasses the current literature on nutrition in the pre-operative, peri-operative, and post-operative phases of esophageal cancer. Both established interventions and potential novel targets for nutritional management are discussed. Expert commentary: To ensure an optimal pre-operative status and to reduce peri-operative complications, it is key to assess nutritional status in all pre-operative esophageal cancer patients and to apply nutritional interventions accordingly. Since esophagectomy results in a permanent anatomical change, a special focus on nutritional strategies is needed in the post-operative phase, including early initiation of enteral feeding, nutritional interventions for post-operative complications, and attention to long-term nutritional intake and status. Nutritional aspects of pre-optimization and peri-operative management should be incorporated in novel Enhanced Recovery After Surgery programs for esophageal cancer.

  20. Perioperative care following complex laryngotracheal reconstruction in infants and children

    Directory of Open Access Journals (Sweden)

    Gupta Punkaj

    2010-01-01

    Full Text Available Laryngotracheal reconstruction (LTR involves surgical correction of a stenotic airway with cartilage interpositional grafting, followed by either placement of a tracheostomy and an intraluminal stent (two-stage LTR or placement of an endotracheal tube with postoperative sedation and mechanical ventilation for an extended period of time (single-stage LTR. With single-stage repair, there may be several perioperative challenges including the provision of adequate sedation, avoidance of the development of tolerance to sedative and analgesia agents, the need to use neuromuscular blocking agents, the maintenance of adequate pulmonary toilet to avoid perioperative nosocomial infections, and optimization of postoperative respiratory function to facilitate successful tracheal extubation. We review the perioperative management of these patients, discuss the challenges during the postoperative period, and propose recommendations for the prevention of reversible causes of extubation failure in this article. Optimization to ensure a timely tracheal extubation and successful weaning of mechanical ventilator, remains the primary key to success in these surgeries as extubation failure or the need for prolonged postoperative mechanical ventilation can lead to failure of the graft site, the need for prolonged Pediatric Intensive Care Unit care, and in some cases, the need for a tracheostomy to maintain an adequate airway.

  1. A Systematic Approach to Creation of a Perioperative Data Warehouse.

    Science.gov (United States)

    Hofer, Ira S; Gabel, Eilon; Pfeffer, Michael; Mahbouba, Mohammed; Mahajan, Aman

    2016-06-01

    Extraction of data from the electronic medical record is becoming increasingly important for quality improvement initiatives such as the American Society of Anesthesiologists Perioperative Surgical Home. To meet this need, the authors have built a robust and scalable data mart based on their implementation of EPIC containing data from across the perioperative period. The data mart is structured in such a way so as to first simplify the overall EPIC reporting structure into a series of Base Tables and then create several Reporting Schemas each around a specific concept (operating room cases, obstetrics, hospital admission, etc.), which contain all of the data required for reporting on various metrics. This structure allows centralized definitions with simplified reporting by a large number of individuals who access only the Reporting Schemas. In creating the database, the authors were able to significantly reduce the number of required table identifiers from >10 to 3, as well as to correct errors in linkages affecting up to 18.4% of cases. In addition, the data mart greatly simplified the code required to extract data, making the data accessible to individuals who lacked a strong coding background. Overall, this infrastructure represents a scalable way to successfully report on perioperative EPIC data while standardizing the definitions and improving access for end users.

  2. Risk Factors for Perioperative Complications in Endoscopic Surgery with Irrigation

    Directory of Open Access Journals (Sweden)

    João Manoel Silva, Jr.

    2013-07-01

    Full Text Available Background and objectives: Currently, endoscopic medicine is being increasingly used, albeit not without risks. Therefore, this study evaluated the factors associated with perioperative complications in endoscopic surgery with intraoperative irrigation. Method: A cohort study of six months duration. Patients aged ≥ 18 years undergoing endoscopic surgery with the use of irrigation fluids during the intraoperative period were included. Exclusion criteria were: use of diuretics, kidney failure, cognitive impairment, hyponatremia prior to surgery, pregnancy, and critically ill. The patients who presented with or without complications during the perioperative period were allocated into two groups. Complications evaluated were related to neurological, cardiovascular and renal changes, and perioperative bleeding. Results: In total, 181 patients were enrolled and 39 excluded; therefore, 142 patients met the study criteria. Patients with complications amounted to 21.8%, with higher prevalence in endoscopic prostate surgery, followed by hysteroscopy, bladder, knee, and shoulder arthroscopy (58.1%, 36.9%, 19.4%, 3.8%, 3.2% respectively. When comparing both groups, we found association with complications in univariate analysis: age, sex, smoking, heart disease, ASA, serum sodium at the end of surgery, total irrigation fluid administered, TURP, and hysteroscopy. However, in multiple regression analysis for complications, only age (OR = 1.048, serum sodium (OR = 0.962, and volume of irrigation fluid administered during surgery (OR = 1.001 were independent variables. Keywords: Anesthesia, Endoscopy, Hyponatremia, Postoperative Complications, Risk Assessment, Risk Factors.

  3. Perioperative feedback in surgical training: A systematic review.

    Science.gov (United States)

    McKendy, Katherine M; Watanabe, Yusuke; Lee, Lawrence; Bilgic, Elif; Enani, Ghada; Feldman, Liane S; Fried, Gerald M; Vassiliou, Melina C

    2017-07-01

    Changes in surgical training have raised concerns about residents' operative exposure and preparedness for independent practice. One way of addressing this concern is by optimizing teaching and feedback in the operating room (OR). The objective of this study was to perform a systematic review on perioperative teaching and feedback. A systematic literature search identified articles from 1994 to 2014 that addressed teaching, feedback, guidance, or debriefing in the perioperative period. Data was extracted according to ENTREQ guidelines, and a qualitative analysis was performed. Thematic analysis of the 26 included studies identified four major topics. Observation of teaching behaviors in the OR described current teaching practices. Identification of effective teaching strategies analyzed teaching behaviors, differentiating positive and negative teaching strategies. Perceptions of teaching behaviors described resident and attending satisfaction with teaching in the OR. Finally models for delivering structured feedback cited examples of feedback strategies and measured their effectiveness. This study provides an overview of perioperative teaching and feedback for surgical trainees and identifies a need for improved quality and quantity of structured feedback. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Update on perioperative management of the child with asthma

    Directory of Open Access Journals (Sweden)

    Francesco Dones

    2012-04-01

    Full Text Available Asthma represents the leading cause of morbidity from a chronic disease among children. Dealing with this disease during the perioperative period of pediatric surgical procedures is, therefore, quite common for the anesthesiologist and other professionalities involved. Preoperative assessment has a key role in detecting children at increased risk of perioperative respiratory complications. For children without an optimal control of symptoms or with a recent respiratory tract infection elective surgery should be postponed, if possible, after the optimization of therapy. According to clinical setting, loco-regional anesthesia represents the desirable option since it allows to avoid airway instrumentation. Airway management goals are preventing the increase of airflow resistance during general anesthesia along with avoiding triggers of bronchospasm. When their use is possible, face mask ventilation and laringeal mask are considered more reliable than tracheal intubation for children with asthma. Sevoflurane is the most commonly used anesthetic for induction and manteinance. Salbutamol seems to be useful in preventing airflow resistance rise after endotracheal intubation. Mechanical ventilation should be tailored according to pathophysiology of asthma: an adequate expiratory time should be setted in order to avoid a positive end-expiratory pressure due to expiratory airflow obstruction. Pain should be prevented and promptly controlled with a loco-regional anesthesia technique when it is possible. Potential allergic reactions to drugs or latex should always be considered during the whole perioperative period. Creating a serene atmosphere should be adopted as an important component of interventions in order to guarantee the best care to the asthmatic child.

  5. X-ray shout echoing through space

    Science.gov (United States)

    2004-01-01

    a flash of X-rays hi-res Size hi-res: 3991 Kb Credits: ESA, S. Vaughan (University of Leicester) EPIC camera shows the expanding rings caused by a flash of X-rays XMM-Newton's X-ray EPIC camera shows the expanding rings caused by a flash of X-rays scattered by dust in our Galaxy. The X-rays were produced by a powerful gamma-ray burst that took place on 3 December 2003. The slowly fading afterglow of the gamma-ray burst is at the centre of the expanding rings. Other, unrelated, X-ray sources can also be seen. The time since the gamma-ray explosion is shown in each panel in hours. At their largest size, the rings would appear in the sky about five times smaller than the full moon. a flash of X-rays hi-res Size hi-res: 2153 Kb Credits: ESA, S. Vaughan (University of Leicester) EPIC camera shows the expanding rings caused by a flash of X-rays (Please choose "hi-res" version for animation) XMM-Newton's X-ray EPIC camera shows the expanding rings caused by a flash of X-rays scattered by dust in our Galaxy. The X-rays were produced by a powerful gamma-ray burst that took place on 3 December 2003. The slowly fading afterglow of the gamma-ray burst is at the centre of the expanding rings. Other, unrelated, X-ray sources can also be seen. The time since the gamma-ray explosion is shown in each panel in seconds. At their largest size, the rings would appear in the sky about five times smaller than the full moon. This echo forms when the powerful radiation of a gamma-ray burst, coming from far away, crosses a slab of dust in our Galaxy and is scattered by it, like the beam of a lighthouse in clouds. Using the expanding rings to precisely pin-point the location of this dust, astronomers can identify places where new stars and planets are likely to form. On 3 December 2003 ESA's observatory, Integral, detected a burst of gamma rays, lasting about 30 seconds, from the direction of a distant galaxy. Within minutes of the detection, thanks to a sophisticated alert network, many

  6. E-region echo characteristics governed by auroral arc electrodynamics

    Directory of Open Access Journals (Sweden)

    S. E. Milan

    Full Text Available Observations of a pair of auroral arc features by two imagers, one ground- and one space-based, allows the associated field-aligned current (FAC and electric field structure to be inferred. Simultaneous observations of HF radar echoes provide an insight into the irregularity-generating mechanisms. This is especially interesting for the E-region echoes observed, which form the focus of our analysis, and from which several conclusions can be drawn, summarized as follows. Latitudinal variations in echo characteristics are governed by the FAC and electric field background. Particularly sharp boundaries are found at the edges of auroral arcs. Within regions of auroral luminosity, echoes have Doppler shifts below the ion-acoustic speed and are proportional to the electric field, suggesting scatter from gradient drift waves. Regions of downward FAC are associated with mixed high and low Doppler shift echoes. The high Doppler shift component is greatly in excess of the ion-acoustic speed, but seems to be commensurate with the driving electric field. The low Doppler shift component appears to be much depressed below expectations.

    Key words. Ionosphere (ionospheric irregularities; electric fields and currents

  7. Dynamic rayed aurora and enhanced ion-acoustic radar echoes

    Directory of Open Access Journals (Sweden)

    E. M. Blixt

    2005-01-01

    Full Text Available The generation mechanism for naturally enhanced ion-acoustic echoes is still debated. One important issue is how these enhancements are related to auroral activity. All events of enhanced ion-acoustic echoes observed simultaneously with the EISCAT Svalbard Radar (ESR and with high-resolution narrow field-of-view auroral imagers have been collected and studied. Characteristic of all the events is the appearance of very dynamic rayed aurora, and some of the intrinsic features of these auroral displays are identified. Several of these identified features are directly related to the presence of low energy (10-100eV precipitating electrons in addition to the higher energy population producing most of the associated light. The low energy contribution is vital for the formation of the enhanced ion-acoustic echoes. We argue that this type of aurora is sufficient for the generation of naturally enhanced ion-acoustic echoes. In one event two imagers were used to observe the auroral rays simultaneously, one from the radar site and one 7km away. The data from these imagers shows that the auroral rays and the strong backscattering filaments (where the enhanced echoes are produced are located on the same field line, which is in contrast to earlier statements in the litterature that they should be separated.

  8. E-region echo characteristics governed by auroral arc electrodynamics

    Directory of Open Access Journals (Sweden)

    S. E. Milan

    2003-07-01

    Full Text Available Observations of a pair of auroral arc features by two imagers, one ground- and one space-based, allows the associated field-aligned current (FAC and electric field structure to be inferred. Simultaneous observations of HF radar echoes provide an insight into the irregularity-generating mechanisms. This is especially interesting for the E-region echoes observed, which form the focus of our analysis, and from which several conclusions can be drawn, summarized as follows. Latitudinal variations in echo characteristics are governed by the FAC and electric field background. Particularly sharp boundaries are found at the edges of auroral arcs. Within regions of auroral luminosity, echoes have Doppler shifts below the ion-acoustic speed and are proportional to the electric field, suggesting scatter from gradient drift waves. Regions of downward FAC are associated with mixed high and low Doppler shift echoes. The high Doppler shift component is greatly in excess of the ion-acoustic speed, but seems to be commensurate with the driving electric field. The low Doppler shift component appears to be much depressed below expectations.Key words. Ionosphere (ionospheric irregularities; electric fields and currents

  9. Faraday rotation echo spectroscopy and detection of quantum fluctuations.

    Science.gov (United States)

    Chen, Shao-Wen; Liu, Ren-Bao

    2014-04-15

    Central spin decoherence is useful for detecting many-body physics in environments and moreover, the spin echo control can remove the effects of static thermal fluctuations so that the quantum fluctuations are revealed. The central spin decoherence approach, however, is feasible only in some special configurations and often requires uniform coupling between the central spin and individual spins in the baths, which are very challenging in experiments. Here, by making analogue between central spin decoherence and depolarization of photons, we propose a scheme of Faraday rotation echo spectroscopy (FRES) for studying quantum fluctuations in interacting spin systems. The echo control of the photon polarization is realized by flipping the polarization with a birefringence crystal. The FRES, similar to spin echo in magnetic resonance spectroscopy, can suppress the effects of the static magnetic fluctuations and therefore reveal dynamical magnetic fluctuations. We apply the scheme to a rare-earth compound LiHoF4 and calculate the echo signal, which is related to the quantum fluctuations of the system. We observe enhanced signals at the phase boundary. The FRES should be useful for studying quantum fluctuations in a broad range of spin systems, including cold atoms, quantum dots, solid-state impurities, and transparent magnetic materials.

  10. Musculoskeletal Problems Among Greek Perioperative Nurses in Regional Hospitals in Southern Peloponnese : Musculoskeletal Problems in Perioperative Nurses.

    Science.gov (United States)

    Bakola, Helen; Zyga, Sofia; Stergioulas, Apostolos; Kipreos, George; Panoutsopoulos, George

    2017-01-01

    The surgery unit is a particularly labor-intensive environment in the hospital. Studies reflect the correlation of labor risk factors for musculoskeletal injuries among nurses but few have investigated the relationship to perioperative nurses. The purpose of this study is the identification and definition of ergonomic risk factors in the operating room and their connection with musculoskeletal disorders in perioperative nurses in regional hospitals in Greece. Forty four Greek perioperative nurses working in regional hospitals in southern Peloponnese participated. Anonymous self-administered questionnaire was used to collect the data, which consisted of three parts (investigating musculoskeletal symptoms, description of work, psychometric evaluation). The analysis was done with the statistical program SPSS.19. Symptoms of musculoskeletal problems emerged. Specifically, 54.4% in the lumbar, 47.7% in the neck, 45.5% in the shoulder, followed by smaller percentages of the hip, knee, elbow and ankle. 6.8% of participants indicated no musculoskeletal symptoms in the last year while 74.9% of those who had symptoms presented them in two or more areas. Activities rated as a major problem among others were the manual handling, tools with weight and vibration etc. 100% of respondents agreed that the work in the surgery unit is demanding and has anxiety. The lack of support from the government (81.8%), combined with the low perioperative nurses (6.8%) having the opportunity to participate in administrative decisions concerning them were related to problems in the organization and management of work. Apart from engineers target factors, a main aim should be the organization of work within the framework of a national policy based on European directives on the protection and promotion of the health and safety of workers.

  11. Importance of Perioperative Glycemic Control in General Surgery

    Science.gov (United States)

    Kwon, Steve; Thompson, Rachel; Dellinger, Patchen; Yanez, David; Farrohki, Ellen; Flum, David

    2014-01-01

    Objective To determine the relationship of perioperative hyperglycemia and insulin administration on outcomes in elective colon/rectal and bariatric operations. Background There is limited evidence to characterize the impact of perioperative hyperglycemia and insulin on adverse outcomes in patients, with and without diabetes, undergoing general surgical procedures. Methods The Surgical Care and Outcomes Assessment Program is a Washington State quality improvement benchmarking-based initiative. We evaluated the relationship of perioperative hyperglycemia (>180 mg/dL) and insulin administration on mortality, reoperative interventions, and infections for patients undergoing elective colorectal and bariatric surgery at 47 participating hospitals between fourth quarter of 2005 and fourth quarter of 2010. Results Of the 11,633 patients (55.4 ± 15.3 years; 65.7% women) with a serum glucose determination on the day of surgery, postoperative day 1, or postoperative day 2, 29.1% of patients were hyperglycemic. After controlling for clinical factors, those with hyperglycemia had a significantly increased risk of infection [odds ratio (OR) 2.0; 95% confidence interval (CI), 1.63–2.44], reoperative interventions (OR, 1.8; 95% CI, 1.41–2.3), and death (OR, 2.71; 95% CI, 1.72–4.28). Increased risk of poor outcomes was observed both for patients with and without diabetes. Those with hyperglycemia on the day of surgery who received insulin had no significant increase in infections (OR, 1.01; 95% CI, 0.72–1.42), reoperative interventions (OR, 1.29; 95% CI, 0.89–1.89), or deaths (OR, 1.21; 95% CI, 0.61–2.42). A dose-effect relationship was found between the effectiveness of insulin-related glucose control (worst 180–250 mg/dL, best adverse outcomes. Conclusions Perioperative hyperglycemia was associated with adverse outcomes in general surgery patients with and without diabetes. However, patients with hyperglycemia who received insulin were at no greater risk than

  12. Evidence utilisation project: Management of inadvertent perioperative hypothermia. The challenges of implementing best practice recommendations in the perioperative environment.

    Science.gov (United States)

    Munday, Judy; Hines, Sonia Jane; Chang, Anne M

    2013-12-01

    The prevention of inadvertent perioperative hypothermia (IPH) remains an important issue in perioperative healthcare. The aims of this project were to: (i) assess current clinical practice in the management of IPH and (ii) promote best practice in the management of IPH in adult operating theatres. This project from August 2010 to March 2012 utilised a system of audit and feedback to implement best practice recommendations. Data were collected via chart audits against criteria developed from best practice recommendations for managing IPH. Evidence-based best practices, such as consistent temperature monitoring and patient warming, were implemented using multifaceted interventions. Perioperative records for 73 patients (baseline) and 72 patients (post-implementation) were audited. Post-implementation audit showed an increase in patients with temperatures >36°C admitted to the post-anaesthetic care unit (PACU) (8%) and discharged from PACU (28%). The percentage of patients receiving preoperative temperature monitoring increased (38%); however, low levels of intraoperative monitoring remained (31% of patients with surgery of 30 min or longer duration). Small increases were found in patient warming of 5% intraoperatively and 8% postoperatively. Preoperative warming was not successfully implemented during this phase of the project. Temperature monitoring, warming and rates of normothermia improved; however, barriers to best practice of IPH management were experienced, which negatively impacted on the project. Further stages of implementation and audit were added to further address IPH management in this department. © 2013 The Authors. International Journal of Evidence-Based Healthcare © 2013 The Joanna Briggs Institute.

  13. Variable-flip-angle spin-echo imaging (VFSE)

    International Nuclear Information System (INIS)

    Kasai, Toshifumi; Sugimura, Kazuro; Kawamitsu, Hideaki; Yasui, Kiyoshi; Ishida, Tetsuya; Tsukamoto, Tetsuji.

    1990-01-01

    T 2 weighted imaging provides images with high object contrast for pathologic conditions in which the water content of tissues is increased. The authors predicted theoretical analysis of the effects of changing flip angle, and analyzed the effects in MR imaging of both phantoms and humans. Variable flip angle spin echo MR imaging (VFSE) with a 1,000/80 (repetition time msec/echo time msec) can obtain T 2 weighted image when flip angle is smaller than 80 degrees. VFSE with 40 to 60 degrees flip angle have higher contrast than other flip angle images. Signal to noise ratio (S/N) of VFSE are 55% at a 30 degree, 76% at a 45 degree, 92% at a 60 degree respectively as compared with conventional spin echo image (2000/80, flip angle 90 degree). VFSE is applicable to obtain T 2 weighted image reduced imaging time. (author)

  14. A spin echo study of A15 intermetallic compounds

    International Nuclear Information System (INIS)

    Schoep, G.K.

    1976-01-01

    This thesis mainly concerns the measurement of spin-lattice relaxation times in intermetallic compounds of the bcc lattice structure, having the formula V 3 X (C = Pt, Ir, Os, Pd, Rh, Ni, Co, Au). When, in a spin echo experiment, a two-pulse sequence was applied, several quadrupolar echoes were observed. Special attention is given to the 'forbidden' echoes (absol.(Δm')GT1) in V 3 Au and V 3 Co. In relation to the V 3 X compounds, several characteristics are discussed including temperature dependence and concentration dependence of spin relaxation times, superconductivity and the importance of d-state electrons in determination of the spin relaxation times. Finally, the above characteristics were determined for 6 different samples of the vanadium-gold alloy, V 3 Au, specifically

  15. Detection of generalized synchronization using echo state networks

    Science.gov (United States)

    Ibáñez-Soria, D.; Garcia-Ojalvo, J.; Soria-Frisch, A.; Ruffini, G.

    2018-03-01

    Generalized synchronization between coupled dynamical systems is a phenomenon of relevance in applications that range from secure communications to physiological modelling. Here, we test the capabilities of reservoir computing and, in particular, echo state networks for the detection of generalized synchronization. A nonlinear dynamical system consisting of two coupled Rössler chaotic attractors is used to generate temporal series consisting of time-locked generalized synchronized sequences interleaved with unsynchronized ones. Correctly tuned, echo state networks are able to efficiently discriminate between unsynchronized and synchronized sequences even in the presence of relatively high levels of noise. Compared to other state-of-the-art techniques of synchronization detection, the online capabilities of the proposed Echo State Network based methodology make it a promising choice for real-time applications aiming to monitor dynamical synchronization changes in continuous signals.

  16. Echo 7: Magnetospheric properties determined by artificial electron beams

    International Nuclear Information System (INIS)

    Nemzek, R.J.

    1990-01-01

    The sounding rocket Echo 7 was launched from the Poker Flat Research Range. An on-board accelerator injected high-power electron beams into the magnetospheric tail near L = 6.5. After mirroring at the southern conjugate point, about 20 percent of the initial beam electrons returned to the North as Conjugate Echoes, where detectors (scintillators and spectrometers) on four subpayloads measured their energy and bounce time. The other 80 percent of the beam was pitch angle diffused by wave near the equatorial plane either into the conjugate atmosphere or up to mirror points above the payload. Comparison of measured values to calculations showed that the actual magnetosphere during the flight was well-described by the Tsyganenko-Usmanov model magnetosphere with a Kp value of 2- or 2+. Analysis of echo energies yielded values for the highly variable magnetospheric convection electric field

  17. A computational model for biosonar echoes from foliage.

    Directory of Open Access Journals (Sweden)

    Chen Ming

    Full Text Available Since many bat species thrive in densely vegetated habitats, echoes from foliage are likely to be of prime importance to the animals' sensory ecology, be it as clutter that masks prey echoes or as sources of information about the environment. To better understand the characteristics of foliage echoes, a new model for the process that generates these signals has been developed. This model takes leaf size and orientation into account by representing the leaves as circular disks of varying diameter. The two added leaf parameters are of potential importance to the sensory ecology of bats, e.g., with respect to landmark recognition and flight guidance along vegetation contours. The full model is specified by a total of three parameters: leaf density, average leaf size, and average leaf orientation. It assumes that all leaf parameters are independently and identically distributed. Leaf positions were drawn from a uniform probability density function, sizes and orientations each from a Gaussian probability function. The model was found to reproduce the first-order amplitude statistics of measured example echoes and showed time-variant echo properties that depended on foliage parameters. Parameter estimation experiments using lasso regression have demonstrated that a single foliage parameter can be estimated with high accuracy if the other two parameters are known a priori. If only one parameter is known a priori, the other two can still be estimated, but with a reduced accuracy. Lasso regression did not support simultaneous estimation of all three parameters. Nevertheless, these results demonstrate that foliage echoes contain accessible information on foliage type and orientation that could play a role in supporting sensory tasks such as landmark identification and contour following in echolocating bats.

  18. Knowledge of appropriate blood product use in perioperative patients among clinicians at a tertiary hospital

    Directory of Open Access Journals (Sweden)

    Bradley Yudelowitz

    2016-12-01

    Conclusion: Clinician's knowledge of risks, resources, costs and ordering of blood products for perioperative patients is poor. Transfusion triggers and administration protocols had an acceptable correct response rate.

  19. Perioperative nursing for patients with diabetic foot receiving endovascular interventional therapy

    International Nuclear Information System (INIS)

    Yang Yang; Wang Feng; Li Ke; Li Cheng; Ji Donghua

    2010-01-01

    Objective: To study the effect of perioperative nursing on the living quality of patients with diabetic foot who are treated with endovascular interventional therapy. Methods: Specific perioperative nursing care plan was accordingly designed for 43 patients with diabetic foot. Endovascular balloon angioplasty and stent implantation were formed in these patients to treat their diabetic foot. The clinical results were observed. Results: Perioperative nursing effectively improved patient's limb blood supply, enhanced the healing of diabetic foot ulceration and increased the possibility of limb preservation. Conclusion: Endovascular therapy combined with corresponding perioperative nursing care can benefit more patients with diabetic foot. (authors)

  20. Piston cylinder cell for high pressure ultrasonic pulse echo measurements

    Energy Technology Data Exchange (ETDEWEB)

    Kepa, M. W., E-mail: mkepa@staffmail.ed.ac.uk; Huxley, A. D. [SUPA, Centre for Science at Extreme Conditions and School of Physics and Astronomy, University of Edinburgh, Edinburgh EH9 3JZ (United Kingdom); Ridley, C. J.; Kamenev, K. V. [Centre for Science at Extreme Conditions and School of Engineering, University of Edinburgh, Edinburgh EH9 3FD (United Kingdom)

    2016-08-15

    Ultrasonic techniques such as pulse echo, vibrating reed, or resonant ultrasound spectroscopy are powerful probes not only for studying elasticity but also for investigating electronic and magnetic properties. Here, we report on the design of a high pressure ultrasonic pulse echo apparatus, based on a piston cylinder cell, with a simplified electronic setup that operates with a single coaxial cable and requires sample lengths of mm only. The design allows simultaneous measurements of ultrasonic velocities and attenuation coefficients up to a pressure of 1.5 GPa. We illustrate the performance of the cell by probing the phase diagram of a single crystal of the ferromagnetic superconductor UGe{sub 2}.

  1. A short TE gradient-echo sequence using asymmetric sampling

    International Nuclear Information System (INIS)

    Fujita, Norihiko; Harada, Kohshi; Sakurai, Kosuke; Nakanishi, Katsuyuki; Kim, Shyogen; Kozuka, Takahiro

    1990-01-01

    We have developed a gradient-echo pulse sequence with a short TE less than 4 msec using a data set of asymmetric off-center sampling with a broad bandwidth. The use of such a short TE significantly reduces T 2 * dephasing effect even in a two-dimensional mode, and by collecting an off-center echo, motion-induced phase dispersion is also considerably decreased. High immunity of this sequence to these dephasing effects permits clear visualization of anatomical details near the skull base where large local field inhomogeneities and rapid blood flow such as in the internal carotid artery are present. (author)

  2. Observation of the geometric phase using photon echoes

    International Nuclear Information System (INIS)

    Tian, Mingzhen; Reibel, Randy R.; Barber, Zeb W.; Fischer, Joe A.; Babbitt, Wm. Randall

    2003-01-01

    The geometric phase of an atomic system has been observed in V-type three-level barium atoms using photon echoes. The geometric phase results from a cyclic evolution of a two-level subsystem driven by a laser pulse. The phase change is observed on the echo field produced on a different subsystem that is coupled via the ground state to the driven subsystem. The measured geometric phase was half of the solid angle subtended by the Bloch vector along the driven evolution circuit. This evolution has the potential to form universal operations of quantum bits

  3. MPD model for radar echo signal of hypersonic targets

    Directory of Open Access Journals (Sweden)

    Xu Xuefei

    2014-08-01

    Full Text Available The stop-and-go (SAG model is typically used for echo signal received by the radar using linear frequency modulation pulse compression. In this study, the authors demonstrate that this model is not applicable to hypersonic targets. Instead of SAG model, they present a more realistic echo signal model (moving-in-pulse duration (MPD for hypersonic targets. Following that, they evaluate the performances of pulse compression under the SAG and MPD models by theoretical analysis and simulations. They found that the pulse compression gain has an increase of 3 dB by using the MPD model compared with the SAG model in typical cases.

  4. Robot-assisted partial nephrectomy for hilar tumors: perioperative outcomes.

    Science.gov (United States)

    Eyraud, Rémi; Long, Jean-Alexandre; Snow-Lisy, Devon; Autorino, Riccardo; Hillyer, Shahab; Klink, Joseph; Rizkala, Emad; Stein, Robert J; Kaouk, Jihad H; Haber, Georges-Pascal

    2013-06-01

    To compare perioperative outcomes of robot-assisted partial nephrectomy (RAPN) for hilar vs nonhilar tumors. The study retrospectively reviewed 364 patients with available computed tomography scans undergoing RAPN. Demographic data and perioperative outcomes results were compared between the hilar (group 1, n = 70) and nonhilar tumors (group 2, n = 294). Multivariate analysis was used to identify predictors of warm ischemia time (WIT), estimated blood loss (EBL), major perioperative complications, and postoperative renal function. There were no differences with respect to demographic variables. Hilar tumors had higher RENAL (radius, exophytic/endophytic properties of the tumor, nearness of tumor deepest portion to the collecting system or sinus, anterior/posterior descriptor and the location relative to polar lines) scores (P hilar tumors were associated with greater operative time (210 vs 180 minutes, P hilar vs nonhilar patients on postoperative day 3 (70.12 vs 74.71 mL/min/1.73 m(2), P = .31) or at last follow-up (72.62 vs 75.78 mL/min/1.73 m(2), P = .40), respectively. Multivariate analysis found hilar location was independently associated with increased WIT without significant changes in EBL, major complications, or postoperative renal function. RAPN represents a safe and effective procedure for hilar tumors. Hilar location for patients undergoing RAPN in a high-volume institution seems not be associated with an increased risk of transfusions, major complications, or decline of early postoperative renal function. Copyright © 2013 Elsevier Inc. All rights reserved.

  5. The Efficacy of Perioperative Antibiotic Therapy in Tonsillectomy Patients.

    Science.gov (United States)

    Orłowski, Krzysztof; Lisowska, Grażyna; Misiołek, Hanna; Paluch, Zbigniew; Misiołek, Maciej

    2016-01-01

    While the results of early research suggested that perioperative antibiotic prophylaxis in tonsillectomy patients is associated with many benefits, these data were not confirmed by further studies and meta-analyses. The aim of this study was to investigate the usefulness and efficacy of antibiotic monotherapy in the healing of surgical wounds of patients undergoing bilateral resection of the palatine tonsils, based on an analysis of selected objective and subjective characteristics of wound healing during the postoperative period. The study included 50 men and women who underwent routine resection of the palatine tonsils. The patients were randomized into two groups: Group I, undergoing tonsillectomy with cefuroxime prophylaxis (n = 25), and Group II, who were not given perioperative antibiotic therapy (n = 25). The severity of signs and complaints recorded on postoperative days 1-10 was scored on 3- and 10-item scales. The only significant intergroup differences pertained to problems with swallowing food and fluids on postoperative days 4-6, 8 and 9 (less prevalent in Group II), postoperative use of analgesics on postoperative day 9 (less frequent in Group II), the degree of mucosal swelling in the operated area on postoperative days 3 and 7 (less severe in Group II), and the amount of fibrin covering the tonsillar niches on the third postoperative day (significantly higher in Group I). The administration of antibiotics for prevention or control of infection should be preceded by a comprehensive analysis of the potential benefits and risks. Perioperative use of antibiotics is justified only in selected cases, i.e. in individuals with comorbidities.

  6. Cardiac T2-mapping using a fast gradient echo spin echo sequence - first in vitro and in vivo experience

    OpenAIRE

    Baessler, Bettina; Schaarschmidt, Frank; Stehning, Christian; Schnackenburg, Bernhard; Maintz, David; Bunck, Alexander C.

    2015-01-01

    Background: The aim of this study was the evaluation of a fast Gradient Spin Echo Technique (GraSE) for cardiac T2-mapping, combining a robust estimation of T2 relaxation times with short acquisition times. The sequence was compared against two previously introduced T2-mapping techniques in a phantom and in vivo. Methods: Phantom experiments were performed at 1.5 T using a commercially available cylindrical gel phantom. Three different T2-mapping techniques were compared: a Multi Echo Spin Ec...

  7. Comparison of gradient-recalled echo and spin-echo echo-planar imaging MR elastography in staging liver fibrosis. A meta-analysis

    International Nuclear Information System (INIS)

    Kim, Yong Seek; Jang, Yu Na; Song, Ji Soo

    2018-01-01

    To compare the diagnostic performance of gradient-recalled echo-based magnetic resonance elastography (GRE-MRE) and spin-echo echo-planar imaging-based MRE (SE-EPI-MRE) in liver fibrosis staging. A systematic literature search was performed to identify studies involving the performance of MRE for the diagnosis of liver fibrosis. Pooled sensitivity, specificity, positive and negative likelihood ratios, the diagnostic odds ratio, and a summary receiver operating characteristic (ROC) curve were estimated by using a bivariate random effects model. Subgroup analyses were performed between different study characteristics. Twenty-six studies with a total of 3,200 patients were included in the meta-analysis. Pooled sensitivity and specificity of GRE-MRE and SE-EPI-MRE did not differ significantly. The area under the summary ROC curve for stage diagnosis of any (F ≥ 1), significant (F ≥ 2), advanced (F ≥ 3), and cirrhosis (F = 4) on GRE-MRE and SE-EPI-MRE were 0.93 versus 0.94, 0.95 versus 0.94, 0.94 versus 0.95, and 0.92 versus 0.93, respectively. Substantial heterogeneity was detected for both sequences. Both GRE and SE-EPI-MRE show high sensitivity and specificity for detection of each stage of liver fibrosis, without significant differences. Magnetic resonance elastography (MRE) may be useful for noninvasive evaluation of liver fibrosis in chronic liver disease. (orig.)

  8. Severe antiphospholipid syndrome and cardiac surgery: Perioperative management.

    Science.gov (United States)

    Mishra, Pankaj Kumar; Khazi, Fayaz Mohammed; Yiu, Patrick; Billing, John Stephen

    2016-06-01

    Antiphospholipid syndrome is an antiphospholipid antibody-mediated prothrombotic state leading to arterial and venous thrombosis. This condition alters routine in-vitro coagulation tests, making results unreliable. Antiphospholipid syndrome patients requiring cardiac surgery with cardiopulmonary bypass present a unique challenge in perioperative anticoagulation management. We describe 3 patients with antiphospholipid syndrome who had successful heart valve surgery at our institution. We have devised an institutional protocol for antiphospholipid syndrome patients, and all 3 patients were managed according to this protocol. An algorithm-based approach is recommended because it improves team work, optimizes treatment, and improves patient outcome. © The Author(s) 2015.

  9. Perioperative Care of the Patient With the Total Artificial Heart.

    Science.gov (United States)

    Yaung, Jill; Arabia, Francisco A; Nurok, Michael

    2017-05-01

    Advanced heart failure continues to be a leading cause of morbidity and mortality despite improvements in pharmacologic therapy. High demand for cardiac transplantation and shortage of donor organs have led to an increase in the utilization of mechanical circulatory support devices. The total artificial heart is an effective biventricular assist device that may be used as a bridge to transplant and that is being studied for destination therapy. This review discusses the history, indications, and perioperative management of the total artificial heart with emphasis on the postoperative concerns.

  10. Seafloor characterisation using echo peak amplitudes of multibeam hydrosweep system - A preliminary study at Arabian Sea

    Digital Repository Service at National Institute of Oceanography (India)

    Chakraborty, B.; Sudhakar, T.

    In this paper an interface to acquire 59-beams echo peak amplitudes of the Hydrosweep Multibeam system is established. The echo peak amplitude values collected at varying seabed provinces of Arabian sea are presented. The study reveals...

  11. 31P NMR imaging of solid bone with solid echoes combined with refocused gradients

    International Nuclear Information System (INIS)

    Li, L.; Utah Univ., Salt Lake City, UT; Kruger, R.A.

    1990-01-01

    This note on 31 p NMR imaging presents some observations of the solid echoes acquired from solid bone and how the proposed solid echo imaging method can be employed to obtain the 31 images of solid bone. (UK)

  12. Correction of echo shift in reconstruction processing for ultra-short TE pulse sequence

    International Nuclear Information System (INIS)

    Takizawa, Masahiro; Ootsuka, Takehiro; Abe, Takayuki; Takahashi, Tetsuhiko

    2010-01-01

    An ultra-short echo time (TE) pulse sequence is composed of a radial sampling that acquires echo signals radially in the K-space and a half-echo acquisition that acquires only half of the echo signal. The shift in the position of the echo signal (echo shift) caused by the timing errors in the gradient magnetic field pulses affects the image quality in the radial sampling with the half-echo acquisition. To improve image quality, we have developed a signal correction algorithm that detects and eliminates this echo shift during reconstruction by performing a pre-scan within 10 seconds. The results showed that image quality is improved under oblique and/or off-centering conditions that frequently cause image distortion due to hardware error. In conclusion, we have developed a robust ultra-short TE pulse sequence that allows wide latitude in the scan parameters, including oblique and off-centering conditions. (author)

  13. Edward Albee’s The Zoo Story: Echo/es of Contemporary Subversive Culture

    Directory of Open Access Journals (Sweden)

    Naqibun Nabi

    2016-02-01

    Full Text Available The post-world war II American social and cultural setting was ambiguously featured with enforced conformity in the name of prosperity and Americanization of the nation. Despite of this fact, American writers, especially, dramatists conveyed their message against this fixation through variety and intellectuality. Edward Albee’s The Zoo Story is one of those literary assets which dedicatedly cut through the illusions of contemporary American social and cultural ethos. Here, his characters are seen struggling constantly with their insecurities and existential angst in the society. He presents America, the so-called ‘Land of Free and Home of Braves’ (note 1, in such a portrayal that unveils the traps of cages and confinement underneath. The target of this paper is to trace Edward Albee’s heightened awareness about the post-war American socio-cultural reality evident in The Zoo Story. It also looks for the voice in which the text echoes out the anti-communist, materialistic, gender-coded boundaries, coupled with paradoxical media representations, religious bordering and how Albee challenges these issues with an anti-establishment tone. Keywords: subversive culture, anti-communism, media, religion and homosexuality

  14. Infrared photon-echo spectroscopy of water : The thermalization effects

    NARCIS (Netherlands)

    Pshenichnikov, Maxim S.; Yeremenko, Sergey; Wiersma, Douwe A.; Kobayashi, Takayoshi; Kobayashi, Tetsuro; Nelson, Keith A.; Okada, Tadashi; Silvestri, Sandro De

    2005-01-01

    The larger part of the nonlinear response in IR photon-echo and transient-grating spectroscopy on HDO-D2O mixtures at > 1-ps delays is found to originate from the D2O refractive index modulation due to local volume thermalization.

  15. Characterization of trehalose aqueous solutions by neutron spin echo

    Energy Technology Data Exchange (ETDEWEB)

    Branca, C.; Faraone, A.; Magazu' , S.; Maisano, G.; Mangione, A. [Dipartimento di Fisica and INFM, Universita di Messina, PO Box 55, 98166 Messina (Italy); Pappas, C.; Triolo, A. [Hahn-Meitner-Institut, BENSC (NI), Glienicker Strasse, 14109 Berlin (Germany)

    2002-07-01

    The present work reports neutron spin-echo (NSE) results on aqueous mixtures of trehalose, a naturally occurring disaccharide of glucose, which shows an extraordinary bioprotective effectiveness against dehydration and freezing. The aim of the work is to furnish new results on the dynamics of the trehalose/water system on the nano- and picosecond scales. (orig.)

  16. Spin-Echo Small-Angle Neutron Scattering Development

    NARCIS (Netherlands)

    Uca, O.

    2003-01-01

    Spin-Echo Small-Angle Neutron Scattering (SESANS) instrument is a novel SANS technique which enables one to characterize distances from a few nanometers up to the micron range. The most striking difference between normal SANS and SESANS is that in SESANS one gets information in real space, whereas

  17. Participatory Culture at the Echo Park Film Center

    Science.gov (United States)

    Rosales, Jennifer Ann

    2013-01-01

    The Echo Park Film Center, a Los Angeles nonprofit media education organization, teaches underprivileged youth how to comprehend and make media in order to empower them to speak and be heard. Due to the organization's nonmainstream media courses and its connection to its community, the Center is able to create a participatory and socially…

  18. HF Radar Sea-echo from Shallow Water

    Directory of Open Access Journals (Sweden)

    Josh Kohut

    2008-08-01

    Full Text Available HF radar systems are widely and routinely used for the measurement of ocean surface currents and waves. Analysis methods presently in use are based on the assumption of infinite water depth, and may therefore be inadequate close to shore where the radar echo is strongest. In this paper, we treat the situation when the radar echo is returned from ocean waves that interact with the ocean floor. Simulations are described which demonstrate the effect of shallow water on radar sea-echo. These are used to investigate limits on the existing theory and to define water depths at which shallow-water effects become significant. The second-order spectral energy increases relative to the first-order as the water depth decreases, resulting in spectral saturation when the waveheight exceeds a limit defined by the radar transmit frequency. This effect is particularly marked for lower radar transmit frequencies. The saturation limit on waveheight is less for shallow water. Shallow water affects second-order spectra (which gives wave information far more than first-order (which gives information on current velocities, the latter being significantly affected only for the lowest radar transmit frequencies for extremely shallow water. We describe analysis of radar echo from shallow water measured by a Rutgers University HF radar system to give ocean wave spectral estimates. Radar-derived wave height, period and direction are compared with simultaneous shallow-water in-situ measurements.

  19. Echo pattern of lymph nodes in colorectal cancer

    DEFF Research Database (Denmark)

    Rafaelsen, Søren Rafael; Kronborg, Ole; Fenger, Claus

    1992-01-01

    Surgical specimens from 75 patients with colorectal cancer were examined within 15 min of removal with a 7.5 MHz linear-array transducer. The echo pattern of 139 lymph nodes was analysed to evaluate previous criteria of malignancy and to establish other possible criteria, which could be tested...

  20. Characterization of trehalose aqueous solutions by neutron spin echo

    CERN Document Server

    Branca, C; Magazù, S; Maisano, G; Mangione, A; Pappas, C; Triolo, A

    2002-01-01

    The present work reports neutron spin-echo (NSE) results on aqueous mixtures of trehalose, a naturally occurring disaccharide of glucose, which shows an extraordinary bioprotective effectiveness against dehydration and freezing. The aim of the work is to furnish new results on the dynamics of the trehalose/water system on the nano- and picosecond scales. (orig.)

  1. Echoing in Autistic Children: A Chronometric Study of Semantic Processing.

    Science.gov (United States)

    Shapiro, Theodore; Lucy, Peter

    1978-01-01

    Explores the idea that echoing in autistics differs from normal imitation and represents a different species of production. Subjects were five autistic children, ranging in age from 3 years 10 months to 6 years 8 months, and two normal children, aged 2 years 6 months and 3 years 11 months. (MP)

  2. Analysis of multibeam-hydrosweep echo peaks for seabed characterisation

    Digital Repository Service at National Institute of Oceanography (India)

    Chakraborty, B.; Schenke, H.W.; Kodagali, V.N.; Hagen, R.

    , in general, Gaussian in nature except in the case of the Kainan Maru seamount summit (area D). The outer beams of the Enderby abyssal plain (area C) echo-peak PDF statistics reveal the highest possible large-scale feature dominance. Interestingly, Extremal...

  3. Relativistic electron dropout echoes induced by interplanetary shocks

    Science.gov (United States)

    Schiller, Q.; Kanekal, S. G.; Boyd, A. J.; Baker, D. N.; Blake, J. B.; Spence, H. E.

    2017-12-01

    Interplanetary shocks that impact Earth's magnetosphere can produce immediate and dramatic responses in the trapped relativistic electron population. One well-studied response is a prompt injection capable of transporting relativistic electrons deep into the magnetosphere and accelerating them to multi-MeV energies. The converse effect, electron dropout echoes, are observations of a sudden dropout of electron fluxes observed after the interplanetary shock arrival. Like the injection echo signatures, dropout echoes can also show clear energy dispersion signals. They are of particular interest because they have only recently been observed and their causal mechanism is not well understood. In the analysis presented here, we show observations of electron drift echo signatures from the Relativistic Electron-Proton Telescope (REPT) and Magnetic Electron and Ion Sensors (MagEIS) onboard NASA's Van Allen Probes mission, which show simultaneous prompt enhancements and dropouts within minutes of the associated with shock impact. We show that the observations associated with both enhancements and dropouts are explained by the inward motion caused by the electric field impulse induced by the interplanetary shock, and either energization to cause the enhancement, or lack of a seed population to cause the dropout.

  4. Electron Dropout Echoes Induced by Interplanetary Shock: A Statistical Study

    Science.gov (United States)

    Liu, Z.; Zong, Q.; Hao, Y.; Zhou, X.; Ma, X.; Liu, Y.

    2017-12-01

    "Electron dropout echo" as indicated by repeated moderate dropout and recovery signatures of the flux of energetic electron in the out radiation belt region has been investigated systematically. The electron dropout and its echoes are usually found for higher energy (> 300 keV) channels fluxes, whereas the flux enhancements are obvious for lower energy electrons simultaneously after the interplanetary shock arrives at the Earth's geosynchronous orbit. 104 dropout echo events have been found from 215 interplanetary shock events from 1998 to 2007 based on LANL satellite data. In analogy to substorm injections, these 104 events could be naturally divided into two categories: dispersionless (49 events) or dispersive (55 events) according to the energy dispersion of the initial dropout. It is found that locations of dispersionless events are distributed mainly in the duskside magnetosphere. Further, the obtained locations derived from dispersive events with the time-of-flight technique of the initial dropout regions are mainly located at the duskside as well. Statistical studies have shown that the effect of shock normal, interplanetary magnetic field Bz and solar wind dynamic pressure may be insignificant to these electron dropout events. We suggest that the electric field impulse induced by the IP shock produces a more pronounced inward migration of electrons at the dusk side, resulting in the observed dusk-side moderate dropout of electron flux and its consequent echoes.

  5. Real-Time Forecasting of Echo-Centroid Motion.

    Science.gov (United States)

    1979-01-01

    is apparent that after five observations are obtained, the forecast error drops considerably. The normal lifetime of an echo (25 to 30 min) is...10kmI I ! Fig. 11. Track of 5 April 1978 mesocyclone (M) and two TVS’s (1) and (2). Times are CST. Pumpkin Center tornado is hatched and Marlow tornado is

  6. Larry Echo Hawk: A Rising Star from Idaho.

    Science.gov (United States)

    Wisecarver, Charmaine

    1993-01-01

    Larry Echo Hawk, Idaho attorney general and former state legislator, discusses success factors in college and law school; early experiences as an Indian lawyer; first election campaign; and his views on tribal sovereignty, state-tribal relationship, gambling, and his dual responsibility to the general public and Native American issues. (SV)

  7. Numerical experiment with modelled return echo of a satellite

    Indian Academy of Sciences (India)

    Abstract. We have simulated the return echo of a satellite altimeter from a rough ocean surface using an analytical formula and have studied its sensitivity with respect to various oceanic and altimeter parameters. Our numerical expcriment shows that for normally observed significant wave heights (SWFI) the effect of ...

  8. Direct magnetic field estimation based on echo planar raw data.

    Science.gov (United States)

    Testud, Frederik; Splitthoff, Daniel Nicolas; Speck, Oliver; Hennig, Jürgen; Zaitsev, Maxim

    2010-07-01

    Gradient recalled echo echo planar imaging is widely used in functional magnetic resonance imaging. The fast data acquisition is, however, very sensitive to field inhomogeneities which manifest themselves as artifacts in the images. Typically used correction methods have the common deficit that the data for the correction are acquired only once at the beginning of the experiment, assuming the field inhomogeneity distribution B(0) does not change over the course of the experiment. In this paper, methods to extract the magnetic field distribution from the acquired k-space data or from the reconstructed phase image of a gradient echo planar sequence are compared and extended. A common derivation for the presented approaches provides a solid theoretical basis, enables a fair comparison and demonstrates the equivalence of the k-space and the image phase based approaches. The image phase analysis is extended here to calculate the local gradient in the readout direction and improvements are introduced to the echo shift analysis, referred to here as "k-space filtering analysis." The described methods are compared to experimentally acquired B(0) maps in phantoms and in vivo. The k-space filtering analysis presented in this work demonstrated to be the most sensitive method to detect field inhomogeneities.

  9. Characteristics of spondylotic myelopathy on 3D driven-equilibrium fast spin echo and 2D fast spin echo magnetic resonance imaging: a retrospective cross-sectional study.

    Science.gov (United States)

    Abdulhadi, Mike A; Perno, Joseph R; Melhem, Elias R; Nucifora, Paolo G P

    2014-01-01

    In patients with spinal stenosis, magnetic resonance imaging of the cervical spine can be improved by using 3D driven-equilibrium fast spin echo sequences to provide a high-resolution assessment of osseous and ligamentous structures. However, it is not yet clear whether 3D driven-equilibrium fast spin echo sequences adequately evaluate the spinal cord itself. As a result, they are generally supplemented by additional 2D fast spin echo sequences, adding time to the examination and potential discomfort to the patient. Here we investigate the hypothesis that in patients with spinal stenosis and spondylotic myelopathy, 3D driven-equilibrium fast spin echo sequences can characterize cord lesions equally well as 2D fast spin echo sequences. We performed a retrospective analysis of 30 adult patients with spondylotic myelopathy who had been examined with both 3D driven-equilibrium fast spin echo sequences and 2D fast spin echo sequences at the same scanning session. The two sequences were inspected separately for each patient, and visible cord lesions were manually traced. We found no significant differences between 3D driven-equilibrium fast spin echo and 2D fast spin echo sequences in the mean number, mean area, or mean transverse dimensions of spondylotic cord lesions. Nevertheless, the mean contrast-to-noise ratio of cord lesions was decreased on 3D driven-equilibrium fast spin echo sequences compared to 2D fast spin echo sequences. These findings suggest that 3D driven-equilibrium fast spin echo sequences do not need supplemental 2D fast spin echo sequences for the diagnosis of spondylotic myelopathy, but they may be less well suited for quantitative signal measurements in the spinal cord.

  10. The electron capture in 163Ho experiment - ECHo

    Science.gov (United States)

    Gastaldo, L.; Blaum, K.; Chrysalidis, K.; Day Goodacre, T.; Domula, A.; Door, M.; Dorrer, H.; Düllmann, Ch. E.; Eberhardt, K.; Eliseev, S.; Enss, C.; Faessler, A.; Filianin, P.; Fleischmann, A.; Fonnesu, D.; Gamer, L.; Haas, R.; Hassel, C.; Hengstler, D.; Jochum, J.; Johnston, K.; Kebschull, U.; Kempf, S.; Kieck, T.; Köster, U.; Lahiri, S.; Maiti, M.; Mantegazzini, F.; Marsh, B.; Neroutsos, P.; Novikov, Yu. N.; Ranitzsch, P. C. O.; Rothe, S.; Rischka, A.; Saenz, A.; Sander, O.; Schneider, F.; Scholl, S.; Schüssler, R. X.; Schweiger, Ch.; Simkovic, F.; Stora, T.; Szücs, Z.; Türler, A.; Veinhard, M.; Weber, M.; Wegner, M.; Wendt, K.; Zuber, K.

    2017-06-01

    Neutrinos, and in particular their tiny but non-vanishing masses, can be considered one of the doors towards physics beyond the Standard Model. Precision measurements of the kinematics of weak interactions, in particular of the 3H β-decay and the 163Ho electron capture (EC), represent the only model independent approach to determine the absolute scale of neutrino masses. The electron capture in 163Ho experiment, ECHo, is designed to reach sub-eV sensitivity on the electron neutrino mass by means of the analysis of the calorimetrically measured electron capture spectrum of the nuclide 163Ho. The maximum energy available for this decay, about 2.8 keV, constrains the type of detectors that can be used. Arrays of low temperature metallic magnetic calorimeters (MMCs) are being developed to measure the 163Ho EC spectrum with energy resolution below 3 eV FWHM and with a time resolution below 1 μs. To achieve the sub-eV sensitivity on the electron neutrino mass, together with the detector optimization, the availability of large ultra-pure 163Ho samples, the identification and suppression of background sources as well as the precise parametrization of the 163Ho EC spectrum are of utmost importance. The high-energy resolution 163Ho spectra measured with the first MMC prototypes with ion-implanted 163Ho set the basis for the ECHo experiment. We describe the conceptual design of ECHo and motivate the strategies we have adopted to carry on the present medium scale experiment, ECHo-1K. In this experiment, the use of 1 kBq 163Ho will allow to reach a neutrino mass sensitivity below 10 eV/ c 2. We then discuss how the results being achieved in ECHo-1k will guide the design of the next stage of the ECHo experiment, ECHo-1M, where a source of the order of 1 MBq 163Ho embedded in large MMCs arrays will allow to reach sub-eV sensitivity on the electron neutrino mass.

  11. Improving Pain Care with Project ECHO in Community Health Centers.

    Science.gov (United States)

    Anderson, Daren; Zlateva, Ianita; Davis, Bennet; Bifulco, Lauren; Giannotti, Tierney; Coman, Emil; Spegman, Douglas

    2017-10-01

    Pain is an extremely common complaint in primary care, and patient outcomes are often suboptimal. This project evaluated the impact of Project ECHO Pain videoconference case-based learning sessions on knowledge and quality of pain care in two Federally Qualified Health Centers. Quasi-experimental, pre-post intervention, with comparison group. Two large, multisite federally qualified health centers in Connecticut and Arizona. Intervention (N = 10) and comparison (N = 10) primary care providers. Primary care providers attended 48 weekly Project ECHO Pain sessions between January and December 2013, led by a multidisciplinary pain specialty team. Surveys and focus groups assessed providers' pain-related knowledge and self-efficacy. Electronic health record data were analyzed to evaluate opioid prescribing and specialty referrals. Compared with control, primary care providers in the intervention had a significantly greater increase in pain-related knowledge and self-efficacy. Providers who attended ECHO were more likely to use formal assessment tools and opioid agreements and refer to behavioral health and physical therapy compared with control providers. Opioid prescribing decreased significantly more among providers in the intervention compared with those in the control group. Pain is an extremely common and challenging problem, particularly among vulnerable patients such as those cared for at the more than 1,200 Federally Qualified Health Centers in the United States. In this study, attendance at weekly Project ECHO Pain sessions not only improved knowledge and self-efficacy, but also altered prescribing and referral patterns, suggesting that knowledge acquired during ECHO sessions translated into practice changes. © 2017 American Academy of Pain Medicine.

  12. Duel frequency echo data acquisition system for sea-floor classification

    Digital Repository Service at National Institute of Oceanography (India)

    Navelkar, G.S.; Desai, R.G.P.; Chakraborty, B.

    An echo data acquisition system is designed to digitize echo signal from a single beam shipboard echo-sounder for use in sea-floor classification studies using a 12 bit analog to digital (A/D) card with a maximum sampling frequency of 1 MHz. Both 33...

  13. Effect of perioperative blood transfusions on long term graft outcomes in renal transplant patients.

    LENUS (Irish Health Repository)

    O'Brien, Frank J

    2012-06-01

    It is established that blood transfusions will promote sensitization to human leucocyte antigen (HLA) antigens, increase time spent waiting for transplantation and may lead to higher rates of rejection. Less is known about how perioperative blood transfusion influence patient and graft outcome. This study aims to establish if there is an association between perioperative blood transfusion and graft or patient survival.

  14. In-Hospital Haloperidol Use and Perioperative Changes in QTc-Duration

    NARCIS (Netherlands)

    Blom, M T; de Jonghe, A; van Munster, B C; de Rooij, S E; Tan, H L; van der Velde, Nathalie; Jansen, S.

    2015-01-01

    OBJECTIVES: Haloperidol may prolong ECG QTc-duration but is often prescribed perioperatively to hip-fracture patients. We aimed to determine (1) how QTc-duration changes perioperatively, (2) whether low-dose haloperidol-use influences these changes, and (3) which clinical variables are associated

  15. A 10-year review of perioperative complications in pharyngeal flap surgery

    NARCIS (Netherlands)

    Hofer, SOP; Dhar, BK; Robinson, PH; Goorhuis-Brouwer, SM; Nicolai, JPA

    2002-01-01

    A 10-year retrospective study was undertaken to investigate perioperative complications in pharyngeal flap surgery in one institution using inferiorly and superiorly based flaps. In this fashion the current practice of surgical technique based on local findings and perioperative care, through

  16. Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative

    DEFF Research Database (Denmark)

    Myles, P S; Boney, O; Botti, M

    2018-01-01

    Medicine initiative was established to derive a set of standardised endpoints for use in perioperative clinical trials. METHODS: We undertook a systematic review to identify measures of patient comfort used in the anaesthetic, surgical, and other perioperative literature. A multi-round Delphi consensus...

  17. Perioperative versus postoperative measurement of Taylor Spatial Frame mounting parameters.

    Science.gov (United States)

    Sökücü, Sami; Demir, Bilal; Lapçin, Osman; Yavuz, Umut; Kabukçuoğlu, Yavuz S

    2014-01-01

    The aim of this study was to determine the differences, if any, between application parameters for the Taylor Spatial Frame (TSF) system obtained during surgery under fluoroscopy and after surgery from digital radiography. This retrospective study included 17 extremities of 15 patients (8 male, 7 female; mean age: 21.9 years, range: 10 to 55 years) who underwent TSF after deformity and fracture. Application parameters measured by fluoroscopy at the end of surgery after mounting the fixator were compared with parameters obtained from anteroposterior and lateral digital radiographs taken 1 day after surgery. Fixator was applied to the femur in 8 patients, tibia in 6 and radius in 3. Mean time to removal of the frame was 3.5 (range: 3 to 7) months. Mean perioperative anteroposterior, lateral and axial frame offsets of patients were 9.1 (range: 3 to 20) mm, 18.1 (range: 5 to 37) mm and 95.3 (range: 25 to 155) mm, respectively. Mean postoperative anteroposterior, lateral and axial frame offset radiographs were 11.8 (range: 2 to 30) mm, 18 (range: 6 to 47) mm and 109.5 (range: 28 to 195) mm, respectively. There was no statistically significant difference between the groups (p>0.05). While measurements taken during operation may lengthen the duration in the operation room, fluoroscopy may provide better images and is easier to perform than digital radiography. On the other hand, there is no difference between measurements taken during perioperative fluoroscopy and postoperative digital radiography.

  18. Perioperative nutritional status changes in gastrointestinal cancer patients.

    Science.gov (United States)

    Shim, Hongjin; Cheong, Jae Ho; Lee, Kang Young; Lee, Hosun; Lee, Jae Gil; Noh, Sung Hoon

    2013-11-01

    The presence of gastrointestinal (GI) cancer and its treatment might aggravate patient nutritional status. Malnutrition is one of the major factors affecting the postoperative course. We evaluated changes in perioperative nutritional status and risk factors of postoperative severe malnutrition in the GI cancer patients. Nutritional status was prospectively evaluated using patient-generated subjective global assessment (PG-SGA) perioperatively between May and September 2011. A total of 435 patients were enrolled. Among them, 279 patients had been diagnosed with gastric cancer and 156 with colorectal cancer. Minimal invasive surgery was performed in 225 patients. PG-SGA score increased from 4.5 preoperatively to 10.6 postoperatively (pgastric cancer patients, postoperative severe malnourishment increased significantly (p60, pgastric cancer (pgastric cancer, and open surgery remained significant as risk factors of severe malnutrition. The prevalence of severe malnutrition among GI cancer patients in this study increased from 2.3% preoperatively to 26.3% after an operation. Old age, preoperative weight loss, gastric cancer, and open surgery were shown to be risk factors of postoperative severe malnutrition. In patients at high risk of postoperative severe malnutrition, adequate nutritional support should be considered.

  19. Perioperative Anesthesiological Management of Patients with Pulmonary Hypertension

    Directory of Open Access Journals (Sweden)

    Jochen Gille

    2012-01-01

    Full Text Available Pulmonary hypertension is a major reason for elevated perioperative morbidity and mortality, even in noncardiac surgical procedures. Patients should be thoroughly prepared for the intervention and allowed plenty of time for consideration. All specialty units involved in treatment should play a role in these preparations. After selecting each of the suitable individual anesthetic and surgical procedures, intraoperative management should focus on avoiding all circumstances that could contribute to exacerbating pulmonary hypertension (hypoxemia, hypercapnia, acidosis, hypothermia, hypervolemia, and insufficient anesthesia and analgesia. Due to possible induction of hypotonic blood circulation, intravenous vasodilators (milrinone, dobutamine, prostacyclin, Na-nitroprusside, and nitroglycerine should be administered with the greatest care. A method of treating elevations in pulmonary pressure with selective pulmonary vasodilation by inhalation should be available intraoperatively (iloprost, nitrogen monoxide, prostacyclin, and milrinone in addition to invasive hemodynamic monitoring. During the postoperative phase, patients must be monitored continuously and receive sufficient analgesic therapy over an adequate period of time. All in all, perioperative management of patients with pulmonary hypertension presents an interdisciplinary challenge that requires the adequate involvement of anesthetists, surgeons, pulmonologists, and cardiologists alike.

  20. Evaluation of the appropriate perioperative antibiotic prophylaxis in Italy.

    Directory of Open Access Journals (Sweden)

    Francesco Napolitano

    Full Text Available BACKGROUND: The appropriate use of antibiotics prophylaxis in the prevention and reduction in the incidence of surgical site infection is widespread. This study evaluates the appropriateness of the prescription of antibiotics prophylaxis prior to surgery amongst hospitalized patients in the geographic area of Avellino, Caserta, and Naples (Italy and the factors associated with a poor adherence. METHODS: A sample of 382 patients admitted to 23 surgical wards and undergoing surgery in five hospitals were randomly selected. RESULTS: Perioperative antibiotic prophylaxis was appropriate in 18.1% of cases. The multivariate logistic regression analysis showed that patients with hypoalbuminemia, with a clinical infection, with a wound clean were more likely to receive an appropriate antibiotic prophylaxis. Compared with patients with an American Society of Anesthesiologists (ASA score ≥4, those with a score of 2 were correlated with a 64% reduction in the odds of having an appropriate prophylaxis. The appropriateness of the timing of prophylactic antibiotic administration was observed in 53.4% of the procedures. Multivariate logistic regression model showed that such appropriateness was more frequent in older patients, in those admitted in general surgery wards, in those not having been underwent an endoscopic surgery, in those with a higher length of surgery, and in patients with ASA score 1 when a score ≥4 was chosen as the reference category. The most common antibiotics used inappropriately were ceftazidime, sultamicillin, levofloxacin, and teicoplanin. CONCLUSIONS: Educational interventions are needed to improve perioperative appropriate antibiotic prophylaxis.

  1. High-dose buprenorphine: perioperative precautions and management strategies.

    Science.gov (United States)

    Roberts, D M; Meyer-Witting, M

    2005-02-01

    Buprenorphine has been in clinical use in anaesthesia for several decades. Recently, the high-dose sublingual formulation (Subutex, Reckitt Benckiser, Slough, U.K.) has been increasingly used as maintenance therapy in opioid dependence, as an alternative to methadone and other pharmacological therapies. Buprenorphine has unique pharmacological properties making it well suited for use as a maintenance therapy in opioid dependence. However, these same properties may cause difficulty in the perioperative management of pain. Buprenorphine is a partial opioid agonist, attenuating the effects of supplemental illicit or therapeutic opioid agonists. As a result of its high receptor affinity, supplemental opioids do not readily displace buprenorphine from the opioid receptor in standard doses. High-dose buprenorphine has an extended duration of action that prolongs both of these effects. The perioperative management of patients stabilized on high-dose buprenorphine and undergoing surgery requires consideration of the likely analgesic requirements. Where possible the buprenorphine should be continued. Pain management should focus on maximizing non-opioid analgesia, local anaesthesia and non-pharmacological techniques. Where pain may not be adequately relieved by these methods, the addition of a full opioid agonist such as fentanyl or morphine at appropriate doses should be considered, accompanied by close monitoring in a high dependency unit. In situations where this regimen is unlikely to be effective, preoperative conversion to morphine or methadone may be an option. Where available, liaison with a hospital-based alcohol and drug service should always be considered.

  2. Neurologic Evaluation and Management of Perioperative Nerve Injury.

    Science.gov (United States)

    Watson, James C; Huntoon, Marc A

    2015-01-01

    Neurologic injury after regional anesthesia or pain medicine procedures is rare. Postprocedural neurologic deficits may create high levels of anxiety for the patient and practitioner, although most deficits are limited in severity and can be expected to fully resolve with time. Postoperative anesthesia-related neuraxial and peripheral nerve injuries are reviewed to define an efficient, structured approach to these complications. Emphasis is placed on acutely stratifying the urgency and scope of diagnostic testing or consultation necessity, initiating appropriate definitive treatments, and defining appropriate out-of-hospital follow-up and symptom management. Studies pertinent to the recognition, evaluation, and treatment of neurologic assessment of perioperative nerve injury and published since the last advisory on the topic are reviewed and a new structured algorithmic approach is proposed. The evolving literature on postoperative inflammatory neuropathies is reviewed to help define the clinical criteria and to identify patients who would benefit from early neurological evaluation. New sections review potential acute interventions to improve neurologic outcome and long-term management of neuropathic pain resulting from perioperative nerve injury.

  3. Perioperative factors associated with pressure ulcer development after major surgery

    Science.gov (United States)

    2018-01-01

    Background Postoperative pressure ulcers are important indicators of perioperative care quality, and are serious and expensive complications during critical care. This study aimed to identify perioperative risk factors for postoperative pressure ulcers. Methods This retrospective case-control study evaluated 2,498 patients who underwent major surgery. Forty-three patients developed postoperative pressure ulcers and were matched to 86 control patients based on age, sex, surgery, and comorbidities. Results The pressure ulcer group had lower baseline hemoglobin and albumin levels, compared to the control group. The pressure ulcer group also had higher values for lactate levels, blood loss, and number of packed red blood cell (pRBC) units. Univariate analysis revealed that pressure ulcer development was associated with preoperative hemoglobin levels, albumin levels, lactate levels, intraoperative blood loss, number of pRBC units, Acute Physiologic and Chronic Health Evaluation II score, Braden scale score, postoperative ventilator care, and patient restraint. In the multiple logistic regression analysis, only preoperative low albumin levels (odds ratio [OR]: 0.21, 95% CI: 0.05–0.82; P pressure ulcer development. A receiver operating characteristic curve was used to assess the predictive power of the logistic regression model, and the area under the curve was 0.88 (95% CI: 0.79–0.97; P pressure ulcer development after surgery. PMID:29441175

  4. [Perioperative fibrinogen concentrations in cardiac surgery with cardiopulmonary bypass].

    Science.gov (United States)

    Uji, Makiko; Terada, Yuki; Noguchi, Teruo; Nishida, Takaya; Hasuwa, Kyoko; Shinohara, Kozue; Kumano, Hotaka; Ishimura, Naoko; Nishiwada, Makoto

    2012-08-01

    Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) need many blood products due to deficiency of coagulation factors. Blood transfusion therapy in patients with excessive bleeding after CPB is generally empiric. We checked and studied the fibrinogen concentration and transfusion, as well as bleeding amount in the perioperative period. The study was approved by our institutional ethics committee. Thirty patients were studied. Blood samples were obtained at the induction of anesthesia (before CPB), at the end of CPB, at the end of operation, and on the next morning, or before the patient was given fresh frozen plasma in the intensive care unit. For all cases, fibrinogen concentration and platelet concentration were lowest at the end of CPB. Fibrinogen concentration rose up to before CPB level on the next morning. The group in which fibrinogen concentration was less than 150 mg x dl(-1) at the end of CPB consumed more blood products than the group with fibrinogen concentration of over 150 mg x dl(-1). Blood transfusion therapy based on fibrinogen concentration is needed to maintain adequacy of the perioperative blood transfusion and blood conservation in cardiac surgery.

  5. Hospital competitive intensity and perioperative outcomes following lumbar spinal fusion.

    Science.gov (United States)

    Durand, Wesley M; Johnson, Joseph R; Li, Neill Y; Yang, JaeWon; Eltorai, Adam E M; DePasse, J Mason; Daniels, Alan H

    2018-04-01

    Interhospital competition has been shown to influence the adoption of surgical techniques and approaches, clinical patient outcomes, and health care resource use for select surgical procedures. However, little is known regarding these dynamics as they relate to spine surgery. This investigation sought to examine the relationship between interhospital competitive intensity and perioperative outcomes following lumbar spinal fusion. This study used the Nationwide Inpatient Sample dataset, years 2003, 2006, and 2009. Patients were included based on the presence of the International Classification of Disease, Ninth Edition, Clinical Modification (ICD-9-CM) codes corresponding to lumbar spinal fusion, as well as on the presence of data on the Herfindahl-Hirschman Index (HHI). The outcome measures are perioperative complications, defined using an ICD-9-CM coding algorithm. The HHI, a validated measure of competition within a market, was used to assess hospital market competitiveness. The HHI was calculated based on the hospital cachement area. Multiple regression was performed to adjust for confounding variables including patient age, gender, primary payer, severity of illness score, primary versus revision fusion, anterior versus posterior approach, national region, hospital bed size, location or teaching status, ownership, and year. Perioperative clinical outcomes were assessed based on ICD-9-CM codes with modifications. In total, 417,520 weighted patients (87,999 unweighted records) were analyzed. The mean cachement area HHI was 0.31 (range 0.099-0.724). The average patient age was 55.4 years (standard error=0.194), and the majority of patients were female (55.8%, n=232,727). The majority of procedures were primary spinal fusions (92.7%, n=386,998) and fusions with a posterior-only technique (81.5%, n=340,271). Most procedures occurred in the South (42.5%, n=177,509) or the Midwest (27.0%, n=112,758) regions. In the multiple regression analysis, increased hospital

  6. Clinical characteristics in normal healthy adults with microbleeds on echo-planar gradient-echo T2*-weighted MRI

    International Nuclear Information System (INIS)

    Takahashi, Wakoh; Ide, Michiru; Ohnuki, Tomohide; Takagi, Shigeharu; Shinohara, Yukito

    2004-01-01

    The gradient-echo T 2 * -weighted sequence in magnetic resonance imaging is known to be useful for detecting microbleeds (MBs) in patients with intracranial hemorrhage or lacunar stroke. We investigated the characteristics of apparently healthy adults with MBs but without stroke, employing echo-planar gradient-echo T 2 * -weighted MRI. The subjects were recruited from among 3,537 participants who underwent brain check-ups at the HIMEDIC Imaging Center. Of the 3,537 participants, 3,296 (mean age, 55±11 years) without any history of cerebrovascular disease or apparent focal neurological manifestations were selected for the present study. MBs on echo-planar gradient-echo T 2 * -weighted MRI were observed in 74 (2.2%) of the 3,296 subjects. Of a total of 133 lesions found in these 74 persons, 31 were located in the basal ganglia or cortico-subcortical regions. Thirty were in the deep white matter, 19 in the thalamus, 16 in the cerebellum, and 6 in the brain stem. The subjects with MBs were significantly older than the subjects without MBs, and the mean values for their systolic and diastolic blood pressures were higher than those in the subjects without MBs. Asymptomatic cerebral infarction, periventricular hyperintensity, and deep and subcortical white matter hyperintensity on T 1 - and T 2 -weighted MRI were more frequent in the subjects with MBs, as compared with those without MBs. Asymptomatic cerebral infarction, periventricular hyperintensity, and deep and subcortical white matter hyperintensity on T 1 - and T 2 -weighted MRI were more frequent in the subjects with MBs of the basal ganglia or thalamus than in those with MBs in other regions. MBs on echo-planar gradient-echo T 2 * -weighted MRI were thus relatively rare in apparently healthy adults. However, MBs in the basal ganglia or thalamus are suggested to be closely related to intracerebral microangiopathy. Persons with MBs in such regions should therefore be carefully checked for cerebrovascular risk

  7. Being altered by the unexpected: understanding the perioperative patient's experience: a case study.

    Science.gov (United States)

    Rudolfsson, Gudrun

    2014-08-01

    The present paper focuses on the process of understanding the patient in the context of perioperative caring and reports a story narrated by a perioperative nurse as well as her emerging understanding of the patient prior to surgery at an operating department. This qualitative case study had a dual purpose; firstly, to describe how the perioperative nurse's understanding of the patient emerged and, secondly, to establish how the researcher interpreted the situation. As a perioperative nurse and researcher, the author is both the narrator and interpreter. To date we have rarely discussed the fact that, in a perioperative context, the patient might feel ashamed of his/her body, even before arriving at the operating department. This new understanding emerged from the hermeneutical dialogue in the present study. © 2013 Wiley Publishing Asia Pty Ltd.

  8. MR contrast of ferritin and hemosiderin in the brain: comparison among gradient-echo, conventional spin-echo and fast spin-echo sequences

    Energy Technology Data Exchange (ETDEWEB)

    Haque, Tabassum Laz; Miki, Yukio; Kanagaki, Mitsunori; Takahashi, Takahiro; Yamamoto, Akira; Konishi, Junya; Nozaki, Kazuhiko; Hashimoto, Nobuo; Konishi, Junji

    2003-12-01

    Objective: To compare the magnetic resonance image contrasts due to ferritin and hemosiderin in the brain tissue among different pulse sequences. Materials and methods: Fourteen patients with cavernous hemangioma in the brain prospectively underwent MR imaging with T2*-weighted gradient-echo (GRE), T2-weighted conventional spin-echo (SE) and fast spin-echo (FSE) sequences. The relative contrast ratios (CRs) of the hypointense part of cavernous hemangioma, globus pallidus and putamen to the deep frontal white matter were measured on each pulse sequence and statistically analyzed using analysis of variance followed by paired t-test. Results: In the hypointense part of cavernous hemangioma, relative CRs were significantly lower on T2*-weighted GRE than on T2-weighted SE images (P=0.0001), and on T2-weighted SE than on T2-weighted FSE images (P=0.0001). In the globus pallidus, relative CRs were significantly lower on T2-weighted SE than on T2*-weighted GRE images (P=0.002), and on T2*-weighted GRE than on T2-weighted FSE images (P=0.0002). In the putamen, relative CRs were significantly lower on T2-weighted SE than on T2*-weighted GRE images (P=0.001), and there was no significant difference between CRs on T2-weighted FSE and T2*-weighted GRE images (P=0.90). Conclusion: Hemosiderin showed best image contrast on T2*-weighted GRE images but ferritin showed more prominent image contrast on T2-weighted SE than on T2*-weighted GRE images, which may help to determine an appropriate pulse sequence in neurological diseases associated with excessive ferritin accumulation.

  9. MR contrast of ferritin and hemosiderin in the brain: comparison among gradient-echo, conventional spin-echo and fast spin-echo sequences

    International Nuclear Information System (INIS)

    Haque, Tabassum Laz; Miki, Yukio; Kanagaki, Mitsunori; Takahashi, Takahiro; Yamamoto, Akira; Konishi, Junya; Nozaki, Kazuhiko; Hashimoto, Nobuo; Konishi, Junji

    2003-01-01

    Objective: To compare the magnetic resonance image contrasts due to ferritin and hemosiderin in the brain tissue among different pulse sequences. Materials and methods: Fourteen patients with cavernous hemangioma in the brain prospectively underwent MR imaging with T2*-weighted gradient-echo (GRE), T2-weighted conventional spin-echo (SE) and fast spin-echo (FSE) sequences. The relative contrast ratios (CRs) of the hypointense part of cavernous hemangioma, globus pallidus and putamen to the deep frontal white matter were measured on each pulse sequence and statistically analyzed using analysis of variance followed by paired t-test. Results: In the hypointense part of cavernous hemangioma, relative CRs were significantly lower on T2*-weighted GRE than on T2-weighted SE images (P=0.0001), and on T2-weighted SE than on T2-weighted FSE images (P=0.0001). In the globus pallidus, relative CRs were significantly lower on T2-weighted SE than on T2*-weighted GRE images (P=0.002), and on T2*-weighted GRE than on T2-weighted FSE images (P=0.0002). In the putamen, relative CRs were significantly lower on T2-weighted SE than on T2*-weighted GRE images (P=0.001), and there was no significant difference between CRs on T2-weighted FSE and T2*-weighted GRE images (P=0.90). Conclusion: Hemosiderin showed best image contrast on T2*-weighted GRE images but ferritin showed more prominent image contrast on T2-weighted SE than on T2*-weighted GRE images, which may help to determine an appropriate pulse sequence in neurological diseases associated with excessive ferritin accumulation

  10. Real-time assessment of perioperative behaviors in children and parents: development and validation of the perioperative adult child behavioral interaction scale.

    Science.gov (United States)

    Sadhasivam, Senthilkumar; Cohen, Lindsey L; Hosu, Liana; Gorman, Kristin L; Wang, Yu; Nick, Todd G; Jou, Jing Fang; Samol, Nancy; Szabova, Alexandra; Hagerman, Nancy; Hein, Elizabeth; Boat, Anne; Varughese, Anna; Kurth, Charles Dean; Willging, J Paul; Gunter, Joel B

    2010-04-01

    Behavior in response to distressful events during outpatient pediatric surgery can contribute to postoperative maladaptive behaviors, such as temper tantrums, nightmares, bed-wetting, and attention seeking. Currently available perioperative behavioral assessment tools have limited utility in guiding interventions to ameliorate maladaptive behaviors because they cannot be used in real time, are only intended to be used during 1 phase of the experience (e.g., perioperative), or provide only a static assessment of the child (e.g., level of anxiety). A simple, reliable, real-time tool is needed to appropriately identify children and parents whose behaviors in response to distressful events at any point in the perioperative continuum could benefit from timely behavioral intervention. Our specific aims were to (1) refine the Perioperative Adult Child Behavioral Interaction Scale (PACBIS) to improve its reliability in identifying perioperative behaviors and (2) validate the refined PACBIS against several established instruments. The PACBIS was used to assess the perioperative behaviors of 89 children aged 3 to 12 years presenting for adenotonsillectomy and their parents. Assessments using the PACBIS were made during perioperative events likely to prove distressing to children and/or parents (perioperative measurement of blood pressure, induction of anesthesia, and removal of the IV catheter before discharge). Static measurements of perioperative anxiety and behavioral compliance during anesthetic induction were made using the modified Yale Preoperative Anxiety Scale and the Induction Compliance Checklist (ICC). Each event was videotaped for later scoring using the Child-Adult Medical Procedure Interaction Scale-Short Form (CAMPIS-SF) and Observational Scale of Behavioral Distress (OSBD). Interrater reliability using linear weighted kappa (kappa(w)) and multiple validations using Spearman correlation coefficients were analyzed. The PACBIS demonstrated good to excellent

  11. Self-normalizing multiple-echo technique for measuring the in vivo apparent diffusion coefficient

    International Nuclear Information System (INIS)

    Perman, W.H.; Gado, M.; Sandstrom, J.C.

    1989-01-01

    This paper presents work to develop a new technique for quantitating the in vivo apparent diffusion/perfusion coefficient (ADC) by obtaining multiple data points from only two images with the capability to normalize the data from consecutive images, thus minimizing the effect of interimage variation. Two multiple-echo (six-to eight-echo) cardiac-gated images are obtained, one without and one with additional diffusion/perfusion encoding gradients placed about the 180 RF pulses of all but the first echo. Since the first echoes of both images have identical pulse sequence parameters, variations in signal intensity-between the first echoes represent image-to-image variation. The signal intensities of the subsequent echoes with additional diffusion/perfusion encoding gradients are then normalized by using the ratio of the first-echo signal intensities

  12. Prospects for Precise Measurements with Echo Atom Interferometry

    Directory of Open Access Journals (Sweden)

    Brynle Barrett

    2016-06-01

    Full Text Available Echo atom interferometers have emerged as interesting alternatives to Raman interferometers for the realization of precise measurements of the gravitational acceleration g and the determination of the atomic fine structure through measurements of the atomic recoil frequency ω q . Here we review the development of different configurations of echo interferometers that are best suited to achieve these goals. We describe experiments that utilize near-resonant excitation of laser-cooled rubidium atoms by a sequence of standing wave pulses to measure ω q with a statistical uncertainty of 37 parts per billion (ppb on a time scale of ∼50 ms and g with a statistical precision of 75 ppb. Related coherent transient techniques that have achieved the most statistically precise measurements of atomic g-factor ratios are also outlined. We discuss the reduction of prominent systematic effects in these experiments using off-resonant excitation by low-cost, high-power lasers.

  13. Benefits of the Multiple Echo Technique for Ultrasonic Thickness Testing

    Energy Technology Data Exchange (ETDEWEB)

    Elder, J.; Vandekamp, R.

    2011-02-10

    Much effort has been put into determining methods to make accurate thickness measurements, especially at elevated temperatures. An accuracy of +/- 0.001 inches is typically noted for commercial ultrasonic thickness gauges and ultrasonic thickness techniques. Codes and standards put limitations on many inspection factors including equipment, calibration tolerance and temperature variations. These factors are important and should be controlled, but unfortunately do not guarantee accurate and repeatable measurements in the field. Most technicians long for a single technique that is best for every situation, unfortunately, there are no 'silver bullets' when it comes to nondestructive testing. This paper will describe and discuss some of the major contributors to measurement error as well as some advantages and limitations of multiple echo techniques and why multiple echo techniques should be more widely utilized for ultrasonic thickness measurements.

  14. Efficient Multichannel NLMS Implementation for Acoustic Echo Cancellation

    Directory of Open Access Journals (Sweden)

    Schüldt Christian

    2007-01-01

    Full Text Available An acoustic echo cancellation structure with a single loudspeaker and multiple microphones is, from a system identification perspective, generally modelled as a single-input multiple-output system. Such a system thus implies specific echo-path models (adaptive filter for every loudspeaker to microphone path. Due to the often large dimensionality of the filters, which is required to model rooms with standard reverberation time, the adaptation process can be computationally demanding. This paper presents a selective updating normalized least mean square (NLMS-based method which reduces complexity to nearly half in practical situations, while showing superior convergence speed performance as compared to conventional complexity reduction schemes. Moreover, the method concentrates the filter adaptation to the filter which is most misadjusted, which is a typically desired feature.

  15. Efficient Multichannel NLMS Implementation for Acoustic Echo Cancellation

    Directory of Open Access Journals (Sweden)

    Fredric Lindstrom

    2007-02-01

    Full Text Available An acoustic echo cancellation structure with a single loudspeaker and multiple microphones is, from a system identification perspective, generally modelled as a single-input multiple-output system. Such a system thus implies specific echo-path models (adaptive filter for every loudspeaker to microphone path. Due to the often large dimensionality of the filters, which is required to model rooms with standard reverberation time, the adaptation process can be computationally demanding. This paper presents a selective updating normalized least mean square (NLMS-based method which reduces complexity to nearly half in practical situations, while showing superior convergence speed performance as compared to conventional complexity reduction schemes. Moreover, the method concentrates the filter adaptation to the filter which is most misadjusted, which is a typically desired feature.

  16. Inaudible functional MRI using a truly mute gradient echo sequence

    International Nuclear Information System (INIS)

    Marcar, V.L.; Girard, F.; Rinkel, Y.; Schneider, J.F.; Martin, E.

    2002-01-01

    We performed functional MRI experiments using a mute version of a gradient echo sequence on adult volunteers using either a simple visual stimulus (flicker goggles: 4 subjects) or an auditory stimulus (music: 4 subjects). Because the mute sequence delivers fewer images per unit time than a fast echo planar imaging (EPI) sequence, we explored our data using a parametric ANOVA test and a non-parametric Wilcoxon-Mann-Whitney test in addition to performing a cross-correlation analysis. All three methods were in close agreement regarding the location of the BOLD contrast signal change. We demonstrated that, using appropriate statistical analysis, functional MRI using an MR sequence that is acoustically inaudible to the subject is feasible. Furthermore compared with the ''silent'' event-related procedures involving an EPI protocol, our mGE protocol compares favourably with respect to experiment time and the BOLD signal. (orig.)

  17. Inaudible functional MRI using a truly mute gradient echo sequence

    Energy Technology Data Exchange (ETDEWEB)

    Marcar, V.L. [University of Zurich, Department of Psychology, Neuropsychology, Treichlerstrasse 10, 8032 Zurich (Switzerland); Girard, F. [GE Medical Systems SA, 283, rue de la Miniere B.P. 34, 78533 Buc Cedex (France); Rinkel, Y.; Schneider, J.F.; Martin, E. [University Children' s Hospital, Neuroradiology and Magnetic Resonance, Department of Diagnostic Imaging, Steinwiesstrasse 75, 8032 Zurich (Switzerland)

    2002-11-01

    We performed functional MRI experiments using a mute version of a gradient echo sequence on adult volunteers using either a simple visual stimulus (flicker goggles: 4 subjects) or an auditory stimulus (music: 4 subjects). Because the mute sequence delivers fewer images per unit time than a fast echo planar imaging (EPI) sequence, we explored our data using a parametric ANOVA test and a non-parametric Wilcoxon-Mann-Whitney test in addition to performing a cross-correlation analysis. All three methods were in close agreement regarding the location of the BOLD contrast signal change. We demonstrated that, using appropriate statistical analysis, functional MRI using an MR sequence that is acoustically inaudible to the subject is feasible. Furthermore compared with the ''silent'' event-related procedures involving an EPI protocol, our mGE protocol compares favourably with respect to experiment time and the BOLD signal. (orig.)

  18. NMR polarization echoes in a nematic liquid crystal

    Science.gov (United States)

    Levstein, Patricia R.; Chattah, Ana K.; Pastawski, Horacio M.; Raya, Jésus; Hirschinger, Jérôme

    2004-10-01

    We have modified the polarization echo (PE) sequence through the incorporation of Lee-Goldburg cross polarization steps to quench the 1H-1H dipolar dynamics. In this way, the 13C becomes an ideal local probe to inject and detect polarization in the proton system. This improvement made possible the observation of the local polarization P00(t) and polarization echoes in the interphenyl proton of the liquid crystal N-(4-methoxybenzylidene)-4-butylaniline. The decay of P00(t) was well fitted to an exponential law with a characteristic time τC≈310 μs. The hierarchy of the intramolecular dipolar couplings determines a dynamical bottleneck that justifies the use of the Fermi Golden Rule to obtain a spectral density consistent with the structural parameters. The time evolution of P00(t) was reversed by the PE sequence generating echoes at the time expected by the scaling of the dipolar Hamiltonian. This indicates that the reversible 1H-1H dipolar interaction is the main contribution to the local polarization decrease and that the exponential decay for P00(t) does not imply irreversibility. The attenuation of the echoes follows a Gaussian law with a characteristic time τφ≈527 μs. The shape and magnitude of the characteristic time of the PE decay suggest that it is dominated by the unperturbed homonuclear dipolar Hamiltonian. This means that τφ is an intrinsic property of the dipolar coupled network and not of other degrees of freedom. In this case, one cannot unambiguously identify the mechanism that produces the decoherence of the dipolar order. This is because even weak interactions are able to break the fragile multiple coherences originated on the dipolar evolution, hindering its reversal. Other schemes to investigate these underlying mechanisms are proposed.

  19. Detection of generalized synchronization using echo state networks

    OpenAIRE

    Ibáñez-Soria, D.; García Ojalvo, Jordi; Soria Frisch, Aureli; Ruffini, G.

    2018-01-01

    Generalized synchronization between coupled dynamical systems is a phenomenon of relevance in applications that range from secure communications to physiological modelling. Here, we test the capabilities of reservoir computing and, in particular, echo state networks for the detection of generalized synchronization. A nonlinear dynamical system consisting of two coupled Rössler chaotic attractors is used to generate temporal series consisting of time-locked generalized synchronized sequences i...

  20. Deep Echo State Network (DeepESN): A Brief Survey

    OpenAIRE

    Gallicchio, Claudio; Micheli, Alessio

    2017-01-01

    The study of deep recurrent neural networks (RNNs) and, in particular, of deep Reservoir Computing (RC) is gaining an increasing research attention in the neural networks community. The recently introduced deep Echo State Network (deepESN) model opened the way to an extremely efficient approach for designing deep neural networks for temporal data. At the same time, the study of deepESNs allowed to shed light on the intrinsic properties of state dynamics developed by hierarchical compositions ...

  1. Stimulated nuclear spin echos and spectral diffusion in glasses

    International Nuclear Information System (INIS)

    Borges, N.M.; Engelsberg, M.

    1984-01-01

    Experimental results of stimulated nuclear spin echos decay in glasses are presented. The measurements were performed in B 2 O 3 glasses, at the 23Na and 11 B resonance lines. The data analysis allows the study of Spectral diffusion at an inhomogeneous nuclear magnetic (NMR) resonance line, broadened for a desordered system of nuclear spins. A model is proposed to explain the time constants, and the particular form of the decay. (A.C.A.S.) [pt

  2. Polarimetric neutron spin echo: Feasibility and first results

    Energy Technology Data Exchange (ETDEWEB)

    Pappas, C. [Hahn-Meitner Institut Berlin, Glienickerstr. 100, 14109 Berlin (Germany)], E-mail: pappas@hmi.de; Lelievre-Berna, E. [Institut Laue-Langevin, 6, Rue Jules Horowitz, 38042 Grenoble (France); Bentley, P. [Hahn-Meitner Institut Berlin, Glienickerstr. 100, 14109 Berlin (Germany); Bourgeat-Lami, E. [Institut Laue-Langevin, 6, Rue Jules Horowitz, 38042 Grenoble (France); Moskvin, E. [Hahn-Meitner Institut Berlin, Glienickerstr. 100, 14109 Berlin (Germany); PNPI, 188300 Gatchina, Leningrad District (Russian Federation); Thomas, M. [Institut Laue-Langevin, 6, Rue Jules Horowitz, 38042 Grenoble (France); Grigoriev, S.; Dyadkin, V. [PNPI, 188300 Gatchina, Leningrad District (Russian Federation)

    2008-07-21

    Neutron Spin Echo (NSE) spectroscopy uses polarized neutrons and accordingly polarization analysis is an intrinsic feature of NSE. However, the multifaceted dynamics of antiferromagnets and helimagnets require more than the classical NSE set-up. Here we present the feasibility test and first results of a new and powerful technique: Polarimetric NSE, obtained by combining the wide angle NSE spectrometer SPAN, developed at HMI with the zero-field polarimeter Cryopad developed at ILL.

  3. Polarimetric neutron spin echo: Feasibility and first results

    International Nuclear Information System (INIS)

    Pappas, C.; Lelievre-Berna, E.; Bentley, P.; Bourgeat-Lami, E.; Moskvin, E.; Thomas, M.; Grigoriev, S.; Dyadkin, V.

    2008-01-01

    Neutron Spin Echo (NSE) spectroscopy uses polarized neutrons and accordingly polarization analysis is an intrinsic feature of NSE. However, the multifaceted dynamics of antiferromagnets and helimagnets require more than the classical NSE set-up. Here we present the feasibility test and first results of a new and powerful technique: Polarimetric NSE, obtained by combining the wide angle NSE spectrometer SPAN, developed at HMI with the zero-field polarimeter Cryopad developed at ILL

  4. NovoPen Echo® insulin delivery device

    Directory of Open Access Journals (Sweden)

    Hyllested-Winge J

    2016-01-01

    Full Text Available Jacob Hyllested-Winge,1 Thomas Sparre,2 Line Kynemund Pedersen2 1Novo Nordisk Pharma Ltd, Tokyo, Japan; 2Novo Nordisk A/S, Søborg, Denmark Abstract: The introduction of insulin pen devices has provided easier, well-tolerated, and more convenient treatment regimens for patients with diabetes mellitus. When compared with vial and syringe regimens, insulin pens offer a greater clinical efficacy, improved quality of life, and increased dosing accuracy, particularly at low doses. The portable and discreet nature of pen devices reduces the burden on the patient, facilitates adherence, and subsequently contributes to the improvement in glycemic control. NovoPen Echo® is one of the latest members of the NovoPen® family that has been specifically designed for the pediatric population and is the first to combine half-unit increment (=0.5 U of insulin dosing with a simple memory function. The half-unit increment dosing amendments and accurate injection of 0.5 U of insulin are particularly beneficial for children (and insulin-sensitive adults/elders, who often require small insulin doses. The memory function can be used to record the time and amount of the last dose, reducing the fear of double dosing or missing a dose. The memory function also provides parents with extra confidence and security that their child is taking insulin at the correct doses and times. NovoPen Echo is a lightweight, durable insulin delivery pen; it is available in two different colors, which may help to distinguish between different types of insulin, providing more confidence for both users and caregivers. Studies have demonstrated a high level of patient satisfaction, with 80% of users preferring NovoPen Echo to other pediatric insulin pens. Keywords: NovoPen Echo®, memory function, half-unit increment dosing, adherence, children, adolescents 

  5. Modified echo peak correction for radial acquisition regime (RADAR).

    Science.gov (United States)

    Takizawa, Masahiro; Ito, Taeko; Itagaki, Hiroyuki; Takahashi, Tetsuhiko; Shimizu, Kanichirou; Harada, Junta

    2009-01-01

    Because radial sampling imposes many limitations on magnetic resonance (MR) imaging hardware, such as on the accuracy of the gradient magnetic field or the homogeneity of B(0), some correction of the echo signal is usually needed before image reconstruction. In our previous study, we developed an echo-peak-shift correction (EPSC) algorithm not easily affected by hardware performance. However, some artifacts remained in lung imaging, where tissue is almost absent, or in cardiac imaging, which is affected by blood flow. In this study, we modified the EPSC algorithm to improve the image quality of the radial aquisition regime (RADAR) and expand its application sequences. We assumed the artifacts were mainly caused by errors in the phase map for EPSC and used a phantom on a 1.5-tesla (T) MR scanner to investigate whether to modify the EPSC algorithm. To evaluate the effectiveness of EPSC, we compared results from T(1)- and T(2)-weighted images of a volunteer's lung region using the current and modified EPSC. We then applied the modified EPSC to RADAR spin echo (SE) and RADAR balanced steady-state acquisition with rewound gradient echo (BASG) sequence. The modified EPSC reduced phase discontinuity in the reference data used for EPSC and improved visualization of blood vessels in the lungs. Motion and blood flow caused no visible artifacts in the resulting images in either RADAR SE or RADAR BASG sequence. Use of the modified EPSC eliminated artifacts caused by signal loss in the reference data for EPSC. In addition, the modified EPSC was applied to RADAR SE and RADAR BASG sequences.

  6. Modified echo peak correction for radial acquisition regime (RADAR)

    International Nuclear Information System (INIS)

    Takizawa, Masahiro; Ito, Taeko; Itagaki, Hiroyuki; Takahashi, Tetsuhiko; Shimizu, Kanichirou; Harada, Junta

    2009-01-01

    Because radial sampling imposes many limitations on magnetic resonance (MR) imaging hardware, such as on the accuracy of the gradient magnetic field or the homogeneity of B 0 , some correction of the echo signal is usually needed before image reconstruction. In our previous study, we developed an echo-peak-shift correction (EPSC) algorithm not easily affected by hardware performance. However, some artifacts remained in lung imaging, where tissue is almost absent, or in cardiac imaging, which is affected by blood flow. In this study, we modified the EPSC algorithm to improve the image quality of the radial acquisition regime (RADAR) and expand its application sequences. We assumed the artifacts were mainly caused by errors in the phase map for EPSC and used a phantom on a 1.5-tesla (T) MR scanner to investigate whether to modify the EPSC algorithm. To evaluate the effectiveness of EPSC, we compared results from T 1 -and T 2 -weighted images of a volunteer's lung region using the current and modified EPSC. We then applied the modified EPSC to RADAR spin echo (SE) and RADAR balanced steady-state acquisition with rewound gradient echo (BASG) sequence. The modified EPSC reduced phase discontinuity in the reference data used for EPSC and improved visualization of blood vessels in the lungs. Motion and blood flow caused no visible artifacts in the resulting images in either RADAR SE or RADAR BASG sequence. Use of the modified EPSC eliminated artifacts caused by signal loss in the reference data for EPSC. In addition, the modified EPSC was applied to RADAR SE and RADAR BASG sequences. (author)

  7. Nursing team stress in the perioperative period: an integrative review

    Directory of Open Access Journals (Sweden)

    Dafne Eva Corrêa Brandão

    2013-09-01

    Full Text Available This integrative review aimed at analyzing evidences available in literature regarding stress levels in nursing teams during the perioperative period. Primary studies were searched in the following databases: PubMed, CINAHL and LILACS. Included studies were grouped into the following thematic categories: stress level in the workplace and stress factors (n=8 and stress coping strategies used by the nursing staff (n=6. Evidence suggests that stress in the workplace worsens the health of the nursing team, provoking undesirable effects both in the professional and personal lives of these professionals. The assessment of working conditions to identify the main stressing factors and the implementation of individual and organizational measures to reduce nursing teams stress may increase productivity and workers’ satisfaction, improving the assistance quality offered to surgical patients.

  8. Total hip and knee joint replacement: perioperative clinical aspects

    Directory of Open Access Journals (Sweden)

    Luciana Pereira Almeida de Piano

    2010-09-01

    Full Text Available Objective: To understand the profile of patients undergoing hip and knee replacement during two years, and to compare the data obtained with the literature. Methods: A total of 323 medical records were reviewed to analyze the perioperative data of patients submitted to hip and knee replacement. Results: Osteoarthritis was the main indication for both procedures and male patients were heavier than females (p < 0.05. Hypertension was the prevalent disease among patients. Blood loss was more frequent in knee surgery than in the hip. Conclusions: The profile of patients undergoing total arthroplasty improved substantially over the past decade due to shorter hospital stay, lower risk of thromboembolic events and no infection as compared to previous reports.

  9. PERIOPERATIVE MANAGEMENT OF SICKLE CELL DISEASE: A NARRATIVE REVIEW

    Directory of Open Access Journals (Sweden)

    Kwame Ofori Adjepong

    2018-05-01

    Full Text Available An estimated 30 million people worldwide have sickle cell disease (SCD.  Emergent and non-emergent surgical procedures in SCD have been associated with relatively increased risks of peri-operative mortality, vaso-occlussive (painful crisis, acute chest syndrome, post-operative infections, congestive heart failure, cerebrovascular accident and acute kidney injury.  Pre-operative assessment must include careful review of the patient’s known crisis triggers, baseline hematologic profile, usual transfusion requirements, pre-existing organ dysfunction and narcotic use. Use of preoperative blood transfusions should be selective and decisions individualized based on the baseline hemoglobin, surgical procedure and anticipated volume of blood loss.  Intra- and post-operative management should focus on minimizing hypoxia, hypothermia, acidosis, and intravascular volume depletion. Pre- and post-operative incentive spirometry use should be encouraged.

  10. Migraine and risk of perioperative ischemic stroke and hospital readmission

    DEFF Research Database (Denmark)

    Timm, Fanny P; Houle, Timothy T; Grabitz, Stephanie D

    2017-01-01

    OBJECTIVE: To evaluate whether patients with migraine are at increased risk of perioperative ischemic stroke and whether this may lead to an increased hospital readmission rate. DESIGN: Prospective hospital registry study. SETTING: Massachusetts General Hospital and two satellite campuses between...... was hospital readmission within 30 days of surgery. Exploratory outcomes included post-discharge stroke and strata of neuroanatomical stroke location. RESULTS: 10 179 (8.2%) patients had any migraine diagnosis, of whom 1278 (12.6%) had migraine with aura and 8901 (87.4%) had migraine without aura. 771 (0.......9 (2.9 to 5.0) for migraine without aura, and 6.3 (3.2 to 9.5) for migraine with aura. : Patients with migraine had a higher rate of readmission to hospital within 30 days of discharge (adjusted odds ratio 1.31, 1.22 to 1.41). CONCLUSIONS: Surgical patients with a history of migraine are at increased...

  11. Perioperative management of patient with alkaptonuria and associated multiple comorbidities

    Directory of Open Access Journals (Sweden)

    Ravindra Pandey

    2011-01-01

    Full Text Available Alkaptonuria is a rare inherited genetic disorder of tyrosine metabolism characterized by a triad of homogentisic aciduria, ochronosis, and arthritis. The most common clinical manifestations of ochronosis involve the musculoskeletal, respiratory, airway, cardiovascular, genitourinary, cutaneous, and ocular systems. We report the perioperative anesthetic management of a 56-year-old alkaptonuric patient, with multiple comorbidities scheduled, for revision total hip replacement. A review of her medical history revealed alkaptonuria, hypothyroidism, rheumatoid arthritis, hypertension, diabetes mellitus, and Pott′s spine with disc prolapse. We want to highlight the need of thorough preoperative evaluation in patients of alkaptonuria, as it is associated with multiple comorbidities. The systemic involvement should determine the anesthetic plan. Caution should be exercised during positioning to prevent injury to the joints and the spine.

  12. Perioperative complications of sleeve gastrectomy: Review of the literature.

    Science.gov (United States)

    Iannelli, Antonio; Treacy, Patrick; Sebastianelli, Lionel; Schiavo, Luigi; Martini, Francesco

    2018-05-04

    Sleeve gastrectomy (SG) has known a spectacular rise worldwide during the last decade. The absence of digestive anastomosis simplifies the surgical technique, reducing anastomosis-related complications such as fistula, stricture and marginal ulcer. Furthermore, the respect for digestive continuity preserves the functions of pylorus, that regulates gastric emptying, and duodenum, where calcium, B vitamins and iron are absorbed. Despite the multiple advantages, SG also has specific complications such as bleeding, stenosis, portal thrombosis and leak. The staple line leak at the oesophagogastric junction is the most feared complication and its prevention remains difficult, as the involved mechanisms have been only partially elucidated. Its management is long and requires a multidisciplinary technical platform including Intensive Care Unit, digestive endoscopy and interventional radiology as well as a specialised surgeon. The aim of this review is to explain in detail the perioperative complications of SG, their prevention and treatment, referring to the most recent available literature.

  13. Evaluation of cardiac function using multi-shot echo planar imaging

    Energy Technology Data Exchange (ETDEWEB)

    Nakanishi, Tadashi; Tanitame, Nobuko; Hata, Ryoichiro; Hirai, Nobuhiko; Ikeda, Midori; Ono, Chiaki; Fukuoka, Haruhito; Ito, Katsuhide [Hiroshima Univ. (Japan). School of Medicine

    1998-01-01

    In this study, we performed multi-shot echo planar imaging (8 shot, TR/TE/FL=55 ms/18 ms/60 degrees) and k-space segmented fast gradient echo sequence (8 views per segment, TR/TE/FL=9.9 ms/1.8 ms/30 degrees) to assess cardiac function in healthy volunteers. Transaxial sections of the entire heart were obtained with both sequences in ECG triggered, breath hold, and with a 256 x 128 matrix. Resulting temporal resolution was 55 ms for echo planar imaging, and 71 ms for k-space segmented fast gradient echo sequence, respectively. Ventricular volume and ejection fraction of both ventricles and left ventricular mass obtained with multi-shot echo planar imaging were assessed in comparison with k-space segmented fast gradient echo sequence. Measurements of left ventricular volume, ejection fraction and mass obtained with multi-shot echo planar imaging demonstrated close correlation with those obtained with k-space segmented fast gradient echo sequence. Right ventricular volumes obtained with echo planar imaging were significantly higher than those obtained with k-space segmented fast gradient echo sequence. This tendency is considered to be due to differing contrast between right ventricular myocardium and fat tissue observed with echo planar imaging relative to that observed with fast gradient echo sequence, because fat suppression is always performed in echo planar images. Multi-shot echo planar imaging can be a reliable tool for measurement of cardiac functional parameters, although wall motion analysis of the left ventricle requires higher temporal resolution and a short axial section. (K.H.)

  14. Perioperative care for lumbar microdiscectomy: a survey of Australasian neurosurgeons

    Science.gov (United States)

    Lim, Kai Zheong; Ghosh, Peter; Goldschlager, Tony

    2018-01-01

    Background Lumbar microdiscectomy is the most commonly performed spine surgery procedure. Over time it has evolved to a minimally invasive procedure. Traditionally patients were advised to restrict activity following lumbar spine surgery. However, post-operative instructions are heterogeneous. The purpose of this report is to assess, by survey, the perioperative care practices of Australasian neurosurgeons in the minimally invasive era. Methods A survey was conducted by email invitation sent to all full members of the Neurosurgical Society of Australasia (NSA). This consisted of 11 multi-choice questions relating to operative indications, technique, and post-operative instructions for lumbar microdiscectomy answered by an electronically distributed anonymized online survey. Results The survey was sent to all Australasian Neurosurgeons. In total, 68 complete responses were received (28.9%). Most surgeons reported they would consider a period of either 4 to 8 weeks (42.7%) or 8 to 12 weeks (32.4%) as the minimum duration of radicular pain adequate to offer surgery. Unilateral muscle dissection with unilateral discectomy was practiced by 76.5%. Operative microscopy was the most commonly employed method of magnification (76.5%). The majority (55.9%) always refer patients to undergo inpatient physiotherapy. Sitting restrictions were advised by 38.3%. Lifting restrictions were advised by 83.8%. Conclusions Australasian neurosurgical lumbar microdiscectomy perioperative care practices are generally consistent with international practices and demonstrate a similar degree of heterogeneity. Recommendation of post-operative activity restrictions by Australasian neurosurgeons is still common. This suggests a role for the investigation of the necessity of such restrictions in the era of minimally invasive spine surgery. PMID:29732417

  15. Choice of fluids in the perioperative period of kidney transplantation

    Directory of Open Access Journals (Sweden)

    Alejandro Gonzalez-Castro

    2017-11-01

    Full Text Available Normal saline has traditionally been the resuscitation fluid of choice in the perioperative period of kidney transplantation over balanced potassium solutions. However, the problems arising from hyperchloraemia triggered by the infusion of normal saline have led to studies being conducted that compare this solution with balanced solutions. From this narrative review it can be concluded that the use of balanced crystalloids containing potassium in the perioperative period of kidney transplantation can be considered safe. These solutions do not affect serum potassium levels any more than normal saline, whilst maintaining a better acid–base balance in these patients. Resumen: El suero salino normal (SSN ha sido clásicamente el fluido de resucitación elegido en el periodo perioperatorio del trasplante renal frente a aquellas soluciones balanceadas con potasio. Sin embargo, los problemas derivados de la hipercloremia desencadenada por la infusión de SSN han llevado a la realización de estudios que comparaban esta solución con los fluidos equilibrados. Mediante la presente revisión narrativa se deduce que el uso de cristaloides balanceados con contenido de potasio en su formulación, en el perioperatorio de trasplante renal, puede considerarse seguro. Estas soluciones no provocan una alteración del potasio sérico mayor que la provocada por el SSN y mantienen mejor el equilibrio ácido-base en estos enfermos. Keywords: Kidney transplantation, Normal saline, Balanced solutions, Hyperchloraemia, Hyperkalaemia, Palabras clave: Trasplante renal, Suero salino normal, Soluciones balanceadas, Hipercloremia, Hiperpotasemia

  16. Attacking Postoperative Metastases using Perioperative Oncolytic Viruses and Viral Vaccines

    Science.gov (United States)

    Tai, Lee-Hwa; Auer, Rebecca

    2014-01-01

    Surgical resection of solid primary malignancies is a mainstay of therapy for cancer patients. Despite being the most effective treatment for these tumors, cancer surgery has been associated with impaired metastatic clearance due to immunosuppression. In preclinical surgery models and human cancer patients, we and others have demonstrated a profound suppression of both natural killer (NK) and T cell function in the postoperative period and this plays a major role in the enhanced development of metastases following surgery. Oncolytic viruses (OV) were originally designed to selectively infect and replicate in tumors, with the primary objective of directly lysing cancer cells. It is becoming increasingly clear, however, that OV infection results in a profound inflammatory reaction within the tumor, initiating innate and adaptive immune responses against it that is critical for its therapeutic benefit. This anti-tumor immunity appears to be mediated predominantly by NK and cytotoxic T cells. In preclinical models, we found that preoperative OV prevents postoperative NK cell dysfunction and attenuates tumor dissemination. Due to theoretical safety concerns of administering live virus prior to surgery in cancer patients, we characterized safe, attenuated versions of OV, and viral vaccines that could stimulate NK cells and reduce metastases when administered in the perioperative period. In cancer patients, we observed that in vivo infusion with oncolytic vaccinia virus and ex vivo stimulation with viral vaccines promote NK cell activation. These preclinical studies provide a novel and clinically relevant setting for OV therapy. Our challenge is to identify safe and promising OV therapies that will activate NK and T cells in the perioperative period preventing the establishment of micrometastatic disease in cancer patients. PMID:25161958

  17. Clinical performance feedback and quality improvement opportunities for perioperative physicians

    Directory of Open Access Journals (Sweden)

    Kaye AD

    2014-05-01

    Full Text Available Alan David Kaye,1 Olutoyin J Okanlawon,2 Richard D Urman21Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, 2Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston MA, USAAbstract: Clinical performance feedback is an important component of the ongoing development and education of health care practitioners. For physicians, feedback about their clinical practice and outcomes is central to developing both confidence and competence at all stages of their medical careers. Cultural and financial infrastructures need to be in place, and the concept of feedback needs to be readily embraced and encouraged by clinical leadership and other stakeholders. The "buy-in" includes the expectation and view that feedback occurs on a routine basis, and those engaged in the process are both encouraged to participate and held accountable. Feedback must be part of an overarching quality improvement and physician education agenda; it is not meant to be an isolated, fragmented initiative that is typically undermined by lack of resources or systemic barriers to gaining improvement within programs. Effective feedback should be an integral part of clinical practice. Anesthesiologists and other perioperative physicians are identifying specialty-specific indicators that can be used when creating a broader quality improvement agenda. Placing a more immediate formal feedback strategy that focuses on goal-oriented behavior is rapidly becoming a mainstay. Physicians may use their individual feedback reports for reflection and designing personal development plans as lifelong learners and leaders in improving patient care.Keywords: physician education, outcomes measurement, performance improvement, anesthesiology

  18. Polar mesosphere winter echoes during MaCWAVE

    Directory of Open Access Journals (Sweden)

    S. Kirkwood

    2006-07-01

    Full Text Available During the MaCWAVE winter campaign in January 2003, layers of enhanced echo power known as PMWE (Polar Mesosphere Winter Echoes were detected by the ESRAD 52 MHz radar on several occasions. The cause of these echoes is unclear and here we use observations by meteorological and sounding rockets and by lidar to test whether neutral turbulence or aerosol layers might be responsible. PMWE were detected within 30 min of meteorological rocket soundings (falling spheres on 5 separate days. The observations from the meteorological rockets show that, in most cases, conditions likely to be associated with neutral atmospheric turbulence are not observed at the heights of the PMWE. Observations by instrumented sounding rockets confirm low levels of turbulence and indicate considerable small-scale structure in charge density profiles. Comparison of falling sphere and lidar data, on the other hand, show that any contribution of aerosol scatter to the lidar signal at PMWE heights is less than the detection threshold of about 10%.

  19. Climatology and variability in the ECHO coupled GCM

    International Nuclear Information System (INIS)

    Latif, M.; Stockdale, T.; Wolff, J.; Burgers, G.; Maier-Reimer, E.; Junge, M.M.; Arpe, K.; Bengtsson, L.

    1993-01-01

    ECHO is a new global coupled ocean-atmosphere general circulation model (GCM), consisting of the Hamburg version of the European Centre atmospheric GCM (ECHAM) and the Hamburg Primitive Equation ocean GCM (HOPE). We performed a twenty year integration with ECHO. Climate drift is significant, but typical in the open oceans. Near the boundaries, however, SST errors are considerably larger. The coupled model simulates an irregular ENSO cycle in the tropical Pacific, with spatial patterns similar to those observed. The mechanism behind the model ENSO is related to the subsurface memory of the system, but stochastic forcing by the atmosphere seems to be also important. The variability, however, is somewhat weaker relative to observations. ECHO also simulates significant interannual variability in midlatitudes. Consistent with observations, variability over the North Pacific can be partly attributed to remote forcing from the tropics. In contract, the interannual variability over the North Atlantic appears to be generated locally. Indications for decadal-scale variability are also found over the North Atlantic. (orig.)

  20. THIRTY YEARS OF SN 1980K: EVIDENCE FOR LIGHT ECHOES

    Energy Technology Data Exchange (ETDEWEB)

    Sugerman, Ben E. K. [Department of Physics and Astronomy, Goucher College, 1021 Dulaney Valley Road, Baltimore, MD 21208 (United States); Andrews, Jennifer E. [Department of Astronomy, University of Massachusetts, 710 North Pleasant Street, Amherst, MA 01003 (United States); Barlow, Michael J. [Department of Physics and Astronomy, University College London, Gower Street, London WC1E 6BT (United Kingdom); Clayton, Geoffrey C. [Department of Physics and Astronomy, Lousiana State University, 202 Nicholson Hall, Baton Roughe, LA 70803 (United States); Ercolano, Barbara [Excellence Cluster ' Universe' , Universitaets-Sternwarte Muenchen, Scheinerstr. 1, 81679 Muenchen (Germany); Ghavamian, Parviz [Department of Physics, Astronomy and Geosciences, Towson University, Smith Hall, Towson, MD 21252 (United States); Kennicutt, Robert C. Jr. [Institute of Astronomy, University of Cambridge, Madingley Road, Cambridge, CM3 0HA (United Kingdom); Krause, Oliver [Max Planck Institute for Astronomy, Koenigstuhl 17, 69117 Heidelberg (Germany); Meixner, Margaret [Space Telescope Science Institute, 3700 San Martin Drive, Baltimore, MD 21218 (United States); Otsuka, Masaaki, E-mail: ben.sugerman@goucher.edu [Institute of Astronomy and Astrophysics, Academia Sinica, Taipei 10617, Taiwan (China)

    2012-04-20

    We report optical and mid-infrared photometry of SN 1980K between 2004 and 2010, which shows slow monotonic fading consistent with previous spectroscopic and photometric observations made 8-17 yr after outburst. The slow rate of change over two decades suggests that this evolution may result from scattered and thermal light echoes off of extended circumstellar material. We present a semi-analytic dust radiative-transfer model that uses an empirically corrected effective optical depth to provide a fast and robust alternative to full Monte Carlo radiative-transfer modeling for homogenous dust at low to intermediate optical depths. We find that unresolved echoes from a thin circumstellar shell 14-15 lt-yr from the progenitor, and containing {approx}< 0.02 M{sub Sun} of carbon-rich dust, can explain the broadband spectral and temporal evolution. The size, mass, and dust composition are in good agreement with the contact discontinuity observed in scattered echoes around SN 1987A. The origin of slowly changing high-velocity [O I] and H{alpha} lines is also considered. We propose an origin in shocked high-velocity metal-rich clumps of ejecta, rather than arising in the impact of ejecta on slowly moving circumstellar material, as is the case with hot spots in SN 1987A.

  1. MR fingerprinting using the quick echo splitting NMR imaging technique.

    Science.gov (United States)

    Jiang, Yun; Ma, Dan; Jerecic, Renate; Duerk, Jeffrey; Seiberlich, Nicole; Gulani, Vikas; Griswold, Mark A

    2017-03-01

    The purpose of the study is to develop a quantitative method for the relaxation properties with a reduced radio frequency (RF) power deposition by combining magnetic resonance fingerprinting (MRF) technique with quick echo splitting NMR imaging technique (QUEST). A QUEST-based MRF sequence was implemented to acquire high-order echoes by increasing the gaps between RF pulses. Bloch simulations were used to calculate a dictionary containing the range of physically plausible signal evolutions using a range of T 1 and T 2 values based on the pulse sequence. MRF-QUEST was evaluated by comparing to the results of spin-echo methods. The specific absorption rate (SAR) of MRF-QUEST was compared with the clinically available methods. MRF-QUEST quantifies the relaxation properties with good accuracy at the estimated head SAR of 0.03 W/kg. T 1 and T 2 values estimated by MRF-QUEST are in good agreement with the traditional methods. The combination of the MRF and the QUEST provides an accurate quantification of T 1 and T 2 simultaneously with reduced RF power deposition. The resulting lower SAR may provide a new acquisition strategy for MRF when RF energy deposition is problematic. Magn Reson Med 77:979-988, 2017. © 2016 International Society for Magnetic Resonance in Medicine. © 2016 International Society for Magnetic Resonance in Medicine.

  2. Gravitational wave echoes from macroscopic quantum gravity effects

    Energy Technology Data Exchange (ETDEWEB)

    Barceló, Carlos [Instituto de Astrofísica de Andalucía (IAA-CSIC),Glorieta de la Astronomía, 18008 Granada (Spain); Carballo-Rubio, Raúl [The Cosmology & Gravity Group and the Laboratory for Quantum Gravity & Strings,Department of Mathematics & Applied Mathematics, University of Cape Town,Private Bag, Rondebosch 7701 (South Africa); Garay, Luis J. [Departamento de Física Teórica II,Universidad Complutense de Madrid, 28040 Madrid (Spain); Instituto de Estructura de la Materia (IEM-CSIC),Serrano 121, 28006 Madrid (Spain)

    2017-05-10

    New theoretical approaches developed in the last years predict that macroscopic quantum gravity effects in black holes should lead to modifications of the gravitational wave signals expected in the framework of classical general relativity, with these modifications being characterized in certain scenarios by the existence of dampened repetitions of the primary signal. Here we use the fact that non-perturbative corrections to the near-horizon external geometry of black holes are necessary for these modifications to exist, in order to classify different proposals and paradigms with respect to this criterion and study in a neat and systematic way their phenomenology. Proposals that lead naturally to the existence of echoes in the late-time ringdown of gravitational wave signals from black hole mergers must share the replacement of black holes by horizonless configurations with a physical surface showing reflective properties in the relevant range of frequencies. On the other hand, proposals or paradigms that restrict quantum gravity effects on the external geometry to be perturbative, such as black hole complementarity or the closely related firewall proposal, do not display echoes. For the sake of completeness we exploit the interplay between the timescales associated with the formation of firewalls and the mechanism behind the existence of echoes in order to conclude that even unconventional distortions of the firewall concept (such as naked firewalls) do not lead to this phenomenon.

  3. The peri-operative management of anti-platelet therapy in elective, non-cardiac surgery.

    Science.gov (United States)

    Alcock, Richard F; Naoum, Chris; Aliprandi-Costa, Bernadette; Hillis, Graham S; Brieger, David B

    2013-07-31

    Cardiovascular complications are important causes of morbidity and mortality in patients undergoing elective non-cardiac surgery, with adverse cardiac outcomes estimated to occur in approximately 4% of all patients. Anti-platelet therapy withdrawal may precede up to 10% of acute cardiovascular syndromes, with withdrawal in the peri-operative setting incompletely appraised. The aims of our study were to determine the proportion of patients undergoing elective non-cardiac surgery currently prescribed anti-platelet therapy, and identify current practice in peri-operative management. In addition, the relationship between management of anti-platelet therapy and peri-operative cardiac risk was assessed. We evaluated consecutive patients attending elective non-cardiac surgery at a major tertiary referral centre. Clinical and biochemical data were collected and analysed on patients currently prescribed anti-platelet therapy. Peri-operative management of anti-platelet therapy was compared with estimated peri-operative cardiac risk. Included were 2950 consecutive patients, with 516 (17%) prescribed anti-platelet therapy, primarily for ischaemic heart disease. Two hundred and eighty nine (56%) patients had all anti-platelet therapy ceased in the peri-operative period, including 49% of patients with ischaemic heart disease and 46% of patients with previous coronary stenting. Peri-operative cardiac risk score did not influence anti-platelet therapy management. Approximately 17% of patients undergoing elective non-cardiac surgery are prescribed anti-platelet therapy, the predominant indication being for ischaemic heart disease. Almost half of all patients with previous coronary stenting had no anti-platelet therapy during the peri-operative period. The decision to cease anti-platelet therapy, which occurred commonly, did not appear to be guided by peri-operative cardiac risk stratification. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  4. Effects of perioperative briefing and debriefing on patient safety: a prospective intervention study.

    Science.gov (United States)

    Leong, Katharina Brigitte Margarethe Siew Lan; Hanskamp-Sebregts, Mirelle; van der Wal, Raymond A; Wolff, Andre P

    2017-12-14

    This study was carried out to improve patient safety in the operating theatre by the introduction of perioperative briefing and debriefing, which focused on an optimal collaboration between surgical team members. A prospective intervention study with one pretest and two post-test measurements: 1 month before and 4 months and 2.5 years after the implementation of perioperative briefing and debriefing, respectively. Operating theatres of a tertiary care hospital with 875 beds in the Netherlands. All members of five surgical teams participated in the perioperative briefing and debriefing. The implementation of perioperative briefing and debriefing from July 2012 to January 2014. The primary outcome was changes in the team climate, measured by the Team Climate Inventory. Secondary outcomes were the experiences of surgical teams with perioperative briefing and debriefing, measured with a structured questionnaire, and the duration of the briefings, measured by an independent observer. Two and a half years after the introduction of perioperative briefing and debriefing, the team climate increased statistically significant (p≤0.05). Members of the five surgical teams strongly agreed with the positive influence of perioperative briefing and debriefing on clear agreements and reminding one another of the agreements of the day. They perceived a higher efficiency of the surgical programme with more operations starting on time and less unexpectedly long operation time. The perioperative briefing took less than 4 min to conduct. Perioperative briefing and debriefing improved the team climate of surgical teams and the efficiency of their work within the operating theatre with acceptable duration per briefing. Surgical teams with alternating team compositions have the most benefit of briefing and debriefing. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise

  5. Comparison of dynamic dual spin-echo and fast-gradient-echo techniques in the evaluation of cardiac diseases

    International Nuclear Information System (INIS)

    Pettigrew, R.I.; Eisner, R.L.; Groen, J.P.; Baron, M.G.

    1987-01-01

    To determine the relative roles of a dynamic spin-echo method and a fast acquisition with multiphase excitations (FAME) technique, ten patients with myocardial infarction (MI), five with myocardial masses, and five healthy patients were studied with both methods. The dynamic dual-spin-echo (DSE) technique allows acquisition of each of seven sections at 14 cardiac phases in 20 minutes. Wall motion abnormalities were seen equally well with both techniques, but FAME usually required a shorter study time (10 minutes). DSE, however, was superior for evaluating cardiac masses and provided superior wall blood contrast. Thus, these techniques are complementary, and both are now a routine part of the authors' study of cardiac patients

  6. Proton T2 relaxation effect of superparamagnetic iron oxide. Comparison between fast spin echo and conventional spin echo sequence

    International Nuclear Information System (INIS)

    Tanimoto, Akihiro; Satoh, Yoshinori; Higuchi, Nobuya; Izutsu, Mutsumu; Yuasa, Yuji; Hiramatsu, Kyoichi

    1995-01-01

    Superparamagnetic iron oxide (SPIO) particles have been known to show a great T 2 relaxation effect in the liver, which contributes to significant liver signal decrease and detection of hepatic neoplasms. Recently, fast spin echo (FSE) sequence with less scanning time than conventional spin echo (SE) sequence has been rapidly introduced in clinical MR imaging. To investigate whether SPIO would show decreased T 2 relaxation effect on FSE, we obtained T 2 relaxivity (R2) of SPIO in vitro and liver signal decrease caused by SPIO in vivo. SPIO showed 20% less R2 on Carr-Purcell-Meiboom-Gill (CPMG) sequence than on SE. Relative liver signal-to-noise ratio (SNR) decrease caused by SPIO was significantly smaller (p 2 relaxation effect on FSE than on SE. However, further studies will be required to assess the diagnostic capability of SPIO on FSE, in the detection of hepatic neoplasms. (author)

  7. NMR multiple-echo phase-contrast blood flow imaging

    International Nuclear Information System (INIS)

    O'Donnell, M.

    1986-01-01

    A method is described for magnetic resonance imaging of fluid flow in a sample, comprising the steps of: (a) immersing the sample in a static magnetic field disposed in a first direction; (b) applying a first sequence of magnetic field gradients and radio-frequency signals to the sample to both define a slab, of the sample to be imaged, in a plane substantially orthogonal to a selected direction for which flow velocity is to be measured, and to obtain a plurality N of spin-echo response signals form that slab; (c) processing the plurality of first sequence spin-echo signals to obtain a complex value A/sub 1/(X,Y,Z) relating both the spin density rho'(X,Y,Z),... and the phase rotation phi(X,Y,Z), induced by the first sequence, for each of a selected number of sequential locations (X,Y,Z) in the sample slab; (d) applying a second sequence of magnetic field gradient and radio-frequency signals to both define the same sample slab as in step (b) and to obtain another plurality N of spin-echo response signals from that slab; (e) including a waveform in at least one of the magnetic field gradient and radio-frequency signals applied in step (d) for imparting to each of the spin-echo signal components from each slab location having a flowing material therein a phase rotation dependent upon the magnitude of the flow velocity therein in the selected direction; (f) processing the plurality of second sequence spin-echo signals to obtain a complex value A/sub 2/(X,Y,Z) relating the spin density rho'(X,Y,Z) and the imparted phase rotation of the sample material along the selected flow measurement direction for each of the sequential locations (X,Y,Z) in the sample slab; and (g) processing the complex values A/sub 1/(X,Y,Z) and A/sub 2/(X,Y,Z) for each sample location to obtain a differential phase-contrast value related to the velocity of the flowing material therein in the selected measurement direction

  8. Depolarization of neutron spin echo by magnetic fluid

    International Nuclear Information System (INIS)

    Achiwa, N.; Sirozu, G.; Nishioka, T.; Ebisawa, T.; Hino, M.; Tasaki, S.; Kawai, T.; Yamazaki, D.

    2001-01-01

    A new method to study the fluctuations of magnetization in magnetic fluids by measuring relations between the phase shift of Larmor precession and the visibility of the neutron spin echo caused by the change of flight path length is studied. Magnetic fluid in which fine particles of magnetite of about 10 nm diameters coated with oleic acid and suspended in water was used. Thickness of the sample was 2 mm. In the dynamics of magnetic fluids, Brownian motions of colloids and the thermal fluctuations of magnetization known as the superparamagnetism are dominant. Isolated ferromagnetic particles of the present size are superparamagnetic but they aggregate to form clusters in a weak magnetic field in the sample of 40% weight density. When neutrons pass the sample, spins process in the magnetic flux density of the clusters fluctuating in time and space. Consequently the Larmor precession phases become distributed and the quantization axes are fluctuated. The result is observed as a decrease of the visibility of the spin echo signals. The change of magnetic flux density in the magnetic fluid is measured from the change of echo visibility of the neutrons, vice versa. In the present experiment, echo was measured at q=0. It is observed that the phase shift changes as a quadratic function of the sample angle reflecting the change of the path length through the sample. Since the number of Larmor precession is proportional to the product of the magnetic field and the length of the flight path, mean flux density in the magnetic fluid is calculated from the phase shift. On the other hand, the decrease of the spin echo amplitude as the function of the sample angle reflects the time and space fluctuations of the flux density in the sample. If the direction of the magnetic flux density vector (quantization axis) changes slowly enough compared to the Larmor precession period while a neutron passes one magnetic domain, the neutron spin rotation in the domain is given by the spin

  9. A new technique for MR elastography of the supraspinatus muscle: A gradient-echo type multi-echo sequence.

    Science.gov (United States)

    Ito, Daiki; Numano, Tomokazu; Mizuhara, Kazuyuki; Takamoto, Koichi; Onishi, Takaaki; Nishijo, Hisao

    2016-10-01

    Magnetic resonance elastography (MRE) can measure tissue stiffness quantitatively and noninvasively. Supraspinatus muscle injury is a significant problem among throwing athletes. The purpose of this study was to develop an MRE technique for application to the supraspinatus muscle by using a conventional magnetic resonance imaging (MRI). MRE acquisitions were performed with a gradient-echo type multi-echo MR sequence at 100Hz pneumatic vibration. A custom-designed vibration pad was used as a pneumatic transducer in order to adapt to individual shoulder shapes. In a gradient-echo type multi-echo MR sequence, without motion encoding gradient (MEG) that synchronizes with vibrations, bipolar readout gradient lobes achieved a similar function to MEG (MEG-like effect). In other words, a dedicated MRE sequence (built-in MEG) is not always necessary for MRE. In this study, 7 healthy volunteers underwent MRE. We investigated the effects of direction of the MEG-like effect and selected imaging planes on the patterns of wave propagation (wave image). The results indicated that wave images showed clear wave propagation on a condition that the direction of the MEG-like effect was nearly perpendicular to the long axis of the supraspinatus muscle, and that the imaging plane was superior to the proximal supraspinatus muscle. This limited condition might be ascribed to specific features of fibers in the supraspinatus muscle and wave reflection from the boundaries of the supraspinous fossa. The mean stiffness of the supraspinatus muscle was 10.6±3.17kPa. Our results demonstrated that using MRE, our method can be applied to the supraspinatus muscle by using conventional MRI. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Magnetic resonance imaging of lumbar spine. Comparison of multiple spin echo and low flip angle gradient echo imaging

    Energy Technology Data Exchange (ETDEWEB)

    Murakami, Takamichi; Fujita, Norihiko; Harada, Koushi; Kozuka, Takahiro (Osaka Univ. (Japan). Faculty of Medicine)

    1989-07-01

    Sixteen patients including 13 cases with disk herniation and 3 cases with spondylosis of lumbar spine were examined on a resistive MRI system operating at 0.1 T. All lesions were studied with both multiple spin echo (MSE) and low flip angle gradient echo (LF) techniques to evaluate which technique is more effective in detecting the disk degeneration and the indentation on subarachnoid space. MSE images were obtained with repetition time (TR) of 1100-1500 ms or cardiac gating, an echo time (TE) of 30, 60, 90, 120, 150, and 180 ms symmetrical 6 echoes, and total acquisition time of more than 281 sec. LF images were obtained with TR of 500, 250, and 100 ms, TE of 18 ms, a flip angle of 30 degree, and total acquisition time of 128 sec. Eleven lesions of spinal disk degeneration and 12 of indentation on subarachnoid space were detected with LF. On the other hand, 26 lesions of spinal disk degeneration and 38 of indentation on subarachnoid space were detected with MSE. Although the parameters of LF employed in this study were relatively effective to emphasize T2{sup *}-based contrast, the ability of LF in detection of spinal disk degeneration and indentation on subarachnoid space is less than that of MSE. Signal contrast to noise ratios for normal disk and degenerative disk, epidural-fat and disk herniated material, CSF and disk herniated material, and epidural-fat and CSF were less than 4 with LF, but more than 4 with MSE. This difference of contrast to noise ratio between MSE and LF was one of the main causes of the difference of the detection rate of spinal disk degeneration and indentation on subarachnoid space. (author).

  11. Usefulness of dual echo volumetric isotropic turbo spin echo acquisition (VISTA) in MR imaging of the temporomandibular joint

    International Nuclear Information System (INIS)

    Sugimori, Yuko; Tanaka, Shigeko; Naito, Yukari; Nishimura, Tetsuya; Yamamoto, Akira; Miki, Yukio; Ohfuji, Satoko; Katsumata, Yasutomo

    2013-01-01

    We investigated the ability to detect the articular disk and joint effusion of the temporomandibular joint (TMJ) of a method of dual echo volumetric isotropic turbo spin echo acquisition (DE-VISTA) additional fusion images (AFI). DE-VISTA was performed in the 26 TMJ of 13 volunteers and 26 TMJ of 13 patients. Two-dimensional (2D) dual echo turbo spin echo was performed in the 26 TMJ of 13 volunteers. On a workstation, we added proton density-weighted images (PDWI) and T 2 weighted images (T 2 WI) of the DE-VISTA per voxel to reconstruct DE-VISTA-AFI. Two radiologists reviewed these images visually and quantitatively. Visual evaluation of the articular disk was equivalent between DE-VISTA-AFI and 2D-PDWI. The sliding thin-slab multiplanar reformation (MPR) method of DE-VISTA-AFI could detect all articular disks. The ratio of contrast (CR) of adipose tissue by the articular disk to that of the articular disk itself was significantly higher in DE-VISTA-AFI than DE-VISTA-PDWI (P 2 WI but in only 3 of those joints in 2D-T 2 WI. The CR of joint effusion to adipose tissue on DE-VISTA-AFI did not differ significantly from that on DE-VISTA-PDWI. However, using DE-VISTA-T 2 WI in addition to DE-VISTA-PDWI, we could visually identify joint effusion on DE-VISTA-AFI that could not be identified on DE-VISTA-PDWI alone. DE-VISTA-AFI can depict the articular disk and a small amount of joint effusion by the required plane of MPR using the sliding thin-slab MPR method. (author)

  12. Theory of single-photon echo (SP-echo) and the possibility of its experimental study in the gamma-region

    International Nuclear Information System (INIS)

    Moiseev, S.A.

    1997-01-01

    The single-photon echo (SP-echo) effect is predicted to appear in the case of three-level medium excitation by means of a single photon propagating to the medium along two optical paths with a mutual time delay surpassing the temporal duration of the photon wave packet. The quantum electrodynamical theory describing this interaction is presented and the S-matrix of the field is shown for infinite time (t=∞). Using the S-matrix approach, physical properties of the scattering field are studied. Hence, it is shown that the field has an echo signal at the ω 32 0 carrier frequency. It has been shown that the echo signal exists only in the field amplitude while being absent in its intensity behaviour. Thus, SP-echo is an interference effect and is not influenced by the energy irradiation. The problems of SP-echo detection in the gamma-region (where special generation difficulties appear) are discussed. The influence of the additional detection of theω 21 0 frequency field on the echo signal has been shown. A special case is the EPR-paradox which can appear within the echo phenomenon

  13. Theory of single-photon echo (SP-echo) and the possibility of its experimental study in the gamma-region

    Energy Technology Data Exchange (ETDEWEB)

    Moiseev, S.A

    1997-05-15

    The single-photon echo (SP-echo) effect is predicted to appear in the case of three-level medium excitation by means of a single photon propagating to the medium along two optical paths with a mutual time delay surpassing the temporal duration of the photon wave packet. The quantum electrodynamical theory describing this interaction is presented and the S-matrix of the field is shown for infinite time (t={infinity}). Using the S-matrix approach, physical properties of the scattering field are studied. Hence, it is shown that the field has an echo signal at the {omega}{sub 32}{sup 0} carrier frequency. It has been shown that the echo signal exists only in the field amplitude while being absent in its intensity behaviour. Thus, SP-echo is an interference effect and is not influenced by the energy irradiation. The problems of SP-echo detection in the gamma-region (where special generation difficulties appear) are discussed. The influence of the additional detection of the{omega}{sub 21}{sup 0} frequency field on the echo signal has been shown. A special case is the EPR-paradox which can appear within the echo phenomenon.

  14. Improved sensitivity and specificity for resting state and task fMRI with multiband multi-echo EPI compared to multi-echo EPI at 7T.

    NARCIS (Netherlands)

    Boyacioglu, R.; Schulz, J.; Koopmans, P.J.; Barth, M.; Norris, David Gordon

    2015-01-01

    A multiband multi-echo (MBME) sequence is implemented and compared to a matched standard multi-echo (ME) protocol to investigate the potential improvement in sensitivity and spatial specificity at 7 T for resting state and task fMRI. ME acquisition is attractive because BOLD sensitivity is less

  15. Diuretic-enhanced gadolinium excretory MR urography: comparison of conventional gradient-echo sequences and echo-planar imaging

    Energy Technology Data Exchange (ETDEWEB)

    Nolte-Ernsting, C.C.A.; Tacke, J.; Adam, G.B.; Haage, P.; Guenther, R.W. [Univ. of Technology, Aachen (Germany). Dept. of Diagnostic Radiology; Jung, P.; Jakse, G. [Univ. of Technology, Aachen (Germany). Dept. of Urology

    2001-01-01

    The aim of this study was to investigate the utility of different gadolinium-enhanced T1-weighted gradient-echo techniques in excretory MR urography. In 74 urologic patients, excretory MR urography was performed using various T1-weighted gradient-echo (GRE) sequences after injection of gadolinium-DTPA and low-dose furosemide. The examinations included conventional GRE sequences and echo-planar imaging (GRE EPI), both obtained with 3D data sets and 2D projection images. Breath-hold acquisition was used primarily. In 20 of 74 examinations, we compared breath-hold imaging with respiratory gating. Breath-hold imaging was significantly superior to respiratory gating for the visualization of pelvicaliceal systems, but not for the ureters. Complete MR urograms were obtained within 14-20 s using 3D GRE EPI sequences and in 20-30 s with conventional 3D GRE sequences. Ghost artefacts caused by ureteral peristalsis often occurred with conventional 3D GRE imaging and were almost completely suppressed in EPI sequences (p < 0.0001). Susceptibility effects were more pronounced on GRE EPI MR urograms and calculi measured 0.8-21.7% greater in diameter compared with conventional GRE sequences. Increased spatial resolution degraded the image quality only in GRE-EPI urograms. (orig.)

  16. Patterns in current perioperative practice: survey of colorectal surgeons in five northern European countries

    DEFF Research Database (Denmark)

    Lassen, K; Hannemann, P; Ljungqvist, O

    2005-01-01

    Evidence for optimal perioperative care in colorectal surgery is abundant. By avoiding fasting, intravenous fluid overload, and activation of the neuroendocrine stress response, postoperative catabolism is reduced and recovery enhanced. The specific measures that can be used routinely include no ...

  17. Guideline-oriented perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease.

    Science.gov (United States)

    Yamakage, Michiaki; Iwasaki, Sohshi; Namiki, Akiyoshi

    2008-01-01

    Increased airway hyperresponsiveness is a major concern in the perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease. Guidelines using evidence-based medicine are continually being updated and published regarding the diagnosis, treatment, and prevention of these respiratory disorders. Perioperative management in these patients involves: (1) adequate control of airway hyperresponsiveness, including detection of purulent sputum and infection before surgery; (2) evidence-based control of anesthesia; and (3) the aggressive use of beta-2 adrenergic stimulants and the systemic administration of steroids for the treatment of acute attacks. Good preoperative control, including the use of leukotriene antagonists, can reduce the incidence of life-threatening perioperative complications. Awareness of recent guidelines is thus important in the management of patients with airway hyperresponsiveness. This review covers the most recent guidelines for the perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease.

  18. Perioperative pregabalin improves pain and functional outcomes 3 months after lumbar discectomy.

    LENUS (Irish Health Repository)

    Burke, Siun M

    2010-04-01

    Patient outcome after lumbar discectomy for radicular low back pain is variable and the benefit is inconsistent. Many patients continue to experience pain 3 months after surgery. Pregabalin, a membrane stabilizer, may decrease perioperative central sensitization and subsequent persistent pain.

  19. Perioperative volume replacement in children undergoing cardiac surgery: albumin versus hydroxyethyl starch 130/0.4

    NARCIS (Netherlands)

    Hanart, Christophe; Khalife, Maher; de Villé, Andrée; Otte, Florence; de Hert, Stefan; van der Linden, Philippe

    2009-01-01

    OBJECTIVE: To compare 4% albumin with 6% hydroxyethyl starch (HES) 130/0.4 in terms of perioperative blood loss and intraoperative fluid requirements in children undergoing cardiac surgery. DESIGN: Prospective randomized study. SETTING: Single University Hospital. PATIENTS: Pediatric patients

  20. The Role of Emotional Intelligence in Perioperative Nursing and Leadership: Developing Skills for Improved Performance.

    Science.gov (United States)

    Beydler, Kathy Williams

    2017-10-01

    Many responsibilities of perioperative professionals involve concrete tasks that require high technical competence. Emotional intelligence, referred to as EQ, which involves the ability to relate to and influence others, may also be important for perioperative professionals. High EQ has been linked to higher performance in the workplace, higher job satisfaction, lower turnover intentions, and less burnout. Perioperative professionals who demonstrate a combination of technical skills and EQ could be more attuned to the humanity of health care (ie, providing more holistic care for the patient). Perioperative nurses who value providing holistic care for their patients may possess many of the elements of EQ. Leaders who recognize the importance of their own EQ and actively assist staff members to enhance and develop their EQ competency may help to create a competitive advantage by establishing a workforce of nurses who possess strong technical skills and high EQ. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  1. Perioperative Statin Therapy Is Not Associated With Reduced Risk of Anastomotic Leakage After Colorectal Resection

    DEFF Research Database (Denmark)

    Bisgård, Anne Sofie; Noack, Morten Westergaard; Klein, Mads

    2013-01-01

    Anastomotic leakage is a serious complication of colorectal surgery. Several studies have demonstrated the beneficial pleiotropic effects of statins, and preliminary studies have suggested that perioperative statin treatment may be associated with reduced risk of anastomotic leakage....

  2. Perioperative management of gastrostomy tube placement in Duchenne muscular dystrophy adolescent and young adult patients: A role for a perioperative surgical home.

    Science.gov (United States)

    Boivin, Ariane; Antonelli, Richard; Sethna, Navil F

    2018-02-01

    In past decades, Duchenne muscular dystrophy patients have been living longer and as the disease advances, patients experience multisystemic deterioration. Older patients often require gastrostomy tube placement for nutritional support. For optimizing the perioperative care, a practice of multidisciplinary team can better anticipate, prevent, and manage possible complications and reduce the overall perioperative morbidity and mortality. The aim of this study was to review our experience with perioperative care of adolescent and young adults with Duchenne muscular dystrophy undergoing gastrostomy by various surgical approaches in order to identify challenges and improve future perioperative care coordination to reduce morbidity. We retrospectively examined cases of gastrostomy tube placement in patients of ages 15 years and older between 2005 and 2016. We reviewed preoperative evaluation, anesthetic and surgical management, and postoperative complications. Twelve patients were identified; 1 had open gastrostomy, 3 laparoscopic gastrostomies, 5 percutaneous endoscopic guided, and 3 radiologically inserted gastrostomy tubes. All patients had preoperative cardiac evaluation with 6 patients demonstrating cardiomyopathy. Nine patients had preoperative pulmonary consultations and the pulmonary function tests reported forced vital capacity of ≤36% of predicted. Eight patients were noninvasive positive pressure ventilation dependent. General anesthesia with tracheal intubation was administered in 8 patients, and intravenous sedation in 4 patients; 1 received sedation supplemented with regional anesthesia and 3 received deep sedation. One patient had a difficult intubation that resulted in trauma and prolonged tracheal intubation. Three patients developed postoperative respiratory complications. Two patients' procedures were postponed due to inadequate preoperative evaluation and 1 because of disagreement between anesthesia and procedural services as to the optimal

  3. Multidisciplinary perioperative protocol in patients undergoing acute high-risk abdominal surgery

    DEFF Research Database (Denmark)

    Tengberg, L. T.; Bay-Nielsen, M.; Bisgaard, T.

    2017-01-01

    Background: Acute high-risk abdominal (AHA) surgery carries a very high risk of morbidity and mortality and represents a massive healthcare burden. The aim of the present study was to evaluate the effect of a standardized multidisciplinary perioperative protocol in patients undergoing AHA surgery...... = 0·004). Conclusion: The introduction of a multidisciplinary perioperative protocol was associated with a significant reduction in postoperative mortality in patients undergoing AHA surgery. NCT01899885 (http://www.clinicaltrials.gov)....

  4. Multicentre trial of a perioperative protocol to reduce mortality in patients with peptic ulcer perforation

    DEFF Research Database (Denmark)

    Møller, M H; Adamsen, S; Thomsen, R W

    2011-01-01

    Morbidity and mortality rates in patients with perforated peptic ulcer (PPU) remain substantial. The aim of the present study was to evaluate the effect of a multimodal and multidisciplinary perioperative care protocol on mortality in patients with PPU.......Morbidity and mortality rates in patients with perforated peptic ulcer (PPU) remain substantial. The aim of the present study was to evaluate the effect of a multimodal and multidisciplinary perioperative care protocol on mortality in patients with PPU....

  5. Impact of surgical case order on perioperative outcomes for robotic-assisted radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Anil A Thomas

    2014-01-01

    Conclusions: Surgical case order may influence perioperative outcomes for RARP with decreased operative times and increased length of hospital stay associated with later cases. These findings indicate that select perioperative factors may improve with ascending case order as the surgical team "warms up" during the day. In addition, 3 rd round cases can increase hospital costs associated with increased lengths of hospital stay. Knowledge of these differences may assist in surgical planning to improve outcomes and limit costs.

  6. Evidence or eminence in abdominal surgery: Recent improvements in perioperative care

    OpenAIRE

    Segelman, Josefin; Nygren, Jonas

    2014-01-01

    Repeated surveys from Europe, the United States, Australia, and New Zealand have shown that adherence to an evidence-based perioperative care protocol, such as Enhanced Recovery After Surgery (ERAS), has been generally low. It is of great importance to support the implementation of the ERAS protocol as it has been shown to improve outcomes after a number of surgical procedures, including major abdominal surgery. However, despite an increasing awareness of the importance of structured perioper...

  7. Developing and validating the Perioperative Thirst Discomfort Scale.

    Science.gov (United States)

    Martins, Pamela Rafaela; Fonseca, Lígia Fahl; Rossetto, Edilaine Giovanini

    2017-07-20

    Developing and validating a scale to assess perioperative thirst discomfort. A methodological research conducted in 2014 and 2015 at the surgical center of a public hospital in the north of Paraná, Brazil. The scale was developed after literature review, followed by face and content validation, and reliability assessment through its internal consistency and inter-observer equivalence. Seven items make up the scale: dry mouth; dry lips; thick tongue; thick saliva; dry throat, bad taste and desire to drink water. The content validity index for attributes and items was 0.98, and the reliability index was 1 for the scale attributes and items. Internal consistency assessed by Cronbach's alpha was 0.91 and inter-rater equivalence was 1, as measured by weighted kappa coefficient. ThePerioperative Thirst Discomfort Scaleshowed high content and reliability indexes. Elaborar e validar uma escala para avaliação do desconforto da sede perioperatória. Pesquisa metodológica realizada em 2014 e 2015, no centro cirúrgico de um hospital público do norte do Paraná. A escala foi elaborada após revisão bibliográfica, seguida de validação aparente e de conteúdo e avaliação da fidedignidade através de sua consistência interna e da equivalência inter observadores. Sete itens compuseram a escala: boca seca; lábios ressecados; língua grossa; saliva grossa; garganta seca; gosto ruim e vontade de beber água. O índice de validade de conteúdo para atributos e itens foi de 0,98, e o índice de fidedignidade foi de 1 para os atributos e itens da escala. A consistência interna avaliada pelo alfa de Cronbach foi de 0,91, e a equivalência interobservadores foi de 1, medida pelo coeficiente de kappa ponderado. A escala de desconforto da sede perioperatóriademonstrou altos índices de validade de conteúdo e fidedignidade.

  8. Making the invisible visible--operating theatre nurses' perceptions of caring in perioperative practice.

    Science.gov (United States)

    Blomberg, Ann-Catrin; Bisholt, Birgitta; Nilsson, Jan; Lindwall, Lillemor

    2015-06-01

    The aim of this study was to describe operating theatre nurses' (OTNs') perceptions of caring in perioperative practice. A qualitative descriptive design was performed. Data were collected with interviews were carried out with fifteen strategically selected operating theatre nurses from different operating theatres in the middle of Sweden. A phenomenographic analysis was used to analyse the interviews. The findings show that operating theatre nurses' perceptions of caring in perioperative practice can be summarised in one main category: To follow the patient all the way. Two descriptive categories emerged: To ensure continuity of patient care and keeping a watchful eye. The operating theatre nurses got to know the patient and as a result became responsible for the patient. They protected the patient's body and preserved patient dignity in perioperative practice. The findings show different aspects of caring in perioperative practice. OTNs wanted to be more involved in patient care and follow the patient throughout the perioperative nursing process. Although OTNs have the ambition to make the care in perioperative practice visible, there is today a medical technical approach which promotes OTNs continuing to offer care in secret. © 2014 Nordic College of Caring Science.

  9. Comparative study of perioperative complication rates of cervical laminoplasty performed by residents and teaching neurosurgeons.

    Science.gov (United States)

    Niimura, Manabu; Takai, Keisuke; Taniguchi, Makoto

    2017-11-01

    Early surgical education is required for neurosurgical residents to learn many surgical procedures. However, the participation of less experienced residents may increase perioperative complication rates. Perioperative complication studies in the field of neurosurgery are being increasingly published; however, studies have not yet focused on cervical laminoplasty. The study population included 193 consecutive patients who underwent cervical laminoplasty in Tokyo Metropolitan Neurological Hospital between 2008 and 2014. Patient and surgeon background factors, as well as perioperative complication rates were retrospectively compared between resident and board-certified spine neurosurgeon groups. Deteriorated or newly developed neurological deficits and surgical site complications within 30days of cervical laminoplasty were defined as perioperative complications. Out of 193 patients, 123 (64%) were operated on by residents as the first operator and 70 (36%) by board-certified spine neurosurgeons. No significant differences were observed in patient and surgeon factors between the two groups, except for hyperlipidemia (13 vs 17, p=0.02). Furthermore, no significant differences were noted in perioperative complication rates between the two groups (7 [5.7%] vs 4 [5.7%], p=1). Cervical laminoplasty performed in a standardized manner by residents who received their surgical training in our hospital did not increase perioperative complication rates, and ensured the safety of patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. [The standardized perioperative treatment of chronic rhinosinusitis with nasal polyps and asthma].

    Science.gov (United States)

    Li, Tingting; Ju, Jianbao; Yu, Hailing; Xie, Daoyu

    2015-04-01

    To discuss the perioperative treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma. Retrospective analysis of perioperative clinical data of 43 cases with CRSwNP and asthma. The admitted and under endoscopic surgery. Patients with preventing perioperative asthma attacks and corresponding standardized treatment were Observed. Thirty-five cases were stable during perioperative period and without asthma. Seven patients diagnosed as mild and moderate asthma attacks because of low pulse oximetry (SpO2 92%-95%) and scattered wheeze heard in the lungs. So these patients were sent to ICU for the treatment. They went back to ward after their conditions turned to stable and no asthma during perioperative. One patient diagnosed as severe asthma attack, because irritability and suffocation happened, SpO2 decreased from 99% to 84%-81%, diffuse wheeze could be heard in the whole lung . So we give him tracheal intubation and sent him to ICU for advanced treatment after breathing smooth. Five days later the patient retuned to the ward in stable condition and with no asthma attack again. Before operation the patients should be give some corresponding standardized comprehensive treatment according to the nasal symptoms and the degree of asthma attack, such as the application of topical steroid and antiallergic medicine. And some special treatment should be given to reduce airway hyperresponsiveness mucosa during anesthesia. These methods can reduce the risk of the asthma attacks and improve perioperative safety, prevent serious complications.

  11. Identification of pulse echo impulse responses for multi source transmission

    DEFF Research Database (Denmark)

    Gran, Fredrik; Jensen, Jørgen Arendt

    2004-01-01

    is a mixture of the information corresponding to several transmitters. There is, thus, no direct way of determining which information corresponds to which transmitter, preventing proper focusing. In this paper we decode the received signal by estimating the pulse echo impulse responses between every....... The method is evaluated using the simulation tool Field II. Three point spread functions are simulated where axial movement of 1 m/s is present. The axial resolution for the moving scatterer is 0.249 mm (-3dB) and 0.291 mm (-6dB), which is compared to a standard STA transmission scheme with sequential...

  12. Chandra Discovers Light Echo from the Milky Way's Black Hole

    Science.gov (United States)

    2007-01-01

    Like cold case investigators, astronomers have used NASA's Chandra X-ray Observatory to uncover evidence of a powerful outburst from the giant black hole at the Milky Way's center. A light echo was produced when X-ray light generated by gas falling into the Milky Way's supermassive black hole, known as Sagittarius A* (pronounced "A-star"), was reflected off gas clouds near the black hole. While the primary X-rays from the outburst would have reached Earth about 50 years ago, the reflected X-rays took a longer path and arrived in time to be recorded by Chandra. Variability in Chandra Images of Light Echo Variability in Chandra Images of Light Echo "This dramatic event happened before we had satellites in space that could detect it," said Michael Muno of the California Institute of Technology in Pasadena. "So, it's remarkable that we can use Chandra to dig into the past and see this monster black hole's capacity for destruction." Previously, scientists have used Chandra to directly detect smaller and more recent outbursts from the black hole. This latest outburst revealed by the X-ray echo was about 1,000 times brighter and lasted well over 1,000 times longer than any of the recent outbursts observed by Chandra. Theory predicts that an outburst from Sagittarius A* would cause X-ray emission from the clouds to vary in both intensity and shape. Muno and his team found these changes for the first time, thus ruling out other interpretations. The latest results corroborate other independent, but indirect, evidence for light echoes generated by the black hole in the more distant past. Illustrations of Light Echo Illustrations of Light Echo Scientists have long known that Sagittarius A*, with a mass of about 3 million suns, lurked at the center for Milky Way. However, the black hole is incredibly faint at all wavelengths, especially in X-rays. "This faintness implies that stars and gas rarely get close enough to the black hole to be in any danger," said co-author Frederick

  13. The echo-enabled harmonic generation options for FLASH II

    International Nuclear Information System (INIS)

    Deng, Haixiao; Decking, Winfried; Faatz, Bart

    2011-03-01

    FLASH II is an upgrade to the existing free electron laser (FEL) FLASH. The echo-enabled harmonic generation (EEHG) scheme is proposed to be a potential seeding option of FLASH II. In this paper, the possibility of EEHG operation of FLASH II is investigated for the first time. With a combination of existing numerical codes, i.e. a laser-beam interaction code in an undulator (LBICU), a beam tracking code in a chicane (ELEGANT) and an universal FEL simulating code (GENESIS), the effects of beam energy chirp and coherent synchrotron radiation (CSR) on EEHG operation are studied as well. In addition, several interesting issues concerning EEHG simulation are discussed. (orig.)

  14. Neutron optics using transverse field neutron spin echo method

    International Nuclear Information System (INIS)

    Achiwa, Norio; Hino, Masahiro; Yamauchi, Yoshihiro; Takakura, Hiroyuki; Tasaki, Seiji; Akiyoshi, Tsunekazu; Ebisawa, Toru.

    1993-01-01

    A neutron spin echo (NSE) spectrometer with perpendicular magnetic field to the neutron scattering plane, using an iron yoke type electro-magnet has been developed. A combination of cold neutron guider, supermirror neutron polarizer of double reflection type and supermirror neutron analyser was adopted for the spectrometer. The first application of the NSE spectrometer to neutron optics by passing Larmor precessing neutrons through gas, solid and liquid materials of several different lengths which are inserted in one of the precession field have been examined. Preliminary NSE spectra of this sample geometry are discussed. (author)

  15. CFAR Detection from Noncoherent Radar Echoes Using Bayesian Theory

    Directory of Open Access Journals (Sweden)

    Wataru Suganuma

    2010-01-01

    Full Text Available We propose a new constant false alarm rate (CFAR detection method from noncoherent radar echoes, considering heterogeneous sea clutter. It applies the Bayesian theory for adaptive estimation of the local clutter statistical distribution in the cell under test. The detection technique can be readily implemented in existing noncoherent marine radar systems, which makes it particularly attractive for economical CFAR detection systems. Monte Carlo simulations were used to investigate the detection performance and demonstrated that the proposed technique provides a higher probability of detection than conventional techniques, such as cell averaging CFAR (CA-CFAR, especially with a small number of reference cells.

  16. CFAR Detection from Noncoherent Radar Echoes Using Bayesian Theory

    Directory of Open Access Journals (Sweden)

    Yamaguchi Hiroyuki

    2010-01-01

    Full Text Available Abstract We propose a new constant false alarm rate (CFAR detection method from noncoherent radar echoes, considering heterogeneous sea clutter. It applies the Bayesian theory for adaptive estimation of the local clutter statistical distribution in the cell under test. The detection technique can be readily implemented in existing noncoherent marine radar systems, which makes it particularly attractive for economical CFAR detection systems. Monte Carlo simulations were used to investigate the detection performance and demonstrated that the proposed technique provides a higher probability of detection than conventional techniques, such as cell averaging CFAR (CA-CFAR, especially with a small number of reference cells.

  17. Four-wave neutron-resonance spin echo

    International Nuclear Information System (INIS)

    Grigoriev, S.V.; Kraan, W.H.; Rekveldt, M.Th.

    2004-01-01

    We develop a technique of scattering from many-body systems. It is based on the principle of the neutron spin echo (SE), where a neutron wave in the magnetic field splits into two waves, which are separated in space or in time after propagation in this field. The neutron thus prepared as a probe passes through the sample to test its properties on a space R or time t scale. This separation in space or in time can be measured using coherence of these two waves as a phase shift φ between them. These two waves are collected or focused and compensated by the SE technique in order to compare their phases after interaction with the sample. In this way one studies interference between these waves and thus can directly measure the pair-correlation function in space or in time. Instead of two-wave SE we propose to realize the four-wave neutron-resonance spin-echo (NRSE). In our experiments, spin precession produced by a couple of the neutron-resonance coils in one arm is compensated by an identical couple of other NR coils in a second arm of a spin-echo machine. The neutron spin-flip probability ρ in the resonance coils is a key parameter of the NRSE arm. The limiting cases, ρ=0 and ρ=1, provide, in quantum terms, a two-level-two-wave k splitting of the neutron and result in the separation of the split waves into two different lengths in space (R 1 ,R 2 ) or in time (t 1 ,t 2 ). These two cases correspond to Larmor precession with phase φ 1 in the static magnetic fields of the NR flippers or to NRSE precession with φ 2 , respectively. The intermediate case, 0 1 ,R 2 ,R 3 ) or in time (t 1 ,t 2 ,t 3 ). The interference of each pair of waves after compensation results in three different echos with phases φ 1 , φ 2 , and φ 3 =(φ 1 +φ 2 )/2. Focusing or compensating all four waves into a single point of the phase-of-waves diagram produces quantum interference of all newly created waves. This task of focusing is experimentally performed. Different options for the

  18. Fast spin echo MRI techniques. Contrast characteristics and clinical potential. Techniques d'IRM en fast spin echo. Caracteristiques de contraste et potentiels cliniques

    Energy Technology Data Exchange (ETDEWEB)

    Melki, P.; Mulkern, R.V.; Dacher, J.N.; Helenon, O.; Higuchi, N. (Harvard Medical School, Boston, MA (United States)); Oshio, K.; Jolesz, F. (Keio Univ., Tokyo (Japan)); Pourcelot, L. (Hopital Bretonneau, 37 - Tours (France)); Einstein, S. (General Electric Medical System, Milwaukee, WI (United States))

    1993-03-01

    Based on partial RF echo planar principles, Fast Spin Echo techniques (FSE) were implemented on high field systems. These methods produce image quality and contrast which resemble to conventional spin echo (SE) techniques. By reducing acquisition times by factors between 1.4 and 16 over SE methods, FSE allows for several imaging options usually prohibitive with conventional spin echo (SE) sequences. These include fast scans (especially breathold acquisitions); improved T2 contrast with longer TR intervals; increased spatial resolution with the use of larger image matrices and/or smaller fields of view; and 3D volume imaging with a 3D multislab FSE technique. Contrast features of FSE techniques are directly comparable to those of multiple echo SE sequences using the same echo spacing than FSE methods. However, essential contrast differences existing between the FSE sequences and their routine asymmetric dual SE counterpart can be identified. Decreased magnetic susceptibility effects and increased fat signal present within T2 weighted images compared to conventional dual SE images are due to the use of shorter echo spacings employed in FSE sequences. Off-resonance irradiation inherent to the use of a large number of radio frequency pulses in shown to results in dramatic magnetization contrast transfer effects in FSE images acquired in multislice mode.

  19. Ultrasound pulse-echo measurements on rough surfaces with linear array transducers

    DEFF Research Database (Denmark)

    Sjøj, Sidsel M. N.; Blanco, Esther N.; Wilhjelm, Jens E.

    2012-01-01

    The echo from planar surfaces with rms roughness, Rq, in the range from 0-155 μm was measured with a clinical linear array transducer at different angles of incidence at 6 MHz and 12 MHz. The echo-pulse from the surfaces was isolated with an equal sized window and the power of the echo-pulse was ......The echo from planar surfaces with rms roughness, Rq, in the range from 0-155 μm was measured with a clinical linear array transducer at different angles of incidence at 6 MHz and 12 MHz. The echo-pulse from the surfaces was isolated with an equal sized window and the power of the echo......-pulse was calculated. The power of the echo from the smooth surface (Rq = 0) is highly angle-dependent due to a high degree of specular reflection. Within the angular range considered here, -10° to 10°, the variation spans a range of 18 dB at both 6 MHz and 12 MHz. When roughness increases, the angle......-dependence decreases, as the echo process gradually changes from pure reflection to being predominantly governed by backscattering. The power of the echoes from the two roughest surfaces (Rq = 115 μm and 155 μm) are largely independent of angle at both 6 MHz and 12 MHz with a variation of 2 dB in the angular range...

  20. Magnetic resonance, especially spin echo, in spinor Bose-Einstein condensates

    International Nuclear Information System (INIS)

    Yasunaga, Masashi; Tsubota, Makoto

    2009-01-01

    Magnetic resonance, especially NMR and ESR, has been studied in magnetic materials for a long time, having been used in various fields. Spin echo is typical phenomenon in magnetic resonance. The magnetic resonance should be applied to spinor Bose-Einstein condensates (BECs). We numerically study spin echo of a spinor BEC in a gradient magnetic field by calculating the spin-1 two-dimensional Gross-Pitaevskii equations, obtaining the recovery of the signal of the spins, which is called spin echo. We will discuss the relation between the spin echo and the Stern-Gelrach separation in the system.

  1. Echo questions as a means of building coherence in conversational discourse

    Directory of Open Access Journals (Sweden)

    Strelchenko Natalia

    2017-06-01

    Full Text Available The study focuses on the cognitive-communicative characteristics of echo questions in English conversational discourse. Drawing on van Dijk's sociocognitive (mental model theory and cognitive discourse analysis, the paper suggests viewing echo questions as a means of building/updating a mental context model of a communicative situation. As discourse comprehension presupposes building its coherent mental model, echo questions resolving misunderstanding are regarded as an instrument for increasing coherence in conversational discourse. Based on the mental model theory, the study offers a typology of misunderstandings corrected by echo questions.

  2. Realtime identification of the propagation direction of received echoes in long range ultrasonic testing

    International Nuclear Information System (INIS)

    Choi, Myoung Seon; Heo, Won Nyoung

    2013-01-01

    In long range ultrasonic testing, a phased array probe composed of multiple identical transducers with an uniform interval of one quarter wavelength is usually used for the transmission or reception directivity control. This paper shows that the propagation directions of individual echoes can be identified in real time by displaying the inputs of a process for summing the constitution reception signals after compensating the phase difference due to the transducer interval, together with the output of the process. A constructive interference of the constitution echoes indicates a forward direction echo propagating along an intended direction while a destructive interference implies a reverse direction echo propagating along the direction opposite to the intended one

  3. Depth of Anesthesia as a Risk Factor for Perioperative Morbidity

    Directory of Open Access Journals (Sweden)

    Argyro Petsiti

    2015-01-01

    Full Text Available Introduction. The prognostic value of age, physical status, and duration of surgery on perioperative course has been extensively studied. However, the impact of deep hypnotic time (time when Bispectral Index values are less than 40 has not been well evaluated. Methods. We designed an observational study to clarify the relative influence of deep hypnotic time (DHT on outcome. Eligible participants were mentally stable patients over 18 years old scheduled for elective major abdominal surgery. In total, 248 patients enrolled. Data were analyzed using Fisher’s exact test and multiple logistic regression. Results. Five variables (DHT, hypotension, age, comorbidity, and duration of surgery showed statistically significant association with complications, when examined independently. However, when all variables were examined together in a multiple logistic regression model, age and comorbidity were no longer associated with outcome. DHT, hypotension, and duration of surgery were significant predictors of “complications,” and “hypotension” was a significant predictor of prolonged hospital stay (P<0.001.  Conclusion. Deep hypnotic time emerged as a new factor associated with outcome, and its impact compared to other factors such as age, surgery duration, hypotension, and comorbidity is redefined. Monitoring and managing depth of anesthesia during surgery are important and should be part of careful operation planning.

  4. [Current concepts in perioperative management of children : preface and comments].

    Science.gov (United States)

    Kuratani, Norifumi; Kikuchi, Hirosato

    2007-05-01

    In the past few years, pediatric anesthesia management changed rapidly to more evidence-based and patient-oriented practice. It has been emphasized that "focused and individualized" pre-anesthesia evaluation is preferred to routine screening of laboratory tests and X-rays. Anesthesia induction should be less stressful for children through the use of various approaches, such as preoperative preparation, sedative premedication, and parent-present induction. Cuffed tracheal tube is becoming popular for small children, and its indication should be considered individually. Laryngeal mask airway is frequently used for simple short cases. Perioperative fluid infusion therapy has been a controversial issue. Traditional therapeutic regimen using hypotonic solution with glucose is criticized as a result of the growing evidence of hyponatremia and hyperglycemia. New ventilatory modes and sedative medications are now available for pediatric patients, and lung-protective ventilatory strategy should be considered to protect immature lung from ventilator-induced lung injury. Emergence agitation from general anesthesia is an evolving problem. Sevoflurane is known to be a major risk factor for stormy wake-up. Pediatric anesthesiologists should pursue high quality of anesthesia emergence. All anesthesia residency programs should include pediatric rotation; otherwise anesthesia residents will lose opportunities to learn basic concepts of pediatric anesthesia.

  5. Evaluation of the intensity and discomfort of perioperative thirst

    Directory of Open Access Journals (Sweden)

    Isadora Pierotti

    2018-05-01

    Full Text Available Abstract Objective: To evaluate the intensity and discomfort of perioperative thirst and related factors during anesthesia recovery. Method: This is a quantitative, cross-sectional, descriptive study. Results: Of the 203 participants, 182 (89.6% reported they were thirsty. The mean intensity of thirst was 6.9 measured using a verbal numerical scale of 0 to 10 and discomfort was 7.3 on a scale of 0 to 14. All attributes evaluated by the scale were cited including dry mouth and desire to drink water (87.3%, dry lips (79.1%, thick tongue feeling (43.4%, thick saliva (56.5%, dry throat (75.2% and bad taste in the mouth (63.1%. There was a positive correlation between the intensity of thirst and discomfort assessed by the scale (Spearman coefficient: 0.474; p-value: <0.05. No correlation was found between age, length of fasting and use of opioids with the intensity of thirst and discomfort. Conclusion and implication in the clinical practice: Discomfort arising from the attributes of thirst is evidenced as the intensity of thirst increases.

  6. Open radical prostatectomy after transurethral resection: perioperative, functional, oncologic outcomes.

    Science.gov (United States)

    Fragkoulis, Charalampos; Pappas, Athanasios; Theocharis, Georgios; Papadopoulos, Georgios; Stathouros, Georgios; Ntoumas, Konstantinos

    2018-04-01

    To demonstrate any differences in the perioperative, functional and oncologic outcomes after radical retropubic prostatectomy (RRP) among those patients having previously performed transurethral resection of prostate (TURP) and those not. A total of 35 patients were diagnosed with prostate cancer (T1a and T1b) after TURP, underwent RRP and completed a 1 year follow up (group A). They were matched with a cohort of another 35 men (group B) in terms of age, body mass index (BMI), prostatic specific antigen (PSA), Gleason score, prostate volume (before surgery), pathological stage and neurovascular bundle-sparing technique. That was a retrospective study completed between September 2011 and March 2014. Not a significant difference was demonstrated among the two groups of patients concerning the functional and oncologic results. On the other hand, previous prostate surgery made the operation procedure more demanding. Besides, operative time and blood loss (though not translated in transfusion rates) were higher among patients in group A. Besides, catheter removal in group A patients was performed later than their counterparts of group B. RRP after TURP is a relatively safe procedure and in the hands of experienced surgeons, a previously performed TURP, does not seem to compromise oncologic outcomes of the operation. Continence is preserved, though erectile function seems to be compromised compared with patients undergoing RRP without prior TURP. Moreover, defining the prostate and bladder neck margins can be challenging and the surgeon has to be aware of the difficulties that might confront.

  7. Anesthetic and Perioperative Management of Patients With Brugada Syndrome.

    Science.gov (United States)

    Dendramis, Gregory; Paleologo, Claudia; Sgarito, Giuseppe; Giordano, Umberto; Verlato, Roberto; Baranchuk, Adrian; Brugada, Pedro

    2017-09-15

    Brugada syndrome (BrS) is an arrhythmogenic disease reported to be one among the leading causes of cardiac death in subjects under the age of 40 years. In these patients, episodes of lethal arrhythmias may be induced by several factors or situations, and for this reason, management during anesthesia and surgery must provide some precautions and drugs restrictions. To date, it is difficult to formulate guidelines for anesthetic management of patients with BrS because of the absence of prospective studies, and there is not a definite recommendation for neither general nor regional anesthesia, and there are no large studies in merit. For this reason, in the anesthesia management of patients with BrS, the decision of using each drug must be made after careful consideration and always in controlled conditions, avoiding other factors that are known to have the potential to induce arrhythmias and with a close cooperation between anesthetists and cardiologists, which is essential before and after surgery. In conclusion, given the absence of large studies in literature, we want to focus on some general rules, which resulted from case series and clinical practice, to be followed during the perioperative and anesthetic management of patients with BrS. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Teamwork in perioperative nursing. Understanding team development, effectiveness, evaluation.

    Science.gov (United States)

    Farley, M J

    1991-03-01

    Teams are an essential part of perioperative nursing practice. Nurses who have a knowledge of teamwork and experience in working on teams have a greater understanding of the processes and problems involved as teams develop from new, immature teams to those that are mature and effective. This understanding will assist nurses in helping their teams achieve a higher level of productivity, and members will be more satisfied with team efforts. Team development progresses through several stages. Each stage has certain characteristics and desired outcomes. At each stage, team members and leaders have certain responsibilities. Team growth does not take place automatically and inevitably, but as a consequence of conscious and unconscious efforts of its leader and members to solve problems and satisfy needs. Building and maintaining a team is certainly work, but work that brings a great deal of satisfaction and feelings of pride in accomplishment. According to I Tenzer, RN, MS, teamwork "is not a panacea; it is a viable approach to developing a hospital's most valuable resource--people."

  9. Perioperative events influence cancer recurrence risk after surgery.

    Science.gov (United States)

    Hiller, Jonathan G; Perry, Nicholas J; Poulogiannis, George; Riedel, Bernhard; Sloan, Erica K

    2018-04-01

    Surgery is a mainstay treatment for patients with solid tumours. However, despite surgical resection with a curative intent and numerous advances in the effectiveness of (neo)adjuvant therapies, metastatic disease remains common and carries a high risk of mortality. The biological perturbations that accompany the surgical stress response and the pharmacological effects of anaesthetic drugs, paradoxically, might also promote disease recurrence or the progression of metastatic disease. When cancer cells persist after surgery, either locally or at undiagnosed distant sites, neuroendocrine, immune, and metabolic pathways activated in response to surgery and/or anaesthesia might promote their survival and proliferation. A consequence of this effect is that minimal residual disease might then escape equilibrium and progress to metastatic disease. Herein, we discuss the most promising proposals for the refinement of perioperative care that might address these challenges. We outline the rationale and early evidence for the adaptation of anaesthetic techniques and the strategic use of anti-adrenergic, anti-inflammatory, and/or antithrombotic therapies. Many of these strategies are currently under evaluation in large-cohort trials and hold promise as affordable, readily available interventions that will improve the postoperative recurrence-free survival of patients with cancer.

  10. Perioperative management and monitoring of a super-obese patient.

    Science.gov (United States)

    Pellis, Tommaso; Leykin, Yigal; Albano, Giovanni; Zannier, Gianfederico; Di Capua, Gabriella; Marzano, Bernardo; Gullo, Antonino

    2004-01-01

    Anesthetic management of super-obese patients is inferred from evidence which has been based on obese or morbidly obese patients. We present the perioperative management and monitoring of a 44-year-old 232-kg patient (BMI 70) admitted for laparoscopic gastric bypass surgery. Awake fiberoptic endotracheal intubation preceded induction with propofol and rocuronium. Anesthesia was maintained with desflurane and remifentanil. Desflurane was titrated on BIS values, whereas remifentanil was based on hemodynamic monitoring (invasive arterial pressure and HemoSonic). Rocuronium was administered based on ideal body weight and recovery of twitch tension. Safe and rapid extubation in the operating theatre was made possible by the use of short-acting agents coupled with continuous intraoperative monitoring. Recovery in the post-anesthesia care unit was uneventful, pain was managed with meperidine, and after 5 hours the patient was discharged to the surgical ward. Oxygen therapy and SpO2 monitoring were continued overnight. No desaturation episodes were recorded. Pain was managed with I.V. drip of ketorolac and tramadole.

  11. Utility of dual echo T2-weighted turbo spin echo MR imaging for differentiation of solid, malignant hepatic lesions from nonsolid, benign hepatic lesions

    International Nuclear Information System (INIS)

    Yang, Dal Mo; Yoon, Myung Hwan; Kim, Hak Soo; Lee, Eun Joo; Kim, Jong Ho; Kim, Hyung Sik; Chung, Jin Woo

    1999-01-01

    To evaluate the additive value of multiphasic contrast-enhanced dynamic MR imaging as a supplement to dual-echo T2-weighted TSE MR imaging for the differentiation of solid, malignant hepatic lesions from nonsolid, benign hepatic lesions. Two radiologists retrospectively reviewed dual-echo T2-weighted TSE MR images and gadolinium-enhanced MR images in 51 patients with hepatic lesions (28 malignant, 69 benign). For the differentiation of malignant from benign lesions, as seen on dual-echo T2-weighted TSE MR images, we evaluated sensitivity, specificity, and accuracy, and compared with the results with those for dual echo T2-weighted MR images plus multiphasic contrast-enhanced dynamic MR images. In addition, Az values for dual echo T2-weighted MR images were compared with those for dual echo T2-weighted MR images plus multiphasic contrast-enhanced dynamic MR images. For the differentiation of malignant from benign hepatic lesions, as seen on dual-echo T2-weighted TSE images, sensitivity, specificity, and accuracy were 80.0%, 97.5%, and 93.9%, respectively, for lesions less than 3cm in diameter, and 92.3%, 95.0%, and 93.5%, respectively, for those that were 3cm or larger. The results for dual-echo T2-weighted MR imaging plus multiphasic contrast-enhanced dynamic MR imaging were 86.7%, 100.0%, and 97.3%, respectively, for lesions less than 3cm, and 92.3%, 100.0%, and 95.7%, respectively for those that were 3cm or larger. There were no significant differences in sensitivity, specificity, or accuracy between the results obtained using dual-echo T2-weighted MR imaging and those obtained with dual-echo T2-weighted MR imaging plus multiphasic contrast-enhanced dynamic MR imaging. Nor were these statistically significant differences in Az values between the two groups. For the differentiation of solid, malignant hepatic lesions from nonsolid, benign hepatic lesions, there is no difference in accuracy between dual-echo T2-weighted TSE MR imaging and the additional use of

  12. MRI of the breast with 2D spin-echo and gradient echo sequences in diagnostically difficult cases

    International Nuclear Information System (INIS)

    Allgayer, B.; Lukas, P.; Loos, W.; Kersting-Sommerhoff, B.

    1993-01-01

    One or both breasts of 296 patients with equivocal clinical or mammographical findings were examined with MRI. T 1 weighted spinecho (SE) and gradient echo (FFE) sequences were acquired before and after i.v. application of Gadolinium DTPA. 50 lesions with enhancement after Gd-DTPA were biopsied -26 carcinomas, 17 proliferating mastopathic tissues, 5 fibroadenomas and 1 abscess were found. Contrast enhanced MRI with 2D-SE and FFE sequences is an effective technqiue for evaluating suspicious breast lesions with high diagnostic acurracy. (orig.) [de

  13. Radar cross sections for mesospheric echoes at Jicamarca

    Directory of Open Access Journals (Sweden)

    G. A. Lehmacher

    2009-07-01

    Full Text Available Radar cross sections (RCS of mesospheric layers at 50 MHz observed at Jicamarca, Peru, range from 10−18 to 10−16 m−1, three orders of magnitudes smaller than cross sections reported for polar mesospheric winter echoes during solar proton events and six orders of magnitude smaller than polar mesospheric summer echoes. Large RCS are found in thick layers around 70 km that also show wide radar spectra, which is interpreted as turbulent broadening. For typical atmospheric and ionospheric conditions, volume scattering RCS for stationary, homogeneous, isotropic turbulence at 3 m are also in the range 10−18 to 10−16 m−1, in reasonable agreement with measurements. Moreover, theory predicts maximum cross sections around 70 km, also in agreement with observations. Theoretical values are still a matter of order-of-magnitude estimation, since the Bragg scale of 3 m is near or inside the viscous subrange, where the form of the turbulence spectrum is not well known. In addition, steep electron density gradients can increase cross-sections significantly. For thin layers with large RCS and narrow spectra, isotropic turbulence theory fails and scattering or reflection from anisotropic irregularities may gain relevance.

  14. Sum-frequency generation echo and grating from interface

    International Nuclear Information System (INIS)

    Volkov, Victor

    2014-01-01

    The work addresses spectroscopy of fourth-order Sum Frequency Generation Echo and Grating responses as an experimental tool to study structure and dynamics at interfaces. First, it addresses experimental geometry to extract background-free fourth-order Echo and Grating responses. Further, the article provides the analytical expressions of the response functions for these nonlinearities. The derived expressions are used to model the χ (4) two-dimensional spectral responses of a hydrated methyl acetate, which resembles a hydrated carbonyl moiety at the polar outer side of a phospholipid membrane. Orientation, transition dipole moments, and Raman tensors are obtained from the results of classical and quantum calculations, respectively. The numerical studies for the nonlinear responses under different polarization schemes and timings suggest the possibility of securely factoring of spectral contributions of χ YYYZX and χ YYYZY macroscopic susceptibilities. As such, the nonlinearities provide an experimental perspective on orientation of a generic (low-symmetry) molecular system at interfaces. Besides, the spectral properties of the tensors may reflect correlations of the in-plane and out-of-plane field components specific to the interface. For the case of a phospholipid membrane, the experiment would address in-plane and out-of-plane anisotropy of hydrogen bonding and related dynamics

  15. Chirp echo Fourier transform EPR-detected NMR.

    Science.gov (United States)

    Wili, Nino; Jeschke, Gunnar

    2018-04-01

    A new ultra-wide band (UWB) pulse EPR method is introduced for observing all nuclear frequencies of a paramagnetic center in a single shot. It is based on burning spectral holes with a high turning angle (HTA) pulse that excites forbidden transitions and subsequent detection of the hole pattern by a chirp echo. We term this method Chirp Echo Epr SpectroscopY (CHEESY)-detected NMR. The approach is a revival of FT EPR-detected NMR. It yields similar spectra and the same type of information as electron-electron double resonance (ELDOR)-detected NMR, but with a multiplex advantage. We apply CHEESY-detected NMR in Q band to nitroxides and correlate the hyperfine spectrum to the EPR spectrum by varying the frequency of the HTA pulse. Furthermore, a selective π pulse before the HTA pulse allows for detecting hyperfine sublevel correlations between transitions of one nucleus and for elucidating the coupling regime, the same information as revealed by the HYSCORE experiment. This is demonstrated on hexaaquamanganese(II). We expect that CHEESY-detected NMR is generally applicable to disordered systems and that our results further motivate the development of EPR spectrometers capable of coherent UWB excitation and detection, especially at higher fields and frequencies. Copyright © 2018 The Author(s). Published by Elsevier Inc. All rights reserved.

  16. MR respiratory navigator echo gated coronary angiography at 3 T

    International Nuclear Information System (INIS)

    Chang Shixin; Wang Yibin; Zong Genlin; Hao Nanxin; Du Yushan

    2007-01-01

    Objective: To investigate the techniques and influence factors for the respiratory navigator echo triggered whole-heart coronary MR angiography (WH-CMRA) and evaluate its application in visualizing coronary arteries and the image quality. Methods: Ninety two volunteers were acquired with WH-CMRA at 3 T MR scanner using respiratory navigator-echo gated TFE sequence. Imaging quality was visually graded as 0-IV grade according to the visual inspection, average length, diameter and sharpness of coronary arteries. The correlation between the imaging quality and respiratory pattern, heart rate and navigator efficiency was analyzed. Results: The imaging quality in 92 cases was that 28 were graded as IV, 53 were graded as III, 9 were graded as II and 2 were graded as I. The successful rate of scan was 88% (81/92). The imaging quality is mainly graded as IV when the heart rate was less than 75 beats per minute (bpm) and the sharpness of vessel was (48±11)%. When heart rate was more than 75 bpm, the image quality was mostly graded as 111 and the sharpness was (33±15)%. The correlation between heart rate and imaging quality score was negative (r= -0.726, P O.05). Conclusion: 3 T WH-CMRA technique could facilitated the visualization of whole coronary arteries at free breathing but having indications on heart rate. (authors)

  17. A conception of a new neutron spin echo reflectometer

    International Nuclear Information System (INIS)

    Kali, Gy.

    1999-01-01

    Complete text of publication follows. The tilted field technique in the neutron spin echo (NSE) spectroscopy came into the centre of attention in the recent few years. The method was first proposed by F. Mezei and R. Pynn in 1980. A real measurement for high resolution small angle scattering (SANS) on their resonance spin-echo spectrometer was published by Keller et al. [1]. A conception of a new instrument was proposed by M.T. Rekveldt [2] for SANS and reflectometry, using dc field perpendicular to the neutron beam. By further developing these ideas, the setup of a multitask instrument using the traditional way (dc field parallel to the beam) is discussed. This spectrometer may be best applicable in liquid surface reflectometry combining NSE by separating specular and nonspecular reflection. This instrument setup uses wide wavelength band and/or non-collimated neutron beam. (author) [1] T. Keller et al, Neutron News 6, no 3 (1995) 16.; [2] M.T. Rekveldt, Nuc. Inst. and Meth. in Physics Res. B 114 (1996) 366

  18. Bipartite fidelity and Loschmidt echo of the bosonic conformal interface

    Science.gov (United States)

    Zhou, Tianci; Lin, Mao

    2017-12-01

    We study the quantum quench problem for a class of bosonic conformal interfaces by computing the Loschmidt echo and the bipartite fidelity. The quench can be viewed as a sudden change of boundary conditions parametrized by θ when connecting two one-dimensional critical systems. They are classified by S (θ ) matrices associated with the current scattering processes on the interface. The resulting Loschmidt echo of the quench has long time algebraic decay t-α, whose exponent also appears in the finite size bipartite fidelity as L-α/2. We perform analytic and numerical calculations of the exponent α , and find that it has a quadratic dependence on the change of θ if the prior and post-quench boundary conditions are of the same type of S , while remaining 1/4 otherwise. Possible physical realizations of these interfaces include, for instance, connecting different quantum wires (Luttinger liquids), quench of the topological phase edge states, etc., and the exponent can be detected in an x-ray edge singularity-type experiment.

  19. Chirp echo Fourier transform EPR-detected NMR

    Science.gov (United States)

    Wili, Nino; Jeschke, Gunnar

    2018-04-01

    A new ultra-wide band (UWB) pulse EPR method is introduced for observing all nuclear frequencies of a paramagnetic center in a single shot. It is based on burning spectral holes with a high turning angle (HTA) pulse that excites forbidden transitions and subsequent detection of the hole pattern by a chirp echo. We term this method Chirp Echo Epr SpectroscopY (CHEESY)-detected NMR. The approach is a revival of FT EPR-detected NMR. It yields similar spectra and the same type of information as electron-electron double resonance (ELDOR)-detected NMR, but with a multiplex advantage. We apply CHEESY-detected NMR in Q band to nitroxides and correlate the hyperfine spectrum to the EPR spectrum by varying the frequency of the HTA pulse. Furthermore, a selective π pulse before the HTA pulse allows for detecting hyperfine sublevel correlations between transitions of one nucleus and for elucidating the coupling regime, the same information as revealed by the HYSCORE experiment. This is demonstrated on hexaaquamanganese(II). We expect that CHEESY-detected NMR is generally applicable to disordered systems and that our results further motivate the development of EPR spectrometers capable of coherent UWB excitation and detection, especially at higher fields and frequencies.

  20. Echo Chambers: Emotional Contagion and Group Polarization on Facebook

    Science.gov (United States)

    Del Vicario, Michela; Vivaldo, Gianna; Bessi, Alessandro; Zollo, Fabiana; Scala, Antonio; Caldarelli, Guido; Quattrociocchi, Walter

    2016-12-01

    Recent findings showed that users on Facebook tend to select information that adhere to their system of beliefs and to form polarized groups - i.e., echo chambers. Such a tendency dominates information cascades and might affect public debates on social relevant issues. In this work we explore the structural evolution of communities of interest by accounting for users emotions and engagement. Focusing on the Facebook pages reporting on scientific and conspiracy content, we characterize the evolution of the size of the two communities by fitting daily resolution data with three growth models - i.e. the Gompertz model, the Logistic model, and the Log-logistic model. Although all the models appropriately describe the data structure, the Logistic one shows the best fit. Then, we explore the interplay between emotional state and engagement of users in the group dynamics. Our findings show that communities’ emotional behavior is affected by the users’ involvement inside the echo chamber. Indeed, to an higher involvement corresponds a more negative approach. Moreover, we observe that, on average, more active users show a faster shift towards the negativity than less active ones.

  1. Sum-frequency generation echo and grating from interface

    Energy Technology Data Exchange (ETDEWEB)

    Volkov, Victor [Bereozovaya 2A, Konstantinovo, Moscow Region 140207 (Russian Federation)

    2014-10-14

    The work addresses spectroscopy of fourth-order Sum Frequency Generation Echo and Grating responses as an experimental tool to study structure and dynamics at interfaces. First, it addresses experimental geometry to extract background-free fourth-order Echo and Grating responses. Further, the article provides the analytical expressions of the response functions for these nonlinearities. The derived expressions are used to model the χ{sup (4)} two-dimensional spectral responses of a hydrated methyl acetate, which resembles a hydrated carbonyl moiety at the polar outer side of a phospholipid membrane. Orientation, transition dipole moments, and Raman tensors are obtained from the results of classical and quantum calculations, respectively. The numerical studies for the nonlinear responses under different polarization schemes and timings suggest the possibility of securely factoring of spectral contributions of χ{sub YYYZX} and χ{sub YYYZY} macroscopic susceptibilities. As such, the nonlinearities provide an experimental perspective on orientation of a generic (low-symmetry) molecular system at interfaces. Besides, the spectral properties of the tensors may reflect correlations of the in-plane and out-of-plane field components specific to the interface. For the case of a phospholipid membrane, the experiment would address in-plane and out-of-plane anisotropy of hydrogen bonding and related dynamics.

  2. Suppressing magnetization exchange effects in stimulated-echo diffusion experiments.

    Science.gov (United States)

    Pagès, Guilhem; Dvinskikh, Sergey V; Furó, István

    2013-09-01

    Exchange of nuclear magnetization between spin pools, either by chemical exchange or by cross-relaxation or both, has a significant influence on the signal attenuation in stimulated-echo-type pulsed field gradient experiments. Hence, in such cases the obtained molecular self-diffusion coefficients can carry a large systematic error. We propose a modified stimulated echo pulse sequence that contains T2-filters during the z-magnetization store period. We demonstrate, using a common theoretical description for chemical exchange and cross-relaxation, that these filters suppress the effects of exchange on the diffusional decay in that frequent case where one of the participating spin pools is immobile and exhibits a short T2. We demonstrate the performance of this experiment in an agarose/water gel. We posit that this new experiment has advantages over other approaches hitherto used, such as that consisting of measuring separately the magnetization exchange rate, if suitable by Goldman-Shen type experiments, and then correcting for exchange effects within the framework of a two-site exchange model. We also propose experiments based on selective decoupling and applicable in systems with no large T2 difference between the different spin pools. Copyright © 2013 The Authors. Published by Elsevier Inc. All rights reserved.

  3. Project ECHO: A Telementoring Network Model for Continuing Professional Development.

    Science.gov (United States)

    Arora, Sanjeev; Kalishman, Summers G; Thornton, Karla A; Komaromy, Miriam S; Katzman, Joanna G; Struminger, Bruce B; Rayburn, William F

    2017-01-01

    A major challenge with current systems of CME is the inability to translate the explosive growth in health care knowledge into daily practice. Project ECHO (Extension for Community Healthcare Outcomes) is a telementoring network designed for continuing professional development (CPD) and improving patient outcomes. The purpose of this article was to describe how the model has complied with recommendations from several authoritative reports about redesigning and enhancing CPD. This model links primary care clinicians through a knowledge network with an interprofessional team of specialists from an academic medical center who provide telementoring and ongoing education enabling community clinicians to treat patients with a variety of complex conditions. Knowledge and skills are shared during weekly condition-specific videoconferences. The model exemplifies learning as described in the seven levels of CPD by Moore (participation, satisfaction, learning, competence, performance, patient, and community health). The model is also aligned with recommendations from four national reports intended to redesign knowledge transfer in improving health care. Efforts in learning sessions focus on information that is relevant to practice, focus on evidence, education methodology, tailoring of recommendations to individual needs and community resources, and interprofessionalism. Project ECHO serves as a telementoring network model of CPD that aligns with current best practice recommendations for CME. This transformative initiative has the potential to serve as a leading model for larger scale CPD, nationally and globally, to enhance access to care, improve quality, and reduce cost.

  4. Diffusion-weighted echo-planar MRI of lacunar infarcts

    International Nuclear Information System (INIS)

    Noguchi, K.; Nagayoshi, T.; Watanabe, N.; Kanazawa, T.; Toyoshima, S.; Morijiri, M.; Shojaku, H.; Shimizu, M.; Seto, H.

    1998-01-01

    We studied 35 patients with lacunar infarcts, using diffusion-weighted echo-planar imaging (DW-EPI) at 1.5 T. The relative apparent diffusion coefficient ratio (ADCR) of each lesion was calculated and lesion conspicuity on DW-EPI was compared to that on images aquired with fast fluid-attenuated inversion recovery and T2-weighted fast spin-echo sequences. Acute small infarcts (within 3 days) were identified with DW-EPI as an area of decreased ADCR (range 0.33-0.87; mean 0.67) and high signal, subacute small infarcts (4-30 days) as a high-signal or isointense areas of decreased or nearly normal ADCR (0.54-0.98; 0.73), and chronic small infarcts (> 30 days) as low- or high-signal areas of nearly normal or increased ADCR (0.97-1.92; 1.32). In three patients, small infarcts of the brain stem in the hyperacute phase (within 6 h) were seen only with DW-EPI. In five patients, fresh small infarcts adjacent to multiple old infarcts could be distinguished only with DW-EPI. (orig.)

  5. Intracardiac echo-guided radiofrequency catheter ablation of atrial fibrillation in patients with atrial septal defect or patent foramen ovale repair: a feasibility, safety, and efficacy study.

    Science.gov (United States)

    Lakkireddy, Dhanunjaya; Rangisetty, Umamahesh; Prasad, Subramanya; Verma, Atul; Biria, Mazda; Berenbom, Loren; Pimentel, Rhea; Emert, Martin; Rosamond, Thomas; Fahmy, Tamer; Patel, Dimpi; Di Biase, Luigi; Schweikert, Robert; Burkhardt, David; Natale, Andrea

    2008-11-01

    Intracardiac Echo-Guided Radiofrequency Catheter. Patients with atrial septal defect (ASD) are at higher risk for atrial fibrillation (AF) even after repair. Transseptal access in these patients is perceived to be difficult. We describe the feasibility, safety, and efficacy of pulmonary vein antral isolation (PVAI) in these patients. We prospectively compared post-ASD/patent foramen ovale (PFO) repair patients (group I, n = 45) with age-gender-AF type matched controls (group II, n = 45). All the patients underwent PVAI through a double transseptal puncture with a roving circular mapping catheter technique guided by intracardiac echocardiography (ICE). The short-term (3 months) and long-term (12 month) failure rates were assessed. In group I, 23 (51%) had percutaneous closure devices and 22 (49%) had a surgical closure. There was no significant difference between group I and II in the baseline characteristics. Intracardiac echo-guided double transseptal access was obtained in 98% of patients in group I and in 100% of patients in group II. PVAI was performed in all patients, with right atrial flutter ablation in 7 patients in group I and in 4 patients in group II. Over a mean follow-up of 15 +/- 4 months, group I had higher short-term (18% vs 13%, P = 0.77) and long-term recurrence (24% vs 18%, P = 0.6) than group II. There was no significant difference in the perioperative complications between the two groups. Echocardiography at 3 months showed interatrial communication in 2 patients in group I and 1 patient in group II, which resolved at 12 months. Percutaneous AF ablation using double transseptal access is feasible, safe, and efficacious in patients with ASD and PFO repairs.

  6. Perioperative drug management. Reduction of potential drug-related problems in patients undergoing orthopaedic surgery by perioperative participation of a hospital pharmacist

    NARCIS (Netherlands)

    Duyvendak, M.; Bosman, J.; Klopotowska, J.; Kuiper-Herder, A.J.; Van Roon, E.N.; Brouwers, J.R.B.J.

    2007-01-01

    Objective: Drug management in the perioperative period is complex. Only little is known about the effects of clinical pharmaceutical care in this setting. The aim of this study was to determine the effect of a clinical pharmacy-based intervention on the number of potential drug-related problems in

  7. A Pilot Study Assessing ECG versus ECHO Ventriculoventricular Optimization in Pediatric Resynchronization Patients.

    Science.gov (United States)

    Punn, Rajesh; Hanisch, Debra; Motonaga, Kara S; Rosenthal, David N; Ceresnak, Scott R; Dubin, Anne M

    2016-02-01

    Cardiac resynchronization therapy indications and management are well described in adults. Echocardiography (ECHO) has been used to optimize mechanical synchrony in these patients; however, there are issues with reproducibility and time intensity. Pediatric patients add challenges, with diverse substrates and limited capacity for cooperation. Electrocardiographic (ECG) methods to assess electrical synchrony are expeditious but have not been extensively studied in children. We sought to compare ECHO and ECG CRT optimization in children. Prospective, pediatric, single-center cross-over trial comparing ECHO and ECG optimization with CRT. Patients were assigned to undergo either ECHO or ECG optimization, followed for 6 months, and crossed-over to the other assignment for another 6 months. ECHO pulsed-wave tissue Doppler and 12-lead ECG were obtained for 5 VV delays. ECG optimization was defined as the shortest QRSD and ECHO optimization as the lowest dyssynchrony index. ECHOs/ECGs were interpreted by readers blinded to optimization technique. After each 6 month period, these data were collected: ejection fraction, velocimetry-derived cardiac index, quality of life, ECHO-derived stroke distance, M-mode dyssynchrony, study cost, and time. Outcomes for each optimization method were compared. From June 2012 to December 2013, 19 patients enrolled. Mean age was 9.1 ± 4.3 years; 14 (74%) had structural heart disease. The mean time for optimization was shorter using ECG than ECHO (9 ± 1 min vs. 68 ± 13 min, P cost for charges was $4,400 ± 700 less for ECG. No other outcome differed between groups. ECHO optimization of synchrony was not superior to ECG optimization in this pilot study. ECG optimization required less time and cost than ECHO optimization. © 2015 Wiley Periodicals, Inc.

  8. Investigating the Group-Level Impact of Advanced Dual-Echo fMRI Combinations

    Directory of Open Access Journals (Sweden)

    Adam Kettinger

    2016-12-01

    Full Text Available Multi-echo fMRI data acquisition has been widely investigated and suggested to optimize sensitivity for detecting the BOLD signal. Several methods have also been proposed for the combination of data with different echo times. The aim of the present study was to investigate how these advance echo combination methods provide advantages over the simple averaging of echoes when state-of-the-art group-level random-effect analyses are performed. Both resting-state and task-based dual-echo fMRI data were collected from 27 healthy adult individuals (14 male, mean age = 25.75 years using standard echo-planar acquisition methods at 3T. Both resting-state and task-based data were subjected to a standard image pre-processing pipeline. Subsequently the two echoes were combined as a weighted average, using four different strategies for calculating the weights: (1 simple arithmetic averaging, (2 BOLD sensitivity weighting, (3 temporal-signal-to-noise ratio weighting and (4 temporal BOLD sensitivity weighting. Our results clearly show that the simple averaging of data with the different echoes is sufficient. Advanced echo combination methods may provide advantages on a single-subject level but when considering random-effects group level statistics they provide no benefit regarding sensitivity (i.e. group-level t-values compared to the simple echo-averaging approach. One possible reason for the lack of clear advantages may be that apart from increasing the average BOLD sensitivity at the single-subject level, the advanced weighted averaging methods also inflate the inter-subject variance. As the echo combination methods provide very similar results, the recommendation is to choose between them depending on the availability of time for collecting additional resting-state data or whether subject-level or group-level analyses are planned.

  9. The perspective of children on factors influencing their participation in perioperative care.

    Science.gov (United States)

    Sjöberg, Carina; Amhliden, Helene; Nygren, Jens M; Arvidsson, Susann; Svedberg, Petra

    2015-10-01

    To describe the experiences of participation in perioperative care of 8- to 11-year-old children. All children have the right to participate in decisions that affect them and have the right to express their views in all matters that concern them. Allowing children to be involved in their perioperative care can make a major difference in terms of their well-being by decreasing fear and anxiety and having more positive experiences. Taking the views of children into account and facilitating their participation could thus increase the quality of care. Descriptive qualitative design. The study was conducted in 2013 and data were collected by narrative interviews with 10 children with experience from perioperative care in Sweden. Qualitative content analysis was chosen to describe the variations, differences and similarities in children's experiences of participation in perioperative care. The result showed that receiving preparatory information, lack of information regarding postoperative care and wanting to have detailed information are important factors for influencing children's participation. Interaction with healthcare professionals, in terms of being listened to, being a part of the decision-making and feeling trust, is important for children's participation in the decision-making process. Poor adaptation of the care environment to the children's needs, feeling uncomfortable while waiting and needs for distraction are examples of how the environment and the care in the operating theatre influence the children's experiences of participation. Efforts should be made to improve children's opportunities for participation in the context of perioperative care and further research is needed to establish international standards for information strategies and care environment that promotes children's participation in perioperative care. Nurse anaesthetists need to acquire knowledge and develop strategies for providing preparatory visits and information to children prior to

  10. Proton T2 Relaxation effect of superparamagnetic iron oxide on fast spin echo sequence. Influence of echo number (even or odd) of effective TE

    International Nuclear Information System (INIS)

    Tsuchihashi, Toshio; Maki, Toshio; Kitagawa, Matsuo; Suzuki, Takeshi; Fujita, Isao

    1999-01-01

    The T 2 relaxation effect of the fast spin echo sequence (FSE) was investigated using superparamagnetic iron oxide (SPIO) particles. When even echoes were used as the effective TE of FSE, the signal intensity ratio [signal intensity of FSE/signal intensity of conventional spin echo sequence (CSE)] of FSE and CSE increased, whereas the T 2 relaxation effect of SPIO with FSE was reduced. However, when odd echoes were used, neither signal intensity changed, and weakening of the T 2 relaxation effect, considered a problem with FSE, was reduced. This phenomenon was not observed when the refocusing flip angle was changed to 30 and 60 degrees. However, it was observed when the refocusing flip angle was 120 and 150 degrees. Thus, this phenomenon can be considered to be related to oscillation in longitudinal magnetization when using the Carr-Purcell-Meiboom-Gill (CPMG) technique. (author)

  11. Implications of Perioperative Team Setups for Operating Room Management Decisions.

    Science.gov (United States)

    Doll, Dietrich; Kauf, Peter; Wieferich, Katharina; Schiffer, Ralf; Luedi, Markus M

    2017-01-01

    Team performance has been studied extensively in the perioperative setting, but the managerial impact of interprofessional team performance remains unclear. We hypothesized that the interplay between anesthesiologists and surgeons would affect operating room turnaround times, and teams that worked together over time would become more efficient. We analyzed 13,632 surgical cases at our hospital that involved 64 surgeons and 48 anesthesiologists. We detrended and adjusted the data for potential confounders including age, American Society of Anesthesiologists physical status, and surgical list (scheduled cases of specific surgical specialties). The surgical lists were categorized as ear, nose, and throat surgery; trauma surgery; general surgery; and gynecology. We assessed the relationship between turnaround times and assignment of different anesthesiologists to specific surgeons using a Monte Carlo simulation. We found significant differences in team performances among the different surgical lists but no team learning. We constructed managerial decision tables for the assignment of anesthesiologists to specific surgeons at our hospital. We defined a decision algorithm based on these tables. Our analysis indicated that had this algorithm been used in staffing the operating room for the surgical cases represented in our data, median turnaround times would have a reduction potential of 6.8% (95% confidence interval 6.3% to 7.1%). A surgeon is usually predefined for scheduled surgeries (surgical list). Allocation of the right anesthesiologist to a list and to a surgeon can affect the team performance; thus, this assignment has managerial implications regarding the operating room efficiency affecting turnaround times and thus potentially overutilized time of a list at our hospital.

  12. Enhancing engraftment of islets using perioperative sodium 4-phenylbutyrate.

    Science.gov (United States)

    Hsu, Brend Ray-Sea; Chen, Szu-Tah; Fu, Shin-Huei

    2006-12-20

    Primary nonfunction (PNF) adversely impacts islet transplantation. In addition to determining whether sodium 4-phenylbutyrate (4-SPB), an anti-inflammatory agent, reduces PNF, this study investigates how 4-SPB affects PNF. Streptozotocin-induced diabetic C57BL/6 mice, that received 75 syngeneic islets underneath left subrenal space, were fed twice daily of either 4-SPB at 500 mg/kg body weight or isotonic saline (NaCl) from 2 days before through 7 days after transplantation. The graft was removed at days 3, 10 and 84 following transplantation. At 68 h following transplantation, serum levels of interleukin-1beta (IL-1beta) were 2.2+/-0.4 and 0.4+/-0.2 pmol/L (n=6, p<0.005) for NaCl and 4-SPB groups, respectively. Graft genetic expression of IL-1beta was significantly suppressed in 4-SPB group (p<0.01). At day 10, the blood glucose levels were 22.7+/-1.0 and 17.1+/-1.7 mmol/L (n=12, p<0.05) and graft insulin contents (IC) were 35.0+/-8.3 and 107.6+/-29.7 pmol (n=12, p<0.05) for NaCl and 4-SPB groups, respectively. Moreover, the 4-SPB group had a shorter temporary hyperglycemia (15+/-2, n=21 vs. 25+/-2 days, n=19, p=0.001) and a higher cumulative cure rate of diabetes (p<0.001) than the NaCl group. In-vitro studies indicated that 4-SPB did not impact the islets function. These experimental results demonstrated that perioperative administration of 4-SPB decreased serum level and graft genetic expression of IL-1beta and attenuated PNF, which enhanced islet engraftment in a syngeneic transplantation mouse model.

  13. Fast-track surgery: Toward comprehensive peri-operative care.

    Science.gov (United States)

    Nanavati, Aditya J; Prabhakar, S

    2014-01-01

    Fast-track surgery is a multimodal approach to patient care using a combination of several evidence-based peri-operative interventions to expedite recovery after surgery. It is an extension of the critical pathway that integrates modalities in surgery, anesthesia, and nutrition, enforces early mobilization and feeding, and emphasizes reduction of the surgical stress response. It entails a great partnership between a surgeon and an anesthesiologist with several other specialists to form a multi-disciplinary team, which may then engage in patient care. The practice of fast-track surgery has yielded excellent results and there has been a significant reduction in hospital stay without a rise in complications or re-admissions. The effective implementation begins with the formulation of a protocol, carrying out each intervention and gathering outcome data. The care of a patient is divided into three phases: Before, during, and after surgery. Each stage needs active participation of few or all the members of the multi-disciplinary team. Other than surgical technique, anesthetic drugs, and techniques form the cornerstone in the ability of the surgeon to carry out a fast-track surgery safely. It is also the role of this team to keep abreast with the latest development in fast-track methodology and make appropriate changes to policy. In the Indian healthcare system, there is a huge benefit that may be achieved by the successful implementation of a fast-track surgery program at an institutional level. The lack of awareness regarding this concept, fear and apprehension regarding its implementation are the main barriers that need to be overcome.

  14. Perioperative outcomes of video- and robot-assisted segmentectomies.

    Science.gov (United States)

    Rinieri, Philippe; Peillon, Christophe; Salaün, Mathieu; Mahieu, Julien; Bubenheim, Michael; Baste, Jean-Marc

    2016-02-01

    Video-assisted thoracic surgery appears to be technically difficult for segmentectomy. Conversely, robotic surgery could facilitate the performance of segmentectomy. The aim of this study was to compare the early results of video- and robot-assisted segmentectomies. Data were collected prospectively on videothoracoscopy from 2010 and on robotic procedures from 2013. Fifty-one patients who were candidates for minimally invasive segmentectomy were included in the study. Perioperative outcomes of video-assisted and robotic segmentectomies were compared. The minimally invasive segmentectomies included 32 video- and 16 robot-assisted procedures; 3 segmentectomies (2 video-assisted and 1 robot-assisted) were converted to lobectomies. Four conversions to thoracotomy were necessary for anatomical reason or arterial injury, with no uncontrolled bleeding in the robotic arm. There were 7 benign or infectious lesions, 9 pre-invasive lesions, 25 lung cancers, and 10 metastatic diseases. Patient characteristics, type of segment, conversion to thoracotomy, conversion to lobectomy, operative time, postoperative complications, chest tube duration, postoperative stay, and histology were similar in the video and robot groups. Estimated blood loss was significantly higher in the video group (100 vs. 50 mL, p = 0.028). The morbidity rate of minimally invasive segmentectomy was low. The short-term results of video-assisted and robot-assisted segmentectomies were similar, and more data are required to show any advantages between the two techniques. Long-term oncologic outcomes are necessary to evaluate these new surgical practices. © The Author(s) 2016.

  15. Predictive factors for perioperative blood transfusion in neck dissection.

    Science.gov (United States)

    Abu-Ghanem, Sara; Warshavsky, Anton; Carmel, Narin-Nard; Abu-Ghanem, Yasmin; Abergel, Avraham; Fliss, Dan M; Yehuda, Moshe

    2016-04-01

    There is growing interest in reducing the exposure of patients to allogeneic blood transfusions by lowering preoperative cross-matched blood ordering and adopting alternative practices, such as autologous blood donations. Our aim was to investigate the predictors for perioperative blood transfusion (PBT) in head and neck cancer patients undergoing neck dissection (ND). Retrospective cohort study. Retrospective observational study. All patients who underwent ND between January 2011 and August 2014. The primary outcome measure was PBT. Predictors tested included: gender, age, American Society of Anesthesiologists comorbidity score, Charlson comorbidity index, preoperative hemoglobin level, head and neck primary tumor location, tumor and nodal staging, side and laterality of ND, central versus lateral ND, elective ND, preoperative chemotherapy/radiotherapy/I(131) therapy, history of previous ND, other surgical procedures in addition to the ND, bone resection, use and type of reconstruction, and the use of bony free flap reconstruction. Twenty-one preoperative and operative variables were tested for an association with PBT using univariate and multivariate analyses. Multivariate analysis found only the following three predictors to be significantly associated with PBT in patients undergoing ND: low preoperative hemoglobin level, advanced N stage, and concurrent reconstructive surgery. Evaluation of specific risk factors for predicting the need for PBT prior to neck dissection may be helpful in identifying the head and neck cancer patients in whom preoperative ordering of cross-matched blood is required or who could benefit from alternative means, such as preoperative autologous blood donation. 4. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  16. Variations in the occurrence of SuperDARN F region echoes

    Directory of Open Access Journals (Sweden)

    M. Ghezelbash

    2014-02-01

    Full Text Available The occurrence of F region ionospheric echoes observed by a number of SuperDARN HF radars is analyzed statistically in order to infer solar cycle, seasonal, and diurnal trends. The major focus is on Saskatoon radar data for 1994–2012. The distribution of the echo occurrence rate is presented in terms of month of observation and magnetic local time. Clear repetitive patterns are identified during periods of solar maximum and solar minimum. For years near solar maximum, echoes are most frequent near midnight during winter. For years near solar minimum, echoes occur more frequently near noon during winter, near dusk and dawn during equinoxes and near midnight during summer. Similar features are identified for the Hankasalmi and Prince George radars in the northern hemisphere and the Bruny Island TIGER radar in the southern hemisphere. Echo occurrence for the entire SuperDARN network demonstrates patterns similar to patterns in the echo occurrence for the Saskatoon radar and for other radars considered individually. In terms of the solar cycle, the occurrence rate of nightside echoes is shown to increase by a factor of at least 3 toward solar maximum while occurrence of the near-noon echoes does not significantly change with the exception of a clear depression during the declining phase of the solar cycle.

  17. Stationary echo canceling in velocity estimation by time-domain cross-correlation

    DEFF Research Database (Denmark)

    Jensen, Jørgen Arendt

    1993-01-01

    The application of stationary echo canceling to ultrasonic estimation of blood velocities using time-domain cross-correlation is investigated. Expressions are derived that show the influence from the echo canceler on the signals that enter the cross-correlation estimator. It is demonstrated...

  18. Investigations on resolution enhancement in EPR by means of electron spin echoes

    International Nuclear Information System (INIS)

    Merks, R.P.J.

    1979-01-01

    The electron spin echo technique has been applied in four types of experiments: the measurement of electric field induced shifts of the EPR line; the detection of electron spin echo ENDOR; a relaxation measurement and the measurement of hyperfine interactions via the nuclear modulation effect. (Auth.)

  19. Using the Echo Nest's automatically extracted music features for a musicological purpose

    DEFF Research Database (Denmark)

    Andersen, Jesper Steen

    2014-01-01

    This paper sums up the preliminary observations and challenges encountered during my first engaging with the music intelligence company Echo Nest's automatically derived data of more than 35 million songs. The overall purpose is to investigate whether musicologists can draw benefit from Echo Nest...

  20. Echo and reverberation in a Pekeris waveguide by convolution and by the product rule

    NARCIS (Netherlands)

    Ainslie, M.A.

    2013-01-01

    The detection performance of an active sonar depends on the intensity of the signal (target echo) relative to that of a background of reverberation plus noise. The echo is calculated for a standard test problem by convolving the time-domain impulse response at the target position with itself. The

  1. Zonal asymmetry of daytime 150-km echoes observed by Equatorial Atmosphere Radar in Indonesia

    Directory of Open Access Journals (Sweden)

    T. Yokoyama

    2009-03-01

    Full Text Available Multi-beam observations of the daytime ionospheric E-region irregularities and the so-called 150-km echoes with the 47-MHz Equatorial Atmosphere Radar (EAR in West Sumatra, Indonesia (0.20° S, 100.32° E, 10.36° S dip latitude are presented. 150-km echoes have been frequently observed by the EAR, and their characteristics are basically the same as the equatorial ones, except for an intriguing zonal asymmetry; stronger echoes in lower altitudes in the east directions, and weaker echoes in higher altitudes in the west. The highest occurrence is seen at 5.7° east with respect to the magnetic meridian, and the altitude gradually increases as viewing from the east to west. Arc structures which return backscatter echoes are proposed to explain the asymmetry. While the strength of radar echoes below 105 km is uniform within the wide coverage of azimuthal directions, the upper E-region (105–120 km echoes also show a different type of zonal asymmetry, which should be generated by an essentially different mechanism from the lower E-region and 150-km echoes.

  2. Comparison of Echo 7 field line length measurements to magnetospheric model predictions

    International Nuclear Information System (INIS)

    Nemzek, R.J.; Winckler, J.R.; Malcolm, P.R.

    1992-01-01

    The Echo 7 sounding rocket experiment injected electron beams on central tail field lines near L = 6.5. Numerous injections returned to the payload as conjugate echoes after mirroring in the southern hemisphere. The authors compare field line lengths calculated from measured conjugate echo bounce times and energies to predictions made by integrating electron trajectories through various magnetospheric models: the Olson-Pfitzer Quiet and Dynamic models and the Tsyganenko-Usmanov model. Although Kp at launch was 3-, quiet time magnetic models est fit the echo measurements. Geosynchronous satellite magnetometer measurements near the Echo 7 field lies during the flight were best modeled by the Olson-Pfitzer Dynamic Model and the Tsyganenko-Usmanov model for Kp = 3. The discrepancy between the models that best fit the Echo 7 data and those that fit the satellite data was most likely due to uncertainties in the small-scale configuration of the magnetospheric models. The field line length measured by the conjugate echoes showed some temporal variation in the magnetic field, also indicated by the satellite magnetometers. This demonstrates the utility an Echo-style experiment could have in substorm studies

  3. Seasonal and diel patterns in sedimentary flux of krill fecal pellets recorded by an echo sounder

    KAUST Repository

    Rø stad, Anders; Kaartvedt, Stein

    2013-01-01

    We used a moored upward-facing 200 kHz echo sounder to address sedimentation of fecal pellets (FPs) from dielly migrating Meganyctiphanes norvegica. The echo sounder was located on the bottom at 150 m depth in the Oslofjord, Norway, and was cabled

  4. Unusual Radar Echo from the Wake of Meteor Fireball in Nearly

    Directory of Open Access Journals (Sweden)

    Young-Sook Lee

    2018-06-01

    Full Text Available The summer polar lower thermosphere (90–100 km has an interesting connection to meteors, adjacent to the mesopause region attaining the lowest temperature in summer. Meteors supply condensation nuclei for charged ice particles causing polar mesospheric summer echoes (PMSE. We report the observation of meteor trail with nearly horizontal transit at high speed (20–50 km/s, and at last with re-enhanced echo power followed by diffusive echoes. Changes in phase difference between radar receivers aligned in meridional and zonal directions are used to determine variations in horizontal displacements and speeds with respect to time by taking advantage of radar interferometric analysis. The actual transit of echo target is observed along the straight pathway vertically and horizontally extended as much as a distance of at least 24 km and at most 29 km. The meteor trail initially has a signature similar to ‘head echoes’, with travel speeds from 20 – 50 km/s. It subsequently transforms into a different type of echo target including specular echo and then finally the power reenhanced. The reenhancement of echo power is followed by fume-like diffusive echoes, indicating sudden release of plasma as like explosive process probably involved. We discuss a possible role of meteor-triggered secondary plasma trail, such as fireball embedded with electrical discharge that continuously varies the power and transit speed.

  5. Comparison between two.magnetic resonance sequences (spin-echo and gradient-echo) in the analysis of lesions of the knee joint meniscus

    International Nuclear Information System (INIS)

    Marti-Bonati, L.; Casillas, C.

    1999-01-01

    To compare the diagnostic reliability, the proportion of common diagnoses and the degree of agreement between the results of two magnetic resonance (MR) sequences in the diagnosis of lesions of the meniscus of the knee. One hundred consecutive patients were studied prospectively by MR (1,5 Teslas). All of them underwent T1-weighted spin-echo and T1 and T2-weighted gradient-echo sequences. The final diagnosis was based on the combined results of four imaging sequences. The sensitivity, specificity, positive predictive value (PPV) and negative predictive (NPV) in terms of the final diagnosis were calculated for each meniscus and MR technique. The chi.squared test and kappa test were employed for the statistical analysis. There were discrepancies between the final diagnosis and the spin-echo sequence in 4 cases and between the final diagnosis and the gradient-echo sequences in 5 Both spin-echo and gradient-echo sequences showed the same diagnostic reliabilities: sensitivity of 0.98, specificity of 0.99, PPV of 0.98 and NPV of 0.99. The correlation between the two sequences was highly significant (chi-squared, p < 0.001) with a very high rate of agreement (kappa=0.84). The two sequences can be considered equally reliable in the study of meniscal lesions. (Author) 7 refs

  6. CUTLASS HF radar observations of high-velocity E-region echoes

    Directory of Open Access Journals (Sweden)

    M. V. Uspensky

    Full Text Available A short event of high-velocity E-region echo observations by the Pykkvibaer HF radar is analysed to study echo parameters and the echo relation to the Farley-Buneman plasma instability. The echoes were detected in several beams aligned closely to the magnetic L-shell direction. Two echo groups were identified: one group corresponded to the classical type 1 echoes with velocities close to the nominal ion-acoustic speed of 400 ms1 , while the other group had significantly larger velocities, of the order of 700 ms1 . The mutual relationship between the echo power, Doppler velocity, spectral width and elevation angles for these two groups was studied. Plotting of echo parameters versus slant range showed that all ~700 ms1 echoes originated from larger heights and distances of 500–700 km, while all ~400 ms1 echoes came from lower heights and from farther distances; 700–1000 km. We argue that both observed groups of echoes occurred due to the Farley-Buneman plasma instability excited by strong ( ~70 mVm1 and uniformly distributed electric fields. We show that the echo velocities for the two groups were different because the echoes were received from different heights. Such a separation of echo heights occurred due to the differing amounts of ionospheric refraction at short and large ranges. Thus, the ionospheric refraction and related altitude modulation of ionospheric parameters are the most important factors to consider, when various characteristics of E-region decametre irregularities are derived from HF radar measurements.

    Key words. Ionosphere (ionospheric irregularities; plasma waves and instabilities; polar ionosphere

  7. Echo in a semibounded plasma confined by an inhomogeneous electrostatic potential

    International Nuclear Information System (INIS)

    Revenchuk, S.M.

    1997-01-01

    The effect of the shape of a confining potential (potential barrier) on linear and nonlinear echoes arising due to the reflection of charged particles by this potential is studied. The model of a plasma confined by a potential that is a monotonous power-law function of the space coordinate is used to study the problem. It is shown that a linear echo (the effect of a nonlocal reflection of waves) arises only for a square-law confining potential. The second-order nonlinear echo caused by two external perturbations with different frequencies can occur for potentials with both square-law and inverse power-law coordinate dependences: the frequency of this echo equals the difference of the frequencies of the externally applied perturbations. In the model considered, an echo at the frequency that is the sum of the frequencies of the external perturbations, which was predicted in the previous papers, does not occur

  8. Neoadjuvant Treatment Does Not Influence Perioperative Outcome in Rectal Cancer Surgery

    International Nuclear Information System (INIS)

    Ulrich, Alexis; Weitz, Juergen; Slodczyk, Matthias; Koch, Moritz; Jaeger, Dirk; Muenter, Marc; Buechler, Markus W.

    2009-01-01

    Purpose: To identify the risk factors for perioperative morbidity in patients undergoing resection of primary rectal cancer, with a specific focus on the effect of neoadjuvant therapy. Methods and Materials: This exploratory analysis of prospectively collected data included all patients who underwent anterior resection/low anterior resection or abdominoperineal resection for primary rectal cancer between October 2001 and October 2006. The study endpoints were perioperative surgical and medical morbidity. Univariate and multivariate analyses of potential risk factors were performed. Results: A total of 485 patients were included in this study; 425 patients (88%) underwent a sphincter-saving anterior resection/low anterior resection, 47 (10%) abdominoperineal resection, and 13 (2%) multivisceral resection. Neoadjuvant chemoradiotherapy was performed in 100 patients (21%), and 168 (35%) underwent neoadjuvant short-term radiotherapy (5 x 5 Gy). Patient age and operative time were independently associated with perioperative morbidity, and operative time, body mass index >27 kg/m 2 (overweight), and resection type were associated with surgical morbidity. Age and a history of smoking were confirmed as independent prognostic risk factors for medical complications. Neoadjuvant therapy was not associated with a worse outcome. Conclusion: The results of this prospective study have identified several risk factors associated with an adverse perioperative outcome after rectal cancer surgery. In addition, neoadjuvant therapy was not associated with increased perioperative complications.

  9. Peri-operative chemotherapy in the management of resectable colorectal cancer pulmonary metastases

    Directory of Open Access Journals (Sweden)

    Hawkes Eliza A

    2012-08-01

    Full Text Available Abstract Background Surgery is often advocated in patients with resectable pulmonary metastases from colorectal cancer (CRC. Our study aims to evaluate peri-operative chemotherapy in patients with metastastic CRC undergoing pulmonary metastasectomy. Methods Patients treated for CRC who underwent pulmonary metastasectomy by a single surgeon were identified. Outcome measures included survival, peri-operative complications, radiological and histological evidence of chemotherapy-induced lung toxicities. Results Between 1997 and 2009, 51 eligible patients were identified undergoing a total of 72 pulmonary resections. Thirty-eight patients received peri-operative chemotherapy, of whom 9 received an additional biological agent. Five-year overall survival rate was 72% in the whole cohort - 74% and 68% in those who received peri-operative chemotherapy (CS and those who underwent surgery alone (S respectively. Five-year relapse free survival rate was 31% in the whole cohort - 38% and ≤18% in CS and S groups respectively. Only 8% had disease progression during neoadjuvant chemotherapy. There were no post-operative deaths. Surgical complications occurred in only 4% of patients who received pre-operative chemotherapy. There was neither radiological nor histological evidence of lung toxicity in resected surgical specimens. Conclusions Peri-operative chemotherapy can be safely delivered to CRC patients undergoing pulmonary metastasectomy. Survival in this selected group of patients was favourable.

  10. Perioperative blood transfusion as a poor prognostic factor after aggressive surgical resection for hilar cholangiocarcinoma.

    Science.gov (United States)

    Kimura, Norihisa; Toyoki, Yoshikazu; Ishido, Keinosuke; Kudo, Daisuke; Yakoshi, Yuta; Tsutsumi, Shinji; Miura, Takuya; Wakiya, Taiichi; Hakamada, Kenichi

    2015-05-01

    Blood transfusion is linked to a negative outcome for malignant tumors. The aim of this study was to evaluate aggressive surgical resection for hilar cholangiocarcinoma (HCCA) and assess the impact of perioperative blood transfusion on long-term survival. Sixty-six consecutive major hepatectomies with en bloc resection of the caudate lobe and extrahepatic bile duct for HCCA were performed using macroscopically curative resection at our institute from 2002 to 2012. Clinicopathologic factors for recurrence and survival were retrospectively assessed. Overall survival rates at 1, 3, and 5 years were 86.7, 47.3, and 35.7 %, respectively. In univariate analysis, perioperative blood transfusion and a histological positive margin were two of several variables found to be significant prognostic factors for recurrence or survival (Pblood transfusion was independently associated with recurrence (hazard ratio (HR)=2.839 (95 % confidence interval (CI), 1.370-5.884), P=0.005), while perioperative blood transfusion (HR=3.383 (95 % CI, 1.499-7.637), P=0.003) and R1 resection (HR=3.125 (95 % CI, 1.025-9.530), P=0.045) were independent risk factors for poor survival. Perioperative blood transfusion is a strong predictor of poor survival after radical hepatectomy for HCCA. We suggest that circumvention of perioperative blood transfusion can play an important role in long-term survival for patients with HCCA.

  11. Does training of fellows affect peri-operative outcomes of robot-assisted partial nephrectomy?

    Science.gov (United States)

    Khene, Zine-Eddine; Peyronnet, Benoit; Bosquet, Elise; Pradère, Benjamin; Robert, Corentin; Fardoun, Tarek; Kammerer-Jacquet, Solène-Florence; Verhoest, Grégory; Rioux-Leclercq, Nathalie; Mathieu, Romain; Bensalah, Karim

    2017-10-01

    To evaluate the impact of fellows' involvement on the peri-operative outcomes of robot-assisted partial nephrectomy (RAPN). We analysed 216 patients who underwent RAPN for a small renal tumour. We stratified our cohort into two groups according to the involvement of a fellow surgeon during the procedure: expert surgeon operating alone (expert group) and fellow operating under the supervision of the expert surgeon (fellow group). Peri-operative data were compared between the two groups. Linear and logistic regression analyses were performed to assess the impact of fellows' involvement on peri-operative and postoperative outcomes. Trifecta and margins ischaemia complications (MIC) score achievement rates were used to assess the quality of surgery in both the expert and fellow groups. Trifecta was defined as a combination of warm ischaemia time negative surgical margins and no peri-operative complications. MIC score was defined as negative surgical margins, ischaemia time Training fellows to perform RAPN is associated with longer operating time and WIT but does not appear to compromise other peri-operative outcomes. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

  12. Quantitation of structural distortion with gradient-echo imaging techniques

    International Nuclear Information System (INIS)

    Tien, R.D.; Schwaighofer, B.W.; Hesselink, J.R.; Chu, P.K.

    1990-01-01

    This paper determines the structural distortion and measurement error associated with fast MR imaging of the spinal neural foramina. Dry skeletal specimens and a thin cadaveric sagittal section through the neural foramina were placed in a water bath. MR images were obtained with a 1.5-T unit in different planes and with various pulse sequences. The size and shape of each neural foramen were carefully measured on the images and on the skeletal specimens. Gradient-echo (GRE) techniques (gradient recalled acquisition in a steady state, MPGR, three-dimensional volume acquisition) resulted in structural distortion in up to 10% on the fresh skeleton and 30% of the dry skeleton specimens when a small TE was used (the foramina appear narrower on the images)

  13. Bunching phase and constraints on echo enabled harmonic generation

    Science.gov (United States)

    Hemsing, E.

    2018-05-01

    A simple mathematical description is developed for the bunching spectrum in echo enabled harmonic generation (EEHG) that incorporates the effect of additional electron beam energy modulations. Under common assumptions, they are shown to contribute purely through the phase of the longitudinal bunching factor, which allows the spectral moments of the bunching to be calculated directly from the known energy modulations. In particular, the second moment (spectral bandwidth) serves as simple constraint on the amplitude of the energy modulations to maintain a transform-limited seed. We show that, in general, the impact on the spectrum of energy distortions that develop between the EEHG chicanes scales like the harmonic number compared to distortions that occur upstream. This may limit the parameters that will allow EEHG to reach short wavelengths in high brightness FELs.

  14. Deterministic Echo State Networks Based Stock Price Forecasting

    Directory of Open Access Journals (Sweden)

    Jingpei Dan

    2014-01-01

    Full Text Available Echo state networks (ESNs, as efficient and powerful computational models for approximating nonlinear dynamical systems, have been successfully applied in financial time series forecasting. Reservoir constructions in standard ESNs rely on trials and errors in real applications due to a series of randomized model building stages. A novel form of ESN with deterministically constructed reservoir is competitive with standard ESN by minimal complexity and possibility of optimizations for ESN specifications. In this paper, forecasting performances of deterministic ESNs are investigated in stock price prediction applications. The experiment results on two benchmark datasets (Shanghai Composite Index and S&P500 demonstrate that deterministic ESNs outperform standard ESN in both accuracy and efficiency, which indicate the prospect of deterministic ESNs for financial prediction.

  15. Neutron spin echo and high resolution inelastic spectroscopy

    International Nuclear Information System (INIS)

    Mezei, F.; Hungarian Academy of Sciences, Budapest. Central Research Inst. for Physics)

    1982-01-01

    The principles of neutrons spin echo (NSE) technique are considered. It is shown that the basis of NSE principle is a single step measurement of the change of the neutron velocity in the scattering process. The backscattering soectroscopy and the NSE techniques are compared. The NSF spectrometer is described. It is shown that 0.5 MeV energy resolution achieved in the NSE experiment is about 40 times superior to those achieved by the other techniques. The NSE technique has the unique feature that provides high resolution in neutron energy change independently of the monochromatization of the beam. The NSE instrument not only covers a wider dynamic range on a pulsed source that on a continuous one, but also collects data more efficiently

  16. Neutron spin-echo spectroscopy for diffusion in crystalline solids

    International Nuclear Information System (INIS)

    Kaisermayr, M.; Rennhofer, M.; Vogl, G.; Pappas, C.; Longeville, S.

    2002-01-01

    Neutron spin-echo spectroscopy (NSE) offers unprecedented opportunities in the investigation of diffusion in crystalline systems due to its outstanding energy resolution. NSE not only enables measurements at lower diffusivities than the established techniques of neutron spectroscopy, but it also gives a very immediate access to the different time scales involved in the diffusion process. This is demonstrated in detail on the example of the binary alloy NiGa where the Ni atoms hop between regular sites on the Ni sublattice and anti-sites on the Ga sublattice. Experiments on two different NSE instruments are compared to measurements using neutron backscattering spectroscopy. The potential of NSE for the investigation of jump diffusion and experimental requirements are discussed

  17. Neutron spin echo spectrometer at JRR-3M

    International Nuclear Information System (INIS)

    Takeda, Takayoshi; Komura, Shigehiro; Seto, Hideki; Nagai, Michihiro; Kobayashi, Hideki; Yokoi, Eiji; Ebisawa, Tooru; Tasaki, Seiji.

    1993-01-01

    We have designed and have been constructing at C 2-2 cold neutron guide port of JRR-3M, JAERI, a neutron spin echo spectrometer (NSE) which is equipped with two optimized magnets for neutron spin precession, a position sensitive detector (PSD), a converging polarizer and a wide area analyzer. The dynamic range of scattering vector Q covers from 0.01 A -1 to 0.3 A -1 and that of energy E from 30neV to 0.1meV. This spectrometer makes it possible to study a mesoscopic spatial structure of the order of 1-100nm combined with a nanosecond temporal structure of the order of 0.1-100ns corresponding to dynamical behavior of large molecules such as polymer. A test experiment shows that the homogeneity condition of the precession magnet is loosened by means of PSD. (author)

  18. Heavy ion collision evolution modeling with ECHO-QGP

    Science.gov (United States)

    Rolando, V.; Inghirami, G.; Beraudo, A.; Del Zanna, L.; Becattini, F.; Chandra, V.; De Pace, A.; Nardi, M.

    2014-11-01

    We present a numerical code modeling the evolution of the medium formed in relativistic heavy ion collisions, ECHO-QGP. The code solves relativistic hydrodynamics in (3 + 1)D, with dissipative terms included within the framework of Israel-Stewart theory; it can work both in Minkowskian and in Bjorken coordinates. Initial conditions are provided through an implementation of the Glauber model (both Optical and Monte Carlo), while freezeout and particle generation are based on the Cooper-Frye prescription. The code is validated against several test problems and shows remarkable stability and accuracy with the combination of a conservative (shock-capturing) approach and the high-order methods employed. In particular it beautifully agrees with the semi-analytic solution known as Gubser flow, both in the ideal and in the viscous Israel-Stewart case, up to very large times and without any ad hoc tuning of the algorithm.

  19. Increased flow sensitivity from gradient recalled echoes and short TRs

    International Nuclear Information System (INIS)

    Hearshen, D.O.; Froelich, J.W.; Wehrli, F.W.; Haggar, A.M.; Shimakawa, A.

    1986-01-01

    Time-of-flight effects from flow have been characterized in spin-echo images. ''Paradoxical'' enhancement and flow void are observed. Similar enhancement is seen on GRASS images. With no flow void and gradients existing throughout the volume, spins experiencing radio-frequency pulses will give rise to signals even for fast flow, providing a greater velocity sensitivity. GRASS images were obtained from a volunteer with a blood pressure cuff placed over the right thigh. With the cuff inflated, flow in the popliteal vein results in signal saturation. Increasing TR increases intensity in the popliteal vein relative to other vessels. This suggests a clinical role for the technique in assessment of slow flow

  20. Echo simulator with novel training and competency testing tools.

    Science.gov (United States)

    Sheehan, Florence H; Otto, Catherine M; Freeman, Rosario V

    2013-01-01

    We developed and validated an echo simulator with three novel tools that facilitate training and enable quantitative and objective measurement of psychomotor as well as cognitive skill. First, the trainee can see original patient images - not synthetic or simulated images - that morph in real time as the mock transducer is manipulated on the mannequin. Second, augmented reality is used for Visual Guidance, a tool that assists the trainee in scanning by displaying the target organ in 3-dimensions (3D) together with the location of the current view plane and the plane of the anatomically correct view. Third, we introduce Image Matching, a tool that leverages the aptitude of the human brain for recognizing similarities and differences to help trainees learn to perform visual assessment of ultrasound images. Psychomotor competence is measured in terms of the view plane angle error. The construct validity of the simulator for competency testing was established by demonstrating its ability to discriminate novices vs. experts.

  1. Ultra-high-speed inversion recovery echo planar MR imaging

    International Nuclear Information System (INIS)

    Stehling, M.K.; Ordidge, R.J.; Coxon, R.; Chapman, B.; Houseman, A.M.; Guifoyle, D.; Blamire, A.; Gibbs, P.; Mansfield, P.

    1988-01-01

    Fast two-dimensional FT MR imaging techniques such as fast low-angle shot do not allow inversion recovery (IR). Rapid repetition of low-angle pulses is incompatible with a 180 0 inversion pulse. Echo planar imaging (EPI) can be applied in conjunction with IR, because after preparation of the spin system, a complete image is acquired. Data acquisition in less than 100 msec and real-time display allows interactive optimization of inversion time (4.0-9,000 msec) with little time penalty. The authors have applied IR EPI to the study of the brain, liver, and kidneys in normal volunteers and patients. Technical details are presented, and the applications of this first ultra-high-speed IR technique will be shown

  2. Artificial intelligence for the EChO mission planning tool

    Science.gov (United States)

    Garcia-Piquer, Alvaro; Ribas, Ignasi; Colomé, Josep

    2015-12-01

    The Exoplanet Characterisation Observatory (EChO) has as its main goal the measurement of atmospheres of transiting planets. This requires the observation of two types of events: primary and secondary eclipses. In order to yield measurements of sufficient Signal-to-Noise Ratio to fulfil the mission objectives, the events of each exoplanet have to be observed several times. In addition, several criteria have to be considered to carry out each observation, such as the exoplanet visibility, its event duration, and no overlapping with other tasks. It is expected that a suitable mission plan increases the efficiency of telescope operation, which will represent an important benefit in terms of scientific return and operational costs. Nevertheless, to obtain a long term mission plan becomes unaffordable for human planners due to the complexity of computing the huge number of possible combinations for finding an optimum solution. In this contribution we present a long term mission planning tool based on Genetic Algorithms, which are focused on solving optimization problems such as the planning of several tasks. Specifically, the proposed tool finds a solution that highly optimizes the defined objectives, which are based on the maximization of the time spent on scientific observations and the scientific return (e.g., the coverage of the mission survey). The results obtained on the large experimental set up support that the proposed scheduler technology is robust and can function in a variety of scenarios, offering a competitive performance which does not depend on the collection of exoplanets to be observed. Specifically, the results show that, with the proposed tool, EChO uses 94% of the available time of the mission, so the amount of downtime is small, and it completes 98% of the targets.

  3. High signal intensity of fat on fast spin echo imaging

    International Nuclear Information System (INIS)

    Ogura, Akio; Yamazaki, Masaru; Hongoh, Takaharu; Inoue, Hiroshi; Ishikuro, Akihiro

    2000-01-01

    The fast spin echo (FSE) technique of producing T 2 -weighted images in greatly reduced imaging times has recently been used for routine clinical study. FSE images show contrast that is very similar in most tissues to that of conventional SE images. However, fat shows a high signal intensity that is influenced by j-coupling and the magnetization transfer effect. The purpose of this study was to assess whether the higher signal intensity of fat is different among MRI systems and to examine the effects of j-coupling and magnetization transfer on the high signal intensity of fat on FSE. The contrast in signal intensity between fat and water was measured for various echo train lengths (ETL) with and without multislicing on FSE using a contrast phantom. Measurements were obtained with four different MRI systems. In addition, the effective T 2 values of fat were calculated for the above conditions. Results indicated that contrast for fat and water was reduced with increased ETL and by using multislicing and was different among the four MRI systems. The effective T 2 values of fat were extended for increased ETL and were not dependent on multislicing. They also differed among the four MRI systems. The extent of effective T 2 values was affected by j-coupling. In this study, it was indicated that the degree of the high signal intensity of fat on FSE differed for different MRI systems. In addition, the reasons for the high signal intensity of fat on FSE were related to the effects of j-coupling and magnetization transfer. (author)

  4. Whole brain, high resolution multiband spin-echo EPI fMRI at 7 T: A comparison with gradient-echo EPI using a color-word Stroop task

    NARCIS (Netherlands)

    Boyacioglu, R.; Schulz, J.; Müller, N.C.J.; Koopmans, P.J.; Barth, M.; Norris, David Gordon

    2014-01-01

    A whole brain, multiband spin-echo (SE) echo planar imaging (EPI) sequence employing a high spatial (1.5 mm isotropic) and temporal (TR of 2 s) resolution was implemented at 7 T. Its overall performance (tSNR, sensitivity and CNR) was assessed and compared to a geometrically matched gradient-echo

  5. Defining clinically important perioperative blood loss and transfusion for the Standardised Endpoints for Perioperative Medicine (StEP) collaborative: a protocol for a scoping review.

    Science.gov (United States)

    Bartoszko, Justyna; Vorobeichik, Leon; Jayarajah, Mohandas; Karkouti, Keyvan; Klein, Andrew A; Lamy, Andre; Mazer, C David; Murphy, Mike; Richards, Toby; Englesakis, Marina; Myles, Paul S; Wijeysundera, Duminda N

    2017-06-30

    'Standardised Endpoints for Perioperative Medicine' (StEP) is an international collaboration undertaking development of consensus-based consistent definitions for endpoints in perioperative clinical trials. Inconsistency in endpoint definitions can make interpretation of trial results more difficult, especially if conflicting evidence is present. Furthermore, this inconsistency impedes evidence synthesis and meta-analyses. The goals of StEP are to harmonise definitions for clinically meaningful endpoints and specify standards for endpoint reporting in clinical trials. To help inform this endeavour, we aim to conduct a scoping review to systematically characterise the definitions of clinically important endpoints in the existing published literature on perioperative blood loss and transfusion. The scoping review will be conducted using the widely adopted framework developed by Arksey and O'Malley, with modifications from Levac. We refined our methods with guidance from research librarians as well as researchers and clinicians with content expertise. The electronic literature search will involve several databases including Medline, PubMed-not-Medline and Embase. Our review has three objectives, namely to (1) identify definitions of significant blood loss and transfusion used in previously published large perioperative randomised trials; (2) identify previously developed consensus-based definitions for significant blood loss and transfusion in perioperative medicine and related fields; and (3) describe the association between different magnitudes of blood loss and transfusion with postoperative outcomes. The multistage review process for each question will involve two reviewers screening abstracts, reading full-text articles and performing data extraction. The abstracted data will be organised and subsequently analysed in an iterative process. This scoping review of the previously published literature does not require research ethics approval. The results will be used

  6. Perioperative incidents associated with internal maxillary distraction osteogenesis: a retrospective study of 20 patients.

    Science.gov (United States)

    Kristian, Andersen; Erik, Nørholt Sven; Annelise, Küseler; John, Jensen; Klit, Pedersen Thomas

    2012-12-01

    This retrospective study aimed to assess the frequency and distribution of incidents encountered during the perioperative period of maxillary distraction with internal devices. The perioperative period was defined as the period between device placement and removal. Records of 20 patients treated during 2004-2011 with internal maxillary distraction osteogenesis were examined. Incidents were registered in terms of severity and need of intervention. Eighty percent of the patients experienced minor incidents, of which the most frequent were pain during activation and infections; 80% of these experienced ≥1 hard and soft tissue-related incidents, and 20% ≥1 device-related incidents. All incidents were solved with minimal or no intervention. Maxillary distraction using internal devices is a safe treatment with only minor incidents in the perioperative period. Preoperative planning and good cooperation are essential for preventing postoperative incidents. Prophylactic antibiotic treatment during the distraction period may be indicated. Copyright © 2012 Elsevier Inc. All rights reserved.

  7. Perioperative pharmacological management of pulmonary hypertensive crisis during congenital heart surgery.

    Science.gov (United States)

    Brunner, Nathan; de Jesus Perez, Vinicio A; Richter, Alice; Haddad, François; Denault, André; Rojas, Vanessa; Yuan, Ke; Orcholski, Mark; Liao, Xiaobo

    2014-03-01

    Pulmonary hypertensive crisis is an important cause of morbidity and mortality in patients with pulmonary arterial hypertension secondary to congenital heart disease (PAH-CHD) who require cardiac surgery. At present, prevention and management of perioperative pulmonary hypertensive crisis is aimed at optimizing cardiopulmonary interactions by targeting prostacyclin, endothelin, and nitric oxide signaling pathways within the pulmonary circulation with various pharmacological agents. This review is aimed at familiarizing the practitioner with the current pharmacological treatment for dealing with perioperative pulmonary hypertensive crisis in PAH-CHD patients. Given the life-threatening complications associated with pulmonary hypertensive crisis, proper perioperative planning can help anticipate cardiopulmonary complications and optimize surgical outcomes in this patient population.

  8. [Perioperative management of Jehovah's Witness patients. Special consideration of religiously motivated refusal of allogeneic blood transfusion].

    Science.gov (United States)

    Habler, O; Voss, B

    2010-04-01

    The religious organization of Jehovah's Witnesses numbers more than 7 million members worldwide, including 165,000 members in Germany. Although Jehovah's Witnesses strictly refuse the transfusion of allogeneic red blood cells, platelets and plasma, Jehovah's Witness patients may nevertheless benefit from modern therapeutic concepts including major surgical procedures without facing an excessive risk of death. The present review describes the perioperative management of surgical Jehovah's Witness patients aiming to prevent fatal anemia and coagulopathy. The cornerstones of this concept are 1) education of the patient about blood conservation techniques generally accepted by Jehovah's Witnesses, 2) preoperative optimization of the cardiopulmonary status and correction of preoperative anemia and coagulopathy, 3) perioperative collection of autologous blood, 4) minimization of perioperative blood loss and 5) utilization of the organism's natural anemia tolerance and its acute accentuation in the case of life-threatening anemia.

  9. The clinical nurse leader in the perioperative setting: a preceptor experience.

    Science.gov (United States)

    Wesolowski, Michael S; Casey, Gwendolyn L; Berry, Shirley J; Gannon, Jane

    2014-07-01

    The U.S. Veterans Administration (VA) has implemented the clinical nurse leader (CNL) role nationwide. Nursing leaders at the Malcolm Randall VA Medical Center in Gainesville, Florida, implemented the development of the CNL role in the perioperative setting during the summer of 2012. The perioperative department developed the position in partnership with the University of Florida College of Nursing, Gainesville, Florida. The team developed a description of the roles and experiences of the preceptors, the clinical nurse leader resident, and the University of Florida faculty member. The clinical nurse leader resident's successes and the positive outcomes, such as improved patient outcomes, experienced by the perioperative department demonstrated the importance of the CNL role. Published by Elsevier Inc.

  10. The IOM report on the future of nursing: what perioperative nurses need to know.

    Science.gov (United States)

    Battié, Renae N

    2013-09-01

    The 2010 Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, continues to be the most-viewed report in IOM history. Nearly three years after its publication, there are action coalitions of nursing and non-nursing agencies in 50 states and the District of Columbia collaborating to move the eight recommendations for action forward. There is much work to do to reshape health care delivery in the United States, and the IOM has identified nurses as key leaders in driving the reform. Every nurse must be educated on the key messages of the IOM report and become involved in moving these recommendations forward as well as in educating others on what needs to be done. AORN and perioperative nurses have a key role in voicing the unique needs of perioperative patients and in ensuring that perioperative patient care is represented in reform activities. Copyright © 2013 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  11. USE OF BETA-BLOCKERS IN THE PERIOPERATIVE PERIOD: HOW STRONG ARE THE EVIDENCES?

    Directory of Open Access Journals (Sweden)

    V. V. Samoylenko

    2015-09-01

    Full Text Available Optimization of the pharmacotherapy in preoperative period is the cornerstone of the concept of risk modification of cardiovascular complications in the perioperative period. Therefore, special attention has recently been focused on the use of beta-blockers in the postoperative period. Nowadays convincing evidence base for the use of this class of drugs in the perioperative period that was the basis for the development of clinical guidelines is accumulated. Moreover, results of large randomized trials of beta-blockers are controversial. This has resulted in significant differences in the classes of recommendations and levels of evidence.Analysis of the results of basic researches and the provisions of recommendations of the international and national professional medical societies on the use of beta-blockers in patients with cardiovascular disease to reduce the risk of cardiac complications in the perioperative period for planned extracardiac surgical procedures is presented.

  12. The challenge of perioperative pain management in opioid-tolerant patients

    Science.gov (United States)

    Coluzzi, Flaminia; Bifulco, Francesca; Cuomo, Arturo; Dauri, Mario; Leonardi, Claudio; Melotti, Rita Maria; Natoli, Silvia; Romualdi, Patrizia; Savoia, Gennaro; Corcione, Antonio

    2017-01-01

    The increasing number of opioid users among chronic pain patients, and opioid abusers among the general population, makes perioperative pain management challenging for health care professionals. Anesthesiologists, surgeons, and nurses should be familiar with some pharmacological phenomena which are typical of opioid users and abusers, such as tolerance, physical dependence, hyperalgesia, and addiction. Inadequate pain management is very common in these patients, due to common prejudices and fears. The target of preoperative evaluation is to identify comorbidities and risk factors and recognize signs and symptoms of opioid abuse and opioid withdrawal. Clinicians are encouraged to plan perioperative pain medications and to refer these patients to psychiatrists and addiction specialists for their evaluation. The aim of this review was to give practical suggestions for perioperative management of surgical opioid-tolerant patients, together with schemes of opioid conversion for chronic pain patients assuming oral or transdermal opioids, and patients under maintenance programs with methadone, buprenorphine, or naltrexone. PMID:28919771

  13. Design and Implementation of a Perioperative Surgical Home at a Veterans Affairs Hospital.

    Science.gov (United States)

    Walters, Tessa L; Howard, Steven K; Kou, Alex; Bertaccini, Edward J; Harrison, T Kyle; Kim, T Edward; Shafer, Audrey; Brun, Carlos; Funck, Natasha; Siegel, Lawrence C; Stary, Erica; Mariano, Edward R

    2016-06-01

    The innovative Perioperative Surgical Home model aims to optimize the outcomes of surgical patients by leveraging the expertise and leadership of physician anesthesiologists, but there is a paucity of practical examples to follow. Veterans Affairs health care, the largest integrated system in the United States, may be the ideal environment in which to explore this model. We present our experience implementing Perioperative Surgical Home at one tertiary care university-affiliated Veterans Affairs hospital. This process involved initiating consistent postoperative patient follow-up beyond the postanesthesia care unit, a focus on improving in-hospital acute pain management, creation of an accessible database to track outcomes, developing new clinical pathways, and recruiting additional staff. Today, our Perioperative Surgical Home facilitates communication between various services involved in the care of surgical patients, monitoring of patient outcomes, and continuous process improvement. © The Author(s) 2015.

  14. Perioperative thirst: an analysis from the perspective of the Symptom Management Theory

    Directory of Open Access Journals (Sweden)

    Marilia Ferrari Conchon

    2015-02-01

    Full Text Available A theoretical study aimed to analyze the existing knowledge in the literature on the perioperative thirst symptom from the perspective of Symptom Management Theory, and supplemented with the experience of the study group and thirst research. Thirst is described as a very intense symptom occurring in the perioperative period, and for this reason it cannot be ignored. The Symptom Management Theory is adequate for understanding the thirst symptom and is a deductive theory, focused on the domains of the Person, Environment and Health / Illness Status, as well as on the dimensions of Experience, Management Strategies and Symptom Outcomes. Using the theory leads us to consider perioperative thirst in its multifactorial aspects, analyzing the interrelation of its domains and dimensions in order to draw attention to this symptom that has been insufficiently valued, recorded and treated in clinical practice.

  15. Perioperative management of endocrine insufficiency after total pancreatectomy for neoplasia.

    Science.gov (United States)

    Maker, Ajay V; Sheikh, Raashid; Bhagia, Vinita

    2017-09-01

    infusion, and glucagon rescue therapy has greatly improved management in the modern era and constitute the current standard of care. A simple immediate post-operative algorithm was constructed. Successful perioperative surgical management of total pancreatectomy and resulting pancreatogenic diabetes is critical to achieve acceptable post-operative outcomes, and we review the pertinent literature and provide a simple, evidence-based algorithm for immediate post-resection glycemic control.

  16. Perioperative Myocardial Injury After Noncardiac Surgery: Incidence, Mortality, and Characterization.

    Science.gov (United States)

    Puelacher, Christian; Lurati Buse, Giovanna; Seeberger, Daniela; Sazgary, Lorraine; Marbot, Stella; Lampart, Andreas; Espinola, Jaqueline; Kindler, Christoph; Hammerer, Angelika; Seeberger, Esther; Strebel, Ivo; Wildi, Karin; Twerenbold, Raphael; du Fay de Lavallaz, Jeanne; Steiner, Luzius; Gurke, Lorenz; Breidthardt, Tobias; Rentsch, Katharina; Buser, Andreas; Gualandro, Danielle M; Osswald, Stefan; Mueller, Christian

    2018-03-20

    Perioperative myocardial injury (PMI) seems to be a contributor to mortality after noncardiac surgery. Because the vast majority of PMIs are asymptomatic, PMI usually is missed in the absence of systematic screening. We performed a prospective diagnostic study enrolling consecutive patients undergoing noncardiac surgery who had a planned postoperative stay of ≥24 hours and were considered at increased cardiovascular risk. All patients received a systematic screening using serial measurements of high-sensitivity cardiac troponin T in clinical routine. PMI was defined as an absolute high-sensitivity cardiac troponin T increase of ≥14 ng/L from preoperative to postoperative measurements. Furthermore, mortality was compared among patients with PMI not fulfilling additional criteria (ischemic symptoms, new ECG changes, or imaging evidence of loss of viable myocardium) required for the diagnosis of spontaneous acute myocardial infarction versus those that did. From 2014 to 2015 we included 2018 consecutive patients undergoing 2546 surgeries. Patients had a median age of 74 years and 42% were women. PMI occurred after 397 of 2546 surgeries (16%; 95% confidence interval, 14%-17%) and was accompanied by typical chest pain in 24 of 397 patients (6%) and any ischemic symptoms in 72 of 397 (18%). Crude 30-day mortality was 8.9% (95% confidence interval [CI], 5.7-12.0) in patients with PMI versus 1.5% (95% CI, 0.9-2.0) in patients without PMI ( P PMI not fulfilling any other of the additional criteria required for spontaneous acute myocardial infarction (280/397, 71%) versus those with at least 1 additional criterion (10.4%; 95% CI, 6.7-15.7, versus 8.7%; 95% CI, 4.2-16.7; P =0.684). PMI is a common complication after noncardiac surgery and, despite early detection during routine clinical screening, is associated with substantial short- and long-term mortality. Mortality seems comparable in patients with PMI not fulfilling any other of the additional criteria required for

  17. Disruptive behaviour in the perioperative setting: a contemporary review.

    Science.gov (United States)

    Villafranca, Alexander; Hamlin, Colin; Enns, Stephanie; Jacobsohn, Eric

    2017-02-01

    Disruptive behaviour, which we define as behaviour that does not show others an adequate level of respect and causes victims or witnesses to feel threatened, is a concern in the operating room. This review summarizes the current literature on disruptive behaviour as it applies to the perioperative domain. Searches of MEDLINE ® , Scopus™, and Google books identified articles and monographs of interest, with backreferencing used as a supplemental strategy. Much of the data comes from studies outside the operating room and has significant methodological limitations. Disruptive behaviour has intrapersonal, interpersonal, and organizational causes. While fewer than 10% of clinicians display disruptive behaviour, up to 98% of clinicians report witnessing disruptive behaviour in the last year, 70% report being treated with incivility, and 36% report being bullied. This type of conduct can have many negative ramifications for clinicians, students, and institutions. Although the evidence regarding patient outcomes is primarily based on clinician perceptions, anecdotes, and expert opinion, this evidence supports the contention of an increase in morbidity and mortality. The plausible mechanism for this increase is social undermining of teamwork, communication, clinical decision-making, and technical performance. The behavioural responses of those who are exposed to such conduct can positively or adversely moderate the consequences of disruptive behaviour. All operating room professions are involved, with the rank order (from high to low) being surgeons, nurses, anesthesiologists, and "others". The optimal approaches to the prevention and management of disruptive behaviour are uncertain, but they include preventative and professional development courses, training in soft skills and teamwork, institutional efforts to optimize the workplace, clinician contracts outlining the clinician's (and institution's) responsibilities, institutional policies that are monitored and

  18. Perioperative fasting time among cancer patients submitted to gastrointestinal surgeries.

    Science.gov (United States)

    Pereira, Nayara de Castro; Turrini, Ruth Natalia Teresa; Poveda, Vanessa de Brito

    2017-05-25

    To identify the length of perioperative fasting among patients submitted to gastrointestinal cancer surgeries. Retrospective cohort study, developed by consulting the medical records of 128 patients submitted to gastrointestinal cancer surgeries. The mean of total length of fasting was 107.6 hours. The total length of fasting was significantly associated with the number of symptoms presented before (p=0.000) and after the surgery (p=0.007), the length of hospital stay (p=0.000), blood transfusion (p=0.013), nasogastric tube (p=0.001) and nasojejunal tube (p=0,003), postoperative admission at ICU (p=0.002), postoperative death (p=0.000) and length of preoperative fasting (p=0.000). The length of fasting is associated with complications that affect the quality of the patients' postoperative recovery and nurses' work. The nursing team should be alert to this aspect and being responsible for overseeing the patients' interest, should not permit the unnecessary extension of fasting. Identificar la duración del ayuno perioperatorio entre los pacientes sometidos a cirugías de cáncer gastrointestinal. Estudio de cohorte retrospectivo, por consulta de los registros médicos de 128 pacientes sometidos a cirugías de cáncer gastrointestinal. La media de la duración total del ayuno fue de 107,6 horas. La duración total del ayuno se asoció significativamente con el número de síntomas presentados antes (p=0,000) y después de la cirugía (p=0,007), la duración de la estancia hospitalaria (p=0,000), transfusión de sangre (p=0,013),tubo nasogástrico (P=0,003), ingreso postoperatorio en la UCI (p=0,002), muerte postoperatoria (p=0,000) y duración del ayuno preoperatorio (p=0,000). La duración del ayuno se asocia con complicaciones que afectan la calidad de la recuperación postoperatoria de los pacientes y el trabajo de enfermería. El equipo de enfermería debe estar alerta en relación a este aspecto y ser responsable de supervisar el interés de los pacientes, no

  19. Total joint Perioperative Surgical Home: an observational financial review.

    Science.gov (United States)

    Raphael, Darren R; Cannesson, Maxime; Schwarzkopf, Ran; Garson, Leslie M; Vakharia, Shermeen B; Gupta, Ranjan; Kain, Zeev N

    2014-01-01

    The numbers of people requiring total arthroplasty is expected to increase substantially over the next two decades. However, increasing costs and new payment models in the USA have created a sustainability gap. Ad hoc interventions have reported marginal cost reduction, but it has become clear that sustainability lies only in complete restructuring of care delivery. The Perioperative Surgical Home (PSH) model, a patient-centered and physician-led multidisciplinary system of coordinated care, was implemented at UC Irvine Health in 2012 for patients undergoing primary elective total knee arthroplasty (TKA) or total hip arthroplasty (THA). This observational study examines the costs associated with this initiative. The direct cost of materials and services (excluding professional fees and implants) for a random index sample following the Total Joint-PSH pathway was used to calculate per diem cost. Cost of orthopedic implants was calculated based on audit-verified direct cost data. Operating room and post-anesthesia care unit time-based costs were calculated for each case and analyzed for variation. Benchmark cost data were obtained from literature search. Data are presented as mean ± SD (coefficient of variation) where possible. Total per diem cost was $10,042 ± 1,305 (13%) for TKA and $9,952 ± 1,294 (13%) for THA. Literature-reported benchmark per diem cost was $17,588 for TKA and $16,267 for THA. Implant cost was $7,482 ± 4,050 (54%) for TKA and $9869 ± 1,549 (16%) for THA. Total hospital cost was $17,894 ± 4,270 (24%) for TKA and $20,281 ± 2,057 (10%) for THA. In-room to incision time cost was $1,263 ± 100 (8%) for TKA and $1,341 ± 145 (11%) for THA. Surgery time cost was $1,558 ± 290 (19%) for TKA and $1,930 ± 374 (19%) for THA. Post-anesthesia care unit time cost was $507 ± 187 (36%) for TKA and $557 ± 302 (54%) for THA. Direct hospital costs were driven substantially below USA benchmark levels using the Total Joint-PSH pathway. The incremental

  20. Dual-echo, chemical shift gradient-echo magnetic resonance imaging to quantify hepatic steatosis: Implications for living liver donation.

    Science.gov (United States)

    Rinella, Mary E; McCarthy, Richard; Thakrar, Kiran; Finn, John Paul; Rao, Sambasiva M; Koffron, Alan J; Abecassis, Michael; Blei, Andres T

    2003-08-01

    In living liver donation, a fatty liver poses risks for both recipient and donor. Currently, liver biopsy is the standard for assessing the presence and extent of steatosis. The goals of this study were to correlate a steatosis index derived from magnetic resonance imaging (MRI) to the histologic grade on biopsy as well as to determine the topographic distribution of steatosis within the liver. We examined the ability of dual-echo, chemical shift gradient-echo MRI to predict the degree of steatosis on liver biopsy. A total of 22 subjects received both a liver biopsy and detailed MRI evaluation. These individuals included 15 potential living donors and 7 patients with nonalcoholic fatty liver disease. MRI steatosis index was then compared with histologic grade on liver biopsy. The topographic distribution of hepatic steatosis was determined from those subjects in whom MRI detected hepatic steatosis. The steatosis index had a positive correlation with grade of steatosis on liver biopsy (correlation coefficient, 0.84). There was no significant variation in the degree of steatosis among segments. A steatosis index of >0.2 had good positive and negative predictive value for the presence of significant steatosis (>15%) on biopsy. Our quantitative MRI protocol can predict the degree of hepatic steatosis when it is minimal to moderate, and may obviate the need for liver biopsy for the purpose of quantification of steatosis in living donors. Fat saturation added to the MRI protocol may further improve diagnostic accuracy. This technique may be applicable to the larger population with hepatic steatosis.