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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. How to misuse echo contrast

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    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.

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

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    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.

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

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    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.

  6. 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

  7. Perioperative anaphylaxis

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    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.

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

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    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

  9. 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.

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

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    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.

  11. 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

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

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    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.

  13. 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.

  14. 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

  15. ECHO Gov Login | ECHO | US EPA

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    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. Perioperative Management of Neurological Conditions

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    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.

  17. 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)

  18. 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.

  19. 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 ...

  20. 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

  1. 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...

  2. 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.

  3. 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

  4. 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.

  5. Rapid Gradient-Echo Imaging

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    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

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

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    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. 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.

  8. 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.

  9. 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

  10. 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.

  11. 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.)

  12. 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...

  13. 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.)

  14. 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.

  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. 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.

  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. 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.

  19. 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).

  20. 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.

  1. 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.

  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. 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

  4. 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.

  5. 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.

  6. 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

  7. 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

  8. 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.

  9. 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

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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...

  15. 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...

  16. 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....

  17. 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

  18. 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.)

  19. 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).

  20. 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)

  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. 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.

  3. Successful management of diastolic heart failure in a patient with restrictive cardiomyopathy following an anterior communicating artery aneurysm clipping

    Directory of Open Access Journals (Sweden)

    Rajasekar Arumugam

    2017-01-01

    Full Text Available Perioperative management of neurosurgical patients with an underlying myocardial dysfunction poses a unique challenge to the neuroanaesthesiologist and the neurointensivist. Sudden catecholamine surge during the aneurysmal subarachnoid haemorrhage (SAH can cause severe cardiac dysfunction such as myocardial ischaemia and cardiomyopathy. SAH in a patient with restrictive cardiomyopathy could be hazardous to the myocardium leading to severe cardiac morbidity. We report the successful management of an acute post-operative diastolic heart failure with a milrinone infusion in a patient with restrictive cardiomyopathy, following anterior communicating artery aneurysm clipping. We have discussed the 'dual beneficial' role of milrinone on the heart and the brain in this clinical setting. In addition, the importance of peri-operative utilisation of transoesophageal echocardiography and transthoracic echocardiography for the successful management of diastolic heart failure is highlighted.

  4. 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.

  5. 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

  6. 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.

  7. 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

  8. 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.

  9. 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.

  10. 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.

  11. 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....

  12. 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

  13. [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.

  14. [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.

  15. 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.

  16. 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.

  17. 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

  18. 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

  19. 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.

  20. 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)

  1. 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

  2. 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.)

  3. 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.

  4. 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.)

  5. 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.

  6. 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.

  7. MR imaging of articular cartilage : comparison of magnetization transfer contrast and fat-suppression in multiplanar and 3D gradient-echo, spin-echo, turbo spin-echo techniques

    International Nuclear Information System (INIS)

    Lee, Young Joon; Joo, Eun Young; Eun, Choong Ki

    1999-01-01

    The purpose of this study was to evaluate the effects of magnetization transfer contrast(MTC) and fat-suppression(FS) in variable spin-echo and gradient-echo sequences for articular cartilage imaging and to determine the optimal pulse sequences. Using variable 7-pulse sequences, the knees of 15 pigs were imaged Axial images were obtained using proton density and T2-weighted spin-echo (PDWSE and T2WSE), turbo spin-echo (TSE), multiplanar gradient-echo (MPGR), and 3D steady-state gradient-echo (3DGRE) sequences, and the same pulse sequences were then repeated using MTC. Also T1-weighted spin-echo(T1WSE) and 3D spoiled gradient-echo(3DSPGR) images of knees were also acquired, and the procedure was repeated using FS. For each knee, a total of 14 axial images were acquired, and using a 6-band scoring system, the visibility of and the visibilities of the the articular cartilage was analyzed. The visual effect of MTC and FS was scored using a 4-band scale. For each image, the signal intensities of articular cartilage, subchondral bone, muscles, and saline were measured, and signal-to-noise ratios(SNR) and contrast-to-noise ratios(CNR) were also calculated. Visibility of the cartilage was best when 3DSPGR and T1WSE sequences were used. MTC imaging increased the negative contrast between cartilage and saline, but FS imaging provided more positive contrast. CNR between cartilage and saline was highest when using TSE with FS(-351.1±15.3), though CNR between cartilage and bone then fell to -14.7±10.8. In MTC imaging using MPGR showed the greatest increase of negative contrast between cartilage and saline(CNR change=-74.7); the next highest was when 3DGRE was used(CNR change=-34.3). CNR between cartilage and bone was highest with MPGR(161.9±17.7), but with MTC, the greatest CNR decrease(-81.8) was observed. The greatest CNR increase between cartilage and bone was noted in T1WSE with FS. In all scans, FS provided a cartilage-only positive contrast image, though the absolute

  8. 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)

  9. 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.

  10. 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...

  11. 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 ...

  12. 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)

  13. 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)

  14. 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....

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. 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

  3. 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.

  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. 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

  6. 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.

  7. 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...

  8. 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.

  9. 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

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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

  20. 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

  1. 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.

  2. 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....

  3. 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

  4. 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.

  5. 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.

  6. [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.

  7. 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.

  8. 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

  9. 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.

  10. 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.)

  11. 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.)

  12. 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

  13. 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.

  14. 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.)

  15. 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.

  16. 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.

  17. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. ExampleDFR.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_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.

  5. monperload_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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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....

  17. 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

  18. 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...

  19. 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.

  20. 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.

  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. 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.

  4. 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.

  5. 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.).

  6. 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.

  7. 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

  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. 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...

  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. 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.

  12. 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

  13. 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

  14. 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.

  15. 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

  16. 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 . . ....

  17. 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

  18. Time-resolved echo-shared parallel MRA of the lung: observer preference study of image quality in comparison with non-echo-shared sequences

    International Nuclear Information System (INIS)

    Fink, C.; Puderbach, M.; Zaporozhan, J.; Plathow, C.; Kauczor, H.-U.; Ley, S.

    2005-01-01

    The aim of this study was to evaluate the image quality of time-resolved echo-shared parallel MRA of the lung. The pulmonary vasculature of nine patients (seven females, two males; median age: 44 years) with pulmonary disease was examined using a time-resolved MRA sequence combining echo sharing with parallel imaging (time-resolved echo-shared angiography technique, or TREAT). The sharpness of the vessel borders, conspicuousness of peripheral lung vessels, artifact level, and overall image quality of TREAT was assessed independently by four readers in a side-by-side comparison with non-echo-shared time-resolved parallel MRA data (pMRA) previously acquired in the same patients. Furthermore, the SNR of pulmonary arteries (PA) and veins (PV) achieved with both pulse sequences was compared. The mean voxel size of TREAT MRA was decreased by 24% compared with the non-echo-shared MRA. Regarding the sharpness of the vessel borders, conspicuousness of peripheral lung vessels, and overall image quality the TREAT sequence was rated superior in 75-76% of all cases. If the TREAT images were preferred over the pMRA images, the advantage was rated as major in 61-71% of all cases. The level of artifacts was not increased with the TREAT sequence. The mean interobserver agreement for all categories ranged between fair (artifact level) and good (overall image quality). The maximum SNR of TREAT did not differ from non-echo-shared parallel MRA (PA: TREAT: 273±45; pMRA: 280±71; PV: TREAT: 273±33; pMRA: 258±62). TREAT achieves a higher spatial resolution than non-echo-shared parallel MRA which is also perceived as an improved image quality. (orig.)

  19. 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

  20. 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.

  1. 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...

  2. 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.

  3. 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.

  4. Post-surgical infections and perioperative antibiotics usage in pediatric genitourinary procedures.

    Science.gov (United States)

    Ellett, Justin; Prasad, Michaella M; Purves, J Todd; Stec, Andrew A

    2015-12-01

    Post-surgical infections (PSIs) are a source of preventable perioperative morbidity. No guidelines exist for the use of perioperative antibiotics in pediatric urologic procedures. This study reports the rate of PSIs in non-endoscopic pediatric genitourinary procedures at our institution. Secondary aims evaluate the association of PSI with other perioperative variables, including wound class (WC) and perioperative antibiotic administration. Data from consecutive non-endoscopic pediatric urologic procedures performed between August 2011 and April 2014 were examined retrospectively. The primary outcome was the rate of PSIs. PSIs were classified as superficial skin (SS) and deep/organ site (D/OS) according to Centers for Disease Control and Prevention guidelines, and urinary tract infection (UTI). PSIs were further stratified by WC1 and WC2 and perioperative antibiotic usage. A relative risk and chi-square analysis compared PSI rates between WC1 and WC2 procedures. A total of 1185 unique patients with 1384 surgical sites were reviewed; 1192 surgical sites had follow-up for inclusion into the study. Ten total PSIs were identified, for an overall infection rate of 0.83%. Of these, six were SS, one was D/OS, and three were UTIs. The PSI rate for WC1 (885 sites) and WC2 (307 sites) procedures was 0.34% and 2.28%, respectively, p antibiotics (0.35% vs. 0.33%). All WC2 procedures received antibiotics. Post-surgical infections are associated with significant perioperative morbidity. In some studies, PSI can double hospital costs, and contribute to hospital length of stay, admission to intensive care units, and impact patient mortality. Our study demonstrates that the rate of PSI in WC1 operations is low, irrespective of whether the patient received perioperative antibiotics (0.35%) or no antibiotics (0.33%). WC2 operations were the larger source of morbidity with an infection rate of 2.28% and a 6.7 fold higher increase in relative risk. WC1 procedures have a rate of

  5. [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.

  6. 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...

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. 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

  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. 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.

  7. 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)

  8. 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.

  9. 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

  10. 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,...

  11. 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

  12. 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

  13. 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.

  14. 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.

  15. 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.

  16. Visual Perceptual Echo Reflects Learning of Regularities in Rapid Luminance Sequences.

    Science.gov (United States)

    Chang, Acer Y-C; Schwartzman, David J; VanRullen, Rufin; Kanai, Ryota; Seth, Anil K

    2017-08-30

    A novel neural signature of active visual processing has recently been described in the form of the "perceptual echo", in which the cross-correlation between a sequence of randomly fluctuating luminance values and occipital electrophysiological signals exhibits a long-lasting periodic (∼100 ms cycle) reverberation of the input stimulus (VanRullen and Macdonald, 2012). As yet, however, the mechanisms underlying the perceptual echo and its function remain unknown. Reasoning that natural visual signals often contain temporally predictable, though nonperiodic features, we hypothesized that the perceptual echo may reflect a periodic process associated with regularity learning. To test this hypothesis, we presented subjects with successive repetitions of a rapid nonperiodic luminance sequence, and examined the effects on the perceptual echo, finding that echo amplitude linearly increased with the number of presentations of a given luminance sequence. These data suggest that the perceptual echo reflects a neural signature of regularity learning.Furthermore, when a set of repeated sequences was followed by a sequence with inverted luminance polarities, the echo amplitude decreased to the same level evoked by a novel stimulus sequence. Crucially, when the original stimulus sequence was re-presented, the echo amplitude returned to a level consistent with the number of presentations of this sequence, indicating that the visual system retained sequence-specific information, for many seconds, even in the presence of intervening visual input. Altogether, our results reveal a previously undiscovered regularity learning mechanism within the human visual system, reflected by the perceptual echo. SIGNIFICANCE STATEMENT How the brain encodes and learns fast-changing but nonperiodic visual input remains unknown, even though such visual input characterizes natural scenes. We investigated whether the phenomenon of "perceptual echo" might index such learning. The perceptual echo is a

  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. 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

  19. 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

  20. 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.

  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. 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

  3. Diagnostic accuracy of dual-echo (in- and opposed-phase) T1-weighted gradient recalled echo for detection and grading of hepatic iron using quantitative and visual assessment

    Energy Technology Data Exchange (ETDEWEB)

    Schieda, Nicola; Ramanathan, Subramaniyan; Ryan, John; Khanna, Maneesh; Virmani, Vivek; Avruch, Leonard [The University of Ottawa, The Ottawa Hospital, Ottawa, Ontario (Canada)

    2014-07-15

    Detection and quantification of hepatic iron with dual-echo gradient recalled echo (GRE) has been proposed as a rapid alternative to other magnetic resonance imaging (MRI) techniques. Co-existing steatosis and T1 weighting are limitations. This study assesses the accuracy of routine dual-echo GRE. Between 2010 and 2013, 109 consecutive patients underwent multi-echo (ME) MRI and dual-echo GRE for quantification of hepatic iron. Liver iron concentration (LIC) was calculated from ME-MRI. Relative signal intensity (RSI) and fat signal fraction (FSF) were calculated from dual-echo GRE. Four radiologists subjectively evaluated dual-echo GRE (±subtraction). Diagnostic accuracy was compared between techniques and correlated with biopsy using Fisher's exact test, Spearman correlation and regression. The sensitivity of visual detection of iron ranged from 48 to 55 %. Subtraction did not increase sensitivity (p < 0.001). Inter-observer variability was substantial (κ = 0.72). The specificity of visual detection of iron approached 100 % with false-positive diagnoses observed using subtraction. LIC showed a higher correlation with histopathological iron grade (r = 0.94, p < 0.001) compared with RSI (r = 0.65, p = 0.02). Univariate regression showed an association between RSI and LIC (B = 0.98, p < 0.001, CI 0.73-1.23); however, the association was not significant with multi-variate regression including FSF (p = 0.28). Dual-echo GRE has low sensitivity for hepatic iron. Subtraction imaging can result in false-positive diagnoses. (orig.)

  4. 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

  5. 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.

  6. 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.

  7. 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

  8. 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)

  9. 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.

  10. New spoiled spin-echo technique for three-dimensional MR imaging

    International Nuclear Information System (INIS)

    Darrasse, L.; Mao, L.; Saint-Jalmes, H.

    1989-01-01

    For 3D MR imaging within a convenient scanning time, the authors propose an improved spin-echo technique that permits the use of TRs shorter than 100 msec. They use a two-pulse RF sequence (α-π echo). The echo is read with conventional 3DFT encoding. To avoid steady-state signal refocusing before either α or (imperfect) π pulses, we apply randomized gradient spoilers both before each α pulse and on each side of the π pulse. So the sequence works like standard spin- echo sequences, with the z-magnetization recovery being adjusted by means of α rather than TR. The authors have investigated the method on a new 0.1-T Magnetom system dedicated for 3D MR imaging

  11. 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.

  12. 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.

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

    Science.gov (United States)

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

    2015-05-01

    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 with potentially dangerous perioperative QTc-prolongation (PD-QTc; increase >50 ms or to >500 ms). Prospective cohort study. Tertiary university teaching-hospital. Patients enrolled in a randomized controlled clinical trial of melatonin versus placebo on occurrence of delirium in hip-fracture patients. Data from ECGs made before and after hip surgery (1-3 days and/or 4-6 days post-surgery) were analyzed. QTc-duration was measured by hand, blinded for haloperidol and pre/post-surgery status. Clinical variables were measured at baseline. Mixed model analysis was used to estimate changes in QTc-duration. Risk-factors for PD-QTc were estimated by logistic regression analysis. We included 89 patients (mean age 84 years, 24% male); 39 were treated with haloperidol. Patients with normal pre-surgery QTc-duration (male ≤430 ms, female ≤450 ms) had a significant increase (mean 12 ms, SD 28) in QTc-duration. A significant decrease (mean 19 ms, SD 34) occurred in patients with prolonged pre-surgery QTc-duration (male >450ms, female >470 ms). Haloperidol-use did not influence the perioperative course of the QTc-interval (p=0.351). PD-QTc (n=8) was not associated with any of the measured risk-factors. QTc-duration changed differentially, increasing in patients with normal, but decreasing in patients with abnormal baseline QTc-duration. PD-QTc was not associated with haloperidol-use or other risk-factors. Low-dose oral haloperidol did not affect perioperative QTc-interval.

  14. 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.

  15. 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.

  16. 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.

  17. 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

  18. Characterization of echoes: A Dyson-series representation of individual pulses

    Science.gov (United States)

    Correia, Miguel R.; Cardoso, Vitor

    2018-04-01

    The ability to detect and scrutinize gravitational waves from the merger and coalescence of compact binaries opens up the possibility to perform tests of fundamental physics. One such test concerns the dark nature of compact objects: are they really black holes? It was recently pointed out that the absence of horizons—while keeping the external geometry very close to that of General Relativity—would manifest itself in a series of echoes in gravitational wave signals. The observation of echoes by LIGO/Virgo or upcoming facilities would likely inform us on quantum gravity effects or unseen types of matter. Detection of such signals is in principle feasible with relatively simple tools but would benefit enormously from accurate templates. Here we analytically individualize each echo waveform and show that it can be written as a Dyson series, for arbitrary effective potential and boundary conditions. We further apply the formalism to explicitly determine the echoes of a simple toy model: the Dirac delta potential. Our results allow to read off a few known features of echoes and may find application in the modeling for data analysis.

  19. 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...

  20. 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.

  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. 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...

  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. 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%.

  5. 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

  6. 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

  7. 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

  8. 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...

  9. 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.

  10. 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.

  11. 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

  12. 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.

  13. 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...

  14. 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.)

  15. 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.

  16. 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.

  17. Spontaneous cerebral microbleeds on gradient echo MR imaging in the stroke patients

    International Nuclear Information System (INIS)

    Kwak, Seong Ho; Song, Chang June; Kim, Dae Bong; Jeong, Geum Chae

    2003-01-01

    To investigate the spontaneous cerebral microbleeding occurring at gradient-echo MRI, and its relationship with associated stroke lesions and risk factors. Between September 2001 and December, 2002, 32 patients (21 men and 11 women; mean age 63 years) in whom cerebral microbleeding occurred at gradient-echo MRI were retrospectively investigated. Using a 1.5T MR imager, spin-echo T1-weighted, fast spin-echo T2-weighted, diffusion-weighted, and gradient-echo images were obtained. The number and location of microbleeds seen on gradient echo images, patients data, and associated stroke lesions such as intracerebral hemorrhage and lacunar and territorial infarction were assessed. Among the 32 patients, 563 microbleeds and between 1 and 66 (mean, 17.6) were noted at gradient-echo imaging. Microbleeding occurred in the cortical/subcortical area (n=216), the basal ganglia (n=173), thalamus (n=92), cerebellum (n=41), brainstem (n=36) and corpus callosum (n=1), and in 20 patients was bilateral. Patients had a history of hypertension (n=26), hypertriglycemia (n=12), heart disease (n=4), and diabetes mellitus (n=3). Stroke lesions were seen in 27 patients, intracerebral hemorrhage in ten, lacunar infarction in 24, and territorial infarction in four. The incidence and number of microbleeds was greater in older patients and in those with hypertension, hypertriglycemia, and stroke lesions such as intracerebral hemorrhage or lacunar infarction. The detection of microbleeding at gradient-echo imaging is helpful, since it predicts the possibility of cerebral hemorrhage in these patients

  18. 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)

  19. 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.

  20. Layer disturbances and the radio-echo free zone in ice sheets

    Directory of Open Access Journals (Sweden)

    R. Drews

    2009-08-01

    Full Text Available Radio-echo sounding of the Antarctic and Greenlandic ice sheets often reveals a layer in the lowest hundreds of meters above bedrock more or less free of radio echoes, known as the echo-free zone (EFZ. The cause of this feature is unclear, so far lacking direct evidence for its origin. We compare echoes around the EPICA drill site in Dronning Maud Land, Antarctica, with the dielectric properties, crystal orientation fabrics and optical stratigraphy of the EPICA-DML ice core. We find that echoes disappear in the depth range where the dielectric contrast is blurred, and where the coherency of the layers in the ice core is lost due to disturbances caused by the ice flow. At the drill site, the EFZ onset at ~2100 m marks a boundary, below which the ice core may have experienced flow induced disturbances on various scales. The onset may indicate changing rheology which needs to be accounted for in the modeling of ice sheet dynamics.

  1. 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.

  2. 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.

  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. 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.

  5. 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.

  6. 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.

  7. [Current status and prospect of perioperative thrombus management in gastrointestinal cancer].

    Science.gov (United States)

    Qin, X Y

    2016-03-01

    Thanks to the progress of surgical theory and skills, as well as the application of modern medical devices in general surgery, both the occurrence of perioperative complications and mortality of gastrointestinal surgery have significantly reduced recently. However, it is still far from optimal in terms of the perioperative venous thromboembolism (VTE) management in gastrointestinal cancer, and what is responsible for that? This paper aims at finding out the reasons contributing to the current status, giving suggestions for how to make improvement at both disease level and hospital management level. At the same time, while paying attention for the prophylaxis of VTE, there have been more and more patients receiving antithrombotic treatment require elective or emergent surgery in clinical practice, due to aging and increased incidence of cardiovascular disease year by year. How to balance the bleeding and thrombosis risk for these patients during perioperative periods is also a question we are going to discuss. In conclusion, as to the issue of the management of perioperative thrombosis, there will be a long way for Chinese doctors to go. Our peers should pay more attention to this problem and take more efforts, so that the thrombotic complications in surgical patients can be reduced.

  8. 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.

  9. HST Archival Imaging of the Light Echoes of SN 1987A

    Science.gov (United States)

    Lawrence, S. S.; Hayon, M.; Sugerman, B. E. K.; Crotts, A. P. S.

    2002-12-01

    We have undertaken a search for light echo signals from Supernova 1987A that have been serendipitously recorded in images taken near the 30 Doradus region of the Large Magellanic Cloud by HST. We used the MAST interface to create a database of the 1282 WF/PC, WFPC2 and STIS images taken within 15 arcminutes of the supernova, between 1992 April and 2002 June. These 1282 images are grouped into 125 distinct epochs and pointings, with each epoch containing between 1 and 42 separate exposures. Sorting this database with various programs, aided by the STScI Visual Target Tuner, we have identified 63 pairs of WFPC2 imaging epochs that are not centered on the supernova but that have a significant amount of spatial overlap between their fields of view. These image data were downloaded from the public archive, cleaned of cosmic rays, and blinked to search for light echoes at radii larger than 2 arcminutes from the supernova. Our search to date has focused on those pairs of epochs with the largest degree of overlap. Of 16 pairs of epochs scanned to date, we have detected 3 strong light echoes and one faint, tentative echo signal. We will present direct and difference images of these and any further echoes, as well as the 3-D geometric, photometric and color properties of the echoing dust structures. In addition, a set of 20 epochs of WF/PC and WFPC2 imaging centered on SN 1987A remain to be searched for echoes within 2 arcminutes of the supernova. We will discuss our plans to integrate the high spatial-resolution HST snapshots of the echoes with our extensive, well-time-sampled, ground-based imaging data. We gratefully acknowledge the support of this undergraduate research project through an HST Archival Research Grant (HST-AR-09209.01-A).

  10. 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.

  11. Collision-induced stimulated photon echoes in ‘strong’ magnetic field

    Science.gov (United States)

    Reshetov, V. A.

    2018-05-01

    Collision-induced stimulated photon echoes formed in a gaseous medium on the transition with the angular momentum change Ja=0 → Jb=1 under the action of ‘strong’ longitudinal magnetic field, when the echo pulse becomes unpolarized, are considered with an account of elastic depolarizing collisions. In the case of narrow spectral line the explicit expressions for the echo polarization density matrix and the degree of polarization are obtained. In the case of broad spectral line the results of the numeric calculations reproduce qualitatively the curve obtained in the experiments with ytterbium vapor.

  12. 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.

  13. 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...

  14. 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)....

  15. 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...

  16. 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

  17. 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...

  18. 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.

  19. Echoing Sentiments: Art and Melancholy in the Work of Pleshette DeArmitt

    Directory of Open Access Journals (Sweden)

    Michael Naas

    2015-12-01

    Full Text Available During those first few days, those first few weeks, truth be told, still today, something in me has wanted simply to echo the sentiments of others. That’s because I myself didn’t know exactly what to say and, truth be told, I still don’t know today. But it’s also because others, including and especially some of the people here today, beginning with my co-panelists and, perhaps especially, early on, Leigh Johnson, knew at the time just what had to be said and so expressed so well the sentiments that we all—that I at least—just wanted to echo. Just to echo, that’s what I wanted to do, because by echoing the sentiments of others I would be able to protect myself just a bit longer, I thought, though also, I self-justified, by echoing others I would be able to give back in some way to Pleshette herself, who showed us in her work that Echo does not simply repeat but initiates even when it looks or sounds as if she is not, Echo who gives back even when it sounds as if she has nothing to give, Echo who not only has her own Narcissus but her own narcissism—which Pleshette would have been the first to tell us is not only not a bad thing but a necessary one, and perhaps just what is needed for a new thinking of empathy, of mourning, and, perhaps, as I will try to say, of the ephemeral.

  20. 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.

  1. 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.

  2. 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.

  3. Experimental observation of fluid echoes in a non-neutral plasma

    International Nuclear Information System (INIS)

    Yu, Jonathan H.; Driscoll, C. Fred

    2002-01-01

    Experimental observation of a nonlinear fluid echo is presented which demonstrates the reversible nature of spatial Landau damping, and that non-neutral plasmas behave as nearly ideal 2D fluids. These experiments are performed on UCSD's CamV Penning-Malmberg trap with magnetized electron plasmas. An initial m i =2 diocotron wave is excited, and the received wall signal damps away in about 5 wave periods. The density perturbation filaments are observed to wrap up as the wave is spatially Landau damped. An m t =4 'tickler' wave is then excited, and this wave also Landau damps. The echo consists of a spontaneous appearance of a third m e =2 wave after the responses to the first two waves have inviscidly damped away. The appearance time of the echo agrees with theory, and data suggests the echo is destroyed at least partly due to saturation

  4. 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 ...

  5. Perioperative Variables Contributing to the Rupture of Intracranial Aneurysm: An Update

    Directory of Open Access Journals (Sweden)

    Tumul Chowdhury

    2013-01-01

    Full Text Available Background. Perioperative aneurysm rupture (PAR is one of the most dreaded complications of intracranial aneurysms, and approximately 80% of nontraumatic SAHs are related to such PAR aneurysms. The literature is currently scant and even controversial regarding the issues of various contributory factors on different phases of perioperative period. Thus this paper highlights the current understanding of various risk factors, variables, and outcomes in relation to PAR and try to summarize the current knowledge. Method. We have performed a PubMed search (1 January 1991–31 December 2012 using search terms including “cerebral aneurysm,” “intracranial aneurysm,” and “intraoperative/perioperative rupture.” Results. Various risk factors are summarized in relation to different phases of perioperative period and their relationship with outcome is also highlighted. There exist many well-known preoperative variables which are responsible for the highest percentage of PAR. The role of other variables in the intraoperative/postoperative period is not well known; however, these factors may have important contributory roles in aneurysm rupture. Preoperative variables mainly include natural course (age, gender, and familial history as well as the pathophysiological factors (size, type, location, comorbidities, and procedure. Previously ruptured aneurysm is associated with rupture in all the phases of perioperative period. On the other hand intraoperative/postoperative variables usually depend upon anesthesia and surgery related factors. Intraoperative rupture during predissection phase is associated with poor outcome while intraoperative rupture at any step during embolization procedure imposes poor outcome. Conclusion. We have tried to create such an initial categorization but know that we cannot scale according to its clinical importance. Thorough understanding of various risk factors and other variables associated with PAR will assist in better

  6. 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

  7. 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)

  8. 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.

  9. Oral surgery in patients under antithrombotic therapy: perioperative bleeding as a significant risk factor for postoperative hemorrhage.

    Science.gov (United States)

    Rocha, Amanda L; Souza, Alessandra F; Martins, Maria A P; Fraga, Marina G; Travassos, Denise V; Oliveira, Ana C B; Ribeiro, Daniel D; Silva, Tarcília A

    2018-01-01

    : To investigate perioperative and postoperative bleeding, complications in patients under therapy with anticoagulant or antiplatelet drugs submitted to oral surgery. To evaluate the risk of bleeding and safety for dental surgery, a retrospective chart review was performed. Medical and dental records of patients taking oral antithrombotic drugs undergoing dental surgery between 2010 and 2015 were reviewed. Results were statistically analyzed using Fisher's exact test, t test or the χ test. One hundred and seventy-nine patients underwent 293 surgical procedures. A total of eight cases of perioperative and 12 episodes of postoperative bleeding were documented. The complications were generally managed with local measures and did not require hospitalization. We found significant association of postoperative hemorrhage with increased perioperative bleeding (P = 0.043) and combination of anticoagulant and antiplatelet therapy (P bleeding is 8.8 times bigger than procedures without perioperative bleeding. Dental surgery in patients under antithrombotic therapy might be carried out without altering the regimen because of low risk of perioperative and postoperative bleeding. However, patients with increased perioperative bleeding should be closely followed up because of postoperative complications risk.

  10. 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.

  11. Perioperative management of haemophilia B: A critical appraisal of the evidence and current practices.

    Science.gov (United States)

    Neufeld, E J; Solimeno, L; Quon, D; Walsh, C; Seremetis, S; Cooper, D; Iyer, N N; Hoxer, C S; Giangrande, P

    2017-11-01

    While there is substantial literature addressing the principles of general management of haemophilia, literature on perioperative management of haemostasis is scarce. The aim of this study was to better understand perioperative management among congenital haemophilia B patients (without inhibitors) and to gain insights into real-world surgical practices. A systematic literature review, with an emphasis on haemophilia B, was conducted using EMBASE ® , Medline ® and the Cochrane Library. Studies from 1974 to June 2015 were accessed, and 132 studies were eligible for the full-study review. An international expert panel with five haematologists and one surgeon reviewed the resulting literature and provided further insights. The literature review revealed that documented experience in the perioperative management of bleeding risk in haemophilia B patients is relatively scarce. Therefore, the review was amended to provide a comprehensive overview of the perioperative management for haemophilia A and B patients; the expert panel applied a particular focus to haemophilia B. Several gaps were identified in the literature including the lack of consensus on defining surgery in terms of bleeding risk, optimal factor levels during surgery and lack of robust evidence on surgical outcomes. The ensuing discussions with the expert panel provided validation of some of the results from the systematic literature review and proposed future directions for perioperative management. Suggestions included collaboration with haemophilia treatment centres (HTCs) to collect real-world data on perioperative management, establishing the need for optimal factor level monitoring practice, and the appropriate adoption of extended half-life products in clinical settings. © 2017 John Wiley & Sons Ltd.

  12. Bias-Voltage Stabilizer for HVHF Amplifiers in VHF Pulse-Echo Measurement Systems.

    Science.gov (United States)

    Choi, Hojong; Park, Chulwoo; Kim, Jungsuk; Jung, Hayong

    2017-10-23

    The impact of high-voltage-high-frequency (HVHF) amplifiers on echo-signal quality is greater with very-high-frequency (VHF, ≥100 MHz) ultrasound transducers than with low-frequency (LF, ≤15 MHz) ultrasound transducers. Hence, the bias voltage of an HVHF amplifier must be stabilized to ensure stable echo-signal amplitudes. We propose a bias-voltage stabilizer circuit to maintain stable DC voltages over a wide input range, thus reducing the harmonic-distortion components of the echo signals in VHF pulse-echo measurement systems. To confirm the feasibility of the bias-voltage stabilizer, we measured and compared the deviations in the gain of the HVHF amplifier with and without a bias-voltage stabilizer. Between -13 and 26 dBm, the measured gain deviations of a HVHF amplifier with a bias-voltage stabilizer are less than that of an amplifier without a bias-voltage stabilizer. In order to confirm the feasibility of the bias-voltage stabilizer, we compared the pulse-echo responses of the amplifiers, which are typically used for the evaluation of transducers or electronic components used in pulse-echo measurement systems. From the responses, we observed that the amplitudes of the echo signals of a VHF transducer triggered by the HVHF amplifier with a bias-voltage stabilizer were higher than those of the transducer triggered by the HVHF amplifier alone. The second, third, and fourth harmonic-distortion components of the HVHF amplifier with the bias-voltage stabilizer were also lower than those of the HVHF amplifier alone. Hence, the proposed scheme is a promising method for stabilizing the bias voltage of an HVHF amplifier, and improving the echo-signal quality of VHF transducers.

  13. 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.)

  14. Study of turbulent flow using Half-Fourier Echo-Planar imaging

    International Nuclear Information System (INIS)

    Rodriguez, A.O.

    2006-01-01

    The Echo-Planar Imaging technique combined with a partial Fourier acquisition method was used to obtain velocity images for liquid flows in a circular cross-section pipe at Reynolds number of up to 8000. This partial-Fourier imaging scheme is able to generate shorter echo times than the full-Fourier Echo-Planar Imaging methods, reducing the signal attenuation due to T2 * and flow. Velocity images along the z axis were acquired with a time-scale of 80 ms thus obtaining a real-time description of flow in both the laminar and turbulent regimes. Velocity values and velocity fluctuations were computed with the flow image data. A comparison plot of NMR velocity and bulk velocity and a plot of velocity fluctuations were calculated to investigate the feasibility of this imaging technique. Flow encoded Echo-Planar Imaging together with a reduced data acquisition method can provide us with a real-time technique to capture instantaneous images of the flow field for both laminar and turbulent regimes. (author)

  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. 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.

  17. 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.

  18. 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).

  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. Two-pulse and stimulated nuclear-quadrupole-resonance echoes in YAlO3:Pr3+

    International Nuclear Information System (INIS)

    Erickson, L.E.

    1991-01-01

    The dephasing of trivalent praseodymium dilute in yttrium aluminum oxide (YAlO 3 ) in the ground electronic state 3 H 4 state is evaluated using an optically detected method, to measure two-rf-pulse- and three-rf-pulse-stimulated nuclear quadrupole echoes. The magnitude of the echo is obtained by detecting the weak Raman optical field generated by the interaction of the magnetic moment of the echo and a light beam resonant with the 3 H 4 (0 cm 1 ) to 1 D 2 (16 374 cm -1 ) optical transition. This same light beam is used as an optical pump (37-ms duration) prior the rf-pulse sequence to increase the population difference of the hyperfine energy levels, thereby improving the echo signal. The light is turned off 9 ms before the rf-pulse sequence and remains off until the echo to avoid optical-pumping effects on the measured nuclear-quadrupole-resonance (NQR) echo lifetime. The dephasing time T 2 from two-pulse nuclear-quadrupole-echo measurement is found to be 366±29 μs

  1. Perioperative Endocrine Therapy for Patients with Cushing's Syndrome Undergoing Retroperitoneal Laparoscopic Adrenalectomy

    Directory of Open Access Journals (Sweden)

    Xiaobo Cui

    2012-01-01

    Full Text Available Objectives. To investigate the efficacy and safety of perioperative endocrine therapy (PET for patients with Cushing’s syndrome (CS undergoing retroperitoneal laparoscopic adrenalectomy (RLA. Methods. The novel, simplified PET modality of 82 patients who underwent RLA procedures for CS were studied. Clinical manifestations were observed for all patients on days 1 and 5 postoperatively, and clinical data, such as blood pressure (BP, levels of serum cortisol, adrenocorticotropin (ACTH, blood glucose, and electrolytes, were acquired and analyzed. Results. Supraphysiological doses of glucocorticoid were administered during the perioperative period, and the dosage was reduced gradually. In all 82 cases, the RLAs were performed successfully without any perioperative complication, such as steroid withdrawal symptoms. The patient’s symptoms and signs were improved quickly and safely during the hospital days. The serum cortisol and potassium levels were rather stable on days 1 and 5 postoperatively, and most were within the normal range. The clinical manifestations, serum levels of cortisol, ACTH, and potassium in most patients restored to normal gradually after several months (mean, 6.7 ± 1.2 months, except for one patient undergoing bilateral adrenalectomy. Conclusions. This perioperative endocrine therapy for patients with Cushing’s syndrome (mainly for adrenocortical adenoma undergoing retro-laparoscopic adrenalectomy is both effective and safe.

  2. 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

  3. Adverse effects of perioperative paracetamol, NSAIDs, glucocorticoids, gabapentinoids and their combinations

    DEFF Research Database (Denmark)

    Mathiesen, O; Wetterslev, Jørn; Kontinen, V K

    2014-01-01

    with the most common perioperative non-opioid analgesics: paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids (GCCs), gabapentinoids and their combinations. The review is based on data from systematic reviews with meta-analyses of analgesic efficacy and/or adverse effects...... of perioperative non-opioid analgesics, and randomised trials and cohort/retrospective studies. Generally, data on AE are sparse and related to the immediate post-operative period. For paracetamol, the incidence of AEs appears trivial. Data are inconclusive regarding an association of NSAIDs with mortality...

  4. On the factors controlling occurrence of F-region coherent echoes

    Directory of Open Access Journals (Sweden)

    D. W. Danskin

    2002-09-01

    Full Text Available Several factors are known to control the HF echo occurrence rate, including electron density distribution in the ionosphere (affecting the propagation path of the radar wave, D-region radio wave absorption, and ionospheric irregularity intensity. In this study, we consider 4 days of CUTLASS Finland radar observations over an area where the EISCAT incoherent scatter radar has continuously monitored ionospheric parameters. We illustrate that for the event under consideration, the D-region absorption was not the major factor affecting the echo appearance. We show that the electron density distribution and the radar frequency selection were much more significant factors. The electron density magnitude affects the echo occurrence in two different ways. For small F-region densities, a minimum value of 1 × 1011 m-3 is required to have sufficient radio wave refraction so that the orthogonality (with the magnetic field lines condition is met. For too large densities, radio wave strong "over-refraction" leads to the ionospheric echo disappearance. We estimate that the over-refraction is important for densities greater than 4 × 1011 m-3. We also investigated the backscatter power and the electric field magnitude relationship and found no obvious relationship contrary to the expectation that the gradient-drift plasma instability would lead to stronger irregularity intensity/echo power for larger electric fields.Key words. Ionosphere (ionospheric irregularities; plasma waves and instabilities; auroral ionosphere

  5. 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.

  6. 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.

  7. 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).

  8. Significance of spin-echo intracardiac signal during cine cardiac MR imaging

    International Nuclear Information System (INIS)

    Feiglin, D.H.I.; O'Donnell, J.K.

    1987-01-01

    Thirty patient studies were performed using several multisection spin multi-echo pulse sequences (SEPS) formattable into the cine mode, with repetition time (TR)≤RR interval and 18 msec ≤ echo time (TE) ≤ 64 msec. Thirteen studies were performed in patients with various cardiomyopathies, ten in patients with cardiac tumors, and seven in healthy volunteers. The SEPS in the multi-echo acquisition format differentiated between tumor and stasis in terms of signal behavior. Healthy subjects may exhibit stasis of flow adjacent to the endocardium during the cardiac cycle

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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....

  14. 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...

  15. 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...

  16. Myocardial viability: comparison of free-breathing navigator-echo-gated three-dimensional inversion-recovery gradient-echo MR and standard multiple breath-hold two-dimensional inversion-recovery gradient-echo MR

    International Nuclear Information System (INIS)

    Kim, Jin Hee; Seo, Joon Beom; Do, Kyung Hyun; Yang, Dong Hyun; Lee, Soo Hyun; Ko, Sung Min; Heo, Jeong Nam; Lim, Tae Hwan

    2004-01-01

    To compare a free-breathing, navigator-echo-gated, three-dimensional, inversion-recovery, gradient-echo, MR pulse sequence (3D-MRI) with standard, multiple breath-hold, two-dimensional, inversion-recovery, gradient-echo MR (2D-MRI) for the evaluation of delayed hyperenhancement of nonviable myocardium in patients with chronic ischemic heart disease. Ten patients with chronic ischemic heart disease were enrolled in this study. MRI was performed on a 1.5-T system. 3D-MRI was obtained in the short axis plane at 10 minutes after the administration of Gd-DTPA (0.2 mmol/kg, 4 cc/sec). Prospective gating of the acquisition based on the navigator echo was applied. 2D-MRI was performed immediately after finishing 3D-MRI. The area of total and hyperenhanced myocardium measured on both image sets was compared with paired Student t-test and Bland-Altman method. By using a 60-segment model, the transmural extent and segment width of the hyperenhanced area were recorded by 3-scale grading method. The agreement between the two sequences was evaluated with kappa statistics. We also evaluated the agreement of hyperenhancement among the three portions (apical, middle and basal portion) of the left ventricle with kappa statistics. The two sequences showed good agreement for the measured area of total and hyperenhanced myocardium on paired t-test (ρ = 0.11 and ρ = 0.34, respectively). No systematic bias was shown on Bland-Altman analysis. Good agreement was found for the segmental width (Κ = 0.674) and transmural extent (Κ = 0.615) of hyperenhancement on the segmented analysis. However, the agreement of the transmural extent of hyperenhancement in the apical segments was relatively poor compared with that in the middle or basal portions. This study showed good agreement between 3D-MRI and 2D-MRI in evaluation of non-viable myocardium. Therefore, 3D-MRI may be useful in the assessment of myocardial viability in patients with dyspnea and children because it allows free

  17. 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

  18. 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

  19. 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

  20. Application of fast spin-echo T2-weighted imaging for examination of the neurocranium. Comparison with the conventional T2-weighted spin-echo sequence

    International Nuclear Information System (INIS)

    Siewert, C.; Hosten, N.; Felix, R.

    1994-01-01

    T 2 -weighted spin-echo imaging is the standard screening procedure in MR imaging of the neutrocranium. We evaluated fast spin-echo T 2 -weighted imaging (TT 2 ) of the neurocranium in comparison to conventional spin-echo T 2 -weighted imaging (T 2 ). Signal-to-noise and contrast-to-noise ratio of normal brain tissues (basal ganglia, grey and white matter, CSF fluid) and different pathologies were calculated. Signal-to-noise ratio and contrast-to-noise ratio were significantly higher than TT 2 than in T 2 (with the exception of grey-to-white matter contrast). Tissues with increased content of water protons (mobile protons) showed the highest contrast to surrounding tissues. The increased signal intensity of fat must be given due attention in fatty lesions. Because the contrast-to-noise ratio between white matter and basal ganglia is less in TT 2 , Parkinson patients have to be examined by conventional T 2 . If these limitations are taken into account, fast spin-echo T 2 -weighted imaging is well appropriate for MR imaging of the neurocranium, resulting in heavy T 2 -weighting achieved in a short acquisition time. (orig.) [de

  1. Echo III: The study of electric and magnetic fields with conjugate echoes from artificial electron beams injected into the auroral zone ionosphere

    International Nuclear Information System (INIS)

    Hendrickson, R.A.; Winckler, J.R.; Arnoldy, R.L.

    1976-01-01

    The third in a series of rocket flights carrying large electron guns for electron beam-plasma analysis and magnetosphere probing has been carried out from the Poker Flat rocket range near Fairbanks, Alaska at L=6. Echoes from the injected electrons mirroring at the southern hemisphere conjugate point were observed on the rocket by particle detectors and in the nearby ionosphere by photometers on board the rocket. The bounce time and drift velocities of the echoes were measured using the known trajectory and aspect of the rocket. Ionospheric electric fields near the rocket were inferred from drift motion of the ambient ion population measured by two techniques, electrostatic analyzers on board the rocket and incoherent backscatter radar from the ground. Using model magnetic fields, gradient and curvature drift and bound times have been computed under the conditions appropriate for this experiment. Assuming that field lines are equipotentials, the addition of the observed ionospheric electric field drift to the model-independent gradient and curvature drifts predicts a net echo drift velocity that is in agreement with the observations, provided the Mead-Fairfield 1972--73 model is used. The observed bounce time constitutes an independent model check and is in better agreement with the Olson-Pfitzer model. Echo spatial and temporal fluctuations reflected the turbulence associated with the diffuse aurora into which the rocket was launched

  2. Gaussian-approximation formalism for evaluating decay of NMR spin echoes

    International Nuclear Information System (INIS)

    Recchia, C.H.; Gorny, K.; Pennington, C.H.

    1996-01-01

    We present a formalism for evaluating the amplitude of the NMR spin echo and stimulated echo as a function of pulse spacings, for situations in which the nuclear spins experience an effective longitudinal magnetic field h z (t) resulting from an arbitrary number of independent sources, each characterized by its own arbitrary time correlation function. The distribution of accumulated phase angles for the ensemble of nuclear spins at the time of the echo is approximated as a Gaussian. The development of the formalism is motivated by the need to understand the transverse relaxation of 89 Y in YBa 2 Cu 3 O 7 , in which the 89 Y experiences 63,65 Cu dipolar fields which fluctuate due to 63,65 Cu T 1 processes. The formalism is applied successfully to this example, and to the case of nuclei diffusing in a spatially varying magnetic field. Then we examine a situation in which the approximation fails emdash the classic problem of chemical exchange in dimethylformamide, where the methyl protons experience a chemical shift which fluctuates between two discrete values. In this case the Gaussian approximation yields a monotonic decay of the echo amplitude with increasing pulse spacing, while the exact solution yields distinct open-quote open-quote beats close-quote close-quote in the echo height, which we confirm experimentally. In light of this final example the limits of validity of the approximation are discussed. copyright 1996 The American Physical Society

  3. 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

  4. 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)

  5. [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.

  6. 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 

  7. Mono-Exponential Fitting in T2-Relaxometry: Relevance of Offset and First Echo.

    Directory of Open Access Journals (Sweden)

    David Milford

    Full Text Available T2 relaxometry has become an important tool in quantitative MRI. Little focus has been put on the effect of the refocusing flip angle upon the offset parameter, which was introduced to account for a signal floor due to noise or to long T2 components. The aim of this study was to show that B1 imperfections contribute significantly to the offset. We further introduce a simple method to reduce the systematic error in T2 by discarding the first echo and using the offset fitting approach.Signal curves of T2 relaxometry were simulated based on extended phase graph theory and evaluated for 4 different methods (inclusion and exclusion of the first echo, while fitting with and without the offset. We further performed T2 relaxometry in a phantom at 9.4T magnetic resonance imaging scanner and used the same methods for post-processing as in the extended phase graph simulated data. Single spin echo sequences were used to determine the correct T2 time.The simulation data showed that the systematic error in T2 and the offset depends on the refocusing pulse, the echo spacing and the echo train length. The systematic error could be reduced by discarding the first echo. Further reduction of the systematic T2 error was reached by using the offset as fitting parameter. The phantom experiments confirmed these findings.The fitted offset parameter in T2 relaxometry is influenced by imperfect refocusing pulses. Using the offset as a fitting parameter and discarding the first echo is a fast and easy method to minimize the error in T2, particularly for low to intermediate echo train length.

  8. [A survey of perioperative asthmatic attack among patients with bronchial asthma underwent general anesthesia].

    Science.gov (United States)

    Ie, Kenya; Yoshizawa, Atsuto; Hirano, Satoru; Izumi, Sinyuu; Hojo, Masaaki; Sugiyama, Haruhito; Kobayasi, Nobuyuki; Kudou, Kouichirou; Maehara, Yasuhiro; Kawachi, Masaharu; Miyakoshi, Kouichi

    2010-07-01

    We investigated the risk factor of perioperative asthmatic attack and effectiveness of preventing treatment for asthmatic attack before operation. We performed retrospective chart review of one hundred eleven patients with asthma underwent general anesthesia and surgical intervention from January 2006 to October 2007 in our hospital. The rate of perioperative asthmatic attack were as follows; 10.2% (5 in 49 cases) in no pretreatment group, 7.5% (3 in 40 cases) in any pretreatments except for systemic steroid, and 4.5% (1 in 22 cases) in systemic steroid pretreatment group. Neither preoperative asthma severity nor duration from the last attack had significant relevancy to perioperative attack rate. The otolaryngological surgery, especially those have nasal polyp and oral surgery had high perioperative asthma attack rate, although there was no significant difference. We recommend the systemic steroid pretreatment for asthmatic patients, especially when they have known risk factor such as administration of the systemic steroid within 6 months, or possibly new risk factor such as nasal polyp, otolaryngological and oral surgery.

  9. Implementation of the Vocera Communication System in a Quaternary Perioperative Environment.

    Science.gov (United States)

    Friend, Tynan H; Jennings, Samantha J; Copenhaver, Martin S; Levine, Wilton C

    2017-01-01

    In the hospital, fast and efficient communication among clinicians and other employees is paramount to ensure optimal patient care, workflow efficiency, patient safety and patient comfort. The implementation of the wireless Vocera® Badge, a hands-free wearable device distributed to perioperative team members, has increased communication efficiency across the perioperative environment at Massachusetts General Hospital (MGH). This quality improvement project, based upon identical pre- and post-implementation surveys, used qualitative and quantitative analysis to determine if and how the Vocera system affected the timeliness of information flow, ease of communication, and operating room noise levels throughout the perioperative environment. Overall, the system increased the speed of information flow and eased communication between coworkers yet was perceived to have raised the overall noise level in and around the operating rooms (ORs). The perceived increase in noise was outweighed by the closed-loop communication between clinicians. Further education of the system's features in regard to speech recognition and privacy along with expected conversation protocol are necessary to ensure hassle-free communication for all staff.

  10. Multiband multi-echo imaging of simultaneous oxygenation and flow timeseries for resting state connectivity.

    Science.gov (United States)

    Cohen, Alexander D; Nencka, Andrew S; Lebel, R Marc; Wang, Yang

    2017-01-01

    A novel sequence has been introduced that combines multiband imaging with a multi-echo acquisition for simultaneous high spatial resolution pseudo-continuous arterial spin labeling (ASL) and blood-oxygenation-level dependent (BOLD) echo-planar imaging (MBME ASL/BOLD). Resting-state connectivity in healthy adult subjects was assessed using this sequence. Four echoes were acquired with a multiband acceleration of four, in order to increase spatial resolution, shorten repetition time, and reduce slice-timing effects on the ASL signal. In addition, by acquiring four echoes, advanced multi-echo independent component analysis (ME-ICA) denoising could be employed to increase the signal-to-noise ratio (SNR) and BOLD sensitivity. Seed-based and dual-regression approaches were utilized to analyze functional connectivity. Cerebral blood flow (CBF) and BOLD coupling was also evaluated by correlating the perfusion-weighted timeseries with the BOLD timeseries. These metrics were compared between single echo (E2), multi-echo combined (MEC), multi-echo combined and denoised (MECDN), and perfusion-weighted (PW) timeseries. Temporal SNR increased for the MECDN data compared to the MEC and E2 data. Connectivity also increased, in terms of correlation strength and network size, for the MECDN compared to the MEC and E2 datasets. CBF and BOLD coupling was increased in major resting-state networks, and that correlation was strongest for the MECDN datasets. These results indicate our novel MBME ASL/BOLD sequence, which collects simultaneous high-resolution ASL/BOLD data, could be a powerful tool for detecting functional connectivity and dynamic neurovascular coupling during the resting state. The collection of more than two echoes facilitates the use of ME-ICA denoising to greatly improve the quality of resting state functional connectivity MRI.

  11. 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).

  12. Evolution of Web Services in EOSDIS: Search and Order Metadata Registry (ECHO)

    Science.gov (United States)

    Mitchell, Andrew; Ramapriyan, Hampapuram; Lowe, Dawn

    2009-01-01

    During 2005 through 2008, NASA defined and implemented a major evolutionary change in it Earth Observing system Data and Information System (EOSDIS) to modernize its capabilities. This implementation was based on a vision for 2015 developed during 2005. The EOSDIS 2015 Vision emphasizes increased end-to-end data system efficiency and operability; increased data usability; improved support for end users; and decreased operations costs. One key feature of the Evolution plan was achieving higher operational maturity (ingest, reconciliation, search and order, performance, error handling) for the NASA s Earth Observing System Clearinghouse (ECHO). The ECHO system is an operational metadata registry through which the scientific community can easily discover and exchange NASA's Earth science data and services. ECHO contains metadata for 2,726 data collections comprising over 87 million individual data granules and 34 million browse images, consisting of NASA s EOSDIS Data Centers and the United States Geological Survey's Landsat Project holdings. ECHO is a middleware component based on a Service Oriented Architecture (SOA). The system is comprised of a set of infrastructure services that enable the fundamental SOA functions: publish, discover, and access Earth science resources. It also provides additional services such as user management, data access control, and order management. The ECHO system has a data registry and a services registry. The data registry enables organizations to publish EOS and other Earth-science related data holdings to a common metadata model. These holdings are described through metadata in terms of datasets (types of data) and granules (specific data items of those types). ECHO also supports browse images, which provide a visual representation of the data. The published metadata can be mapped to and from existing standards (e.g., FGDC, ISO 19115). With ECHO, users can find the metadata stored in the data registry and then access the data either

  13. 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 ...

  14. 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,...

  15. Photon echo with a few photons in two-level atoms

    International Nuclear Information System (INIS)

    Bonarota, M; Dajczgewand, J; Louchet-Chauvet, A; Le Gouët, J-L; Chanelière, T

    2014-01-01

    To store and retrieve signals at the single photon level, various photon echo schemes have resorted to complex preparation steps involving ancillary shelving states in multi-level atoms. For the first time, we experimentally demonstrate photon echo operation at such a low signal intensity without any preparation step, which allows us to work with mere two-level atoms. This simplified approach relies on the so-coined ‘revival of silenced echo’ (ROSE) scheme. Low noise conditions are obtained by returning the atoms to the ground state before the echo emission. In the present paper we manage ROSE in photon counting conditions, showing that very strong control fields can be compatible with extremely weak signals, making ROSE consistent with quantum memory requirements. (paper)

  16. Perioperative Management of Patients with Inflammatory Rheumatic Diseases Undergoing Major Orthopaedic Surgery: A Practical Overview.

    Science.gov (United States)

    Gualtierotti, Roberta; Parisi, Marco; Ingegnoli, Francesca

    2018-04-01

    Patients with inflammatory rheumatic diseases often need orthopaedic surgery due to joint involvement. Total hip replacement and total knee replacement are frequent surgical procedures in these patients. Due to the complexity of the inflammatory rheumatic diseases, the perioperative management of these patients must envisage a multidisciplinary approach. The frequent association with extraarticular comorbidities must be considered when evaluating perioperative risk of the patient and should guide the clinician in the decision-making process. However, guidelines of different medical societies may vary and are sometimes contradictory. Orthopaedics should collaborate with rheumatologists, anaesthesiologists and, when needed, cardiologists and haematologists with the common aim of minimising perioperative risk in patients with inflammatory rheumatic diseases. The aim of this review is to provide the reader with simple practical recommendations regarding perioperative management of drugs such as disease-modifying anti-rheumatic drugs, corticosteroids, non-steroidal anti-inflammatory drugs and tools for a risk stratification for cardiovascular and thromboembolic risk based on current evidence for patients with inflammatory rheumatic diseases.

  17. 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.

  18. Pattern of perioperative cardiac arrests at University of Maiduguri Teaching Hospital.

    Science.gov (United States)

    Kwari, Y D; Bello, M R; Eni, U E

    2010-01-01

    Perioperative cardiac arrests and death on the table represent the most serious complications of surgery and anaesthesia. This paper was designed to study their pattern, causes and outcomes following cardiopulmonary resuscitation (CPR) and intensive care unit (ICU) management in our institution. Three year retrospective review of perioperative cardiac arrests and death on operating table following surgical procedure under anaesthesia. For each cardiac arrest or death on the table the sequence of events leading to the arrest was evaluated using case notes, anaesthetic chart and ICU records. Study variables which include demographic data, ASA score, anaesthetic technique, causes and outcome were analysed and discussed. Fourteen perioperative cardiac arrests were encountered following 4051 anaesthetics administered over the three year study period. Twelve out of the fourteen cardiac arrests occurred following general anaesthesia, while the remaining two occurred following spinal anaesthesia. There was no cardiac arrest following local anaesthesia. Children suffered more cardiac arrest than adults. ASA class III and IV risk status suffered more arrests than ASA I and II. Hypoxia from airway problems was the commonest cause of cardiac arrest followed by septic shock. Monitoring with pulse oximeter was done in only 4 out of the 14 cardiac arrests. Only 2 (14%) out of 14 cardiac arrests recovered to home discharge, one of them with significant neurological deficit. Majority of arrests were due to hypoxia from airway problems that were not detected early There is need to improve on patient monitoring, knowledge of CPR and intensive care so as to improve the outcome of perioperative cardiac arrest.

  19. 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

  20. 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

  1. Application of fast spin-echo T[sub 2]-weighted imaging for examination of the neurocranium. Comparison with the conventional T[sub 2]-weighted spin-echo sequence. Die Anwendung der T[sub 2]-gewichteten Turbo-Spin-Echo-Sequenz zur Untersuchung des Neurokraniums. Vergleich mit der konventionellen T[sub 2]-gewichteten Spin-Echo-Sequenz

    Energy Technology Data Exchange (ETDEWEB)

    Siewert, C. (Strahlenklinik und Poliklinik, Universitaets-Klinikum Rudolf Virchow, Standort Wedding, Freie Univ. Berlin (Germany)); Hosten, N. (Strahlenklinik und Poliklinik, Universitaets-Klinikum Rudolf Virchow, Standort Wedding, Freie Univ. Berlin (Germany)); Felix, R. (Strahlenklinik und Poliklinik, Universitaets-Klinikum Rudolf Virchow, Standort Wedding, Freie Univ. Berlin (Germany))

    1994-07-01

    T[sub 2]-weighted spin-echo imaging is the standard screening procedure in MR imaging of the neutrocranium. We evaluated fast spin-echo T[sub 2]-weighted imaging (TT[sub 2]) of the neurocranium in comparison to conventional spin-echo T[sub 2]-weighted imaging (T[sub 2]). Signal-to-noise and contrast-to-noise ratio of normal brain tissues (basal ganglia, grey and white matter, CSF fluid) and different pathologies were calculated. Signal-to-noise ratio and contrast-to-noise ratio were significantly higher than TT[sub 2] than in T[sub 2] (with the exception of grey-to-white matter contrast). Tissues with increased content of water protons (mobile protons) showed the highest contrast to surrounding tissues. The increased signal intensity of fat must be given due attention in fatty lesions. Because the contrast-to-noise ratio between white matter and basal ganglia is less in TT[sub 2], Parkinson patients have to be examined by conventional T[sub 2]. If these limitations are taken into account, fast spin-echo T[sub 2]-weighted imaging is well appropriate for MR imaging of the neurocranium, resulting in heavy T[sub 2]-weighting achieved in a short acquisition time. (orig.)

  2. 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).

  3. HTTP-based Search and Ordering Using ECHO's REST-based and OpenSearch APIs

    Science.gov (United States)

    Baynes, K.; Newman, D. J.; Pilone, D.

    2012-12-01

    Metadata is an important entity in the process of cataloging, discovering, and describing Earth science data. NASA's Earth Observing System (EOS) ClearingHOuse (ECHO) acts as the core metadata repository for EOSDIS data centers, providing a centralized mechanism for metadata and data discovery and retrieval. By supporting both the ESIP's Federated Search API and its own search and ordering interfaces, ECHO provides multiple capabilities that facilitate ease of discovery and access to its ever-increasing holdings. Users are able to search and export metadata in a variety of formats including ISO 19115, json, and ECHO10. This presentation aims to inform technically savvy clients interested in automating search and ordering of ECHO's metadata catalog. The audience will be introduced to practical and applicable examples of end-to-end workflows that demonstrate finding, sub-setting and ordering data that is bound by keyword, temporal and spatial constraints. Interaction with the ESIP OpenSearch Interface will be highlighted, as will ECHO's own REST-based API.

  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. 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' ...

  6. Ultrafast Dephasing and Incoherent Light Photon Echoes in Organic Amorphous Systems

    Science.gov (United States)

    Yano, Ryuzi; Matsumoto, Yoshinori; Tani, Toshiro; Nakatsuka, Hiroki

    1989-10-01

    Incoherent light photon echoes were observed in organic amorphous systems (cresyl violet in polyvinyl alcohol and 1,4-dihydroxyanthraquinone in polymethacrylic acid) by using temporally-incoherent nanosecond laser pulses. It was found that an echo decay curve of an organic amorphous system is composed of a sharp peak which decays very rapidly and a slowly decaying wing at the tail. We show that the persistent hole burning (PHB) spectra were reproduced by the Fourier-cosine transforms of the echo decay curves. We claim that in general, we must take into account the multi-level feature of the system in order to explain ultrafast dephasing at very low temperatures.

  7. Electric field and electron density thresholds for coherent auroral echo onset

    International Nuclear Information System (INIS)

    Kustov, A.V.; Uspensky, M.V.; Sofko, G.J.; Koehler, J.A.; Jones, G.O.L.; Williams, P.J.S.

    1993-01-01

    The authors study the threshold dependence of electron density and electric field for the observation of coherent auroral echo onset. They make use of Polar Geophysical Institute 83 MHz auroral radar and the EISCAT facility in Scandanavia, to simultaneously get plasma parameter information and coherent scatter observations. They observe an electron density threshold of roughly 2.5x10 11 m -3 for electric fields of 15 - 20 mV/m (near the Farley-Buneman instability threshold). For electric fields of 5 - 10 mV/m echos are not observed for even twice the previous electron density. Echo strength is observed to have other parametric dependences

  8. 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...

  9. 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...

  10. 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.

  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. 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.

  13. 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.

  14. 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.

  15. Accurate step-FMCW ultrasound ranging and comparison with pulse-echo signaling methods

    Science.gov (United States)

    Natarajan, Shyam; Singh, Rahul S.; Lee, Michael; Cox, Brian P.; Culjat, Martin O.; Grundfest, Warren S.; Lee, Hua

    2010-03-01

    This paper presents a method setup for high-frequency ultrasound ranging based on stepped frequency-modulated continuous waves (FMCW), potentially capable of producing a higher signal-to-noise ratio (SNR) compared to traditional pulse-echo signaling. In current ultrasound systems, the use of higher frequencies (10-20 MHz) to enhance resolution lowers signal quality due to frequency-dependent attenuation. The proposed ultrasound signaling format, step-FMCW, is well-known in the radar community, and features lower peak power, wider dynamic range, lower noise figure and simpler electronics in comparison to pulse-echo systems. In pulse-echo ultrasound ranging, distances are calculated using the transmit times between a pulse and its subsequent echoes. In step-FMCW ultrasonic ranging, the phase and magnitude differences at stepped frequencies are used to sample the frequency domain. Thus, by taking the inverse Fourier transform, a comprehensive range profile is recovered that has increased immunity to noise over conventional ranging methods. Step-FMCW and pulse-echo waveforms were created using custom-built hardware consisting of an arbitrary waveform generator and dual-channel super heterodyne receiver, providing high SNR and in turn, accuracy in detection.

  16. 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.

  17. Application of velocity imaging and gradient-recalled echo in neuroimaging

    International Nuclear Information System (INIS)

    Boyko, O.B.; Pelc, N.J.; Shimakawa, A.

    1990-01-01

    This paper describes the initial clinical experience with imaging blood flow at 1.5 T by means of a phase-sensitive gradient refocused pulse sequence. A spin-echo flow-encoding technique was modified to a gradient recalled acquisition in a steady state sequence, producing a velocity imaging and gradient recalled echo (VIGRE) sequence (TR = 24 msec, TE = 13 msec, flip angle = 45 degrees, 24-cm field of view, 7 mm contiguous sections). Two views per phase-encoding step are acquired; one using the first-moment flow-compensation gradient waveform and the second having a (selectable) nonzero first moment. A phase subtraction image is obtained where the signal is dependent on the direction and velocity of flow. The sequence was done following routine spin-echo imaging in 35 patients

  18. 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.)

  19. Variation in Medicare Expenditures for Treating Perioperative Complications: The Cost of Rescue.

    Science.gov (United States)

    Pradarelli, Jason C; Healy, Mark A; Osborne, Nicholas H; Ghaferi, Amir A; Dimick, Justin B; Nathan, Hari

    2016-12-21

    Treating surgical complications presents a major challenge for hospitals striving to deliver high-quality care while reducing costs. Costs associated with rescuing patients from perioperative complications are poorly characterized. To evaluate differences across hospitals in the costs of care for patients surviving perioperative complications after major inpatient surgery. Retrospective cohort study using claims data from the Medicare Provider Analysis and Review files. We compared payments for patients who died vs patients who survived after perioperative complications occurred. Hospitals were stratified using average payments for patients who survived following complications, and payment components were analyzed across hospitals. Administrative claims database of surgical patients was analyzed at hospitals treating Medicare patients nationwide. This study included Medicare patients aged 65 to 100 years who underwent abdominal aortic aneurysm repair (n = 69 207), colectomy for cancer (n = 107 647), pulmonary resection (n = 91 758), and total hip replacement (n = 307 399) between 2009 and 2012. Data analysis took place between November 2015 and March 2016. Clinical outcome of surgery (eg, no complication, complication and death, or complication and survival) and the individual hospital where a patient received an operation. Risk-adjusted, price-standardized Medicare payments for an episode of surgery. Risk-adjusted perioperative outcomes were also assessed. The mean age for Medicare beneficiaries in this study ranged from 74.1 years (pulmonary resection) to 78.2 years (colectomy). The proportion of male patients ranged from 37% (total hip replacement) to 77% (abdominal aortic aneurysm repair), and most patients were white. Among patients who experienced complications, those who were rescued had higher price-standardized Medicare payments than did those who died for all 4 operations. Assessing variation across hospitals, payments for patients

  20. 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.

  1. 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...

  2. 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.

  3. 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

  4. Numerical calculation of spin echo amplitude in pulsed NMR: effects of quadrupole interaction

    International Nuclear Information System (INIS)

    Sobral, R.R.

    1986-01-01

    The spin echo obtained by nuclear magnetic resonance, in systems which atomic nuclei interact with magnetic fields and electric field gradients, present oscillations in function of the time interval between two excitations pulses. Using the density matrix formalism, the amplitudes of these echo is calculated, analytically. In this work, echo amplitudes obtained under different excitation conditions for nuclei of different nuclear spin values are calculated. The numerical results are compared with disposable analytical solutions. Applications of this method to the case of electric field gradient without axial symmetry were studied. Within the used approximation limits, an expression for attnuation of oscillatory behaviour of echo amplitude in function of the time interval between experimentally observed pulses was obtained. (M.C.K.) [pt

  5. Predicting the risk of perioperative transfusion for patients undergoing elective hepatectomy.

    Science.gov (United States)

    Sima, Camelia S; Jarnagin, William R; Fong, Yuman; Elkin, Elena; Fischer, Mary; Wuest, David; D'Angelica, Michael; DeMatteo, Ronald P; Blumgart, Leslie H; Gönen, Mithat

    2009-12-01

    To develop 2 instruments that predict the probability of perioperative red blood cell transfusion in patients undergoing elective liver resection for primary and secondary tumors. Hepatic resection is the most effective treatment for several benign and malign conditions, but may be accompanied by substantial blood loss and the need for perioperative transfusions. While blood conservation strategies such as autologous blood donation, acute normovolemic hemodilution, or cell saver systems are available, they are economically efficient only if directed toward patients with a high risk of transfusion. Using preoperative data from 1204 consecutive patients who underwent liver resection between 1995 and 2000 at Memorial Sloan- Kettering Cancer Center, we modeled the probability of perioperative red blood cell transfusion. We used the resulting model, validated on an independent dataset (n = 555 patients), to develop 2 prediction instruments, a nomogram and a transfusion score, which can be easily implemented into clinical practice. The planned number of liver segments resected, concomitant extrahepatic organ resection, a diagnosis of primary liver malignancy, as well as preoperative hemoglobin and platelets levels predicted the probability of perioperative red blood cell transfusion. The predictions of the model appeared accurate and with good discriminatory abilities, generating an area under the receiver operating characteristic curve of 0.71. Preoperative factors can be combined into risk profiles to predict the likelihood of transfusion during or after elective liver resection. These predictions, easy to calculate in the frame of a nomogram or of a transfusion score, can be used to identify patients who are at high risk for red cell transfusions and therefore most likely to benefit from blood conservation techniques.

  6. Student nurses' experiences of preserved dignity in perioperative practice - Part I.

    Science.gov (United States)

    Blomberg, Ann-Catrin; Willassen, Elin; von Post, Iréne; Lindwall, Lillemor

    2015-09-01

    In recent years, operating theatre nurse students' education focussed on ethical value issues and how the patient's dignity is respected in the perioperative practice. Health professionals are frequently confronted with ethical issues that can impact on patient's care during surgery. The objective of this study was to present what operating theatre nurse students experienced and interpreted as preserved dignity in perioperative practice. The study has a descriptive design with a hermeneutic approach. Data were collected using Flanagan's critical incident technique. Operating theatre nurse students from Sweden and Norway participated and collected data in 2011, after education in ethics and dignity. Data consisting of 47 written stories and the text were analysed with hermeneutical text interpretation. The study was conducted accordance with the Declaration of Helsinki and approved by a local University Ethics Research Committee. The findings revealed that students experienced that operating theatre nurses perserved patient's dignity in perioperative practice by being present for each other and making themselves known to the patient. Operating theatre nurses caring for the patient by being compassionate and preserved the patient privacy. The new understanding that emerged was that the operating theatre nurse students understood that the operating theatre nurse wanted to care for the patient like a human being. In the discussion, we have illuminated how professional ethics may be threatened by more pragmatic and utilitarian arguments contained in regulations and transplant act. Preserved dignity is an ethical and caring act. Ethical questions and how to preserve dignity in perioperative practice should be discussed more both in educations of healthcare professionals and in clinical practice. © The Author(s) 2014.

  7. Gradient-echo imaging of intervertebral disk degeneration and facet joint disease

    International Nuclear Information System (INIS)

    Berns, D.H.; Kormos, D.; Modic, M.T.; Carter, J.; Masaryk, T.J.; Ross, J.S.

    1988-01-01

    The purpose of this study was to evaluate the accuracy of gradient-echo, partial-flip angle images in the evaluation of components of degenerative spine disease. First, cadaveric spines were studied with plain radiographs, high-resolution CT, T1-weighted spin-echo (SE) MR images (repetition time msec/echo time msec=500/17). T2-weighted SE images (2,000/30-90), and fast low-angle shot (FLASH) images (200/10.50 0 ) before and after intradiskal injection of air (0.1-1cc). Second, lumbar spine MR images were retrospectively evaluated to compare gradient-echo and SE sequences. Results indicate that the signal intensity changes of the intervertebral disk related to degeneration were best appreciated on T2-weighted SE studies in both groups. Vacuum phenomenon and calcification were most accurately assessed with FLASH imaging (based on susceptibility changes) and CT images. SE images appeared more sensitive to adjacent marrow change. In the facet joints, CT was more accurate for changes in the subarticular bone, but FLASH images were more sensitive to change in the articular cartilage

  8. 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

  9. Australian perioperative nurses' experiences of assisting in multi-organ procurement surgery: a grounded theory study.

    Science.gov (United States)

    Smith, Zaneta; Leslie, Gavin; Wynaden, Dianne

    2015-03-01

    Multi-organ procurement surgical procedures through the generosity of deceased organ donors, have made an enormous impact on extending the lives of recipients. There is a dearth of in-depth knowledge relating to the experiences of perioperative nurses working closely with organ donors undergoing multi-organ procurement surgical procedures. The aim of this study was to address this gap by describing the perioperative nurses experiences of participating in multi-organ procurement surgical procedures and interpreting these findings as a substantive theory. This qualitative study used grounded theory methodology to generate a substantive theory of the experiences of perioperative nurses participating in multi-organ procurement surgery. Recruitment of participants took place after the study was advertised via a professional newsletter and journal. The study was conducted with participants from metropolitan, rural and regional areas of two Australian states; New South Wales and Western Australia. Thirty five perioperative nurse participants with three to 39 years of professional nursing experience informed the study. Semi structured in-depth interviews were undertaken from July 2009 to April 2010 with a mean interview time of 60 min. Interview data was transcribed verbatim and analysed using the constant comparative method. The study results draw attention to the complexities that exist for perioperative nurses when participating in multi-organ procurement surgical procedures reporting a basic social psychological problem articulated as hiding behind a mask and how they resolved this problem by the basic social psychological process of finding meaning. This study provides a greater understanding of how these surgical procedures impact on perioperative nurses by providing a substantive theory of this experience. The findings have the potential to guide further research into this challenging area of nursing practice with implications for clinical initiatives, management

  10. 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.

  11. Skew Projection of Echo-Detected EPR Spectra for Increased Sensitivity and Resolution

    Science.gov (United States)

    Bowman, Michael K.; Krzyaniak, Matthew D.; Cruce, Alex A.; Weber, Ralph T.

    2013-01-01

    The measurement of EPR spectra during pulsed EPR experiments is commonly accomplished by recording the integral of the electron spin echo as the applied magnetic field is stepped through the spectrum. This approach to echo-detected EPR spectral measurement (ED-EPR) limits sensitivity and spectral resolution and can cause gross distortions in the resulting spectra because some of the information present in the electron spin echo is discarded in such measurements. However, Fourier Transformation of echo shapes measured at a series of magnetic field values followed by skew projection onto either a magnetic field or resonance frequency axis can increase both spectral resolution and sensitivity without the need to trade one against the other. Examples of skew-projected spectra with single crystals, glasses and powders show resolution improvements as large as a factor of seven with sensitivity increases of as much as a factor of five. PMID:23644351

  12. 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.

  13. 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

  14. 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.

  15. Observations of fast magnetospheric echoes of artificially injected electrons above an auroral arc

    International Nuclear Information System (INIS)

    Wilhelm, K.; Becker, C.; Schmidt, R.

    1984-04-01

    Electron beam experiments using rocket-borne instrumentation have confirmed earlier observations of fast magnetospheric echoes of artificially injected energetic electrons. These experiments were jointly carried out by the University of Minnesota, the National Research Council of Canada and the Max-Planck-Institut fuer Aeronomie. A total of 234 echoes have been observed in a pitch angle range from 0 0 to 110 0 at energies of 1.87 and 3.90 keV. Out of this number, 95 echoes could unambiguously be identified with known accelerator operations at 2, 4 or 8 keV energy and highest current levels resulting in the determination of transit times of typically 400 ms. In most cases, when echoes were present in both energy channels, the higher energy electrons led the lower energy ones by approximately 50 ms. No echoes have been found in the 7.9 keV-detector channels. Adiabatic theory applied to these observations yields a reflection height of 3000 to 4000 km. The injection process is briefly discussed as the strong beam-plasma interaction that occurred near the electron accelerator appears to be instrumental in generating the source of heated electrons required for successful echo detection. Two consequences of this interaction, namely, strong energy and pitch angle diffusion and electron acceleration are illustrated with several examples. (orig.) [de

  16. Effect of peri-operative chemotherapy on the quality of life of patients with early breast cancer

    NARCIS (Netherlands)

    Kiebert, G. M.; Hanneke, J.; de Haes, J. Hanneke C. J. M.; Kievit, J.; van de Velde, C. J.

    1990-01-01

    Since chemotherapy is assumed to have a negative impact on quality of life, the impact of peri-operative chemotherapy on physical, psychological and social well-being and on the activity level of patients with early stage breast cancer was investigated. 24 women received peri-operative chemotherapy

  17. 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...

  18. EchoBASE: an integrated post-genomic database for Escherichia coli.

    Science.gov (United States)

    Misra, Raju V; Horler, Richard S P; Reindl, Wolfgang; Goryanin, Igor I; Thomas, Gavin H

    2005-01-01

    EchoBASE (http://www.ecoli-york.org) is a relational database designed to contain and manipulate information from post-genomic experiments using the model bacterium Escherichia coli K-12. Its aim is to collate information from a wide range of sources to provide clues to the functions of the approximately 1500 gene products that have no confirmed cellular function. The database is built on an enhanced annotation of the updated genome sequence of strain MG1655 and the association of experimental data with the E.coli genes and their products. Experiments that can be held within EchoBASE include proteomics studies, microarray data, protein-protein interaction data, structural data and bioinformatics studies. EchoBASE also contains annotated information on 'orphan' enzyme activities from this microbe to aid characterization of the proteins that catalyse these elusive biochemical reactions.

  19. Perioperative antibiotic usage by facial plastic surgeons: national survey results and comparison with evidence-based guidelines.

    Science.gov (United States)

    Grunebaum, Lisa Danielle; Reiter, David

    2006-01-01

    To determine current practice for use of perioperative antibiotics among facial plastic surgeons, to determine the extent of use of literature support for preferences of facial plastic surgeons, and to compare patterns of use with nationally supported evidence-based guidelines. A link to a Web site containing a questionnaire on perioperative antibiotic use was e-mailed to more than 1000 facial plastic surgeons in the United States. Responses were archived in a dedicated database and analyzed to determine patterns of use and methods of documenting that use. Current literature was used to develop evidence-based recommendations for perioperative antibiotic use, emphasizing current nationally supported guidelines. Preferences varied significantly for medication used, dosage and regimen, time of first dose relative to incision time, setting in which medication was administered, and procedures for which perioperative antibiotic was deemed necessary. Surgical site infection in facial plastic surgery can be reduced by better conformance to currently available evidence-based guidelines. We offer specific recommendations that are supported by the current literature.

  20. Spin echo SPI methods for quantitative analysis of fluids in porous media.

    Science.gov (United States)

    Li, Linqing; Han, Hui; Balcom, Bruce J

    2009-06-01

    Fluid density imaging is highly desirable in a wide variety of porous media measurements. The SPRITE class of MRI methods has proven to be robust and general in their ability to generate density images in porous media, however the short encoding times required, with correspondingly high magnetic field gradient strengths and filter widths, and low flip angle RF pulses, yield sub-optimal S/N images, especially at low static field strength. This paper explores two implementations of pure phase encode spin echo 1D imaging, with application to a proposed new petroleum reservoir core analysis measurement. In the first implementation of the pulse sequence, we modify the spin echo single point imaging (SE-SPI) technique to acquire the k-space origin data point, with a near zero evolution time, from the free induction decay (FID) following a 90 degrees excitation pulse. Subsequent k-space data points are acquired by separately phase encoding individual echoes in a multi-echo acquisition. T(2) attenuation of the echo train yields an image convolution which causes blurring. The T(2) blur effect is moderate for porous media with T(2) lifetime distributions longer than 5 ms. As a robust, high S/N, and fast 1D imaging method, this method will be highly complementary to SPRITE techniques for the quantitative analysis of fluid content in porous media. In the second implementation of the SE-SPI pulse sequence, modification of the basic measurement permits fast determination of spatially resolved T(2) distributions in porous media through separately phase encoding each echo in a multi-echo CPMG pulse train. An individual T(2) weighted image may be acquired from each echo. The echo time (TE) of each T(2) weighted image may be reduced to 500 micros or less. These profiles can be fit to extract a T(2) distribution from each pixel employing a variety of standard inverse Laplace transform methods. Fluid content 1D images are produced as an essential by product of determining the

  1. [The use of the T2-weighted turbo-spin-echo sequence in studying the neurocranium. A comparison with the conventional T2-weighted spin-echo sequence].

    Science.gov (United States)

    Siewert, C; Hosten, N; Felix, R

    1994-07-01

    T2-weighted spin-echo imaging is the standard screening procedure in MR imaging of the neurocranium. We evaluated fast spin-echo T2-weighted imaging (TT2) of the neurocranium in comparison to conventional spin-echo T2-weighted imaging (T2). Signal-to-noise and contrast-to-noise ratio of normal brain tissues (basal ganglia, grey and white matter, CSF fluid) and different pathologies were calculated. Signal-to-noise ratio and contrast-to-noise ratio were significantly higher in TT2 than in T2 (with the exception of gray-to-white matter contrast). Tissues with increased content of water protons (mobile protons) showed the highest contrast to surrounding tissues. The increased signal intensity of fat must be given due attention in fatty lesions. Because the contrast-to-noise ratio between white matter and basal ganglia is less in TT2, Parkinson patients have to be examined by conventional T2. If these limitations are taken into account, fast spin-echo T2-weighted imaging is well appropriate for MR imaging of the neurocranium, resulting in heavy T2-weighting achieved in a short acquisition time.

  2. 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.

  3. 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...

  4. Simultaneous pH-sensitive and oxygen-sensitive MRI of human gliomas at 3 T using multi-echo amine proton chemical exchange saturation transfer spin-and-gradient echo echo-planar imaging (CEST-SAGE-EPI).

    Science.gov (United States)

    Harris, Robert J; Yao, Jingwen; Chakhoyan, Ararat; Raymond, Catalina; Leu, Kevin; Liau, Linda M; Nghiemphu, Phioanh L; Lai, Albert; Salamon, Noriko; Pope, Whitney B; Cloughesy, Timothy F; Ellingson, Benjamin M

    2018-04-06

    To introduce a new pH-sensitive and oxygen-sensitive MRI technique using amine proton CEST echo spin-and-gradient echo (SAGE) EPI (CEST-SAGE-EPI). pH-weighting was obtained using CEST estimations of magnetization transfer ratio asymmetry (MTR asym ) at 3 ppm, and oxygen-weighting was obtained using R2' measurements. Glutamine concentration, pH, and relaxation rates were varied in phantoms to validate simulations and estimate relaxation rates. The values of MTR asym and R2' in normal-appearing white matter, T 2 hyperintensity, contrast enhancement, and macroscopic necrosis were measured in 47 gliomas. Simulation and phantom results confirmed an increase in MTR asym with decreasing pH. The CEST-SAGE-EPI estimates of R 2 , R2*, and R2' varied linearly with gadolinium diethylenetriamine penta-acetic acid concentration (R 2  = 6.2 mM -1 ·sec -1 and R2* = 6.9 mM -1 ·sec -1 ). The CEST-SAGE-EPI and Carr-Purcell-Meiboom-Gill estimates of R 2 (R 2  = 0.9943) and multi-echo gradient-echo estimates of R2* (R 2  = 0.9727) were highly correlated. T 2 lesions had lower R2' and higher MTR asym compared with normal-appearing white matter, suggesting lower hypoxia and high acidity, whereas contrast-enhancement tumor regions had elevated R2' and MTR asym , indicating high hypoxia and acidity. The CEST-SAGE-EPI technique provides simultaneous pH-sensitive and oxygen-sensitive image contrasts for evaluation of the brain tumor microenvironment. Advantages include fast whole-brain acquisition, in-line B 0 correction, and simultaneous estimation of CEST effects, R 2 , R2*, and R2' at 3 T. © 2018 International Society for Magnetic Resonance in Medicine.

  5. The novel echo-guided ProGlide technique during percutaneous transfemoral transcatheter aortic valve implantation.

    Science.gov (United States)

    Honda, Yohsuke; Araki, Motoharu; Yamawaki, Masahiro; Tokuda, Takahiro; Tsutumi, Masakazu; Mori, Shinsuke; Sakamoto, Yasunari; Kobayashi, Norihiro; Hirano, Keisuke; Ito, Yoshiaki

    2018-04-01

    The aim of this study was to assess clinical benefit of the Echo-guided ProGlide technique in patients undergoing percutaneous transfemoral transcatheter aortic valve implantation (TF-TAVI). The efficacy of the Echo-guided ProGlide technique during percutaneous TF-TAVI was not previously clarified. A total of 121 consecutive patients who underwent percutaneous TF-TAVI at our institution between February 2014 and July 2017 were enrolled in this study. According to the introduction of this novel technique in March 2016, patients were divided into two groups (echo-guided group who underwent TAVI from March 2016 to July 2017, n = 63; not echo-guided group who underwent TAVI from February 2014 to February 2016, n = 58). The incidence of major vascular complications, defined per the Valve Academic Research Consortium-2 criteria, and ProGlide complications including acute femoral artery stenosis or occlusion and bleeding requiring any intervention. The incidence of major vascular complication and ProGlide complication were significantly lower in the echo-guided group than in not echo-guided group (1.6% vs 17.2%, P guided ProGlide technique was independently associated with prevention of ProGlide complications (odds ratio, 0.11; 95% confidential interval, 0.01-0.76; P = 0.03). This novel Echo-guided ProGlide technique was associated with a lower rate of major vascular complications, particularly ProGlide complications during percutaneous TF-TAVI. © 2017, Wiley Periodicals, Inc.

  6. 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.)

  7. 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

  8. Scattered-Light Echoes from the Historical Galactic Supernovae Cassiopeia A and Tycho (SN 1572)

    Energy Technology Data Exchange (ETDEWEB)

    Rest, A; Welch, D L; Suntzeff, N B; Oaster, L; Lanning, H; Olsen, K; Smith, R C; Becker, A C; Bergmann, M; Challis, P; Clocchiatti, A; Cook, K H; Damke, G; Garg, A; Huber, M E; Matheson, T; Minniti, D; Prieto, J L; Wood-Vasey, W M

    2008-05-06

    We report the discovery of an extensive system of scattered light echo arclets associated with the recent supernovae in the local neighborhood of the Milky Way: Tycho (SN 1572) and Cassiopeia A. Existing work suggests that the Tycho SN was a thermonuclear explosion while the Cas A supernova was a core collapse explosion. Precise classifications according to modern nomenclature require spectra of the outburst light. In the case of ancient SNe, this can only be done with spectroscopy of their light echo, where the discovery of the light echoes from the outburst light is the first step. Adjacent light echo positions suggest that Cas A and Tycho may share common scattering dust structures. If so, it is possible to measure precise distances between historical Galactic supernovae. On-going surveys that alert on the development of bright scattered-light echo features have the potential to reveal detailed spectroscopic information for many recent Galactic supernovae, both directly visible and obscured by dust in the Galactic plane.

  9. Scattered-Light Echoes from the Historical Galactic Supernovae Cassiopeia A and Tycho (SN 1572)

    International Nuclear Information System (INIS)

    Rest, A.; Welch, D.L.; Suntzeff, N.B.; Oaster, L.; Lanning, H.; Olsen, K.; Smith, R.C.; Becker, A.C.; Bergmann, M.; Challis, P.; Clocchiatti, A.; Cook, K.H.; Damke, G.; Garg, A.; Huber, M.E.; Matheson, T.; Minniti, D.; Prieto, J.L.; Wood-Vasey, W.M.

    2008-01-01

    We report the discovery of an extensive system of scattered light echo arclets associated with the recent supernovae in the local neighborhood of the Milky Way: Tycho (SN 1572) and Cassiopeia A. Existing work suggests that the Tycho SN was a thermonuclear explosion while the Cas A supernova was a core collapse explosion. Precise classifications according to modern nomenclature require spectra of the outburst light. In the case of ancient SNe, this can only be done with spectroscopy of their light echo, where the discovery of the light echoes from the outburst light is the first step. Adjacent light echo positions suggest that Cas A and Tycho may share common scattering dust structures. If so, it is possible to measure precise distances between historical Galactic supernovae. On-going surveys that alert on the development of bright scattered-light echo features have the potential to reveal detailed spectroscopic information for many recent Galactic supernovae, both directly visible and obscured by dust in the Galactic plane

  10. Fast-gradient-echo variable-flip-angle imaging of the cervical spine

    International Nuclear Information System (INIS)

    Van Dyke, C.W.; Ross, J.S.; Masaryk, T.J.; Tkach, J.; Beale, S.; Hueftle, M.G.; Kaufman, B.; Modic, M.T.

    1987-01-01

    Two hundred consecutive patients were studied with 4-mm sagittal and axial T1-weighted images and gradient echo sequences with 6-msec or 13-msec echo time (TE) and 10 0 or 60 0 flip angles to evaluate cervical extradural disease. Images were independently evaluated for contrast behavior and anatomy, then directly compared for conspicuity of lesions. FLASH sequences produced better conspicuity of disease in half the imaging time. T1-weighted spin-echo (SE) sequences were more sensitive to marrow changes and intradural disease. Shorter TEs produced overall image improvement and reduced susceptibility effects. A fast and sensitive cervical examination combines sagittal T1-weighted SE with sagittal and axial FLASH 10 0 sequences with 6-msec TE

  11. A comparison between fast and conventional spin-echo in the detection of multiple sclerosis lesions

    International Nuclear Information System (INIS)

    Thorpe, J.W.; Halpin, S.F.; MacManus, D.G.; Barker, G.J.; Kendall, B.E.; Miller, D.H.

    1994-01-01

    Long repetition time (TR) spin-echo (SE) with T 2 - or proton density weighting is the sequence of choice to detect the brain lesions of multiple sclerosis (MS). Fast spin-echo (FSE) permits the generation of T 2 -weighted images with similar contrast to SE but in a fraction of the time. We compared the sensitivity of FSE and SE in the detection of the brain lesions of MS. Six patients with clinically definite MS underwent brain imaging with both dual echo (long TR, long and short echo time (TE) SE and dual echo FSE. The SE and FSE images were first reviewed independently and then compared. A total of 404 lesions was detected on SE and 398 on FSE. Slightly more periventricular lesions were detected using SE than FSE (145 vs 127), whereas more posterior cranial fossa lesions were detected by FSE (77 vs 57). With both SE and FSE the short TE images revealed more lesions than the long echo. These results suggest that FSE could replace SE as the long TR sequence of choice in the investigation of MS. (orig.)

  12. Pre-ejection period by radial artery tonometry supplements echo doppler findings during biventricular pacemaker optimization

    Directory of Open Access Journals (Sweden)

    Qamruddin Salima

    2011-07-01

    Full Text Available Abstract Background Biventricular (Biv pacemaker echo optimization has been shown to improve cardiac output however is not routinely used due to its complexity. We investigated the role of a simple method involving computerized pre-ejection time (PEP assessment by radial artery tonometry in guiding Biv pacemaker optimization. Methods Blinded echo and radial artery tonometry were performed simultaneously in 37 patients, age 69.1 ± 12.8 years, left ventricular (LV ejection fraction (EF 33 ± 10%, during Biv pacemaker optimization. Effect of optimization on echo derived velocity time integral (VTI, ejection time (ET, myocardial performance index (MPI, radial artery tonometry derived PEP and echo-radial artery tonometry derived PEP/VTI and PEP/ET indices was evaluated. Results Significant improvement post optimization was achieved in LV ET (286.9 ± 37.3 to 299 ± 34.6 ms, p Conclusion An acute shortening of PEP by radial artery tonometry occurs post Biv pacemaker optimization and correlates with improvement in hemodynamics by echo Doppler and may provide a cost-efficient approach to assist with Biv pacemaker echo optimization.

  13. Contrast-enhanced MR imaging of metastatic brain tumor at 3 Tesla. Utility of T1-weighted SPACE compared with 2D spin echo and 3D gradient echo sequence

    International Nuclear Information System (INIS)

    Komada, Tomohiro; Naganawa, Shinji; Ogawa, Hiroshi

    2008-01-01

    We evaluated the newly developed whole-brain, isotropic, 3-dimensional turbo spin-echo imaging with variable flip angle echo train (SPACE) for contrast-enhanced T 1 -weighted imaging in detecting brain metastases at 3 tesla (T). Twenty-two patients with suspected brain metastases underwent postcontrast study with SPACE, magnetization-prepared rapid gradient-echo (MP-RAGE), and 2-dimensional T 1 -weighted spin echo (2D-SE) imaging at 3 T. We quantitatively compared SPACE, MP-RAGE, and 2D-SE images by using signal-to-noise ratios (SNRs) for gray matter (GM) and white matter (WM) and contrast-to-noise ratios (CNRs) for GM-to-WM, lesion-to-GM, and lesion-to-WM. Two blinded radiologists evaluated the detection of brain metastases by segment-by-segment analysis and continuously-distributed test. The CNR between GM and WM was significantly higher on MP-RAGE images than on SPACE images (P 1 -weighted imaging. (author)

  14. 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.

  15. Duty and dilemma: Perioperative nurses hiding an objection to participate in organ procurement surgery.

    Science.gov (United States)

    Smith, Zaneta

    2017-07-01

    Perioperative nurses assist in organ procurement surgery; however, there is a dearth of information of how they encounter making conscientious objection requests or refusals to participate in organ procurement surgery. Organ procurement surgical procedures can present to the operating room ad hoc and can catch a nurse who may not desire to participate by surprise with little opportunity to refuse as a result of staffing, skill mix or organizational work demands. This paper that stems from a larger doctoral research study exploring the experiences of perioperative nurses participating in multi-organ procurement surgery used a grounded theory method to develop a substantive theory of the nurses' experiences. This current paper aimed to highlight the experiences of perioperative nurses when confronted with expressing a conscientious objection towards their participation in these procedures. A number of organizational and cultural barriers within the healthcare organization were seen to hamper their ability in expressing a conscience-based refusal, which lead to their reluctant participation. Perioperative nurses must feel safe to express a conscientious objection towards these types of surgical procedures and feel supported in doing so by their respective hospital organizations and not be forced to participate unwillingly. © 2016 John Wiley & Sons Ltd.

  16. 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

  17. 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.

  18. 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.

  19. 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.

  20. The concept of a composite perioperative quality index in kidney transplantation.

    Science.gov (United States)

    Taber, David J; McGillicuddy, John W; Bratton, Charles F; Lin, Angello; Chavin, Kenneth D; Baliga, Prabhakar K

    2014-04-01

    Public reporting of patient and graft outcomes in a national registry and close Centers for Medicare and Medicaid Services oversight has resulted in transplantation being a highly regulated surgical discipline. Despite this, transplantation surgery lacks comprehensive tracking and reporting of perioperative quality measures. Therefore, the aim of this study was to determine the association between a kidney transplantation centers' perioperative quality benchmarking and graft and patient outcomes. This was an analysis of 2011 aggregate data compiled from 2 national datasets that track outcomes from member hospitals and transplantation centers. The transplantation centers included in this study were composed of accredited US kidney transplantation centers that report data through the national registry and are associate members of the University HealthSystem Consortium. A total of 16,811 kidney transplantations were performed at 236 centers in the United States in 2011, of which 10,241 (61%) from 93 centers were included in the analysis. Of the 6 perioperative quality indicators, 3 benchmarked metrics were significantly associated with a kidney transplantation center's underperformance: mean ICU length of stay (C-statistic 0.731; p = 0.002), 30-day readmissions (C-statistic 0.697; p = 0.012) and in-hospital complications (C-statistic 0.785; p = 0.001). The composite quality index strongly correlated with inadequate center performance (C-statistic 0.854; p < 0.001, R(2) = 0.349). The centers in the lowest quartile of the quality index performed 2,400 kidney transplantations in 2011, which led to 2,640 more hospital days, 4,560 more ICU days, 120 more postoperative complications, and 144 more patients with 30-day readmissions, when compared with centers in the 3 higher-quality quartiles. An objective index of a transplantation center's quality of perioperative care is significantly associated with patient and graft survival. Copyright © 2014 American College of

  1. Normal range of hepatic fat fraction on dual- and triple-echo fat quantification MR in children.

    Science.gov (United States)

    Shin, Hyun Joo; Kim, Hyun Gi; Kim, Myung-Joon; Koh, Hong; Kim, Ha Yan; Roh, Yun Ho; Lee, Mi-Jung

    2015-01-01

    To evaluate hepatic fat fraction on dual- and triple-echo gradient-recalled echo MRI sequences in healthy children. We retrospectively reviewed the records of children in a medical check-up clinic from May 2012 to November 2013. We excluded children with abnormal laboratory findings or those who were overweight. Hepatic fat fraction was measured on dual- and triple-echo sequences using 3T MRI. We compared fat fractions using the Wilcoxon signed rank test and the Bland-Altman 95% limits of agreement. The correlation between fat fractions and clinical and laboratory findings was evaluated using Spearman's correlation test, and the cut-off values of fat fractions for diagnosing fatty liver were obtained from reference intervals. In 54 children (M:F = 26:28; 5-15 years; mean 9 years), the dual fat fraction (0.1-8.0%; median 1.6%) was not different from the triple fat fraction (0.4-6.5%; median 2.7%) (p = 0.010). The dual- and triple-echo fat fractions showed good agreement using a Bland-Altman plot (-0.6 ± 2.8%). Eight children (14.8%) on dual-echo sequences and six (11.1%) on triple-echo sequences had greater than 5% fat fraction. From these children, six out of eight children on dual-echo sequences and four out of six children on triple-echo sequences had a 5-6% hepatic fat fraction. When using a cut-off value of a 6% fat fraction derived from a reference interval, only 3.7% of children were diagnosed with fatty liver. There was no significant correlation between clinical and laboratory findings with dual and triple-echo fat fractions. Dual fat fraction was not different from triple fat fraction. We suggest a cut-off value of a 6% fat fraction is more appropriate for diagnosing fatty liver on both dual- and triple-echo sequences in children.

  2. TOPGEAR: a randomised phase III trial of perioperative ECF chemotherapy versus preoperative chemoradiation plus perioperative ECF chemotherapy for resectable gastric cancer (an international, intergroup trial of the AGITG/TROG/EORTC/NCIC CTG)

    International Nuclear Information System (INIS)

    Leong, Trevor; Smithers, B Mark; Michael, Michael; Gebski, Val; Boussioutas, Alex; Miller, Danielle; Simes, John; Zalcberg, John; Haustermans, Karin; Lordick, Florian; Schuhmacher, Christoph; Swallow, Carol; Darling, Gail; Wong, Rebecca

    2015-01-01

    The optimal management of patients with resectable gastric cancer continues to evolve in Western countries. Following publication of the US Intergroup 0116 and UK Medical Research Council MAGIC trials, there are now two standards of care for adjuvant therapy in resectable gastric cancer, at least in the Western world: postoperative chemoradiotherapy and perioperative epirubicin/cisplatin/fluorouracil (ECF) chemotherapy. We hypothesize that adding chemoradiation to standard perioperative ECF chemotherapy will achieve further survival gains. We also believe there are advantages to administering chemoradiation in the preoperative rather than postoperative setting. In this article, we describe the TOPGEAR trial, which is a randomised phase III trial comparing control arm therapy of perioperative ECF chemotherapy with experimental arm therapy of preoperative chemoradiation plus perioperative ECF chemotherapy. Eligible patients with resectable adenocarcinoma of the stomach or gastroesophageal junction will be randomized to receive either perioperative chemotherapy alone (3 preoperative and 3 postoperative cycles of ECF) or perioperative chemotherapy plus preoperative chemoradiation. In the chemoradiation arm, patients receive 2 cycles of ECF plus chemoradiation prior to surgery, and then following surgery 3 further cycles of ECF are given. The trial is being conducted in two Parts; Part 1 (phase II component) has recruited 120 patients with the aim of assessing feasibility, safety and preliminary efficacy of preoperative chemoradiation. Part 2 (phase III component) will recruit a further 632 patients to provide a total sample size of 752 patients. The primary endpoint of the phase III trial is overall survival. The trial includes quality of life and biological substudies, as well as a health economic evaluation. In addition, the trial incorporates a rigorous quality assurance program that includes real time central review of radiotherapy plans and central review of

  3. 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.

  4. 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

  5. [Are nail polish, artificial nails and piercings allowed outside the surgical area?Recommendations for the perioperative policy].

    Science.gov (United States)

    Bucx, M J L; Krijtenburg, P; Scheffer, G J

    2017-01-01

    - An increasing number of patients wear nail polish, artificial nails or have piercings.- There is uncertainty about the perioperative management of these items, especially when located outside the surgical area.- In the majority of hospitals, patients are urged to remove these items preoperatively, under the assumption that they might cause problems.- Frequently, however, these items cannot be removed straightforwardly.- Nail polish and artificial nails only very rarely cause perioperative problems and therefore do not need to be removed pre-operatively.- The same applies to most piercings, except when located in or near the respiratory tract, if they have sharp endings or if they might cause problems as a result of the perioperative positioning of the patient.- Providing adequate information to the patient, knowledge about removal of these items and documentation of agreed arrangements are all important.- A national guideline concerning perioperative policy is urgently required.

  6. 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....

  7. International consensus statement on the peri-operative management of anaemia and iron deficiency

    DEFF Research Database (Denmark)

    Muñoz, M.; Acheson, A. G.; Auerbach, M.

    2017-01-01

    Despite current recommendations on the management of pre-operative anaemia, there is no pragmatic guidance for the diagnosis and management of anaemia and iron deficiency in surgical patients. A number of experienced researchers and clinicians took part in an expert workshop and developed...... in the peri-operative period. These statements include: a diagnostic approach for anaemia and iron deficiency in surgical patients; identification of patients appropriate for treatment; and advice on practical management and follow-up. We urge anaesthetists and peri-operative physicians to embrace...

  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. Meteor head echo polarization at 930 MHz studied with the EISCAT UHF HPLA radar

    Directory of Open Access Journals (Sweden)

    G. Wannberg

    2011-06-01

    Full Text Available The polarization characteristics of 930-MHz meteor head echoes have been studied for the first time, using data obtained in a series of radar measurements carried out with the tristatic EISCAT UHF high power, large aperture (HPLA radar system in October 2009. An analysis of 44 tri-static head echo events shows that the polarization of the echo signal recorded by the Kiruna receiver often fluctuates strongly on time scales of tens of microseconds, illustrating that the scattering process is essentially stochastic. On longer timescales (> milliseconds, more than 90 % of the recorded events show an average polarization signature that is independent of meteor direction of arrival and echo strength and equal to that of an incoherent-scatter return from underdense plasma filling the tristatic observation volume. This shows that the head echo plasma targets scatter isotropically, which in turn implies that they are much smaller than the 33-cm wavelength and close to spherically symmetric, in very good agreement with results from a previous EISCAT UHF study of the head echo RCS/meteor angle-of-incidence relationship. Significant polarization is present in only three events with unique target trajectories. These all show a larger effective target cross section transverse to the trajectory than parallel to it. We propose that the observed polarization may be a signature of a transverse charge separation plasma resonance in the region immediately behind the meteor head, similar to the resonance effects previously discussed in connection with meteor trail echoes by Herlofson, Billam and Browne, Jones and Jones and others.

  10. 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.

  11. Optimization image of magnetic resonance imaging (MRI) T2 fast spin echo (FSE) with variation echo train length (ETL) on the rupture tendon achilles case

    International Nuclear Information System (INIS)

    Muzamil, Akhmad; Firmansyah, Achmad Haries

    2017-01-01

    The research was done the optimization image of Magnetic Resonance Imaging (MRI) T2 Fast Spin Echo (FSE) with variation Echo Train Length (ETL) on the Rupture Tendon Achilles case. This study aims to find the variations Echo Train Length (ETL) from the results of ankle’s MRI image and find out how the value of Echo Train Length (ETL) works on the MRI ankle to produce optimal image. In this research, the used ETL variations were 12 and 20 with the interval 2 on weighting T2 FSE sagittal. The study obtained the influence of Echo Train Length (ETL) on the quality of ankle MRI image sagittal using T2 FSE weighting and analyzed in 25 images of five patients. The data analysis has done quantitatively with the Region of Interest (ROI) directly on computer MRI image planes which conducted statistical tests Signal to Noise Ratio (SNR) and Contras to Noise Ratio (CNR). The Signal to Noise Ratio (SNR) was the highest finding on fat tissue, while the Contras to Noise Ratio (CNR) on the Tendon-Fat tissue with ETL 12 found in two patients. The statistics test showed the significant SNR value of the 0.007 (p<0.05) of Tendon tissue, 0.364 (p>0.05) of the Fat, 0.912 (p>0.05) of the Fibula, and 0.436 (p>0.05) of the Heel Bone. For the contrast to noise ratio (CNR) of the Tendon-FAT tissue was about 0.041 (p>0.05). The results of the study showed that ETL variation with T2 FSE sagittal weighting had difference at Tendon tissue and Tendon-Fat tissue for MRI imaging quality. SNR and CNR were an important aspect on imaging optimization process to give the diagnose information. (paper)

  12. Diaphragmatic pacing stimulation in spinal cord injury: anesthetic and perioperative management

    Directory of Open Access Journals (Sweden)

    Miguel L. Tedde

    2012-11-01

    Full Text Available OBJECTIVE: The standard therapy for patients with high-level spinal cord injury is long-term mechanical ventilation through a tracheostomy. However, in some cases, this approach results in death or disability. The aim of this study is to highlight the anesthetics and perioperative aspects of patients undergoing insertion of a diaphragmatic pacemaker. METHODS: Five patients with quadriplegia following high cervical traumatic spinal cord injury and ventilator-dependent chronic respiratory failure were implanted with a laparoscopic diaphragmatic pacemaker after preoperative assessments of their phrenic nerve function and diaphragm contractility through transcutaneous nerve stimulation. ClinicalTrials.gov: NCT01385384. RESULTS: The diaphragmatic pacemaker placement was successful in all of the patients. Two patients presented with capnothorax during the perioperative period, which resolved without consequences. After six months, three patients achieved continuous use of the diaphragm pacing system, and one patient could be removed from mechanical ventilation for more than 4 hours per day. CONCLUSIONS: The implantation of a diaphragmatic phrenic system is a new and safe technique with potential to improve the quality of life of patients who are dependent on mechanical ventilation because of spinal cord injuries. Appropriate indication and adequate perioperative care are fundamental to achieving better results.

  13. Lunar phase does not influence perioperative complications in total hip arthroplasty.

    Science.gov (United States)

    Ficklscherer, Andreas; Angermann, Alexander; Weber, Patrick; Wegener, Bernd; Pietschmann, Matthias; Müller, Peter

    2012-02-29

    Lunar calendars, publishing recommendations for daily life, are gaining more and more attention in Germany, where 10.5% of the population believe in lunar effects on disease. A widespread and often heard belief is that a full moon has the most negative effects on surgical outcome. The present study evaluates the effects of lunar phase on perioperative complications in total hip arthroplasty. We performed a retrospective study with 305 patients being provided with a primary hip arthroplasty. To identify possible influences of the lunar phase on perioperative complications we investigated data such as operation length, blood loss and course of C-reactive protein that were collected during the patients' stay in the hospital and allocated them to moon illumination. There were no significant differences in all collected data concerning the lunar phase (p > 0.05). Although not statistically significant, there were fewer operations during the full moon phase. Therefore there is no evidence that lunar phase has an effect on perioperative complications in total hip arthroplasty. Fewer, though not significantly fewer, operations were performed during the full moon phase. Although this was not a prospective randomized trial, the statistical magnitude of the results does not support any recommendations for scheduling patients for total hip arthroplasty at any particular day of the lunar phase.

  14. Best practices in peri-operative management of patients with skeletal dysplasias.

    Science.gov (United States)

    White, Klane K; Bompadre, Viviana; Goldberg, Michael J; Bober, Michael B; Cho, Tae-Joon; Hoover-Fong, Julie E; Irving, Melita; Mackenzie, William G; Kamps, Shawn E; Raggio, Cathleen; Redding, Gregory J; Spencer, Samantha S; Savarirayan, Ravi; Theroux, Mary C

    2017-10-01

    Patients with skeletal dysplasia frequently require surgery. This patient population has an increased risk for peri-operative complications related to the anatomy of their upper airway, abnormalities of tracheal-bronchial morphology and function; deformity of their chest wall; abnormal mobility of their upper cervical spine; and associated issues with general health and body habitus. Utilizing evidence analysis and expert opinion, this study aims to describe best practices regarding the peri-operative management of patients with skeletal dysplasia. A panel of 13 multidisciplinary international experts participated in a Delphi process that included a thorough literature review; a list of 22 possible care recommendations; two rounds of anonymous voting; and a face to face meeting. Those recommendations with more than 80% agreement were considered as consensual. Consensus was reached to support 19 recommendations for best pre-operative management of patients with skeletal dysplasia. These recommendations include pre-operative pulmonary, polysomnography; cardiac, and neurological evaluations; imaging of the cervical spine; and anesthetic management of patients with a difficult airway for intubation and extubation. The goals of this consensus based best practice guideline are to provide a minimum of standardized care, reduce perioperative complications, and improve clinical outcomes for patients with skeletal dysplasia. © 2017 Wiley Periodicals, Inc.

  15. 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 ...

  16. 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)

  17. Spin-echo Echo-planar Imaging MR Elastography versus Gradient-echo MR Elastography for Assessment of Liver Stiffness in Children and Young Adults Suspected of Having Liver Disease.

    Science.gov (United States)

    Serai, Suraj D; Dillman, Jonathan R; Trout, Andrew T

    2017-03-01

    Purpose To compare two-dimensional (2D) gradient-recalled echo (GRE) and 2D spin-echo (SE) echo-planar imaging (EPI) magnetic resonance (MR) elastography for measurement of hepatic stiffness in pediatric and young adult patients suspected of having liver disease. Materials and Methods In this institutional review board-approved, HIPAA-compliant study, 58 patients underwent both 2D GRE and 2D SE-EPI MR elastography at 1.5 T during separate breath holds. Liver stiffness (mean of means; in kilopascals) was measured by five blinded reviewers. Pooled mean liver stiffness and region-of-interest (ROI) size were compared by using paired t tests. Intraclass correlation coefficients (ICCs) were used to assess agreement between techniques. Respiratory motion artifacts were compared across sequences by using the Fisher exact test. Results Mean patient age was 14.7 years ± 5.2 (standard deviation; age range, 0.7-20.5 years), and 55.2% (32 of 58) of patients were male. Mean liver stiffness was 2.92 kPa ± 1.29 measured at GRE MR elastography and 2.76 kPa ± 1.39 at SE-EPI MR elastography (n = 290; P = .15). Mean ROI sizes were 8495 mm 2 ± 4482 for 2D GRE MR elastography and 15 176 mm 2 ± 7609 for 2D SE-EPI MR elastography (n = 290; P range, 0.91-0.95). Moderate or severe breathing artifacts were observed on 27.5% (16 of 58) of 2D GRE images versus 0% 2D SE-EPI images (P < .001). Conclusion There is excellent agreement on measured hepatic stiffness between 2D GRE and 2D SE-EPI MR elastography across multiple reviewers. SE-EPI MR elastography allowed for stiffness measurement across larger areas of the liver and can be performed in a single breath hold. © RSNA, 2016.

  18. Implementation of Perioperative Music Using the Consolidated Framework for Implementation Research.

    Science.gov (United States)

    Carter, Jessica E; Pyati, Srinivas; Kanach, Frances A; Maxwell, Ann Miller W; Belden, Charles M; Shea, Christopher M; Van de Ven, Thomas; Thompson, Jillian; Hoenig, Helen; Raghunathan, Karthik

    2018-06-12

    Complementary integrative health therapies have a perioperative role in the reduction of pain, analgesic use, and anxiety, and increasing patient satisfaction. However, long implementation lags have been quantified. The Consolidated Framework for Implementation Research (CFIR) can help mitigate this translational problem. We reviewed evidence for several nonpharmacological treatments (CFIR domain: characteristics of interventions) and studied external context and organizational readiness for change by surveying providers at 11 Veterans Affairs (VA) hospitals (domains: outer and inner settings). We asked patients about their willingness to receive music and studied the association between this and known risk factors for opioid use (domain: characteristics of individuals). We implemented a protocol for the perioperative use of digital music players loaded with veteran-preferred playlists and evaluated its penetration in a subgroup of patients undergoing joint replacements over a 6-month period (domain: process of implementation). We then extracted data on postoperative recovery time and other outcomes, comparing them with historic and contemporary cohorts. Evidence varied from strong and direct for perioperative music and acupuncture, to modest or weak and indirect for mindfulness, yoga, and tai chi, respectively. Readiness for change surveys completed by 97 perioperative providers showed overall positive scores (mean >0 on a scale from -2 to +2, equivalent to >2.5 on the 5-point Likert scale). Readiness was higher at Durham (+0.47) versus most other VA hospitals (range +0.05 to +0.63). Of 3307 veterans asked about willingness to receive music, approximately 68% (n = 2252) answered "yes." In multivariable analyses, a positive response (acceptability) was independently predicted by younger age and higher mean preoperative pain scores (>4 out of 10 over 90 days before admission), factors associated with opioid overuse. Penetration was modest in the targeted subset (39

  19. 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, ...

  20. 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 ...

  1. Disease-related effects of perioperative blood transfusions associated with 125I seed implantation for prostate carcinoma

    International Nuclear Information System (INIS)

    Petersen, J.P.; Schellhammer, P.F.; el-Mahdi, A.M.

    1990-01-01

    In some retrospective studies perioperative transfusions during oncologic surgery have been shown to decrease the time interval between surgery and local and/or distant recurrence of cancer. This study examines the disease-related effect, if any, of perioperative blood transfusions among 108 patients with localized carcinoma of the prostate treated by radioactive iodine-125 seed implantation of the prostate and lymphadenectomy. When all subjects were analyzed, there was no statistical difference of local and distant failure between the transfused and nontransfused groups. Patients with well-differentiated tumors had statistically fewer local recurrences (0% vs 22%, p = 0.036) if they were transfused perioperatively. However, the difference in distant metastases (0% vs 11%) was not statistically significant (p = 0.21). In contrast, patients with moderately and poorly differentiated disease receiving transfusions had more local recurrences and metastases, though this was not statistically significant. Our data suggest that there is no obvious evidence that perioperative blood transfusions have an adverse effect on local recurrence or distant metastases for iodine-125 seed implantation of carcinoma of the prostate

  2. Concept of fast-track surgery and its application in perioperative period of hepatectomy for liver cancer

    Directory of Open Access Journals (Sweden)

    HAN Wei

    2016-10-01

    Full Text Available Fast-track surgery (FTS is widely used in the field of hepatopancreatobiliary surgery and has achieved a great success in the perioperative period of liver cancer. It has been recognized by clinical doctors and patients. This article introduces the concept of FTS, reviews its development, summarizes the detailed measures of FTS in the perioperative period of liver cancer and long-term application experience of FTS, and analyzes the current status of its clinical application. It is pointed out that when applied in the perioperative period of hepatectomy for liver cancer, FTS can reduce stress, lower the incidence of postoperative complications, shorten the length of hospital stay, and bring true benefits to patients.

  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. CISS MR imaging findings of epidermoid tumor : comparison with spin-echo images

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yong Woo; Kim, Hak Jin; Choi, Sang Yoel; Heo, Jin Sam; Jung, Hoon Sik; Lee, Suck Hong; Kim, Byung Soo [Pusan National Univ. College of Medicine, Pusan (Korea, Republic of); Lee, Jong Wha [Ulsan Univ. Hospital, Ulsan (Korea, Republic of)

    1999-03-01

    To evaluate CISS MR imaging findings of epidermoid tumor in comparison with conventional spin-echo images. We studied 6 cases of epidermoid tumor in the subarachnoid space. We used a 1.5T MR unit to obtain CISS images(TR/TE/FA ; 12.3msec/5.9 msec/700) and T1- and T2- weighted spin-echo images. CISS MR imaging findings were evaluated with respect to tumor's signal intensity , contour, and relation with adjacent structures. Conspicuity of the tumor was compared between CISS and spin-echo images. A quantitative analysis was performed by measuring tumor to CSF contrast. In qualitative analysis, three radiologists independently compared CISS image and conventional spin-echo images for visibility of the tumor and graded them into three categories( poor, good, and excellent). Epidermoid tumors were located in the cerebellopontine angle in 4 cases, the prepontine cisstern in 1 case, and the cerebellopontine angle-prepontine cistern in 1 case. The tumors were hyperintense relative to brain parenchyma and hypointense relative to CSF on CISS images, were lobulated, encased adjacent cranial nerve and vessels, and invaginated into brain parenchyma. In qualitative analysis, CISS images showed clear demarcation between tumor and CSF, exact tumor extension, and tumor's relation with cranial nerves and vessels better than conventional spin-echo images. In quantitative analysis, the mean contrast values of tumor to CSF on T1-, T2-weighted images, and CISS images were 0.12, 0.06, and 0.52, respectively. The contrast value for CISS images was significantly higher than that for T1-and T2-weighted images(p<0.05). Epidermoid tumors in the subarachnoid space are better demonstrated on CISS images than on conventional spin-echo images. This special MR sequence can be added as a routine protocol in the diagnosis of subarachnoid epidermoid tumor.

  5. Testing of wooden construction elements with ultrasonic echo technique and x-ray

    International Nuclear Information System (INIS)

    Hasenstab, A.; Krause, M.; Osterloh, K.

    2008-01-01

    Damages inside of wooden construction components (e.g. interior rot) or at inaccessible surfaces represent a special problem, since they are difficult to recognize from the outside, they can even cause a sudden failure of the component. As a result the research, it could be proved that ultrasonic echo technique can be used on wood both with longitudinal and transverse waves. Further more the different influences of the wood fibres on the sound velocity of the longitudinal and transverse waves is pointed out on the basis results of measurements. The efficiency of the ultrasonic echo technique is shown on wooden specimens. The combination of ultrasonic echo technique and radiography resulted in a very substantial reduction of possible misinterpretations of damage. There it is possible to detect the damage from the undamaged side of the specimen by ultrasound echo. The spread of the damage can be obtained with mobile x-ray measurements. Finally the results show, that ultrasonic methods are more sensitive starting decay and cracks parallel to the surface.

  6. 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.

  7. Outpatient vaginal hysterectomy: optimizing perioperative management for same-day discharge.

    Science.gov (United States)

    Zakaria, Mark A; Levy, Barbara S

    2012-12-01

    To present tactics for optimizing outpatient vaginal hysterectomy and describe perioperative outcomes in a large consecutive case series. This is a descriptive study and review of clinical outcomes in 1,071 patients selected to undergo vaginal hysterectomy for benign indications from 2000 to 2010. The setting is a single-surgeon private practice in a community hospital. Outcome measures include length of hospital stay, estimated blood loss, operative time, uterine weight, and perioperative complications, including hospital readmissions and emergency room visits. One thousand seventy-one of 1,162 cases (92%, 95% confidence interval [CI] 90.5-93.7) were total vaginal hysterectomies, of which 1,029 (96%, 95% CI 94.9-97.3) were discharged the same day after surgery. The median operative time was 34 minutes (range 17-210 minutes), and estimated blood loss was 45 mL (range 5-800 mL). The median patient age was 46 years (range 27-86 years), and median uterine weight was 160 g (range 25-1,380 g). One hundred ninety-three patients (18%, 95% CI 15.8-20.5) were nulliparous and 218 (20%, 95% CI 18-22.9) had prior pelvic surgery. Five patients (0.5%, 95% CI 0.2-1.1) required readmission or emergency room evaluation within the first 30 days. Vaginal hysterectomy can be successfully adopted as a same-day discharge procedure. In this population, regardless of previous pelvic surgery or nulliparity, good perioperative outcomes have been achieved.

  8. Effectiveness of intervention with a perioperative multidisciplinary support team for radical esophagectomy.

    Science.gov (United States)

    Akiyama, Yuji; Iwaya, Takeshi; Endo, Fumitaka; Shioi, Yoshihiro; Kumagai, Motoi; Takahara, Takeshi; Otsuka, Koki; Nitta, Hiroyuki; Koeda, Keisuke; Mizuno, Masaru; Kimura, Yusuke; Suzuki, Kenji; Sasaki, Akira

    2017-12-01

    We aimed to evaluate the effectiveness of intervention by a perioperative multidisciplinary support team for radical esophagectomy for esophageal cancer. We retrospectively reviewed 85 consecutive patients with esophageal cancer who underwent radical esophagectomy via right thoracotomy or thoracoscopic surgery with gastric tube reconstruction. Twenty-one patients were enrolled in the non-intervention group (group N) from May 2011 to September 2012, 31 patients in the perioperative rehabilitation group (group R) from October 2012 to April 2014, and 33 patients in the multidisciplinary support team group (group S) from May 2014 to September 2015. Morbidity rates were 38, 45.2, and 42.4% for groups N, R, and S, respectively. Although there were no significant differences in the incidence of pneumonia among the groups, the durations of fever and C-reactive protein positivity were shorter in group S. Moreover, postoperative oral intake commenced earlier [5.9 (5-8) days] and postoperative hospital stay was shorter [19.6 (13-29) days] for group S. The intervention by a perioperative multidisciplinary support team for radical esophagectomy was effective in preventing the progression and prolongation of pneumonia as well as earlier ambulation, oral feeding, and shortening of postoperative hospitalization.

  9. 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...

  10. Wideband Radar Echo Frequency-domain Simulation and Analysis for High Speed Moving Targets

    Directory of Open Access Journals (Sweden)

    Ning Chao

    2014-04-01

    Full Text Available A frequency-domain method is proposed for wideband radar echo simulation of high-speed moving targets. Based on the physical process of electromagnetic waves observing a moving target, a frequency-domain echo model of wideband radar is constructed, and the block diagram of the radar echo simulation in frequency-domain is presented. Then, the impacts of radial velocity and slant range on the matching filtering of LFM radar are analyzed, and some quantitative conclusions on the shift and expansion of the radar profiles are obtained. Simulation results illustrate the correctness and efficiency of the proposed method.

  11. Dexmedetomidine as an adjuvant for perioperative pain management in adolescents undergoing bariatric surgery: An observational cohort study.

    Science.gov (United States)

    Vaughns, Janelle D; Martin, Celeste; Nelson, Jonathon; Nadler, Evan; Quezado, Zenaide M

    2017-11-01

    The anesthetic management of adolescents undergoing bariatric surgery presents a number of challenges, including increased risk of postoperative opioid-related respiratory depression. These patients could benefit from adjunctive analgesics with opioid-sparring effects to optimize perioperative pain control. Dexmedetomidine, a selective α2-adrenoreceptor agonist, has sedative and analgesic properties with no respiratory depressant effects. To determine the effect of intraoperative dexmedetomidine on opioid requirement and perioperative pain management in obese adolescents undergoing bariatric surgery. An observational study of 26 consecutive patients treated with and without dexmedetomidine during the intraoperative period was conducted. The dexmedetomidine treated patients received a loading dose over 30min and a continuous infusion thereafter. The standard group represented patients who received an institutional standard anesthetic without dexmedetomidine. The primary outcome was total perioperative intravenous morphine equivalent (MEq). We also examined reported pain scores during the perioperative period. While there were no significant differences in age, height and weight category, there were imbalances on race distribution between the two groups. Both groups received similar doses of ketorolac and acetaminophen perioperatively. Overall, during 48h postoperatively, the dexmedetomidine group received significantly less total MEq administration compared with the standard group. Three patients in the dexmedetomidine group required ephedrine to treat an episode of hypotension. These results suggest that the use of dexmedetomidine during bariatric surgery in the morbidly obese adolescent population is associated with decreased opioid utilization during the perioperative period. Future randomized studies will determine the role of dexmedetomidine in the pain management of obese adolescents undergoing bariatric surgery. Therapeutic, Level III. Copyright © 2017

  12. 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.

  13. 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.

  14. 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)

  15. Evaluation of the chondromalacia patella using a microscopy coil: comparison of the two-dimensional fast spin echo techniques and the three-dimensional fast field echo techniques.

    Science.gov (United States)

    Kim, Hyun-joo; Lee, Sang Hoon; Kang, Chang Ho; Ryu, Jeong Ah; Shin, Myung Jin; Cho, Kyung-Ja; Cho, Woo Shin

    2011-01-01

    We wanted to compare the two-dimensional (2D) fast spin echo (FSE) techniques and the three-dimensional (3D) fast field echo techniques for the evaluation of the chondromalacia patella using a microscopy coil. Twenty five patients who underwent total knee arthroplasty were included in this study. Preoperative MRI evaluation of the patella was performed using a microscopy coil (47 mm). The proton density-weighted fast spin echo images (PD), the fat-suppressed PD images (FS-PD), the intermediate weighted-fat suppressed fast spin echo images (iw-FS-FSE), the 3D balanced-fast field echo images (B-FFE), the 3D water selective cartilage scan (WATS-c) and the 3D water selective fluid scan (WATS-f) were obtained on a 1.5T MRI scanner. The patellar cartilage was evaluated in nine areas: the superior, middle and the inferior portions that were subdivided into the medial, central and lateral facets in a total of 215 areas. Employing the Noyes grading system, the MRI grade 0-I, II and III lesions were compared using the gross and microscopic findings. The sensitivity, specificity and accuracy were evaluated for each sequence. The significance of the differences for the individual sequences was calculated using the McNemar test. The gross and microscopic findings demonstrated 167 grade 0-I lesions, 40 grade II lesions and eight grade III lesions. Iw-FS-FSE had the highest accuracy (sensitivity/specificity/accuracy = 88%/98%/96%), followed by FS-PD (78%/98%/93%, respectively), PD (76%/98%/93%, respectively), B-FFE (71%/100%/93%, respectively), WATS-c (67%/100%/92%, respectively) and WATS-f (58%/99%/89%, respectively). There were statistically significant differences for the iw-FS-FSE and WATS-f and for the PD-FS and WATS-f (p chondromalacia patella.

  16. Human listeners provide insights into echo features used by dolphins (Tursiops truncatus) to discriminate among objects.

    Science.gov (United States)

    Delong, Caroline M; Au, Whitlow W L; Harley, Heidi E; Roitblat, Herbert L; Pytka, Lisa

    2007-08-01

    Echolocating bottlenose dolphins (Tursiops truncatus) discriminate between objects on the basis of the echoes reflected by the objects. However, it is not clear which echo features are important for object discrimination. To gain insight into the salient features, the authors had a dolphin perform a match-to-sample task and then presented human listeners with echoes from the same objects used in the dolphin's task. In 2 experiments, human listeners performed as well or better than the dolphin at discriminating objects, and they reported the salient acoustic cues. The error patterns of the humans and the dolphin were compared to determine which acoustic features were likely to have been used by the dolphin. The results indicate that the dolphin did not appear to use overall echo amplitude, but that it attended to the pattern of changes in the echoes across different object orientations. Human listeners can quickly identify salient combinations of echo features that permit object discrimination, which can be used to generate hypotheses that can be tested using dolphins as subjects.

  17. Optical decoherence times and spectral diffusion in an Er-doped optical fiber measured by two-pulse echoes, stimulated photon echoes, and spectral hole burning

    International Nuclear Information System (INIS)

    Macfarlane, R.M.; Sun, Y.; Sellin, P.B.; Cone, R.L.

    2007-01-01

    Two-pulse and stimulated photon echoes and spectral hole burning were measured on the transition from the lowest component of the 4 I 15/2 manifold to the lowest component of 4 I 13/2 of Er 3+ in a silicate optical fiber at 1.6 K. The two-pulse echo decays gave decoherence times as long as 230 ns for magnetic fields above 2 T. A large field dependent contribution to the homogeneous line width of >2 MHz was found and interpreted in terms of coupling to magnetic tunneling modes (TLS) in the glass. The stimulated echoes measured at 2 T showed spectral diffusion of 0.8 MHz/decade of time between 0.4 and 500 μs. Spectral diffusion in this high field region is attributed to coupling to elastic TLS modes which have a distribution of flip rates in glasses. Time-resolved spectral hole burning at very low field showed stronger spectral diffusion of 5.7 MHz/decade of time, attributed to coupling to magnetic spin-elastic TLS modes

  18. 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.

  19. 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.

  20. 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.

  1. Optimising perioperative care for hip and knee arthroplasty in South Africa: a Delphi consensus study.

    Science.gov (United States)

    Plenge, U; Nortje, M B; Marais, L C; Jordaan, J D; Parker, R; van der Westhuizen, N; van der Merwe, J F; Marais, J; September, W V; Davies, G L; Pretorius, T; Solomon, C; Ryan, P; Torborg, A M; Farina, Z; Smit, R; Cairns, C; Shanahan, H; Sombili, S; Mazibuko, A; Hobbs, H R; Porrill, O S; Timothy, N E; Siebritz, R E; van der Westhuizen, C; Troskie, A J; Blake, C A; Gray, L A; Munting, T W; Steinhaus, H K S; Rowe, P; van der Walt, J G; Isaacs Noordien, R; Theron, A; Biccard, B M

    2018-05-09

    A structured approach to perioperative patient management based on an enhanced recovery pathway protocol facilitates early recovery and reduces morbidity in high income countries. However, in low- and middle-income countries (LMICs), the feasibility of implementing enhanced recovery pathways and its influence on patient outcomes is scarcely investigated. To inform similar practice in LMICs for total hip and knee arthroplasty, it is necessary to identify potential factors for inclusion in such a programme, appropriate for LMICs. Applying a Delphi method, 33 stakeholders (13 arthroplasty surgeons, 12 anaesthetists and 8 physiotherapists) from 10 state hospitals representing 4 South African provinces identified and prioritised i) risk factors associated with poor outcomes, ii) perioperative interventions to improve outcomes and iii) patient and clinical outcomes necessary to benchmark practice for patients scheduled for primary elective unilateral total hip and knee arthroplasty. Thirty of the thirty-three stakeholders completed the 3 months Delphi study. The first round yielded i) 36 suggestions to preoperative risk factors, ii) 14 (preoperative), 18 (intraoperative) and 23 (postoperative) suggestions to best practices for perioperative interventions to improve outcomes and iii) 25 suggestions to important postsurgical outcomes. These items were prioritised by the group in the consecutive rounds and consensus was reached for the top ten priorities for each category. The consensus derived risk factors, perioperative interventions and important outcomes will inform the development of a structured, perioperative multidisciplinary enhanced patient care protocol for total hip and knee arthroplasty. It is anticipated that this study will provide the construct necessary for developing pragmatic enhanced care pathways aimed at improving patient outcomes after arthroplasty in LMICs.

  2. Restrictive use of perioperative blood transfusion does not increase complication rates in microvascular breast reconstruction.

    Science.gov (United States)

    O'Neill, Anne C; Barandun, Marina; Cha, Jieun; Zhong, Toni; Hofer, Stefan O P

    2016-08-01

    With increasing appreciation of the possible adverse effects of peri-operative blood transfusion, restrictive policies regarding use of blood products have been adopted in many surgical specialties. Although microvascular breast reconstruction has become a routine procedure, high peri-operative transfusion rates continue to be reported in the literature. In this study we examine the impact of our restrictive approach on blood transfusion rates and postoperative complications in patients undergoing microvascular blood transfusion. A retrospective review of patients undergoing microvascular breast reconstruction with abdominal flaps at a single institution was performed. Patient age and body mass index as well as type, timing and laterality of reconstruction was recorded. Pre-operative and post-operative hemoglobin and hematocrit were recorded. Peri-operative blood transfusion rates were calculated. Post-operative complication rates were compared between patients with higher and lower post-operative hemoglobin levels. Five hundred and twelve patients were included in this study. The peri-operative transfusion rate was 0.98% in this series. There was no significant difference between transfusion rates in unilateral and bilateral reconstructions (0.68 vs 1.36% p = 0.08) or immediate and delayed reconstructions (1.02 vs 0.51% p = 0.72 and 1.01 vs 1.60% p = 0.09 for unilateral and bilateral respectively). Lower post-operative hemoglobin levels were not associated with increased flap related, surgical or medical complications rates. A restrictive approach to peri-operative blood transfusion can be safely adopted in microvascular breast reconstruction without compromising flap viability or overall complication rates. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  3. 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.

  4. Hemostatic function to regulate perioperative bleeding in patients undergoing spinal surgery: A prospective observational study.

    Directory of Open Access Journals (Sweden)

    Atsushi Kimura

    Full Text Available Although bleeding is a common complication of surgery, routine laboratory tests have been demonstrated to have a low ability to predict perioperative bleeding. Better understanding of hemostatic function during surgery would lead to identification of high-risk patients for bleeding. Here, we aimed to elucidate hemostatic mechanisms to determine perioperative bleeding. We prospectively enrolled 104 patients undergoing cervical spinal surgery without bleeding diathesis. Blood sampling was performed just before the operation. Volumes of perioperative blood loss were compared with the results of detailed laboratory tests assessing primary hemostasis, secondary hemostasis, and fibrinolysis. Platelet aggregations induced by several agonists correlated with each other, and only two latent factors determined inter-individual difference. Platelet aggregability independently determined perioperative bleeding. We also identified low levels of plasminogen-activator inhibitor-1 (PAI-1 and α2-plasmin inhibitor to be independent risk factors for intraoperative and postoperative bleeding, respectively. Most important independent factor to determine postoperative bleeding was body weight. Of note, obese patients with low levels of PAI-1 became high-risk patients for bleeding during surgery. Our data suggest that bleeding after surgical procedure may be influenced by inter-individual differences of hemostatic function including platelet function and fibrinolysis, even in the patients without bleeding diathesis.

  5. 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.

  6. 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.

  7. Perioperative music and its effects on anxiety, hemodynamics, and pain in women undergoing mastectomy.

    Science.gov (United States)

    Binns-Turner, Pamela G; Wilson, Lynda Law; Pryor, Erica R; Boyd, Gwendolyn L; Prickett, Carol A

    2011-08-01

    There is increasing interest in evaluating the use of nonpharmacologic interventions such as music to minimize potential adverse effects of anxiety-reducing medications. This study used a quasi-experimental design to evaluate the effects of a perioperative music intervention (provided continuously throughout the preoperative, intraoperative, and postoperative periods) on changes in mean arterial pressure (MAP), heart rate, anxiety, and pain in women with a diagnosis of breast cancer undergoing mastectomy. A total of 30 women were assigned randomly to a control group or to the music intervention group. Findings indicated that women in the intervention group had a greater decrease in MAP and anxiety with less pain from the preoperative period to the time of discharge from the recovery room compared with women in the control group. Music is a noninvasive and low-cost intervention that can be easily implemented in the perioperative setting, and these findings suggest that perioperative music can reduce MAP, anxiety, and pain among women undergoing mastectomy for breast cancer.

  8. 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)

  9. 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.

  10. Perioperative outcomes following surgery for brain tumors: Objective assessment and risk factor evaluation

    Directory of Open Access Journals (Sweden)

    Aliasgar V Moiyadi

    2012-01-01

    Full Text Available Background: Perioperative outcomes following surgery for brain tumors are an important indicator of the safety as well as efficacy of surgical intervention. Perioperative morbidity not only has implications on direct patient care, but also serves as an indicator of the quality of care provided, and enables objective documentation, for comparision in various clinical trials. We document our experience at a tertiary care referral, a dedicated neuro-oncology center in India. Materials and Methods: One hundred and ninety-six patients undergoing various surgeries for intra-axial brain tumors were analyzed. Routine microsurgical techniques and uniform antibiotic policy were used. Navigation/ intraoperative electrophysiological monitoring was not available. The endpoints assessed included immediate postoperative neurological status, neurological outcome at discharge, regional complications, systemic complications, overall morbidity, and mortality. Various risk factors assessed included clinico-epidemiological factors, tumor-related factors, and surgery-related factors. Univariate and multivariate analysis were performed. Results: Median age was 38 years. 72% had tumors larger than 4 cm. Neurological morbidity, and regional and systemic complications occurred in 16.8, 17.3, and 10.7%, respectively. Overall, major morbidity occurred in 18% and perioperative mortality rate was 3.6%. Although a few of the known risk factors were found to be significant on univariate analysis, none achieved significance on multivariate analysis. Conclusions: Our patients were younger and had larger tumors than are generally reported. Despite the unavailability of advanced intraoperative aids we could achieve acceptable levels of morbidity and mortality. Objective recording of perioperative events is crucial to document outcomes after surgery for brain tumors.

  11. Experience of anaesthesia nurses of perioperative communication in hip fracture patients with dementia.

    Science.gov (United States)

    Krupic, Ferid; Eisler, Thomas; Sköldenberg, Olof; Fatahi, Nabi

    2016-03-01

    Perioperative care in hip fracture patients with dementia can be complex. There is currently little scientific evidence on how care should be undertaken. The aim of the study was to describe the experience of anaesthesia nurses of the difficulties that emerge in care situations and how communication with patients can be maintained in the perioperative setting of hip fracture surgery. Individual interviews were conducted with ten anaesthesia nurses (5 men and 5 women). The interviews were carried out at a university hospital in Gothenburg (Sweden), and the data were analysed using qualitative content analysis. Three main response categories were discerned: 'Communication', 'Dementia as a special issue' and 'Practical issues'. Dementia was viewed as one of the most difficult and shifting diseases an individual may suffer from. Time must be allocated to communicate clearly and patiently, to meticulously plan and carry out care while providing distinct information to enable patient participation. Establishing a mental bridgehead by confirming the patients' perceptions/feelings significantly reduced distress in a majority of the patients. A holistic and respectful approach was deemed mandatory at all times. Patients are sometimes dependent on recognition, so that small personal items brought close to the patient during surgery can calm the patient. State-of-the-art analgesia and anxiolytic medications are mandatory. Perioperative problems can be overcome with patience, empathy and profound knowledge of how patients with dementia respond prior to surgery. Our results may serve as a source for future care and provide information about hospital settings for better perioperative care in patients with dementia. © 2015 Nordic College of Caring Science.

  12. Slow flow and mural thrombus in aortic diseases: Spin-echo MR findings and their differentiation

    International Nuclear Information System (INIS)

    Chung, Jin Wook; Park, Jae Hyung; Han, Man Chung

    1993-01-01

    In order to evaluate the ability of spin-echo MR imaging to differentiate slow flow from mural thrombus in aortic diseases, we reviewed the spin-echo MR images of 13 patients with intraaortic thrombus documented by CT (N=11) or aortography (N=2). Six patients had aortic aneurysms and seven had aortic dissections. Intraaortic mural thrombi were accompanied by flow-related intraluminal signal of various pattern and extents in all 13 patients. On 10 gated MR studies, slow flow regions showed ever-echo rephasing phenomenon (N=8), interslice variation of signal intensities of the intraluminal signal (N=7) and flow-related ghost artifact (N=2). However, these MR flow phenomena were obscured on two of three non-gated studies. Seven of 13 intraaortic thrombi remained hyperintense on T2-weighted second-echo images. In these circumstance, a hypointense boundary layer between slow flow and mural thrombus, which was caused by either ' boundary layer dephasing phenomenon' of slow flow or 'paramagnetic T2 shortening' of fresh clot at the edge of mural thrombus, was very useful in discriminating the area of slow flow from that of mural thrombus. Proper interpretation of spin-echo MR images may obviate the need for phase display imaging or gradient-echo imaging in differentiating slow flow and mural thrombus

  13. Electron ECHO 6: a study by particle detectors of electrons artificially injected into the magnetosphere

    International Nuclear Information System (INIS)

    Malcolm, P.R.

    1986-01-01

    The ECHO-6 sounding rocket was launched from the Poke Flat Research Range, Alaska on 30 March 1983. A Terrier-Black Brant launch vehicle carried the payload on a northward trajectory over an auroral arc and to an apogee of 216 kilometers. The primary objective of the ECHO-6 experiment was to evaluate electric fields, magnetic fields, and plasma processes in the distant magnetosphere by injecting electron beams in the ionosphere and observing conjugate echoes. The experiment succeeded in injection 10-36 keV beams during the existence of a moderate growth-phase aurora, an easterly electrojet system, and a pre-midnight inflation condition of the magnetosphere. The ECHO-6 payload system consisted of an accelerator MAIN payload, a free-flying Plasma Diagnostics Package (PDP), and four rocket-propelled Throw Away Detectors (TADs). The PDP was ejected from the MAIN payload to analyze electric fields, plasma particles, energetic electrons, and photometric effects produced by beam injections. The TADs were ejected from the MAIN payload in a pattern to detect echoes in the conjugate echo region south of the beam-emitting MAIN payload. The TADs reached distances exceeding 3 kilometers from the MAIN payload and made measurements of the ambient electrons by means of solid-state detectors and electrostatic analyzers

  14. Supporting and improving community health services-a prospective evaluation of ECHO technology in community palliative care nursing teams.

    Science.gov (United States)

    White, Clare; McIlfatrick, Sonja; Dunwoody, Lynn; Watson, Max

    2015-12-01

    Project ECHO (Extension for Community Healthcare Outcomes) uses teleconferencing technology to support and train healthcare providers (HCPs) remotely, and has improved care across the USA. A 6-month pilot was trialled in a community palliative care nursing setting to determine if ECHO would be effective in the UK in providing education and support to community hospice nurses (CHN). The pilot involved weekly 2 hour sessions of teaching and case-based discussions facilitated by hospice staff linking with nine teams of CHN using video conferencing technology. A mixed-methods prospective longitudinal cohort study was used to evaluate the pilot. Each CHN provided demographic data, and completed a written knowledge assessment and a self-efficacy tool before and after the pilot. Two focus groups were also performed after the pilot. 28 CHNs completed the evaluation. Mean knowledge score improved significantly from 71.3% to 82.7% (p=0.0005) as did overall self-efficacy scores following the ECHO pilot. Pre-ECHO (p=0.036) and Retro-Pretest ECHO (p=0.0005) self-efficacy were significantly lower than post-ECHO. There was no significant difference between Pretest and Retro-Pretest ECHO self-efficacy (p=0.063). 96% recorded gains in learning, and 90% felt that ECHO had improved the care they provided for patients. 83% would recommend ECHO to other HCPs. 70% stated the technology used in ECHO had given them access to education that would have been hard to access due to geography. This study supports the use of Project ECHO for CHNs in the UK by demonstrating how a 6-month pilot improved knowledge and self-efficacy. As a low-cost high-impact model, ECHO provides an affordable solution to addressing growing need. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  15. 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.

  16. 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.

  17. Rotation commensurate echo of asymmetric molecules—Molecular fingerprints in the time domain

    Energy Technology Data Exchange (ETDEWEB)

    Chesnokov, E. N., E-mail: chesnok@kinetics.nsc.ru [Institute of Chemical Kinetics and Combustion, Novosibirsk 630090 (Russian Federation); Novosibirsk State University, Novosibirsk 630090 (Russian Federation); Kubarev, V. V. [Budker Institute of Nuclear Physics, Novosibirsk 630090 (Russian Federation); Novosibirsk State University, Novosibirsk 630090 (Russian Federation); Koshlyakov, P. V. [Institute of Chemical Kinetics and Combustion, Novosibirsk 630090 (Russian Federation)

    2014-12-29

    Using the pulses of terahertz free electron laser and ultra-fast Schottky diode detectors, we observed the coherent transients within a free induction decay of gaseous nitrogen dioxide NO{sub 2}. The laser excited different sub-bands of rotation spectra of NO{sub 2} containing about 50–70 lines. The free induction signal continued more than 30 ns and consisted of many echo-like bursts duration about 0.2 ns. Unlike the similar effect observed previously for linear and symmetric top molecules, the sequence of echo bursts is not periodic. The values for delay of individual echo are stable, and the set of these delays can be considered as a “molecular fingerprint” in the time domain.

  18. Perioperative Complications in Patients With Sleep Apnea Undergoing Total Joint Arthroplasty.

    Science.gov (United States)

    Naqvi, Syed Y; Rabiei, Amin H; Maltenfort, Mitchell G; Restrepo, Camilo; Viscusi, Eugene R; Parvizi, Javad; Rasouli, Mohammad R

    2017-09-01

    This study aims to evaluate the effect of sleep apnea (SA) on perioperative complications after total joint arthroplasty (TJA) and whether the type of anesthesia influences these complications. Using the ninth and tenth revisions of the International Classification of Diseases, coding systems, we queried our institutional TJA database from January 2005 to June 2016 to identify patients with SA who underwent TJA. These patients were matched in a 1:3 ratio based on age, gender, type of surgery, and comorbidities to patients who underwent TJA but were not coded for SA. Perioperative complications were identified using the same coding systems. Multivariate analysis was used to test if SA is an independent predictor of perioperative complications and if type of anesthesia can affect these complications. A total of 1246 patients with SA were matched to 3738 patients without SA. Pulmonary complications occurred more frequently in patients with SA (1.7% vs 0.6%; P system complications and mortality (odds ratio = 15.88; 95% confidence interval, 3.93-64.07; P gastrointestinal complications, acute anemia, and mortality were lower in SA patients when regional anesthesia was used (P < .05). SA increases risk of postoperative pulmonary complications. The use of regional anesthesia may reduce risk of pulmonary complications and mortality in SA patients undergoing TJA. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Prospective study of use of perioperative antimicrobial therapy in general surgery.

    LENUS (Irish Health Repository)

    Fennessy, Brendan G

    2012-02-03

    BACKGROUND: Perioperative antimicrobial therapy has demonstrated efficacy in reducing the rate of surgical site infections in clinical trials. With the emergence of antibiotic resistance, the risk of reaction, and the inevitable financial repercussions, use of prophylactic antibiotics is not a panacea, and their misuse may have considerable implications. The aim of this study was to assess the use of antibiotics in the perioperative period in both general and vascular surgery procedures. METHODS: A prospective study was undertaken of 131 patients with a mean age of 43 years (range one month-88 years), of whom 68 (51%) were male, who underwent twenty-seven different general or vascular surgery procedures over a four-week period. Each patient was evaluated from the time of antibiotic commencement through their operative procedure until the treatment was discontinued. RESULTS: A total of 73 patients (54%) received ten antibiotics, with 71 (97%) of these uses being prophylactic. Of the 15 appendectomies performed for uncomplicated appendicitis, the mean number of prophylactic antibiotic doses was 5.3 (range 1-12). Where they were documented, written postoperative directives were not adhered to in 18\\/27 prescriptions (66%). CONCLUSION: This study has demonstrated a lack of adherence to guidelines in the perioperative administration of antimicrobial agents. In addition, it calls attention to the economic implications of unnecessary prophylaxis.

  20. ASYMMETRY IN THE OUTBURST OF SN 1987A DETECTED USING LIGHT ECHO SPECTROSCOPY

    International Nuclear Information System (INIS)

    Sinnott, B.; Welch, D. L.; Sutherland, P. G.; Rest, A.; Bergmann, M.

    2013-01-01

    We report direct evidence for asymmetry in the early phases of SN 1987A via optical spectroscopy of five fields of its light echo system. The light echoes allow the first few hundred days of the explosion to be reobserved, with different position angles providing different viewing angles to the supernova. Light echo spectroscopy therefore allows a direct spectroscopic comparison of light originating from different regions of the photosphere during the early phases of SN 1987A. Gemini multi-object spectroscopy of the light echo fields shows fine structure in the Hα line as a smooth function of position angle on the near-circular light echo rings. Hα profiles originating from the northern hemisphere of SN 1987A show an excess in redshifted emission and a blue knee, while southern hemisphere profiles show an excess of blueshifted Hα emission and a red knee. This fine structure is reminiscent of the 'Bochum event' originally observed for SN 1987A, but in an exaggerated form. Maximum deviation from symmetry in the Hα line is observed at position angles 16° and 186°, consistent with the major axis of the expanding elongated ejecta. The asymmetry signature observed in the Hα line smoothly diminishes as a function of viewing angle away from the poles of the elongated ejecta. We propose an asymmetric two-sided distribution of 56 Ni most dominant in the southern far quadrant of SN 1987A as the most probable explanation of the observed light echo spectra. This is evidence that the asymmetry of high-velocity 56 Ni in the first few hundred days after explosion is correlated to the geometry of the ejecta some 25 years later.

  1. 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)

  2. Simultaneous observations of noctilucent clouds and polar mesosphere summer echoes at Syowa Station, Antarctica

    Directory of Open Access Journals (Sweden)

    Keisuke Hosokawa

    2013-11-01

    Full Text Available This paper reports simultaneous observations of visible noctilucent clouds (NLC and polar mesosphere summer echoes (PMSE at Syowa Station (69°01′S, 38°61′E in Antarctica. During a 1.5 h interval from 2000 to 2130 UT (2300 to 0030 LT on Feb. 11, 2009, visible NLC were observed south of Syowa Station. The oblique sounding HF radar of SuperDARN at Syowa Station simultaneously observed peculiar echoes in the closest two range gates. The echoes had a small Doppler velocity and a narrow spectral width, which are consistent with the characteristics of PMSE in the SuperDARN data. The simultaneous appearance of the visible NLC and peculiar near-range echoes observed by the HF radar suggests that the echoes were actually a signature of PMSE in the HF band. In addition, the data from the simultaneous measurements show that the spatial distributions of NLC and PMSE in the HF band were collocated with each other, which implies that oblique sounding HF radar is a useful tool for estimating the two-dimensional horizontal distribution of PMSE.

  3. Perioperative Interrogation of St. Jude Cardiovascular Implantable Electronic Devices: A Guide for Anesthesiologists.

    Science.gov (United States)

    Cronin, Brett; Essandoh, Michael K

    2018-04-01

    Feelings of trepidation or uncertainty regarding cardiovascular implantable electronic devices (CIEDs) in the perioperative period can often be mitigated by a thorough knowledge of societal recommendations, recommended management options, and familiarity with CIEDs. Given that effective interpretation of an interrogation report is vital to determining perioperative management options and applying societal recommendations, the creation and interpretation of St. Jude CIED interrogation reports are discussed. In an effort to increase the familiarity with St. Jude transvenous CIEDs amongst anesthesiologists, basic programming of a St. Jude pacemaker and implantable cardioverter defibrillator (ICD) also are described. Published by Elsevier Inc.

  4. A Narrative Review: Actigraphy as an Objective Assessment of Perioperative Sleep and Activity in Pediatric Patients

    Directory of Open Access Journals (Sweden)

    Nicole Conrad

    2017-04-01

    Full Text Available Sleep is an important component of pediatric health and is crucial for cognitive development. Actigraphy is a validated, objective tool to capture sleep and movement data that is increasingly being used in the perioperative context. The aim of this review is to present recent pediatric studies that utilized actigraphy in the perioperative period, highlight gaps in the literature, and provide recommendations for future research. A literature search was completed using OVID and PubMed databases and articles were selected for inclusion based on relevance to the topic. The literature search resulted in 13 papers that utilized actigraphic measures. Results of the review demonstrated that actigraphy has been used to identify predictors and risk factors for poor postoperative sleep, examine associations among perioperative pain and sleep patterns, and assess activity and energy expenditure in both inpatient and outpatient settings. We propose expansion of actigraphy research to include assessment of sleep via actigraphy to: predict functional recovery in pediatric populations, to study postoperative sleep in high-risk pediatric patients, to test the efficacy of perioperative interventions, and to assess outcomes in special populations for which self-report data on sleep and activity is difficult to obtain.

  5. A review of the peri-operative management of paediatric burns ...

    African Journals Online (AJOL)

    Reasons include peri-operative sepsis, bleeding, issues around thermoregulation, the hypermetabolic state, nutritional and electrolyte issues, inhalation injuries and the amount of movement during procedures to wash patients, change drapes and access different anatomical sites. The appropriate execution of surgery is ...

  6. Peroral endoscopic myotomy: procedural complications and pain management for the perioperative clinician

    Directory of Open Access Journals (Sweden)

    Misra L

    2017-02-01

    Full Text Available Lopa Misra,1 Norio Fukami,2 Katarina Nikolic,1 Terrence L Trentman1 1Department of Anesthesiology, 2Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Phoenix, AZ, USA Abstract: Achalasia refers to the lack of smooth muscle relaxation of the distal esophagus. Although nonsurgical treatments such as pneumatic dilatation of the distal esophagus and botulinum toxin injections have been performed, these procedures have limited duration. Similarly, surgical treatment with Heller myotomy is associated with complications. At our institution, we perform the peroral endoscopic myotomy (POEM in qualified patients. Briefly, POEM involves endoscopic creation of a mid-esophageal submucosal bleb, creation of a submucosal tunnel with the endoscope, and then a distal myotomy, resulting in relaxation of the distal esophagus. The aim of our study is to document perioperative pain and associated pain management for our initial patients undergoing POEM and to review the literature for perioperative complications of this procedure. Therefore, anesthetic and pain management for our initial eleven patients undergoing POEM were reviewed. Patient demographics, pre-POEM pain medication history, perioperative pain medication requirements, and post-POEM pain scores were examined. We found post-POEM pain was usually in the mild–moderate range; a combination of medications was effective (opioids, nonsteroidal anti-inflammatory drugs, acetaminophen. Our literature search revealed a wide frequency range of complications such as pneumoperitoneum and subcutaneous emphysema, with rare serious events such as capnopericardium leading to cardiac arrest. In conclusion, our experience with POEM suggests pain and can be managed adequately with a combination of medications; the procedure appears to be safe and reasonable to perform in an outpatient endoscopy unit. Keywords: pain management, retrospective study, combination of medicines, perioperative, endoscopy

  7. Perioperative high dose rate (HDR brachytherapy in unresectable locally advanced pancreatic tumors

    Directory of Open Access Journals (Sweden)

    Brygida Białas

    2011-07-01

    Full Text Available Purpose: The aim of the study was to present an original technique of catheter implantation for perioperative HDR-Ir192 brachytherapy in patients after palliative operations of unresectable locally advanced pancreatic tumors and to estimate the influence of perioperative HDR-Ir192 brachytherapy on pain relief in terminal pancreatic cancer patients. Material and methods: Eight patients with pancreatic tumors located in the head of pancreas underwent palliative operations with the use of HDR-Ir192 brachytherapy. All patients qualified for surgery reported pain of high intensity and had received narcotic painkillers prior to operation. During the last phase of the surgery, the Nucletron® catheters were implanted in patients to prepare them for later perioperative brachytherapy. Since the 6th day after surgery HDR brachytherapy was performed. Before each brachytherapy fraction the location of implants were checked using fluoroscopy. A fractional dose was 5 Gy and a total dose was 20 Gy in the area of radiation. A comparative study of two groups of patients (with and without brachytherapy with stage III pancreatic cancer according to the TNM scale was taken in consideration. Results and Conclusions: The authors claim that the modification of catheter implantation using specially designed cannula, facilitates the process of inserting the catheter into the tumor, shortens the time needed for the procedure, and reduces the risk of complications. Mean survival time was 5.7 months. In the group of performed brachytherapy, the mean survival time was 6.7 months, while in the group of no brachytherapy performed – 4.4 months. In the group of brachytherapy, only one patient increased the dose of painkillers in the last month of his life. Remaining patients took constant doses of medicines. Perioperative HDR-Ir192 brachytherapy could be considered as a practical application of adjuvant therapy for pain relief in patients with an advanced pancreatic cancer.

  8. Output Pressure and Pulse-Echo Characteristics of CMUTs as Function of Plate Dimensions

    DEFF Research Database (Denmark)

    Diederichsen, Søren Elmin; Hansen, Jesper Mark Fly; Engholm, Mathias

    2017-01-01

    This paper presents an experimental study of the acoustic performance of Capacitive Micromachined Ultrasonic Transducers (CMUTs) as function of plate dimensions. The objective is to increase the output pressure without decreasingthe pulse-echo signal. The CMUTs are fabricated with a LOCOS process......-to-peak output pressure and pulse-echo signal is obtained for the 9.3μm plate, which still has a moderate pulseecho bandwidth of 60%. The 9.3μm plate results in a 1.9 times higher peak-to-peak output pressure and a 3.6 times higherpulse-echo signal compared to the 2μm plate. By adjusting the plate dimensions...

  9. 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

  10. 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.

  11. 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.

  12. 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.

  13. Perioperative antibiotics for surgical site infection in pancreaticoduodenectomy: does the SCIP-approved regimen provide adequate coverage?

    Science.gov (United States)

    Donald, Graham W; Sunjaya, Dharma; Lu, Xuyang; Chen, Formosa; Clerkin, Barbara; Eibl, Guido; Li, Gang; Tomlinson, James S; Donahue, Timothy R; Reber, Howard A; Hines, Oscar J

    2013-08-01

    The Joint Commission Surgical Care Improvement Project (SCIP) includes performance measures aimed at reducing surgical site infections (SSI). One measure defines approved perioperative antibiotics for general operative procedures. However, there may be a subset of procedures not adequately covered with the use of approved antibiotics. We hypothesized that piperacillin-tazobactam is a more appropriate perioperative antibiotic for pancreaticoduodenectomy (PD). In collaboration with hospital epidemiology and the Division of Infectious Diseases, we retrospectively reviewed records of 34 patients undergoing PD between March and May 2008 who received SCIP-approved perioperative antibiotics and calculated the SSI rate. After changing our perioperative antibiotic to piperacillin-tazobactam, we prospectively reviewed PDs performed between June 2008 and March 2009 and compared the SSI rates before and after the change. For 34 patients from March through May 2008, the SSI rate for PD was 32.4 per 100 cases. Common organisms from wound cultures were Enterobacter and Enterococcus (50.0% and 41.7%, respectively), and these were cefoxitin resistant. From June 2008 through March 2009, 106 PDs were performed. During this period, the SSI rate was 6.6 per 100 surgeries, 80% lower than during March through May 2008 (relative risk, 0.204; 95% confidence interval [CI], 0.086-0.485; P = .0004). Use of piperacillin-tazobactam as a perioperative antibiotic in PD may reduce SSI compared with the use of SCIP-approved antibiotics. Continued evaluation of SCIP performance measures in relationship to patient outcomes is integral to sustained quality improvement. Copyright © 2013 Mosby, Inc. All rights reserved.

  14. Intraregional differences of perioperative management strategy for lumbar disc herniation: is the Devil really in the details?

    Science.gov (United States)

    Zoia, Cesare; Bongetta, Daniele; Poli, Jacopo C; Verlotta, Mariarosaria; Pugliese, Raffaelino; Gaetani, Paolo

    2017-01-01

    This study intends to evaluate whether regional common habits or differences in case-volume between surgeons are significative variables in the perioperative management of patients undergoing surgery for lumbar disc herniation. An e-mail survey was sent to all neurosurgeons working in Lombardy, Italy's most populated region. The survey consisted of 17 questions about the perioperative management of lumbar disc herniation. Forty-seven percent (47%) out of 206 Lombard neurosurgeons answered the survey. Although in some respects there is clear evidence in current literature on which is the best practice to adopt for an optimal management strategy, we noticed substantial differences between respondents, not only between hospitals but also between surgeons from the same hospital. Still, no differences were evident in a high vs low case-volume comparison. We identified no regional clusterization as for practical principles in the perioperative management of lumbar disc herniation and neither was case-volume a significative variable. Other causes may be relevant in the variability between the perioperative management and the outcomes achieved by different specialists.

  15. 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.

  16. Can a single-shot black-blood T2-weighted spin-echo echo-planar imaging sequence with sensitivity encoding replace the respiratory-triggered turbo spin-echo sequence for the liver? An optimization and feasibility study.

    Science.gov (United States)

    Hussain, Shahid M; De Becker, Jan; Hop, Wim C J; Dwarkasing, Soendersing; Wielopolski, Piotr A

    2005-03-01

    To optimize and assess the feasibility of a single-shot black-blood T2-weighted spin-echo echo-planar imaging (SSBB-EPI) sequence for MRI of the liver using sensitivity encoding (SENSE), and compare the results with those obtained with a T2-weighted turbo spin-echo (TSE) sequence. Six volunteers and 16 patients were scanned at 1.5T (Philips Intera). In the volunteer study, we optimized the SSBB-EPI sequence by interactively changing the parameters (i.e., the resolution, echo time (TE), diffusion weighting with low b-values, and polarity of the phase-encoding gradient) with regard to distortion, suppression of the blood signal, and sensitivity to motion. The influence of each change was assessed. The optimized SSBB-EPI sequence was applied in patients (N = 16). A number of items, including the overall image quality (on a scale of 1-5), were used for graded evaluation. In addition, the signal-to-noise ratio (SNR) of the liver was calculated. Statistical analysis was carried out with the use of Wilcoxon's signed rank test for comparison of the SSBB-EPI and TSE sequences, with P = 0.05 considered the limit for significance. The SSBB-EPI sequence was improved by the following steps: 1) less frequency points than phase-encoding steps, 2) a b-factor of 20, and 3) a reversed polarity of the phase-encoding gradient. In patients, the mean overall image quality score for the optimized SSBB-EPI (3.5 (range: 1-4)) and TSE (3.6 (range: 3-4)), and the SNR of the liver on SSBB-EPI (mean +/- SD = 7.6 +/- 4.0) and TSE (8.9 +/- 4.6) were not significantly different (P > .05). Optimized SSBB-EPI with SENSE proved to be feasible in patients, and the overall image quality and SNR of the liver were comparable to those achieved with the standard respiratory-triggered T2-weighted TSE sequence. (c) 2005 Wiley-Liss, Inc.

  17. A Hospital Is Not Just a Factory, but a Complex Adaptive System-Implications for Perioperative Care.

    Science.gov (United States)

    Mahajan, Aman; Islam, Salim D; Schwartz, Michael J; Cannesson, Maxime

    2017-07-01

    Many methods used to improve hospital and perioperative services productivity and quality of care have assumed that the hospital is essentially a factory, and therefore, that industrial engineering and manufacturing-derived redesign approaches such as Six Sigma and Lean can be applied to hospitals and perioperative services just as they have been applied in factories. However, a hospital is not merely a factory but also a complex adaptive system (CAS). The hospital CAS has many subsystems, with perioperative care being an important one for which concepts of factory redesign are frequently advocated. In this article, we argue that applying only factory approaches such as lean methodologies or process standardization to complex systems such as perioperative care could account for difficulties and/or failures in improving performance in care delivery. Within perioperative services, only noncomplex/low-variance surgical episodes are amenable to manufacturing-based redesign. On the other hand, complex surgery/high-variance cases and preoperative segmentation (the process of distinguishing between normal and complex cases) can be viewed as CAS-like. These systems tend to self-organize, often resist or react unpredictably to attempts at control, and therefore require application of CAS principles to modify system behavior. We describe 2 examples of perioperative redesign to illustrate the concepts outlined above. These examples present complementary and contrasting cases from 2 leading delivery systems. The Mayo Clinic example illustrates the application of manufacturing-based redesign principles to a factory-like (high-volume, low-risk, and mature practice) clinical program, while the Kaiser Permanente example illustrates the application of both manufacturing-based and self-organization-based approaches to programs and processes that are not factory-like but CAS-like. In this article, we describe how factory-like processes and CAS can coexist within a hospital and how

  18. Computerized surveillance of opioid-related adverse drug events in perioperative care: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Gattis Katherine G

    2009-08-01

    Full Text Available Abstract Background Given the complexity of surgical care, perioperative patients are at high risk of opioid-related adverse drug events. Existing methods of detection, such as trigger tools and manual chart review, are time-intensive which makes sustainability challenging. Using strategic rule design, computerized surveillance may be an efficient, pharmacist-driven model for event detection that leverages existing staff resources. Methods Computerized adverse drug event surveillance uses a logic-based rules engine to identify potential adverse drug events or evolving unsafe clinical conditions. We extended an inpatient rule (administration of naloxone to detect opioid-related oversedation and respiratory depression to perioperative care at a large academic medical center. Our primary endpoint was the adverse drug event rate. For all patients with a naloxone alert, manual chart review was performed by a perioperative clinical pharmacist to assess patient harm. In patients with confirmed oversedation, other patient safety event databases were queried to determine if they could detect duplicate, prior, or subsequent opioid-related events. Results We identified 419 cases of perioperative naloxone administration. Of these, 101 were given postoperatively and 69 were confirmed as adverse drug events after chart review yielding a rate of 1.89 adverse drug events/1000 surgical encounters across both the inpatient and ambulatory settings. Our ability to detect inpatient opioid adverse drug events increased 22.7% by expanding surveillance into perioperative care. Analysis of historical surveillance data as well as a voluntary reporting database revealed that 11 of our perioperative patients had prior or subsequent harmful oversedation. Nine of these cases received intraoperative naloxone, and 2 had received naloxone in the post-anesthesia care unit. Pharmacist effort was approximately 3 hours per week to evaluate naloxone alerts and confirm adverse drug

  19. EchoScan: A new system to objectively assess peripheral hearing disorders

    Directory of Open Access Journals (Sweden)

    Thomas Venet

    2012-01-01

    Full Text Available Pure-tone air-conduction audiometry (PTA is the reference clinical test used in Europe and the United States to measure the extent of hearing loss. It is a subjective, behavioral test, which measures thresholds of hearing sensations and perceptions based on patient responses to frequency-specific pure-tone stimuli. PTA can detect hearing problems due to cochlear or retro-cochlear impairment, without identifying the source of the problem. In contrast, cubic distortion product otoacoustic emissions (DPOAEs detect inner-ear dysfunctions, particularly those involving the outer hair cells sensitive to noise and ototoxicants. Recently, ototoxicants were shown to have an action on the central nuclei driving the middle-ear acoustic reflex. Therefore, a new device, called EchoScan, was conceived to collect and measure performance both in the middle- and inner-ear. Its originality: the use of a battery of DPOAE measurements associated with contra-lateral acoustic stimulation. Changes in DPOAE amplitude due to ageing and gender were incidentally detected and EchoScan was more sensitive than impedancemetry to detect the stapedial reflex. EchoScan can be used both in clinical investigations and in occupational medicine, especially for the auditory follow-up of people exposed to noise or ototoxic agents. EchoScan could be promising to assess early detection in programs to prevent hearing loss.

  20. 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....

  1. Self-calibrated multiple-echo acquisition with radial trajectories using the conjugate gradient method (SMART-CG).

    Science.gov (United States)

    Jung, Youngkyoo; Samsonov, Alexey A; Bydder, Mark; Block, Walter F

    2011-04-01

    To remove phase inconsistencies between multiple echoes, an algorithm using a radial acquisition to provide inherent phase and magnitude information for self correction was developed. The information also allows simultaneous support for parallel imaging for multiple coil acquisitions. Without a separate field map acquisition, a phase estimate from each echo in multiple echo train was generated. When using a multiple channel coil, magnitude and phase estimates from each echo provide in vivo coil sensitivities. An algorithm based on the conjugate gradient method uses these estimates to simultaneously remove phase inconsistencies between echoes, and in the case of multiple coil acquisition, simultaneously provides parallel imaging benefits. The algorithm is demonstrated on single channel, multiple channel, and undersampled data. Substantial image quality improvements were demonstrated. Signal dropouts were completely removed and undersampling artifacts were well suppressed. The suggested algorithm is able to remove phase cancellation and undersampling artifacts simultaneously and to improve image quality of multiecho radial imaging, the important technique for fast three-dimensional MRI data acquisition. Copyright © 2011 Wiley-Liss, Inc.

  2. 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

  3. Perioperative Intravascular Fluid Assessment and Monitoring: A Narrative Review of Established and Emerging Techniques

    Directory of Open Access Journals (Sweden)

    Sumit Singh

    2011-01-01

    Full Text Available Accurate assessments of intravascular fluid status are an essential part of perioperative care and necessary in the management of the hemodynamically unstable patient. Goal-directed fluid management can facilitate resuscitation of the hypovolemic patient, reduce the risk of fluid overload, reduce the risk of the injudicious use of vasopressors and inotropes, and improve clinical outcomes. In this paper, we discuss the strengths and limitations of a spectrum of noninvasive and invasive techniques for assessing and monitoring intravascular volume status and fluid responsiveness in the perioperative and critically ill patient.

  4. 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....

  5. 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.

  6. Fast method of NMR imaging based on trains of spin echoes

    International Nuclear Information System (INIS)

    Hennel, F.

    1993-01-01

    A theoretical introduction to Fourier NMR imaging and a discussion of fast methods are presented. Then an application of the method of echo-planar imaging (EPI) with spin echoes in a micro-imaging system is described together with introduced modifications of the sequence. A new technique for the measurement of flow profiles in liquids which results from a modification of x-pulsed EPI is presented. The development of new software for a NMR micro-imaging system is described, too. 51 refs, 29 refs

  7. Fast spine echo and fast fluid attenuated inversion recovery sequences in multiple sclerosis

    International Nuclear Information System (INIS)

    Paolillo, Andrea; Giugni, Elisabetta; Bozzao, Alessandro; Bastianello, Stefano

    1997-01-01

    Fast spin echo (FSE) and fast fluid attenuated inversion recovery (fast-FLAIR) sequences, were compared with conventional spin echo (CSE) in quantitating multiple sclerosis (MS) lesion burden. For each sequence, the total number and volume of MS lesions were calculated in 38 remitting multiple sclerosis patients using a semiautomated lesion detection program. Conventional spin echo, fast spin echo, and fast fluid attenuated inversion recovery image were reported on randomly and at different times by two expert observers. Interobserver differences, the time needed to quantitative multiple sclerosis lesions and lesion signal intensity (contrast-to-noise ratio and overall contrast) were considered. The lesions were classified by site into infratentorial, white matter and cortical/subcortical. A total of 2970 lesions with a volume of 961.7 cm 3 was calculated on conventional spin echo images. Fast spin echo images depicted fewer (16.6%; p < .005) and smaller (24.9%; p < .0001) lesions and the differences were statistically significant. Despite an overall nonsignificant reduction for fast-FLAIR images (-5% and 4.8% for lesion number and volume, respectively), significantly lower values (lesion number: p < 0.1; volume: p < .04)were observed for infratentorial lesions, while significantly higher values were seen for cortical/subcortical lesions (lesion number: p < .01; volume: p < .02). A higher lesion/white matter contrast (p < .002), a significant time saving for lesion burden quantitation (p < .05) and very low interobserver variability were found in favor of fast-FLAIR. Our data suggest that, despite the limitations regarding infratentorial lesions, fast-FLAIR sequences are indicated in R studies because of their good identification of cortical/subcortical lesions, almost complete interobserver agreement, higher contrast-to-noise ratio and limited time needed for semiautomated quantitation

  8. Interferometric Meteor Head Echo Observations using the Southern Argentina Agile Meteor Radar (SAAMER)

    Science.gov (United States)

    Janches, D.; Hocking, W.; Pifko, S.; Hormaechea, J. L.; Fritts, D. C.; Brunini, C; Michell, R.; Samara, M.

    2013-01-01

    A radar meteor echo is the radar scattering signature from the free-electrons in a plasma trail generated by entry of extraterrestrial particles into the atmosphere. Three categories of scattering mechanisms exist: specular, nonspecular trails, and head-echoes. Generally, there are two types of radars utilized to detect meteors. Traditional VHF meteor radars (often called all-sky1radars) primarily detect the specular reflection of meteor trails traveling perpendicular to the line of sight of the scattering trail, while High Power and Large Aperture (HPLA) radars efficiently detect meteor head-echoes and, in some cases, non-specular trails. The fact that head-echo measurements can be performed only with HPLA radars limits these studies in several ways. HPLA radars are very sensitive instruments constraining the studies to the lower masses, and these observations cannot be performed continuously because they take place at national observatories with limited allocated observing time. These drawbacks can be addressed by developing head echo observing techniques with modified all-sky meteor radars. In addition, the fact that the simultaneous detection of all different scattering mechanisms can be made with the same instrument, rather than requiring assorted different classes of radars, can help clarify observed differences between the different methodologies. In this study, we demonstrate that such concurrent observations are now possible, enabled by the enhanced design of the Southern Argentina Agile Meteor Radar (SAAMER) deployed at the Estacion Astronomica Rio Grande (EARG) in Tierra del Fuego, Argentina. The results presented here are derived from observations performed over a period of 12 days in August 2011, and include meteoroid dynamical parameter distributions, radiants and estimated masses. Overall, the SAAMER's head echo detections appear to be produced by larger particles than those which have been studied thus far using this technique.

  9. Development of Instrumentation for Spin-Echo Induced Spatial Beam Modulations

    DEFF Research Database (Denmark)

    Sales, Morten

    Spin-Echo Modulated Small Angle Neutron Scattering in Time-of-Flight mode (ToF SEMSANS) is an emerging technique extending the measurable phase space covered by neutron scattering. Using inclined magnetic field surfaces, (very) small angle scattering from a sample can be mapped into the spin...... orientation of the neutron as it has been shown in Spin-Echo Small Angle Neutron Scattering (SESANS). Taking this technique further we have shown that it is possible to perform quantitative Dark-Field Imaging, where the small angle scattering signal of individual areas in a neutron image can be obtained...

  10. Leveraging Scarce Resources With Bone Health TeleECHO to Improve the Care of Osteoporosis.

    Science.gov (United States)

    Lewiecki, E Michael; Rochelle, Rachelle; Bouchonville, Matthew F; Chafey, David H; Olenginski, Thomas P; Arora, Sanjeev

    2017-12-01

    Osteoporosis is a common condition with serious consequences because of fractures. Despite availability of treatments to reduce fracture risk, there is a large osteoporosis treatment gap that has reached crisis proportions. There are too few specialists to provide services for patients who need them. Bone Health Extension for Community Health Care Outcomes (TeleECHO) is a strategy using real-time ongoing videoconferencing technology to mentor health care professionals in rural and underserved communities to achieve an advanced level of knowledge for the care of patients with skeletal diseases. Over the first 21 months of weekly Bone Health TeleECHO programs, there were 263 registered health care professionals in the United States and several other countries, with 221 attending at least 1 online clinic and typically 35 to 40 attendees at each session at the end of the reported period. Assessment of self-confidence in 20 domains of osteoporosis care showed substantial improvement with the ECHO intervention ( P = 0.005). Bone Health TeleECHO can contribute to mitigating the crisis in osteoporosis care by leveraging scarce resources, providing motivated practitioners with skills to provide better skeletal health care, closer to home, with greater convenience, and lower cost than referral to a specialty center. Bone Health TeleECHO can be replicated in any location worldwide to reach anyone with Internet access, allowing access in local time zones and languages. The ECHO model of learning can be applied to other aspects of bone care, including the education of fracture liaison service coordinators, residents and fellows, and physicians with an interest in rare bone diseases.

  11. Effect of age on the perioperative and radiographic complications of multilevel cervicothoracic spinal fusions.

    Science.gov (United States)

    Cloyd, Jordan M; Acosta, Frank L; Ames, Christopher P

    2008-12-15

    Retrospective review. To investigate the effect of age on the perioperative and radiographic complications associated with multilevel (>or=5) fusion of the cervicothoracic spine. Although the elderly comprise a substantial proportion of patients presenting with complex spinal pathology necessitating multilevel procedures across the cervical and cervicothoracic spine, the risk of perioperative and radiographic complications after these procedures is unknown. Between 2000 and 2007, 58 patients 65 years of age or older at a single institution underwent instrumented cervicothoracic spinal fusion of at least 5 levels. Fifty-eight patients under the age of 65 from the same time period served as a control group. A retrospective review of all hospital records, operative reports, radiographs, and clinic notes was conducted. Complications were classified as intraoperative, major and minor postoperative, and need for revision surgery. Flexion-extension radiographs were examined at discharge, 1.5, 6, 12 months, and then yearly, thereafter to evaluate fusion status and instrumentation-related complications. Principal diagnoses included spondylostenosis, malignancy, vertebral fracture, and osteomyelitis. Both groups were similar in number of levels fused (elderly, 6.7 +/- 2.1; control, 6.3 +/- 1.7) and circumferential procedures (27 vs. 28), respectively. There were no significant differences in operative time, blood loss, or length of hospital stay. Rates of intraoperative (5.2% vs. 3.4%), major (20.7% vs. 17.2%) and minor postoperative complications (27.6% vs. 22.4%), and reoperation (8.6% vs. 8.6%) were similar between the 2 groups. Utilization of a combined anterior-posterior fusion was associated with increased perioperative complications in the elderly on univariate but not multivariate analyses. Radiographic evidence of fusion was also comparable between the 2 groups. Perioperative complication rates of multilevel (>or=5) cervicothoracic spinal fusion in the elderly are

  12. Adapting the Consolidated Framework for Implementation Research to Create Organizational Readiness and Implementation Tools for Project ECHO.

    Science.gov (United States)

    Serhal, Eva; Arena, Amanda; Sockalingam, Sanjeev; Mohri, Linda; Crawford, Allison

    2018-03-01

    The Project Extension for Community Healthcare Outcomes (ECHO) model expands primary care provider (PCP) capacity to manage complex diseases by sharing knowledge, disseminating best practices, and building a community of practice. The model has expanded rapidly, with over 140 ECHO projects currently established globally. We have used validated implementation frameworks, such as Damschroder's (2009) Consolidated Framework for Implementation Research (CFIR) and Proctor's (2011) taxonomy of implementation outcomes, combined with implementation experience to (1) create a set of questions to assess organizational readiness and suitability of the ECHO model and (2) provide those who have determined ECHO is the correct model with a checklist to support successful implementation. A set of considerations was created, which adapted and consolidated CFIR constructs to create ECHO-specific organizational readiness questions, as well as a process guide for implementation. Each consideration was mapped onto Proctor's (2011) implementation outcomes, and questions relating to the constructs were developed and reviewed for clarity. The Preimplementation list included 20 questions; most questions fall within Proctor's (2001) implementation outcome domains of "Appropriateness" and "Acceptability." The Process Checklist is a 26-item checklist to help launch an ECHO project; items map onto the constructs of Planning, Engaging, Executing, Reflecting, and Evaluating. Given that fidelity to the ECHO model is associated with robust outcomes, effective implementation is critical. These tools will enable programs to work through key considerations to implement a successful Project ECHO. Next steps will include validation with a diverse sample of ECHO projects.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited

  13. Realization of the revival of silenced echo (ROSE) quantum memory scheme in orthogonal geometry

    Science.gov (United States)

    Minnegaliev, M. M.; Gerasimov, K. I.; Urmancheev, R. V.; Moiseev, S. A.; Chanelière, T.; Louchet-Chauvet, A.

    2018-02-01

    We demonstrated quantum memory scheme on revival of silenced echo in orthogonal geometry in Tm3+: Y3Al5O12 crystal. The retrieval efficiency of ˜14% was demonstrated with the 36 µs storage time. In this scheme for the first time we also implemented a suppression of the revived echo signal by applying an external electric field and the echo signal has been recovered on demand if we then applied a second electric pulse with opposite polarity. This technique opens the possibilities for realizing addressing in multi-qubit quantum memory in Tm3+: Y3Al5O12 crystal.

  14. The thermal and dynamical state of the atmosphere during polar mesosphere winter echoes

    Directory of Open Access Journals (Sweden)

    F.-J. Lübken

    2006-01-01

    Full Text Available In January 2005, a total of 18 rockets were launched from the Andøya Rocket Range in Northern Norway (69° N into strong VHF radar echoes called 'Polar Mesosphere Winter Echoes' (PMWE. The echoes were observed in the lower and middle mesosphere during large solar proton fluxes. In general, PMWE occur much more seldom compared to their summer counterparts PMSE (typical occurrence rates at 69° N are 1–3% vs. 80%, respectively. Our in-situ measurements by falling sphere, chaff, and instrumented payloads provide detailed information about the thermal and dynamical state of the atmosphere and therefore allow an unprecedented study of the background atmosphere during PMWE. There are a number of independent observations indicating that neutral air turbulence has caused PMWE. Ion density fluctuations show a turbulence spectrum within PMWE and no fluctuations outside. Temperature lapse rates close to the adiabatic gradient are observed in the vicinity of PMWE indicating persistent turbulent mixing. The spectral broadening of radar echoes is consistent with turbulent velocity fluctuations. Turbulence also explains the mean occurrence height of PMWE (~68–75 km: viscosity increases rapidly with altitude and destroys any small scale fluctuations in the upper mesosphere, whereas electron densities are usually too low in the lower mesosphere to cause significant backscatter. The seasonal variation of echoes in the lower mesosphere is in agreement with a turbulence climatology derived from earlier sounding rocket flights. We have performed model calculations to study the radar backscatter from plasma fluctuations caused by neutral air turbulence. We find that volume reflectivities observed during PMWE are in quantitative agreement with theory. Apart from turbulence the most crucial requirement for PMWE is a sufficiently large number of electrons, for example produced by solar proton events. We have studied the sensitivity of the radar echo strength on

  15. [The geriatric perioperative unit, a high performance care department for elderly surgical patients].

    Science.gov (United States)

    Papas, Anne; Caillard, Laurence; Nion, Nathalie

    2011-01-01

    For over a year Professor Marc Verny's geriatric department at Pitié-Salpêtrière hospital in Paris has had ten beds set aside for the perioperative care of elderly people. This geriatric perioperative unit (UPOG) offers patients the skills of a multidisciplinary team trained in the specificities of caring for elderly patients often suffering from polypathology. The team works closely together around a common goal: the rapid return of the patient's autonomy during the postoperative period, crucial for the future of elderly people. So far UPOG's results have been very positive, as more than 90% of patients regain their autonomy after a short and uncomplicated period of postoperative care.

  16. Anesthesia and perioperative management of colorectal surgical patients - A clinical review (Part 1).

    Science.gov (United States)

    Patel, Santosh; Lutz, Jan M; Panchagnula, Umakanth; Bansal, Sujesh

    2012-04-01

    Colorectal surgery is commonly performed for colorectal cancer and other pathology such as diverticular and inflammatory bowel disease. Despite significant advances, such as laparoscopic techniques and multidisciplinary recovery programs, morbidity and mortality remain high and vary among surgical centers. The use of scoring systems and assessment of functional capacity may help in identifying high-risk patients and predicting complications. An understanding of perioperative factors affecting colon blood flow and oxygenation, suppression of stress response, optimal fluid therapy, and multimodal pain management are essential. These fundamental principles are more important than any specific choice of anesthetic agents. Anesthesiologists can significantly contribute to enhance recovery and improve the quality of perioperative care.

  17. Our experience with implantation of VentrAssist left ventricular assist device

    Directory of Open Access Journals (Sweden)

    Hiriyur Shivalingappa Jayanthkumar

    2013-01-01

    Full Text Available Perioperative anaesthetic management of the VentrAssist TM left ventricular assist device (LVAD is a challenge for anaesthesiologists because patients presenting for this operation have long-standing cardiac failure and often have associated hepatic and renal impairment, which may significantly alter the pharmacokinetics of administered drugs and render the patients coagulopathic. The VentrAssist is implanted by midline sternotomy. A brief period of cardiopulmonary bypass (CPB for apical cannulation of left ventricle is needed. The centrifugal pump, which produces non-pulsatile, continuous flow, is positioned in the left sub-diaphragmatic pocket. This LVAD is preload dependent and afterload sensitive. Transoesophageal echocardiography is an essential tool to rule out contraindications and to ensure proper inflow cannula position, and following the implantation of LVAD, to ensure right ventricular (RV function. The anaesthesiologist should be prepared to manage cardiac decompensation and acute desaturation before initiation of CPB, as well as RV failure and severe coagulopathic bleeding after CPB. Three patients had undergone implantation of VentrAssist in our hospital. This pump provides flow of 5 l/min depending on preload, afterload and pump speed. All the patients were discharged after an average of 30 days. There was no perioperative mortality.

  18. Evaluation of the Chondromalacia Patella Using a Microscopy Coil: Comparison of the Two-Dimensional Fast Spin Echo Techniques and the Three-Dimensional Fast Field Echo Techniques

    International Nuclear Information System (INIS)

    Kim, Hyun Joo; Lee, Sang Hoon; Kang, Chang Ho; Ryu, Jeong Ah; Shin, Myung Jin; Cho, Kyung Ja; Cho, Woo Shin

    2011-01-01

    We wanted to compare the two-dimensional (2D) fast spin echo (FSE) techniques and the three-dimensional (3D) fast field echo techniques for the evaluation of the chondromalacia patella using a microscopy coil. Twenty five patients who underwent total knee arthroplasty were included in this study. Preoperative MRI evaluation of the patella was performed using a microscopy coil (47 mm). The proton density-weighted fast spin echo images (PD), the fat-suppressed PD images (FS-PD), the intermediate weighted-fat suppressed fast spin echo images (iw-FS-FSE), the 3D balanced-fast fi eld echo images (B-FFE), the 3D water selective cartilage scan (WATS-c) and the 3D water selective fluid scan (WATS-f) were obtained on a 1.5T MRI scanner. The patellar cartilage was evaluated in nine areas: the superior, middle and the inferior portions that were subdivided into the medial, central and lateral facets in a total of 215 areas. Employing the Noyes grading system, the MRI grade 0-I, II and III lesions were compared using the gross and microscopic findings. The sensitivity, specificity and accuracy were evaluated for each sequence. The significance of the differences for the individual sequences was calculated using the McNemar test. The gross and microscopic findings demonstrated 167 grade 0-I lesions, 40 grade II lesions and eight grade III lesions. Iw-FS-FSE had the highest accuracy (sensitivity/specificity/accuracy = 88%/98%/96%), followed by FSPD (78%/98%/93%, respectively), PD (76%/98%/93%, respectively), B-FFE (71%/100%/93%, respectively), WATS-c (67%/100%/92%, respectively) and WATS-f (58%/99%/89%, respectively). There were statistically significant differences for the iw-FS-FSE and WATS-f and for the PD-FS and WATS-f (p < 0.01). The iw-FS-FSE images obtained with a microscopy coil show best diagnostic performance among the 2D and 3D GRE images for evaluating the chondromalacia patella

  19. Evaluation of the Chondromalacia Patella Using a Microscopy Coil: Comparison of the Two-Dimensional Fast Spin Echo Techniques and the Three-Dimensional Fast Field Echo Techniques

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Joo; Lee, Sang Hoon; Kang, Chang Ho; Ryu, Jeong Ah; Shin, Myung Jin; Cho, Kyung Ja; Cho, Woo Shin [University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2011-02-15

    We wanted to compare the two-dimensional (2D) fast spin echo (FSE) techniques and the three-dimensional (3D) fast field echo techniques for the evaluation of the chondromalacia patella using a microscopy coil. Twenty five patients who underwent total knee arthroplasty were included in this study. Preoperative MRI evaluation of the patella was performed using a microscopy coil (47 mm). The proton density-weighted fast spin echo images (PD), the fat-suppressed PD images (FS-PD), the intermediate weighted-fat suppressed fast spin echo images (iw-FS-FSE), the 3D balanced-fast fi eld echo images (B-FFE), the 3D water selective cartilage scan (WATS-c) and the 3D water selective fluid scan (WATS-f) were obtained on a 1.5T MRI scanner. The patellar cartilage was evaluated in nine areas: the superior, middle and the inferior portions that were subdivided into the medial, central and lateral facets in a total of 215 areas. Employing the Noyes grading system, the MRI grade 0-I, II and III lesions were compared using the gross and microscopic findings. The sensitivity, specificity and accuracy were evaluated for each sequence. The significance of the differences for the individual sequences was calculated using the McNemar test. The gross and microscopic findings demonstrated 167 grade 0-I lesions, 40 grade II lesions and eight grade III lesions. Iw-FS-FSE had the highest accuracy (sensitivity/specificity/accuracy = 88%/98%/96%), followed by FSPD (78%/98%/93%, respectively), PD (76%/98%/93%, respectively), B-FFE (71%/100%/93%, respectively), WATS-c (67%/100%/92%, respectively) and WATS-f (58%/99%/89%, respectively). There were statistically significant differences for the iw-FS-FSE and WATS-f and for the PD-FS and WATS-f (p < 0.01). The iw-FS-FSE images obtained with a microscopy coil show best diagnostic performance among the 2D and 3D GRE images for evaluating the chondromalacia patella

  20. Hypnosis in the Perioperative Management of Breast Cancer Surgery: Clinical Benefits and Potential Implications

    Science.gov (United States)

    Roelants, Fabienne; Pospiech, Audrey; Momeni, Mona; Watremez, Christine

    2016-01-01

    The aim of this review is to summarize data published on the use of perioperative hypnosis in patients undergoing breast cancer surgery (BCS). Indeed, the majority of BCS patients experience stress, anxiety, nausea, vomiting, and pain. Correct management of the perioperative period and surgical removal of the primary tumor are clearly essential but can affect patients on different levels and hence have a negative impact on oncological outcomes. This review examines the effect of clinical hypnosis performed during the perioperative period. Thanks to its specific properties and techniques allowing it to be used as complementary treatment preoperatively, hypnosis has an impact most notably on distress and postoperative pain. During surgery, hypnosis may be applied to limit immunosuppression, while, in the postoperative period, it can reduce pain, anxiety, and fatigue and improve wound healing. Moreover, hypnosis is inexpensive, an important consideration given current financial concerns in healthcare. Of course, large randomized prospective studies are now needed to confirm the observed advantages of hypnosis in the field of oncology. PMID:27635132