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Sample records for reoperation rate due

  1. The success rate of TED upper eyelid retraction reoperations.

    Science.gov (United States)

    Golan, Shani; Rootman, Dan B; Goldberg, Robert A

    2016-12-01

    Although reoperation rates for upper lid retraction surgery for thyroid eye disease (TED) typically range between 8% and 23%, there is little literature describing the outcomes of these second operations. In this retrospective observational cohort study, all patients that underwent surgery for upper eyelid retraction over a 14-year period at a single institution were included. Cases were included if a second eyelid retraction surgery was performed during the study period. Success of surgery was defined as a marginal reflex distance (MRD1) of 2.5 to 4.5 mm in each eye and less than 1 mm difference in MRD1 between the eyes. Overcorrection and undercorrection were defined as above and below these bounds, respectively. 72 eyes in 49 patients were included in the study. The mean age was 56.6 (±11.5) years. By definition, all patients had at least 1 lid lengthening surgery for upper eyelid retraction, and at least 1 subsequent surgery. For this second surgery, 61 eyes (85%) underwent retraction surgery and 11 eyes (15%) underwent ptosis surgery. After this second operation, 31% were undercorrected and 33% were overcorrected. A third surgery was performed in 19 eyes (25%), 12 had surgery for residual retraction and 7 for ptosis. After the third operation 10% of eyes were under corrected and 11% were over corrected. Four patients underwent a fourth surgery: one for retraction and three for ptosis. Success was noted in 35% after the second surgery and 44% after the third. Surgical success in eyelid retraction surgery increases from a second to a third consecutive surgery, and residual asymmetry was roughly equally distributed between over- and undercorrection.

  2. Influence of surgeon's experience and supervision on re-operation rate after hip fracture surgery

    DEFF Research Database (Denmark)

    Palm, Henrik; Jacobsen, Steffen; Krasheninnikoff, Michael

    2006-01-01

    OBJECTIVE: To investigate the influence of the performing surgeon's experience and degree of supervision on re-operation rate among patients admitted with a proximal femoral fracture (PFF). METHODS: Prospective study of 600 consecutive patients with proximal femoral fracture in our multimodal...... Society of Anaesthesiologists score, New Mobility Score, time to surgery and type of implant, surgery by unsupervised junior registrars was still a significant independent risk factor for re-operation in technically demanding proximal femoral fractures. CONCLUSION: Unsupervised junior registrars should...

  3. Influence of surgeon's experience and supervision on re-operation rate after hip fracture surgery

    DEFF Research Database (Denmark)

    Palm, Henrik; Jacobsen, Steffen; Krasheninnikoff, Michael

    2006-01-01

    rehabilitation programme, between 2002 and 2004. Re-operation rate was assessed 6 months postoperatively. Surgeons were grouped as unsupervised junior registrars versus experienced surgeons operating or supervising. Fractures were stratified as technically undemanding or demanding. RESULTS: Unsupervised junior......OBJECTIVE: To investigate the influence of the performing surgeon's experience and degree of supervision on re-operation rate among patients admitted with a proximal femoral fracture (PFF). METHODS: Prospective study of 600 consecutive patients with proximal femoral fracture in our multimodal...... registrars operated on 23% (137/600) of all and 15% (56/365) of technically demanding proximal femoral fractures. The latter had a higher re-operation rate within 6 months, compared with the rate when more experienced surgeons were present. In logistic regression analysis combining age, gender, American...

  4. Reoperation Rates in Ductal Carcinoma In Situ vs Invasive Breast Cancer After Wire-Guided Breast-Conserving Surgery

    DEFF Research Database (Denmark)

    Langhans, Linnea; Jensen, Maj-Britt; Talman, Maj-Lis M

    2017-01-01

    Importance: New techniques for preoperative localization of nonpalpable breast lesions may decrease the reoperation rate in breast-conserving surgery (BCS) compared with rates after surgery with the standard wire-guided localization. However, a valid reoperation rate for this procedure needs...... to be established for comparison, as previous studies on this procedure include a variety of malignant and benign breast lesions. Objectives: To determine the reoperation rate after wire-guided BCS in patients with histologically verified nonpalpable invasive breast cancer (IBC) or ductal carcinoma in situ (DCIS......) and to examine whether the risk of reoperation is associated with DCIS or histologic type of the IBC. Design, Setting, and Participants: This nationwide study including women with histologically verified IBC or DCIS having wire-guided BCS performed between January 1, 2010, and December 31, 2013, used data from...

  5. Low rate of reoperations after acute type A aortic dissection repair from The Nordic Consortium Registry

    DEFF Research Database (Denmark)

    Pan, Emily; Gudbjartsson, Tomas; Ahlsson, Anders

    2018-01-01

    Bakey classification nor the extent of proximal or distal repair predicted freedom from a later reoperation. The only independent risk factor associated with a later proximal reoperation was a history of connective tissue disease. CONCLUSIONS: Type A aortic dissection repair in low- to medium-volume centers......OBJECTIVES: To describe the relationship between the extent of primary aortic repair and the incidence of reoperations after surgery for type A aortic dissection. METHODS: A retrospective cohort of 1159 patients treated for type A aortic dissection at eight Nordic low- to medium......-sized cardiothoracic centers from 2005 to 2014. Data were gathered from patient records and national registries. Patients were separately divided into 3 groups according to the distal anastomoses technique (ascending aorta [n = 791], hemiarch [n = 247], and total arch [n = 66]), and into 2 groups for proximal repair...

  6. Reoperation Rates for Laparoscopic vs Open Repair of Femoral Hernias in Denmark

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Bisgaard, Thue; Kehlet, Henrik

    2014-01-01

    IMPORTANCE: In Denmark approximately 10 000 groin hernias are repaired annually, of which 2% to 4% are femoral hernias. Several methods for repair of femoral hernias are used including sutured repair and different types of mesh repair with either open or laparoscopic techniques. The use of many...... laparoscopic vs open femoral hernia repair, analyzing data from a nationwide database. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study was conducted. Data on femoral hernia repairs registered in the Danish Hernia Database from January 1998 until February 2012 were extracted and analyzed. All...... repairs were followed in the database and analyzed for reports of reoperation, which were used as a proxy for recurrence. Femoral hernia recurrence and inguinal hernia occurrence after the index repair were analyzed. EXPOSURE: Repair of a femoral hernia. MAIN OUTCOMES AND MEASURES: Reoperation...

  7. Radiographic failure and rates of re-operation after acromioclavicular joint reconstruction: a comparison of surgical techniques.

    Science.gov (United States)

    Spencer, H T; Hsu, L; Sodl, J; Arianjam, A; Yian, E H

    2016-04-01

    To compare radiographic failure and re-operation rates of anatomical coracoclavicular (CC) ligament reconstructional techniques with non-anatomical techniques after chronic high grade acromioclavicular (AC) joint injuries. We reviewed chronic AC joint reconstructions within a region-wide healthcare system to identify surgical technique, complications, radiographic failure and re-operations. Procedures fell into four categories: (1) modified Weaver-Dunn, (2) allograft fixed through coracoid and clavicular tunnels, (3) allograft loop coracoclavicular fixation, and (4) combined allograft loop and synthetic cortical button fixation. Among 167 patients (mean age 38.1 years, (standard deviation (sd) 14.7) treated at least a four week interval after injury, 154 had post-operative radiographs available for analysis. Radiographic failure occurred in 33/154 cases (21.4%), with the lowest rate in Technique 4 (2/42 4.8%, p = 0.001). Half the failures occurred by six weeks, and the Kaplan-Meier survivorship at 24 months was 94.4% (95% confidence interval (CI) 79.6 to 98.6) for Technique 4 and 69.9% (95% CI 59.4 to 78.3) for the other techniques when combined. In multivariable survival analysis, Technique 4 had better survival than other techniques (Hazard Ratio 0.162, 95% CI 0.039 to 0.068, p = 0.013). Among 155 patients with a minimum of six months post-operative insurance coverage, re-operation occurred in 9.7% (15 patients). However, in multivariable logistic regression, Technique 4 did not reach a statistically significant lower risk for re-operation (odds ratio 0.254, 95% CI 0.05 to 1.3, p = 0.11). In this retrospective series, anatomical CC ligament reconstruction using combined synthetic cortical button and allograft loop fixation had the lowest rate of radiographic failure. Anatomical coracoclavicular ligament reconstruction using combined synthetic cortical button and allograft loop fixation had the lowest rate of radiographic failure. ©2016 The British Editorial

  8. Current status towards JMTR reoperation

    International Nuclear Information System (INIS)

    Izumo, Hironobu; Imaizumi, Tomomi; Takemoto, Noriyuki; Hori, Naohiko

    2012-01-01

    Due to the 2011 Great East Japan Earthquake, Japan Materials Testing Reactor (JMTR), as a light-water-moderated cooling type irradiation test reactor, had to conduct the soundness confirmation of the reactor facilities after earthquake (equipment inspection, and earthquake response analysis). JMTR has been working on soundness confirmation with the aim of reoperation in November 2011. However, in order to perform the detailed investigation on the equipment and machinery, such as the repair of partial deformation of the roof truss of reactor building block, change in operation plan was applied again. In the future, the authors will accurately judge the social situation after the Great East Japan Earthquake, and plan the reoperation under safe and stable state, aiming at the world top class operation rate. In addition, our efforts will be directed to the improvement of the facilities by use of external funds based on expanded utilization, and the continuous aggressive activities aiming for JMTR becoming the international hub. (A.O.)

  9. Reoperative Heller myotomy: more pain, less gain.

    Science.gov (United States)

    Wood, Thomas W; Ross, Sharona B; Ryan, Carrie E; Bowman, Ty A; Jacobi, Benjamin L; Konstantinidis, Michael G; Rosemurgy, Alexander S

    2015-06-01

    Heller myotomy provides durable and effective treatment of achalasia. Due to recurrence or persistence of symptoms, a small subset of patients seeks reoperation. This study was undertaken to determine if reoperative Heller myotomy provides salutary amelioration of symptoms. 609 patients undergoing laparoscopic Heller myotomy between 1992 to 2013 were prospectively followed; 38 underwent reoperative myotomy. Patients graded their symptom frequency and severity before and after myotomy on a Likert scale. Median data are reported. Patients undergoing reoperative myotomy, when compared to those undergoing their first myotomy, experienced a higher conversion rate to an "open" myotomy (8% vs 1%, P myotomy led to improvement in symptoms, but the magnitude of improvement in symptoms (e.g., dysphagia, choking, and coughing) was less than for patients undergoing their first myotomy (all P Heller myotomy were less likely to report symptoms occurring once per month or less (83% vs 56%, P myotomy note improvement in symptoms, although to a lesser extent than patients undergoing their first myotomy. Patients undergoing reoperative Heller myotomy can expect to experience less improvement of symptoms, denoting the importance of the first myotomy.

  10. Reoperation for urinary incontinence

    DEFF Research Database (Denmark)

    Foss Hansen, Margrethe; Lose, Gunnar; Kesmodel, Ulrik Schiøler

    2016-01-01

    for urinary incontinence (retropubic midurethral tape, transobturator tape, urethral injection therapy, Burch colposuspension, pubovaginal slings, and miscellaneous operations). Cox proportional hazard models were used to estimate the hazard ratio (HR) with 95% confidence intervals (CIs), adjusted for factors......BACKGROUND: The synthetic midurethral slings were introduced in the 1990s and were rapidly replaced the Burch colposuspension as the gold standard treatment for urinary incontinence. It has been reported that the retropubic midurethral tape has an objective and subjective cure rate of 85% at 5...... years of follow-up, but the rate of reoperation after retropubic midurethral tape at the long-term follow-up is less well described. The existing literature specifies an overall lifetime rate of reoperation of about 8-9% after an initial operation for urinary incontinence. There are, however...

  11. High Re-Operation Rates Using Conserve Metal-On-Metal Total Hip Articulations

    DEFF Research Database (Denmark)

    Mogensen, S L; Jakobsen, Thomas; Christoffersen, Hardy

    2016-01-01

    INTRODUCTION: Metal-on-metal hip articulations have been intensely debated after reports of adverse reactions and high failure rates. The aim of this study was to retrospectively evaluate the implant of a metal-on.metal total hip articulation (MOM THA) from a single manufacture in a two-center st......INTRODUCTION: Metal-on-metal hip articulations have been intensely debated after reports of adverse reactions and high failure rates. The aim of this study was to retrospectively evaluate the implant of a metal-on.metal total hip articulation (MOM THA) from a single manufacture in a two...

  12. Reoperation for persistent or recurrent secondary hyperparathyroidism.

    Science.gov (United States)

    Abruzzo, Alida; Gioviale, Maria Concetta; Damiano, Giuseppe; Palumbo, Vincenzo Davide; Buscemi, Salvatore; Lo Monte, Giulia; Gulotta, Leonardo; Buscemi, Giuseppe; Lo Monte, Attilio Ignazio

    2017-10-23

    Secondary hyperparathyroidism is a common acquired disorder seen in chronic renal failure. Its pathophysiology is mainly due to hyperphosphatemia and vitamin D deficiency and resistance. When medical treatment fails, subtotal and total parathyroidectomy with autotransplantation are the standard procedures, although both are associated with high recurrence rates. 4 patients experienced persistence and 9 relapse. The first 4 were subjected to reoperation after 6 months for the persistence of symptoms due to the finding of a supernumerary adenomatous gland while the remaining patients at the reoperation showed in 5 cases 2 more glands in over thymic position, and 4 an hyperplasia of the residual glandular tissue. A classic cervicotomy was sufficient to remove the residual parathyroid in patients with persistent hyperparathyroidism. For cases of recurrent hyperparathyroidism it was enough a medial approach and sometimes lateral for the complete excision of the hyperplastic tissue. The advent of the intraoperative technique of parathyroid hormone dosage allowed a better performance of the surgical technique for the last 3 patients undergoing reoperation. After reoperation all patients had immediate regression of clinical symptoms with normalization of serum calcium and PTH levels. On the basis of these considerations, diagnostic imaging has a not negligible role because during the first intervention helps to have an idea of the possible location of the glands and thus to avoid the risk of recurrence and relapse due to ectopic or supernumerary tissue.

  13. Lower reoperation rate for cemented hemiarthroplasty than for uncemented hemiarthroplasty and internal fixation following femoral neck fracture

    DEFF Research Database (Denmark)

    Viberg, Bjarke; Overgaard, Søren; Lauritsen, Jens

    2013-01-01

    a reoperation rate (RR) of 5% and was used as reference in the Cox regression analysis, which showed significantly higher hazard ratios (HRs) for IF (HR = 3.8, 95% CI: 1.9-7.5; RR = 18%), uncemented HA (HR = 2.2, CI: 1.1-4.5; RR = 11%) and uncemented hydroxyapatite-coated HA (HR = 3.6, CI: 1.8-7.4; RR = 16...... treated with either internal fixation (IF), cemented HA, or uncemented HA (with or without hydroxyapatite coating), after 12-19 years of follow-up. Methods 4 hospitals with clearly defined guidelines for the treatment of 75+ year-old patients with a displaced femoral neck fracture were included. Cohort 1...... an uncemented hydroxyapatite-coated Furlong HA. Data were retrieved from patient files, from the region-based patient administrative system, and from the National Registry of Patients at the end of 2010. We performed survival analysis with adjustment for comorbidity, age, and sex. Results Cemented HA had...

  14. Use of selective serotonin reuptake inhibitors and risk of re-operation due to post-surgical bleeding in breast cancer patients: a Danish population-based cohort study

    Directory of Open Access Journals (Sweden)

    Lash Timothy L

    2010-01-01

    Full Text Available Abstract Background Selective serotonin reuptake inhibitors (SSRI decrease platelet-function, which suggests that SSRI use may increase the risk of post-surgical bleeding. Few studies have investigated this potential association. Methods We conducted a population-based study of the risk of re-operation due to post-surgical bleeding within two weeks of primary surgery among Danish women with primary breast cancer. Patients were categorised according to their use of SSRI: never users, current users (SSRI prescription within 30 days of initial breast cancer surgery, and former users (SSRI prescription more than 30 days before initial breast cancer surgery. We calculated the risk of re-operation due to post-surgical bleeding within 14 days of initial surgery, and the relative risk (RR of re-operation comparing SSRI users with never users of SSRI adjusting for potential confounders. Results 389 of 14,464 women (2.7% were re-operated. 1592 (11% had a history of SSRI use. Risk of re-operation was 2.6% among never users, 7.0% among current SSRI users, and 2.7% among former users. Current users thus had an increased risk of re-operation due to post-operative bleeding (adjusted relative risk = 2.3; 95% confidence interval (CI = 1.4, 3.9 compared with never users. There was no increased risk of re-operation associated with former use of SSRI (RR = 0.93, 95% CI = 0.66, 1.3. Conclusions Current use of SSRI is associated with an increased risk of re-operation due to bleeding after surgery for breast cancer.

  15. Lower complication and reoperation rates for laminectomy rather than MI TLIF/other fusions for degenerative lumbar disease/spondylolisthesis: A review

    Science.gov (United States)

    Epstein, Nancy E.

    2018-01-01

    Background: Utilizing the spine literature, we compared the complication and reoperation rates for laminectomy alone vs. instrumented fusions including minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) for the surgical management of multilevel degenerative lumbar disease with/without degenerative spondylolisthesis (DS). Methods: Epstein compared complication and reoperation rates over 2 years for 137 patients undergoing laminectomy alone undergoing 2-3 level (58 patients) and 4-6 level (79 patients) Procedures for lumbar stenosis with/without DS. Results showed no new postoperative neurological deficits, no infections, no surgery for adjacent segment disease (ASD), 4 patients (2.9%) who developed intraoperative cerebrospinal fluid (CSF) fistulas, no readmissions, and just 1 reopereation for a (postoperative day 7). These rates were compared to other literature for lumbar laminectomies vs. fusions (e.g. particularly MI TLIF) addressing pathology comparable to that listed above. Results: Some studies in the literature revealed an average 4.8% complication rate for laminectomy alone vs. 8.3% for decompressions/fusion; at 5 postoperative years, reoperation rates were 10.6% vs. 18.4%, respectively. Specifically, the MI TLIF literature complication rates ranged from 7.7% to 23.0% and included up to an 8.3% incidence of wound infections, 6.1% durotomies, 9.7% permanent neurological deficits, and 20.2% incidence of new sensory deficits. Reoperation rates (1.6–6%) for MI TLIF addressed instrumentation failure (2.3%), cage migration (1.26–2.4%), cage extrusions (0.8%), and misplaced screws (1.6%). The learning curve (e.g. number of cases required by a surgeon to become proficient) for MI TLIF was the first 33-44 cases. Furthermore, hospital costs for lumbar fusions were 2.6 fold greater than those for laminectomy alone, with overall neurosurgeon reimbursement quoted in one study as high as $142,075 per year. Conclusions: The spinal literature revealed

  16. Body mass index is not associated with reoperation rates in patients with a surgically treated perforated peptic ulcer

    DEFF Research Database (Denmark)

    Duch, Patricia; Møller, Morten Hylander

    2015-01-01

    INTRODUCTION: The aim of the present nationwide Danish cohort study was to examine the association between body mass index (BMI) and reoperation in patients who are sur-gically treated for perforated peptic ulcer (PPU). METHODS: This was a nationwide cohort study of all Danish patients who were...

  17. Does preoperative breast MRI significantly impact on initial surgical procedure and re-operation rates in patients with screen-detected invasive lobular carcinoma?

    International Nuclear Information System (INIS)

    Sinclair, K.; Sakellariou, S.; Dawson, N.; Litherland, J.

    2016-01-01

    Aim: To investigate whether magnetic resonance imaging (MRI) changes the management of patients with screen-detected invasive lobular carcinoma (ILC). Materials and methods: A retrospective, controlled, single-centre analysis of 138 cases of screen-detected ILC was performed. All patients were assessed by a single multidisciplinary team as to whether preoperative MRI altered the initial management decision or reduced re-operation rates. Results: Forty-three percent of patients had preoperative MRI. MRI guided surgical management in 40.7% patients. Primary mastectomy rates were not significantly different between the MRI and non-MRI groups (32% and 30% respectively, p=0.71). The MRI group had a lower secondary surgery rate (6.8% versus 15.2%); however, the results did not reach statistical significance, and there were no unnecessary mastectomies. Conclusion: MRI can be used appropriately to guide primary surgery in screen-detected ILC cases and affects the initial management decision in 40.7% of patients. It does not significantly affect the overall mastectomy rate or re-operation rates, but reduces the likelihood of the latter. As a result of this review, the authors' local policy for the use of MRI in screen-detected ILC patients has been modified. For patients undergoing mastectomy for ILC, MRI is no longer performed routinely to search for contralateral malignancy as this has no proven added benefit. - Highlights: • Breast magnetic resonance imaging (MRI) allows more accurate tumour assessment and detects additional foci of disease in invasive lobular carcinoma (ILC). • Over the study's 3 year time frame, MRI guided surgical management of 40.7% screen-detected ILC patients scanned. • No statistically significant difference in mastectomy rates between MRI and non MRI groups. • Observed lower re-operation rate (6.8%-v-15.2%) in MRI group not statistically significant. • No MRI benefit for contralateral disease detection in ILC patients for

  18. Risk Balancing of Cold Ischemic Time against Night Shift Surgery Possibly Reduces Rates of Reoperation and Perioperative Graft Loss

    Directory of Open Access Journals (Sweden)

    Nikos Emmanouilidis

    2017-01-01

    Full Text Available Background. This retrospective cohort study evaluates the advantages of risk balancing between prolonged cold ischemic time (CIT and late night surgery. Methods. 1262 deceased donor kidney transplantations were analyzed. Multivariable regression was used to determine odds ratios (ORs for reoperation, graft loss, delayed graft function (DGF, and discharge on dialysis. CIT was categorized according to a forward stepwise pattern ≤1h/>1h, ≤2h/>2h, ≤3h/>3h,…, ≤nh/>nh. ORs for DGF were plotted against CIT and a nonlinear regression function with best R2 was identified. First and second derivative were then implemented into the curvature formula k(x=f′′(x/(1+f′x23/2 to determine the point of highest CIT-mediated risk acceleration. Results. Surgery between 3 AM and 6 AM is an independent risk factor for reoperation and graft loss, whereas prolonged CIT is only relevant for DGF. CIT-mediated risk for DGF follows an exponential pattern fx=A·(1+k·eI·x with a cut-off for the highest risk increment at 23.5 hours. Conclusions. The risk of surgery at 3 AM–6 AM outweighs prolonged CIT when confined within 23.5 hours as determined by a new mathematical approach to calculate turning points of nonlinear time related risks. CIT is only relevant for the endpoint of DGF but had no impact on discharge on dialysis, reoperation, or graft loss.

  19. Surgical outcomes after reoperation for recurrent skull base meningiomas.

    Science.gov (United States)

    Magill, Stephen T; Lee, David S; Yen, Adam J; Lucas, Calixto-Hope G; Raleigh, David R; Aghi, Manish K; Theodosopoulos, Philip V; McDermott, Michael W

    2018-05-04

    OBJECTIVE Skull base meningiomas are surgically challenging tumors due to the intricate skull base anatomy and the proximity of cranial nerves and critical cerebral vasculature. Many studies have reported outcomes after primary resection of skull base meningiomas; however, little is known about outcomes after reoperation for recurrent skull base meningiomas. Since reoperation is one treatment option for patients with recurrent meningioma, the authors sought to define the risk profile for reoperation of skull base meningiomas. METHODS A retrospective review of 2120 patients who underwent resection of meningiomas between 1985 and 2016 was conducted. Clinical information was extracted from the medical records, radiology data, and pathology data. All records of patients with recurrent skull base meningiomas were reviewed. Demographic data, presenting symptoms, surgical management, outcomes, and complications data were collected. Kaplan-Meier analysis was used to evaluate survival after reoperation. Logistic regression was used to evaluate for risk factors associated with complications. RESULTS Seventy-eight patients underwent 100 reoperations for recurrent skull base meningiomas. Seventeen patients had 2 reoperations, 3 had 3 reoperations, and 2 had 4 or more reoperations. The median age at diagnosis was 52 years, and 64% of patients were female. The median follow-up was 8.5 years. Presenting symptoms included cranial neuropathy, headache, seizure, proptosis, and weakness. The median time from initial resection to first reoperation was 4.4 years and 4.1 years from first to second reoperation. Seventy-two percent of tumors were WHO grade I, 22% were WHO grade II, and 6% were WHO grade III. The sphenoid wing was the most common location (31%), followed by cerebellopontine angle (14%), cavernous sinus (13%), olfactory groove (12%), tuberculum sellae (12%), and middle fossa floor (5%). Forty-four (54%) tumors were ≥ 3 cm in maximum diameter at the time of the first

  20. Health related quality of life, reoperation rate and function in patients with diabetes mellitus and hip fracture--a 2 year follow-up study.

    Science.gov (United States)

    Ekström, W; Al-Ani, A N; Sääf, M; Cederholm, T; Ponzer, S; Hedström, M

    2013-06-01

    Diabetes mellitus confers an increased risk of hip fractures. There is a limited knowledge of how the outcome after a hip fracture in patients with diabetes affect Health Related Quality of Life (HRQoL). The primary aim of this study was to evaluate HRQoL. Secondary aims were reoperation rate, complications and functions in patients with diabetes followed for 2 years after a hip fracture. Out of 2133 patients diabetes was present in 234 patients (11%). Main outcome measurements were HRQoL evaluated with EuroQoL 5-Dindex score, reoperation rate, surgical and medical complications, function as walking ability, daily activities, living condition and pain. Preoperatively, patients with diabetes mellitus had more pain (p=0.044), co-morbidities, reduced health status (p=0.001) and more often used a walking frame (p=0.014) than patients without diabetes, whereas Katz ADL index, cognition and body mass index did not differ. There was no difference in fracture type, surgical method or reoperation between the two groups or between patients with insulin treated or oral treated diabetes. The EQ-5Dindex score decreased from 0.64 at admission to 0.45 at 4 months, 0.49 at 12 months and 0.51 at 24 months with similar results for patients with and without diabetes. During the first postoperative year there was not more medical complications among patients with diabetes, however cardiac (p=0.023) and renal failure (p=0.032) were more frequent in patients with diabetes at 24 months. Patients with diabetes more often had severe hip pain at 4 months (p=0.031). At 12 months more diabetic patients were living independently (p=0.034). There was no difference in walking ability, ADL and living condition between the groups at 24 months. The findings of this study indicate that patients with diabetes mellitus had more pain, co-morbidities, reduced health status preoperatively than patients without diabetes. Hip fracture patients with diabetes mellitus have more hip pain at 4 months. Cardiac

  1. Recurrence rate and need for reoperation after surgery with or without internal limiting membrane removal for the treatment of the epiretinal membrane.

    Science.gov (United States)

    De Novelli, Fernando José; Goldbaum, Mauro; Monteiro, Mario Luiz Ribeiro; Aggio, Fabio Bom; Nóbrega, Mario Junqueira; Takahashi, Walter Yukihiko

    2017-01-01

    To compare the recurrence rate and need for reoperation after epiretinal membrane surgery with and without removal of the internal limiting membrane. In this retrospective study, 125 patients operated for epiretinal membrane removal were evaluated, with a minimum 6-month follow-up. Removal of the epiretinal membrane (ERM) was performed in 78 patients, while 47 had removal of the epiretinal membrane associated with internal limiting membrane peeling (ERM + ILM). The mean age in the ERM group was 65.8 years old, ranging from 41 to 80 years old. In the ERM + ILM group, the mean age was 67.2 years old, ranging from 52 to 82 years old. The mean preoperative visual acuity in the ERM group was 20/80p, and in the ERM + ILM group, it was 20/80. The mean postoperative visual acuity in both groups was 20/30. The mean preoperative macular thickness in the ERM group was 467 µm ranging from 281 to 663 µm; in the ERM + ILM group, the preoperative macular thickness was 497 µm, ranging from 172 to 798 µm. After surgery, a reduction in macular thickness was observed in both groups. In the ERM group, the mean macular thickness reduction was 361 ± 101. µm, whereas in the ERM + ILM group, it was 367 ± 75.2 µm. Twenty-two patients presented with a recurrence of epiretinal membrane, of which 16 (20.5%) were from the ERM group and 6 (12.8%) were from the ERM + ILM group (p = 0.39); one patient (2%) was retreated in the ERM + ILM group, whereas 5 patients (6%) where retreated in the ERM group. We postulate that ILM peeling for the treatment of epiretinal membrane is not a relevant factor either for visual recovery or macular thickness reduction, but it may reduce the recurrence and reoperation rate.

  2. Reoperations following proximal interphalangeal joint nonconstrained arthroplasties.

    Science.gov (United States)

    Pritsch, Tamir; Rizzo, Marco

    2011-09-01

    To retrospectively analyze the reasons for reoperations following primary nonconstrained proximal interphalangeal (PIP) joint arthroplasty and review clinical outcomes in this group of patients with 1 or more reoperations. Between 2001 and 2009, 294 nonconstrained (203 pyrocarbon and 91 metal-plastic) PIP joint replacements were performed in our institution. A total of 76 fingers (59 patients) required reoperation (50 pyrocarbon and 26 metal-plastic). There were 40 women and 19 men with an average age of 51 years (range, 19-83 y). Primary diagnoses included osteoarthritis in 35, posttraumatic arthritis in 24, and inflammatory arthritis in 17 patients. There were 21 index, 27 middle, 18 ring, and 10 small fingers. The average number of reoperations per PIP joint was 1.6 (range, 1-4). A total of 45 joints had 1 reoperation, 19 had 2, 11 had 3, and 1 had 4. Extensor mechanism dysfunction was the most common reason for reoperation; it involved 51 of 76 fingers and was associated with Chamay or tendon-reflecting surgical approaches. Additional etiologies included component loosening in 17, collateral ligament failure in 10, and volar plate contracture in 8 cases. Inflammatory arthritis was associated with collateral ligament failure. Six fingers were eventually amputated, 9 had PIP joint arthrodeses, and 2 had resection arthroplasties. The arthrodesis and amputation rates correlated with the increased number of reoperations per finger. Clinically, most patients had no or mild pain at the most recent follow-up, and the PIP joint range-of-motion was not significantly different from preoperative values. Pain levels improved with longer follow-up. Reoperations following primary nonconstrained PIP joint arthroplasties are common. Extensor mechanism dysfunction was the most common reason for reoperation. The average reoperation rate was 1.6, and arthrodesis and amputation are associated with an increasing number of operations. Overall clinical outcomes demonstrated no

  3. Misplaced Cervical Screws Requiring Reoperation.

    Science.gov (United States)

    Peterson, Jeremy C; Arnold, Paul M; Smith, Zachary A; Hsu, Wellington K; Fehlings, Michael G; Hart, Robert A; Hilibrand, Alan S; Nassr, Ahmad; Rahman, Ra'Kerry K; Tannoury, Chadi A; Tannoury, Tony; Mroz, Thomas E; Currier, Bradford L; De Giacomo, Anthony F; Fogelson, Jeremy L; Jobse, Bruce C; Massicotte, Eric M; Riew, K Daniel

    2017-04-01

    A multicenter, retrospective case series. In the past several years, screw fixation of the cervical spine has become commonplace. For the most part, this is a safe, low-risk procedure. While rare, screw backout or misplaced screws can lead to morbidity and increased costs. We report our experiences with this uncommon complication. A multicenter, retrospective case series was undertaken at 23 institutions in the United States. Patients were included who underwent cervical spine surgery from January 1, 2005, to December 31, 2011, and had misplacement of screws requiring reoperation. Institutional review board approval was obtained at all participating institutions, and detailed records were sent to a central data center. A total of 12 903 patients met the inclusion criteria and were analyzed. There were 11 instances of screw backout requiring reoperation, for an incidence of 0.085%. There were 7 posterior procedures. Importantly, there were no changes in the health-related quality-of-life metrics due to this complication. There were no new neurologic deficits; a patient most often presented with pain, and misplacement was diagnosed on plain X-ray or computed tomography scan. The most common location for screw backout was C6 (36%). This study represents the largest series to tabulate the incidence of misplacement of screws following cervical spine surgery, which led to revision procedures. The data suggest this is a rare event, despite the widespread use of cervical fixation. Patients suffering this complication can require revision, but do not usually suffer neurologic sequelae. These patients have increased cost of care. Meticulous technique and thorough knowledge of the relevant anatomy are the best means of preventing this complication.

  4. Reoperations within 48 hours following 7942 pediatric neurosurgery procedures.

    Science.gov (United States)

    Roy, Anil K; Chu, Jason; Bozeman, Caroline; Sarda, Samir; Sawvel, Michael; Chern, Joshua J

    2017-06-01

    OBJECTIVE Various indicators are used to evaluate the quality of care delivered by surgical services, one of which is early reoperation rate. The indications and rate of reoperations within a 48-hour time period have not been previously reported for pediatric neurosurgery. METHODS Between May 1, 2009, and December 30, 2014, 7942 surgeries were performed by the pediatric neurosurgery service in the operating rooms at a single institution. Demographic, socioeconomic, and clinical characteristics associated with each of the operations were prospectively collected. The procedures were grouped into 31 categories based on the nature of the procedure and underlying diseases. Reoperations within 48 hours at the conclusion of the index surgery were reviewed to determine whether the reoperation was planned or unplanned. Multivariate logistic regression was employed to analyze risk factors associated with unplanned reoperations. RESULTS Cerebrospinal fluid shunt-and hydrocephalus-related surgeries accounted for 3245 (40.8%) of the 7942 procedures. Spinal procedures, craniotomy for tumor resections, craniotomy for traumatic injury, and craniofacial reconstructions accounted for an additional 8.7%, 6.8%, 4.5%, and 4.5% of surgical volume. There were 221 reoperations within 48 hours of the index surgery, yielding an overall incidence of 2.78%; 159 of the reoperation were unplanned. Of these 159 unplanned reoperations, 121 followed index operations involving shunt manipulations. Using unplanned reoperations as the dependent variable (n = 159), index operations with a starting time after 3 pm and admission through the emergency department (ED) were associated with a two- to threefold increase in the likelihood of reoperations (after-hour surgery, odds ratio [OR] 2.01 [95% CI 1.43-2.83, p < 0.001]; ED admission, OR 1.97 (95% CI 1.32-2.96, p < 0.05]). CONCLUSIONS Approximately 25% of the reoperations within 48 hours of a pediatric neurosurgical procedure were planned. When

  5. Reoperative fundoplications are effective treatment for dysphagia and recurrent gastroesophageal reflux.

    Science.gov (United States)

    Rosemurgy, Alexander S; Arnaoutakis, Dean J; Thometz, Donald P; Binitie, Odion; Giarelli, Natalie B; Bloomston, Mark; Goldin, Steve G; Albrink, Michael H

    2004-12-01

    With wide application of antireflux surgery, reoperations for failed fundoplications are increasingly seen. This study was undertaken to document outcomes after reoperative fundoplications. Sixty-four patients, 26 men and 38 women, of average age 55 years+/-15.6 (SD), underwent reoperative antireflux surgery between 1992 and 2003. Fundoplication prior to reoperation had been undertaken via celiotomy in 27 and laparoscopically in 37. Both before and after reoperative antireflux surgery, patients scored their reflux and dysphagia on a Likert Scale (0 = none, 10 = continuous). Reoperation was undertaken because of dysphagia in 16 per cent, recurrent reflux in 52 per cent (median DeMeester Score 52), or both in 27 per cent. Failure leading to reoperation was due to hiatal failure in 28 per cent, wrap failure in 19 per cent, both in 33 per cent, and slipped Nissen fundoplication in 20 per cent. Laparoscopic reoperations were completed in 49 of 54 patients (91%); 15 had reoperations undertaken via celiotomy. Eighty-eight per cent of reoperations were Nissen fundoplications. With reoperation, Dysphagia Scores improved from 9.5+/-0.7 to 2.6+/-2.8, and Reflux Scores improved from 9.1+/-1.4 to 1.8+/-2.7. Seventy-nine per cent of patients with reflux prior to reoperation, 100 per cent with dysphagia, and 74 per cent with both noted excellent or good outcomes after reoperation. We conclude that failure after fundoplication occurs. Reoperations reduce the severity of dysphagia and reflux, thus salvaging excellent and good outcomes in most. Laparoscopic reoperations are generally possible. Reoperative fundoplications are effective treatment for dysphagia and recurrent gastroesophageal reflux, and their application is encouraged.

  6. Complications and Reoperations in Mandibular Angle Fractures.

    Science.gov (United States)

    Chen, Collin L; Zenga, Joseph; Patel, Ruchin; Branham, Gregory

    2018-05-01

    Mandible angle fractures can be repaired in a variety of ways, with no consensus on the outcomes of complications and reoperation rates. To analyze patient, injury, and surgical factors, including approach to the angle and plating technique, associated with postoperative complications, as well as the rate of reoperation with regard to mandible angle fractures. Retrospective cohort study analyzing the surgical outcomes of patients with mandible angle fractures between January 1, 2000, and December 31, 2015, who underwent open reduction and internal fixation. Patients were eligible if they were aged 18 years or older, had 3 or less mandible fractures with 1 involving the mandibular angle, and had adequate follow-up data. Patients with comminuted angle fractures, bilateral angle fractures, and multiple surgical approaches were excluded. A total of 135 patients were included in the study. All procedures were conducted at a single, large academic hospital located in an urban setting. Major complications and reoperation rates. Major complications included in this study were nonunion, malunion, severe malocclusion, severe infection, and exposed hardware. Of 135 patients 113 (83.7%) were men; median age was 29 years (range, 18-82 years). Eighty-seven patients (64.4%) underwent the transcervical approach and 48 patients (35.6%) received the transoral approach. Fifteen (17.2%) patients in the transcervical group and 9 (18.8%) patients in the transoral group experienced major complications (difference, 1%; 95% CI, -8% to 10%). Thirteen (14.9%) patients in the transcervical group and 8 (16.7%) patients in the transoral group underwent reoperations (difference, 2%; 95% CI, -13% to 17%). Active smoking had a significant effect on the rate of major complications (odds ratio, 4.04; 95% CI, 1.07 to 15.34; P = .04). During repair of noncomminuted mandibular angle fractures, both of the commonly used approaches-transcervical and transoral-can be used during treatment with equal

  7. Aortic root reoperations after pulmonary autograft implantation

    NARCIS (Netherlands)

    J.A. Bekkers (Jos); L.M.A. Klieverik (Loes Maria Anne); G. Bol-Raap (Goris); J.J.M. Takkenberg (Hanneke); A.J.J.C. Bogers (Ad)

    2010-01-01

    textabstractObjective: To report the results of aortic root reoperations after pulmonary autograft implantation. Methods: All consecutive patients in our prospective Ross research database were selected for analysis, and additional information for patients requiring reoperation was obtained from the

  8. Clinical Outcomes of Reoperation for Failed Antireflux Operations.

    Science.gov (United States)

    Wilshire, Candice L; Louie, Brian E; Shultz, Dale; Jutric, Zeljka; Farivar, Alexander S; Aye, Ralph W

    2016-04-01

    Up to 18% of patients undergoing antireflux operations will require reoperation. Authors caution that with each additional reoperation, fewer patients achieve satisfaction. The quality of life in patients who underwent revision operations was compared with patients who underwent primary antireflux operations to determine the effectiveness of revision operations. We retrospectively reviewed patients who underwent revision after failed antireflux operations from 2004 to 2014. Patients were divided into two groups: first reoperation (Reop[1]) and more than one reoperation (Reop[>1]). For comparison, a control group of patients who underwent primary antireflux operations was included. Patients underwent quality of life assessment preoperatively and postoperatively. We identified 105 reoperative patients: 94 Reop(1), 11 Reop(>1), and 112 controls. The primary reason for failure was combined fundoplication herniation and slippage. Morbidity, mortality, and readmission rates were similar in all groups. Postoperative outcomes were improved in all groups but to a lesser degree in subsequent reoperations. Gastroesophageal Reflux Disease Health-Related Quality of Life: controls, 20.0 to 2.0; Reop(1), 26.5 to 4.0; and Reop(>1), 13.0 to 2.0. Quality of Life in Reflux and Dyspepsia: controls, 4.5 to 7.0; Reop(1), 3.7 to 6.7; and Reop(>1), 3.5 to 5.8. Dysphagia Severity Score: controls, 44.0 to 45.0; Reop(1), 36.0 to 45.0; and Reop(>1), 30.8 to 45.0. Patients undergoing revision antireflux operations have improved quality of life, relatively normal swallowing, and primary symptom resolution at a median of 20 months postoperatively. However, patients who undergo more than one reoperation have lower quality of life scores and less improvement in dysphagia, suggesting that other procedures such as Roux-en-Y or short colon interposition, should be considered after a failed initial reoperation. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights

  9. reoperation rates following intramedullary nailing versus external

    African Journals Online (AJOL)

    Results: Fifty patients were enrolled and completed follow-up at all-time points; twenty-six were treated with IM nail and ... patients over 18 years with Gustilo Type 3A open tibia .... in a randomized fashion with larger sample sizes are.

  10. Reoperation for bleeding in cardiac surgery

    DEFF Research Database (Denmark)

    Kristensen, Katrine Lawaetz; Rauer, Line Juul; Mortensen, Poul Erik

    2012-01-01

    after cardiac surgery was low ejection fraction, high EuroSCORE, procedures other than isolated CABG, elongated time on ECC, low body mass index, diabetes mellitus and preoperatively elevated s-creatinine. Reoperated patients significantly had a greater increase in postoperative s-creatinine and higher...

  11. Re-operation for aortic and mitral prosthetic dysfunctions.

    Science.gov (United States)

    Kaul, T K; Sastry, M R; Mercer, J L; Meade, J B

    1985-01-01

    The overall incidence of re-operation and prosthetic valve endocarditis was low in the present series as mechanical prostheses were used predominantly. The prosthetic dysfunctions were less frequent following the primary implantation with Bjork Shiley prostheses, but high operative risk was associated with the clotted Bjork Shiley prostheses. We also had unusual experience of strut fracture and sticking of Bjork Shiley discs in the closed position in both aortic and mitral positions. The early deaths were nil since the use of cardioplegic protection. Intra-operative bleeding due to adhesions can be minimised by using synthetic or heterologous pericardium during the primary operation.

  12. MIGRATION RATES OF PLANETS DUE TO SCATTERING OF PLANETESIMALS

    International Nuclear Information System (INIS)

    Ormel, C. W.; Ida, S.; Tanaka, H.

    2012-01-01

    Planets migrate due to the recoil they experience from scattering solid (planetesimal) bodies. To first order, the torques exerted by the interior and exterior disks will cancel, analogous to the cancellation of the torques from the gravitational interaction with the gas (Type-I migration). Assuming the dispersion-dominated regime and power laws characterized by indices α and β for the surface density and eccentricity profiles, we calculate the net torque on the planet. We consider both distant encounters and close (orbit-crossing) encounters. We find that the close and distant encounter torques have opposite signs with respect to α and β; and that the torque is especially sensitive to the eccentricity gradient β. Compared to Type-I migration due to excitation of density waves, the planetesimal-driven migration rate is generally lower due to the lower surface density of solids in gas-rich disk, although this may be partially or fully offset when their eccentricity and inclinaton are small. Allowing for the feedback of the planet on the planetesimal disk through viscous stirring, we find that under certain conditions a self-regulated migration scenario emerges, in which the planet migrates at a steady pace that approaches the rate corresponding to the one-sided torque. If the ratio of the local disk mass in planetesimals to planet mass is low, however, migration will stall. We quantify the boundaries separating the three accretion regimes.

  13. Associations between Reoperations and Psychological Factors after Contralateral Risk-Reducing Mastectomy: A Two-Year Follow-Up Study

    Directory of Open Access Journals (Sweden)

    Dmytro Unukovych

    2016-01-01

    Full Text Available Introduction. The aim of the study was to investigate associations between reoperations after contralateral risk-reducing mastectomies (CRRM and emotional problems, body image, sexuality, and health related quality of life (HRQoL in women with breast cancer and hereditary high risk. Patients and Methods. Patients scheduled for CRRM with breast reconstruction between 1998 and 2010 completed questionnaires, comprised of SF-36, the Hospital Anxiety and Depression Scale, the Body Image Scale, and the Sexual Activity Questionnaire, preoperatively and two years after CRRM. Data on reoperations was collected from medical charts. Results. A total of 80 women participated, with a response rate of 61 (76% preoperatively and 57 (71% at the two-year follow-up. At the two-year assessment, 44 (55% patients had undergone ≥1 reoperation (reoperation group, whereas 36 (45% had not (no reoperation group. No statistically significant differences between the groups were found for HRQoL, sexuality, anxiety, or depression. A higher proportion of patients in the “reoperation group” reported being dissatisfied with their bodies (81% versus 48%, p=0.01. Conclusion. The results suggest associations between reoperation following CRRM with breast reconstruction and body image problems. Special attention should be paid to body image problems among women who are subject to reoperations after CRRM.

  14. Indoor external dose rates due to decorative sheet stone

    Energy Technology Data Exchange (ETDEWEB)

    Lu, C.H.; Sheu, R.D.; Jiang, S.H. [Dept. of Engineering and System Science, National Tsing Hua Univ., Hsinchu (Taiwan)

    2002-03-01

    The specific activities in decorative sheet stone made of granite or marble were measured, whereby the absolute peak efficiency of the HPGe detectors employed in the measurements for the sheet-stone sample was determined using the semi-empirical method. The spatial distribution for the indoor external dose rates due to the radionuclides present in the decorative sheet stone used to clad the floor and the four walls of a standard room was calculated using a three-dimensional point kernel computer code. It was found that the spatial distribution for the indoor dose rates was complex and non-uniform, which represents a difference in relation to the results of earlier studies. (orig.)

  15. Indoor external dose rates due to decorative sheet stone

    International Nuclear Information System (INIS)

    Lu, C.H.; Sheu, R.D.; Jiang, S.H.

    2002-01-01

    The specific activities in decorative sheet stone made of granite or marble were measured, whereby the absolute peak efficiency of the HPGe detectors employed in the measurements for the sheet-stone sample was determined using the semi-empirical method. The spatial distribution for the indoor external dose rates due to the radionuclides present in the decorative sheet stone used to clad the floor and the four walls of a standard room was calculated using a three-dimensional point kernel computer code. It was found that the spatial distribution for the indoor dose rates was complex and non-uniform, which represents a difference in relation to the results of earlier studies. (orig.)

  16. [Reoperative valve replacement in patients undergoing cardiac reoperation: a report of 104 cases].

    Science.gov (United States)

    Zou, Liang-jian; Xu, Zhi-yun; Wang, Zhi-nong; Lang, Xi-long; Han, Lin; Lu, Fang-lin; Xu, Ji-bin; Tang, Hao; Ji, Guang-yu; Wang, Er-song; Wang, Jun; Qu, Yi

    2010-08-15

    To review the experience of reoperative valve replacement for 104 patients. From January 2002 to December 2009, 104 patients underwent heart valve replacement in reoperations, accounting for 2.92% of the total patient population (3557 cases) who had valve replacement during this period. In this group, 53 male and 51 female patients were included with a median age of 46 years (ranged from 13 to 72 years). The reasons of reoperation included 28 cases suffered from another valve lesion after valve replacement, 10 cases suffered from valve lesion after mitral valvuloplasty, 19 cases suffered from perivalvular leakage after valve replacement, 18 cases suffered from valve lesion after previous correction of congenital heart defect, 7 cases suffered from bioprosthetic valve decline, 10 cases suffered from prosthetic valve endocarditis, 9 cases suffered from dysfunction of machine valve, and 3 cases suffered from other causes. The re-operations were mitral and aortic valve replacement in 2 cases, mitral valve replacement in 59 cases, aortic valve replacement in 24 cases, tricuspid valve replacement in 16 cases, and Bentall's operation in 3 cases. The interval from first operation to next operation was 1 month-19 years. There were 8 early deaths from heart failure, renal failure and multiple organ failure (early mortality 7.69%). Major complications were intraoperative hemorrhage in 2 cases, re-exploration for mediastinal bleeding in 2 cases and sternotomy surgical site infection in 1 case. Complete follow-up (3 months-7 years and 2 months) was available for all patients. Two patients died, one patient died of intracranial hemorrhage, and another cause was unknown. Satisfactory short-term and long-term results can be obtained in reoperative valve replacement with appropriate timing of operation control, satisfactory myocardial protection, accurate surgical procedure and suitable perioperative treatment.

  17. Reoperation for suboptimal outcomes after deep brain stimulation surgery.

    Science.gov (United States)

    Ellis, Tina-Marie; Foote, Kelly D; Fernandez, Hubert H; Sudhyadhom, Atchar; Rodriguez, Ramon L; Zeilman, Pamela; Jacobson, Charles E; Okun, Michael S

    2008-10-01

    To examine a case series of reoperations for deep brain stimulation (DBS) leads in which clinical scenarios revealed suboptimal outcome from a previous operation. Suboptimally placed DBS leads are one potential reason for unsatisfactory results after surgery for Parkinson's disease (PD), essential tremor (ET), or dystonia. In a previous study of patients who experienced suboptimal results, 19 of 41 patients had misplaced leads. Similarly, another report commented that lead placement beyond a 2- to 3-mm window resulted in inadequate clinical benefit, and, in 1 patient, revision improved outcome. The goal of the current study was to perform an unblinded retrospective chart review of DBS patients with unsatisfactory outcomes who presented for reoperation. Patients who had DBS lead replacements after reoperation were assessed with the use of a retrospective review of an institutional review board-approved movement disorders database. Cases of reoperation for suboptimal clinical benefit were included, and cases of replacement of DBS leads caused by infection or hardware malfunction were excluded. Data points studied included age, disease duration, diagnosis, motor outcomes (the Unified Parkinson Disease Rating Scale III in PD, the Tremor Rating Scale in ET, and the Unified Dystonia Rating Scale in dystonia), quality of life (Parkinson's Disease Questionnaire-39 in PD), and the Clinician Global Impression scale. The data from before and after reoperation were examined to determine the estimated impact of repeat surgery. There were 11 patients with PD, 7 with ET, and 4 with dystonia. The average age of the PD group was 52 years, the disease duration was 10 years, and the average vector distance of the location of the active DBS contact was adjusted 5.5 mm. Six patients (54%) with PD had preoperative off medication on DBS Unified Parkinson Disease Rating Scale scores that could be compared with postoperative off medication on DBS scores. The average improvement across this

  18. Outcomes promote reoperative Heller myotomy for symptoms of achalasia.

    Science.gov (United States)

    Rakita, S; Villadolid, D; Kalipersad, C; Thometz, D; Rosemurgy, A

    2007-10-01

    Heller myotomy is accepted as first-line therapy for achalasia, yet for a small number of patients, symptoms persist or recur after myotomy. This study was undertaken to report our results with reoperative laparoscopic Heller myotomy for recurrent symptoms of achalasia. We have undertaken laparoscopic Heller myotomy in 275 patients and reoperative myotomy in 12 patients for recurrent dysphagia, of which three had their initial myotomy undertaken by us. For each, studies prior to reoperative Heller myotomy documented a nonrelaxing lower esophageal sphincter without stricture. Patients scored symptoms before and after reoperative myotomy. Before reoperative myotomy, 75% underwent dilation and 42% underwent Botox injection. Ten of twelve reoperative myotomies were undertaken and completed laparoscopically. Median follow-up is 24.1 months (29.0 months + 25.89). Symptom frequency and severity scores improved significantly after reoperative myotomy. Frequency of vomiting and frequency and severity of heartburn were improved after reoperative myotomy, but not to a significant extent. However, they were not particularly notable prior to surgery, compared to obstructive symptoms, such as dysphagia. Excellent or good outcomes were reported in 73%, and notably, 91% stated that they would have the operation again after having been through the process firsthand and knowing their outcomes. Patient outcomes promote the application of reoperative Heller myotomy for recurrent or persistent symptoms of achalasia following Heller myotomy.

  19. The relationship between abduction deficit and reoperation among patients with infantile esotropia

    Directory of Open Access Journals (Sweden)

    Zhale Rajavi

    2018-03-01

    Full Text Available AIM: To determine the relationship between abduction deficit and reoperation among patients with infantile esotropia (IET. METHODS: The records of 216 patients (432 eyes with IET who underwent surgery, from 2010 to 2015 were studied. Patients with IET whose deviation appeared before 6mo of age and had stable preoperative deviation in two examinations with at least 2wk apart and a minimum 3mo postoperative follow up were included. Cases with early onset accommodative esotropia, congenital cataract, retinopathy of prematurity (ROP, manifest nystagmus, fundus lesions, neurologic and ophthalmic anomalies, 6th nerve palsy and Duane’s syndrome were excluded. Preoperative abduction deficit was considered from -1 to -3 grading scale. Three months after surgery, children were classified into no-need reoperation [deviation≤15 prism diopters (PD], and need-reoperation groups (deviation>15 PD. RESULTS: In this retrospective study, 117 female and 99 male patients with the mean surgical age of 4.7±6.4y were included. Reoperation rate was 33.3% and 16.0% in IET patients with and without abduction deficit, respectively in patients who had a history of late surgery. Abduction deficit increased the odds of reoperation by 82% [OR=1.82, 95% confidence interval (CI =1.05 to 3.19, P=0.003] in patients who had a history of late surgery (>2 years old, P=0.021. Abduction deficit was improved significantly after operation (P<0.001. CONCLUSION: Based on our results, abduction deficit can be considered as a risk factor of reoperation in IET patients who are operated at the age of more than 2y.

  20. The relationship between abduction deficit and reoperation among patients with infantile esotropia.

    Science.gov (United States)

    Rajavi, Zhale; Sabbaghi, Hamideh; Torkian, Pooya; Behradfar, Narges; Yaseri, Mehdi; Feizi, Mohadeseh; Faghihi, Mohammad; Sheibani, Kourosh

    2018-01-01

    To determine the relationship between abduction deficit and reoperation among patients with infantile esotropia (IET). The records of 216 patients (432 eyes) with IET who underwent surgery, from 2010 to 2015 were studied. Patients with IET whose deviation appeared before 6mo of age and had stable preoperative deviation in two examinations with at least 2wk apart and a minimum 3mo postoperative follow up were included. Cases with early onset accommodative esotropia, congenital cataract, retinopathy of prematurity (ROP), manifest nystagmus, fundus lesions, neurologic and ophthalmic anomalies, 6 th nerve palsy and Duane's syndrome were excluded. Preoperative abduction deficit was considered from -1 to -3 grading scale. Three months after surgery, children were classified into no-need reoperation [deviation≤15 prism diopters (PD)], and need-reoperation groups (deviation>15 PD). In this retrospective study, 117 female and 99 male patients with the mean surgical age of 4.7±6.4y were included. Reoperation rate was 33.3% and 16.0% in IET patients with and without abduction deficit, respectively in patients who had a history of late surgery. Abduction deficit increased the odds of reoperation by 82% [OR=1.82, 95% confidence interval (CI) =1.05 to 3.19, P =0.003] in patients who had a history of late surgery (>2 years old, P =0.021). Abduction deficit was improved significantly after operation ( P <0.001). Based on our results, abduction deficit can be considered as a risk factor of reoperation in IET patients who are operated at the age of more than 2y.

  1. Non-self-averaging nucleation rate due to quenched disorder

    International Nuclear Information System (INIS)

    Sear, Richard P

    2012-01-01

    We study the nucleation of a new thermodynamic phase in the presence of quenched disorder. The quenched disorder is a generic model of both impurities and disordered porous media; both are known to have large effects on nucleation. We find that the nucleation rate is non-self-averaging. This is in a simple Ising model with clusters of quenched spins. We also show that non-self-averaging behaviour is straightforward to detect in experiments, and may be rather common. (fast track communication)

  2. Process Measurement Deviation Analysis for Flow Rate due to Miscalibration

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Eunsuk; Kim, Byung Rae; Jeong, Seog Hwan; Choi, Ji Hye; Shin, Yong Chul; Yun, Jae Hee [KEPCO Engineering and Construction Co., Deajeon (Korea, Republic of)

    2016-10-15

    An analysis was initiated to identify the root cause, and the exemption of high static line pressure correction to differential pressure (DP) transmitters was one of the major deviation factors. Also the miscalibrated DP transmitter range was identified as another major deviation factor. This paper presents considerations to be incorporated in the process flow measurement instrumentation calibration and the analysis results identified that the DP flow transmitter electrical output decreased by 3%. Thereafter, flow rate indication decreased by 1.9% resulting from the high static line pressure correction exemption and measurement range miscalibration. After re-calibration, the flow rate indication increased by 1.9%, which is consistent with the analysis result. This paper presents the brief calibration procedures for Rosemount DP flow transmitter, and analyzes possible three cases of measurement deviation including error and cause. Generally, the DP transmitter is required to be calibrated with precise process input range according to the calibration procedure provided for specific DP transmitter. Especially, in case of the DP transmitter installed in high static line pressure, it is important to correct the high static line pressure effect to avoid the inherent systematic error for Rosemount DP transmitter. Otherwise, failure to notice the correction may lead to indicating deviation from actual value.

  3. The Effect of Steroids on Complications, Readmission, and Reoperation After Posterior Lumbar Fusion.

    Science.gov (United States)

    Cloney, Michael B; Garcia, Roxanna M; Smith, Zachary A; Dahdaleh, Nader S

    2018-02-01

    The effects of chronic corticosteroid therapy on complications, readmission, and reoperation after posterior lumbar fusion (PLF) remain underinvestigated, and were examined to determine differences in outcomes. We analyzed patients undergoing PLF between 2006 and 2013 using the National Surgery Quality Improvement Program database (NSQIP). Patients taking steroids for a chronic condition were compared with those not taking steroids. Multivariable regression identified factors independently associated with complications, readmission, and reoperation. A risk score was calculated for predicting complications. A total of 8492 patients were identified, of whom 353 used steroids. The patients using steroids were older (mean age, 65.4 years vs. 61.0 years; P steroid group. On multivariable regression, steroids were independently associated with overall complications (odds ratio [OR], 1.38; P = 0.044) and infectious complications (OR, 1.65; P < 0.001), but not with medical complications, readmission, or reoperation. Patients with higher risk scores had higher complication rates. The use of corticosteroid therapy is associated with a moderately increased risk of overall complications, but no association was found with readmission or reoperation. Copyright © 2017. Published by Elsevier Inc.

  4. Contemporary management of anastomotic leak after colon surgery: assessing the need for reoperation.

    Science.gov (United States)

    Moghadamyeghaneh, Zhobin; Hanna, Mark H; Alizadeh, Reza Fazl; Carmichael, Joseph C; Mills, Steven; Pigazzi, Alessio; Stamos, Michael J

    2016-06-01

    We sought to investigate contemporary management of anastomosis leakage (AL) after colonic anastomosis. The American College of Surgeons National Surgical Quality Improvement Program database 2012 to 2013 was used to identify patients with AL. Multivariate regression analysis was performed to find predictors of the need for surgical intervention in management of AL. A total of 32,280 patients underwent colon resection surgery with 1,240 (3.8%) developing AL. Overall, 43.9% of patients with AL did not require reoperation. Colorectal anastomosis had significantly higher risk of AL compared with ileocolonic anastomosis (adjusted odds ratio [AOR], 1.20; P = .04). However, the rate of need for reoperation was higher for AL in colocolonic anastomosis compared with ileocolonic anastomosis (AOR, 1.48; P = .04). White blood cell count (AOR, 1.07; P < .01), the presence of intra-abdominal infection with leakage (AOR, 1.47; P = .01), and protective stoma (AOR, .43, P = .02) were associated with reoperation after AL. Nonoperative treatment is possible in almost half of the patients with colonic AL. The anatomic location of the anastomosis impacts the risk of AL. Severity of leakage, the presence of a stoma, and general condition of patients determine the need for reoperation. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Staged abdominal re-operation for abdominal trauma.

    Science.gov (United States)

    Taviloglu, Korhan

    2003-07-01

    To review the current developments in staged abdominal re-operation for abdominal trauma. To overview the steps of damage control laparotomy. The ever increasing importance of the resuscitation phase with current intensive care unit (ICU) support techniques should be emphasized. General surgeons should be familiar to staged abdominal re-operation for abdominal trauma and collaborate with ICU teams, interventional radiologists and several other specialties to overcome this entity.

  6. Re-admissions, re-operations and length of stay in hospital after aseptic revision knee replacement in Denmark

    DEFF Research Database (Denmark)

    Lindberg-Larsen, M.; Jørgensen, C. C.; Hansen, Torben Bæk

    2014-01-01

    of hospital stay was four days (interquartile range: 3 to 5), with a 90 days re-admission rate of 9.9%, re-operation rate of 3.5% and mortality rate of 0.2%. The age ranges of 51 to 55 years (p = 0.018), 76 to 80 years (p re-admission...

  7. Inlay buccal mucosal graft for reoperative posterior urethroplasty

    Directory of Open Access Journals (Sweden)

    Shou-Hung Tang

    2012-04-01

    Full Text Available Posterior urethral distraction injury following major pelvic trauma is a surgical challenge. Although rarely seen, cases of failure after formal urethral reconstruction are even more problematic. We adapted the concept of augmented free buccal mucosal grafts, which have been successful in anterior urethroplasty, for repairing the posterior urethra in these rare cases with the aim of reducing the likelihood of penile chordee postoperatively. During 2007–2009, four patients were candidates for the proposed procedure because they had received formal transperineal urethral reconstruction but were unable to urinate through the urethra. The urethra was approached transperineally and opened in the midline, rather than divided. Buccal mucosal grafts of an appropriate size were placed in the created urethral groove from 4- to 8 o’clock in the lithotomy view. After the procedure, the urethral catheter was kept for 3 weeks. All patients voided through the urethra after the procedure. The maximal postoperative urinary flow rates were between 12–15 ml/seconds in all cases for a follow-up period of 18–30 months. The recurrence rate was 50% (2/4. Recurrent strictures were minor, and they showed a web-like stricture ring near the suture line. Restricture within 6 months of surgery responded well to endoscopic internal urethrotomy plus dilatations. In conclusion, without further compromising urethral length, reoperative posterior urethroplasty with the inlay grafting technique can be considered in selective cases.

  8. Inlay buccal mucosal graft for reoperative posterior urethroplasty.

    Science.gov (United States)

    Tang, Shou-Hung; Kao, Chien-Chang; Wu, Seng-Tang; Meng, En; Cha, Tai-Lung

    2012-04-01

    Posterior urethral distraction injury following major pelvic trauma is a surgical challenge. Although rarely seen, cases of failure after formal urethral reconstruction are even more problematic. We adapted the concept of augmented free buccal mucosal grafts, which have been successful in anterior urethroplasty, for repairing the posterior urethra in these rare cases with the aim of reducing the likelihood of penile chordee postoperatively. During 2007-2009, four patients were candidates for the proposed procedure because they had received formal transperineal urethral reconstruction but were unable to urinate through the urethra. The urethra was approached transperineally and opened in the midline, rather than divided. Buccal mucosal grafts of an appropriate size were placed in the created urethral groove from 4- to 8 o'clock in the lithotomy view. After the procedure, the urethral catheter was kept for 3 weeks. All patients voided through the urethra after the procedure. The maximal postoperative urinary flow rates were between 12-15 ml/seconds in all cases for a follow-up period of 18-30 months. The recurrence rate was 50% (2/4). Recurrent strictures were minor, and they showed a web-like stricture ring near the suture line. Restricture within 6 months of surgery responded well to endoscopic internal urethrotomy plus dilatations. In conclusion, without further compromising urethral length, reoperative posterior urethroplasty with the inlay grafting technique can be considered in selective cases. Copyright © 2012. Published by Elsevier B.V.

  9. Reoperations after first lumbar disc herniation surgery; a special interest on residives during a 5-year follow-up

    Directory of Open Access Journals (Sweden)

    Kautiainen Hannu

    2007-01-01

    Full Text Available Abstract Background The overall rate of operations after recurrent lumbar disc herniation has been shown to be 3–11%. However, little is known about the rate of residives. Thus the aim of this study was to explore the cumulative rates of re-operations and especially residive disc herniations at the same side and level as the primary disc herniation after first lumbar disc herniation surgery and the factors that influence the risk of re-operations over a five year follow-up study. Methods 166 virgin lumbar disc herniation patients (mean age 42 years, 57% males were studied. Data on patients' initial disc operations and type and timing of re-operations during the follow-up were collected from patient files. Back and leg pain on visual analog scale and employment status were collected by questionnaires. Results The cumulative rate of re-operations for lumbar disc herniation was 10.2% (95% Cl 6.0 to 15.1. The rate of residives at initial site was 7.4% (95% Cl 3.7 to 11.3 and rate of lumbar disc herniations at other sites was 3.1% (95% Cl 0.6 to 6.2. The occurrence of residive lumbar disc herniations was evenly distributed across the 5 years. Neither age, gender, preoperative symptoms, physical activity nor employment had effect on the probability of re-operation. Conclusion Seven percent of the lumbar disc patients had a residive lumbar disc operation within five years of their first operation. No specific factors influencing the risk for re-operation were found.

  10. Reoperation after failed resective epilepsy surgery in children.

    Science.gov (United States)

    Muthaffar, Osama; Puka, Klajdi; Rubinger, Luc; Go, Cristina; Snead, O Carter; Rutka, James T; Widjaja, Elysa

    2017-08-01

    OBJECTIVE Although epilepsy surgery is an effective treatment option, at least 20%-40% of patients can continue to experience uncontrolled seizures resulting from incomplete resection of the lesion, epileptogenic zone, or secondary epileptogenesis. Reoperation could eliminate or improve seizures. Authors of this study evaluated outcomes following reoperation in a pediatric population. METHODS A retrospective single-center analysis of all patients who had undergone resective epilepsy surgery in the period from 2001 to 2013 was performed. After excluding children who had repeat hemispherotomy, there were 24 children who had undergone a second surgery and 2 children who had undergone a third surgery. All patients underwent MRI and video electroencephalography (VEEG) and 21 underwent magnetoencephalography (MEG) prior to reoperation. RESULTS The mean age at the first and second surgery was 7.66 (SD 4.11) and 10.67 (SD 4.02) years, respectively. The time between operations ranged from 0.03 to 9 years. At reoperation, 8 patients underwent extended cortical resection; 8, lobectomy; 5, lesionectomy; and 3, functional hemispherotomy. One year after reoperation, 58% of the children were completely seizure free (International League Against Epilepsy [ILAE] Class 1) and 75% had a reduction in seizures (ILAE Classes 1-4). Patients with MEG clustered dipoles were more likely to be seizure free than to have persistent seizures (71% vs 40%, p = 0.08). CONCLUSIONS Reoperation in children with recurrent seizures after the first epilepsy surgery could result in favorable seizure outcomes. Those with residual lesion after the first surgery should undergo complete resection of the lesion to improve seizure outcome. In addition to MRI and VEEG, MEG should be considered as part of the reevaluation prior to reoperation.

  11. Utility of Indocyanine Green Fluorescence Imaging for Intraoperative Localization in Reoperative Parathyroid Surgery.

    Science.gov (United States)

    Sound, Sara; Okoh, Alexis; Yigitbas, Hakan; Yazici, Pinar; Berber, Eren

    2015-10-27

    Due to the variations in anatomic location, the identification of parathyroid glands may be challenging. Although there have been advances in preoperative imaging modalities, there is still a need for an accurate intraoperative guidance. Indocyanine green (ICG) is a new agent that has been used for intraoperative fluorescence imaging in a number of general surgical procedures. Its utility for parathyroid localization in humans has not been reported in the literature. We report 3 patients who underwent reoperative neck surgery for primary hyperparathyroidism. Using a video-assisted technique with intraoperative ICG fluorescence imaging, the parathyroid glands were recognized and removed successfully in all cases. Surrounding soft tissue structures remained nonfluorescent, and could be distinguished from the parathyroid glands. This report suggests a potential utility of ICG imaging in intraoperative localization of parathyroid glands in reoperative neck surgery. Future work is necessary to assess its benefit for first-time parathyroid surgery. © The Author(s) 2015.

  12. A new measurement for posterior tilt predicts reoperation in undisplaced femoral neck fractures: 113 consecutive patients treated by internal fixation and followed for 1 year

    DEFF Research Database (Denmark)

    Palm, Henrik; Gosvig, Kasper; Krasheninnikoff, Michael

    2009-01-01

    BACKGROUND AND PURPOSE: Preoperative posterior tilt in undisplaced (Garden I-II) femoral neck fractures is thought to influence rates of reoperation. However, an exact method for its measurement has not yet been presented. We designed a new measurement for posterior tilt on preoperative lateral...... radiographs and investigated its association with later reoperation. PATIENTS AND METHODS: A consecutive series of 113 patients, > or = 60 years of age with undisplaced (Garden I-II) femoral neck fractures treated with two parallel implants, was assessed regarding patient characteristics, radiographs...... and able to predict reoperation in patients with undisplaced (Garden I-II) femoral neck fractures....

  13. Mortalidad y reintervenciones en cirugía general Mortality and reoperations in general surgery

    Directory of Open Access Journals (Sweden)

    Zenén Rodríguez Fernández

    2012-11-01

    . Results: The highest number of deaths was related to several reoperations after 10 days of the initial surgery in aged patients. The main complications were intraabdominal abscess, evisceration, residual peritonitis and dehiscence of intestinal sutures. This series represented 24.5% of the total of reoperated patients, and colon neoplasia, complicated peptic ulcer and intestinal occlusion prevailed in the initial preoperative diagnosis. Conclusions: Age, number of reoperations and the time between the initial surgery and reoperation increase the mortality rate associated with multiple organ failure.

  14. Breast cancer recurrence after reoperation for surgical bleeding

    DEFF Research Database (Denmark)

    Pedersen, Rikke Nørgaard; Bhaskaran, K; Heide-Jørgensen, U

    2017-01-01

    BACKGROUND: Bleeding activates platelets that can bind tumour cells, potentially promoting metastatic growth in patients with cancer. This study investigated whether reoperation for postoperative bleeding is associated with breast cancer recurrence. METHODS: Using the Danish Breast Cancer Group...... database and the Danish National Patient Register (DNPR), a cohort of women with incident stage I-III breast cancer, who underwent breast-conserving surgery or mastectomy during 1996-2008 was identified. Information on reoperation for bleeding within 14 days of the primary surgery was retrieved from.......i. 0·89 to 1·26). The estimates did not vary by site of breast cancer recurrence. CONCLUSION: In this large cohort study, there was no evidence of an association between reoperation for bleeding and breast cancer recurrence....

  15. Frequency of reoperations in patients with Marfan syndrome.

    Science.gov (United States)

    Geisbuesch, Sarah; Schray, Deborah; Bischoff, Moritz S; Lin, Hung-Mo; Di Luozzo, Gabriele; Griepp, Randall B

    2012-05-01

    We undertook a retrospective study of the pattern of reoperations in surgical patients with Marfan disease. Between 1985 and 2008, 83 Marfan patients (60 males, 23 females) underwent 155 aortic operations in our institution. Twenty-eight patients had acute dissection (22 type A, 6 type B), and two had aortic rupture. Mean age at initial operation was 32±13 years. Operations included valve-sparing or Bentall aortic root repair, and ascending aorta, arch, descending thoracic, thoracoabdominal aorta, and infrarenal aortic replacement. Sixty-one patients whose initial operation was elective (Group I) were compared with 22 patients with initial emergency surgery (Group II). Overall, 81/83 patients ultimately underwent root/ascending repair: 64% initially and 36% at reoperation. Operative mortality in Group I was 1.6% for both initial operations and reoperations vs 9.0% and 0% in Group II. Significant differences between Group I and Group II patients included: total reoperations (1 vs 3, p=0.05); arch operations (0 vs 1, p=0.003); descending thoracic aortic operations (0 vs 0.5, p=0.003); and total aortic segments replaced (1.6±1.0 vs 2.4±1.1, p=0.001). Survival at 5 and 10 years did not differ between Group I and II patients (87% and 71% vs 82% and 56%, p=0.19). Although reoperation occurs in about half of surgical Marfan patients, reoperative mortality is low. Patients with initial elective procedures fare better than those with initial emergency surgery: they have fewer subsequent operations, fewer aortic segments replaced, and trend toward improved survival. Elective root replacement should be seriously considered in any Marfan patient with significant root dilatation. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Weight Loss Failure and Reoperation After Laparoscopic Adjustable Gastric Banding and Gastric Bypass: a Case-Matched Cohort Study.

    Science.gov (United States)

    Bittner, James G; Clingempeel, Natasha L; Wolf, Luke G

    2017-11-01

    Not long ago, laparoscopic adjustable gastric banding (LAGB) was considered a safe and effective treatment of morbid obesity; however, long-term outcomes revealed significant complication and failure rates. We hypothesized that LAGB has higher rates of weight loss failure, reoperation, and overall failure compared to laparoscopic gastric bypass (LRYGB) at long-term follow-up. A matched case-control study was performed. Patients who underwent primary LAGB or LRYGB at a university hospital between 2004 and 2011 were propensity matched for age, gender, race, body mass index (BMI), and weight-related co-morbidities. Outcomes included demographics, percent excess weight loss (% EWL) and reoperation, weight loss failure (failure (procedure-related reoperation and/or failure at 3 years (75 vs. 10.5%, P failure rates were higher after LAGB. The most common complication after LAGB was pouch/esophageal enlargement (9.7%) and after LRYGB was internal hernia (4.8%). LAGB patients had higher morbidity (19 vs. 12.7%, P = 0.04) but similar procedure-related mortality (0 vs. 0.4%). LAGB has significantly higher rates of weight loss failure compared to LRYGB with similar rates of procedure-related reoperation. Overall failure rates are higher after LAGB. These data suggest the long-term effectiveness of LAGB might be limited.

  17. Breast cancer recurrence after reoperation for surgical bleeding

    DEFF Research Database (Denmark)

    Pedersen, Rikke Nørgaard; Bhaskaran, K; Heide-Jørgensen, U

    2017-01-01

    BACKGROUND: Bleeding activates platelets that can bind tumour cells, potentially promoting metastatic growth in patients with cancer. This study investigated whether reoperation for postoperative bleeding is associated with breast cancer recurrence. METHODS: Using the Danish Breast Cancer Group...... database and the Danish National Patient Register (DNPR), a cohort of women with incident stage I-III breast cancer, who underwent breast-conserving surgery or mastectomy during 1996-2008 was identified. Information on reoperation for bleeding within 14 days of the primary surgery was retrieved from...

  18. Reoperation after laparoscopic colorectal surgery. Does the laparoscopic approach have any advantages?

    Science.gov (United States)

    Ibáñez, Noelia; Abrisqueta, Jesús; Luján, Juan; Sánchez, Pedro; Soriano, María Teresa; Arevalo-Pérez, Julio; Parrilla, Pascual

    2018-02-01

    The laparoscopic approach in colorectal complications is controversial because of its difficulty. However, it has been proven that it can provide advantages over open surgery. The aim of this study is to compare laparoscopic approach in reoperations for complications after colorectal surgery with the open approach taking into account the severity of the patient prior to reoperation. Patients who underwent laparoscopic colorectal surgery from January 2006 to December 2015 were retrospectively reviewed. Patients requiring urgent surgical procedures for complications in the postoperative period were divided in two groups: laparoscopic surgery (LS) and open surgery (OS). To control clinical severity prior to reoperation, The Mannheim Peritonitis Index (MPI) was calculated. A total of 763 patients were studied, 40 required urgent surgery (24 OS/16 LS). More ileostomies were performed in the LS group (68.7% vs. 29.2%) and more colostomies in the OS group (37.5% vs. 6.2%), pstart of oral tolerance and less surgical wound infection (pstart of oral tolerance and a lower abdominal wall complication rate in patients with low severity index. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Is laparoscopic reoperation for failed antireflux surgery feasible?

    Science.gov (United States)

    Floch, N R; Hinder, R A; Klingler, P J; Branton, S A; Seelig, M H; Bammer, T; Filipi, C J

    1999-07-01

    Laparoscopic techniques can be used to treat patients whose antireflux surgery has failed. Case series. Two academic medical centers. Forty-six consecutive patients, of whom 21 were male and 25 were female (mean age, 55.6 years; range, 15-80 years). Previous antireflux procedures were laparoscopic (21 patients), laparotomy (21 patients), thoracotomy (3 patients), and thoracoscopy (1 patient). The cause of failure, operative and postoperative morbidity, and the level of follow-up satisfaction were determined for all patients. The causes of failure were hiatal herniation (31 patients [67%]), fundoplication breakdown (20 patients [43%]), fundoplication slippage (9 patients [20%]), tight fundoplication (5 patients [11%]), misdiagnosed achalasia (2 patients [4%]), and displaced Angelchik prosthesis (2 patients [4%]). Twenty-two patients (48%) had more than 1 cause. Laparoscopic reoperative procedures were Nissen fundoplication (n = 22), Toupet fundoplication (n = 13), paraesophageal hernia repair (n = 4), Dor procedure (n = 2), Angelchik prosthesis removal (n = 2), Heller myotomy (n = 2), and the takedown of a wrap (n = 1). In addition, 18 patients required crural repair and 13 required paraesophageal hernia repair. The mean +/- SEM duration of surgery was 3.5+/-1.1 hours. Operative complications were fundus tear (n = 8), significant bleeding (n = 4), bougie perforation (n = 1), small bowel enterotomy (n = 1), and tension pneumothorax (n = 1). The conversion rate (from laparoscopic to an open procedure) was 20% overall (9 patients) but 0% in the last 10 patients. Mortality was 0%. The mean +/- SEM hospital stay was 2.3+/-0.9 days for operations completed laparoscopically. Follow-up was possible in 35 patients (76%) at 17.2+/-11.8 months. The well-being score (1 best; 10, worst) was 8.6+/-2.1 before and 2.9+/-2.4 after surgery (Papproach may be used successfully to treat patients with failed antireflux operations. Good results were achieved despite the technical

  20. A second chance--reoperation in patients with failed surgery for intractable epilepsy: long-term outcome, neuropsychology and complications.

    Science.gov (United States)

    Grote, Alexander; Witt, Juri-Alexander; Surges, Rainer; von Lehe, Marec; Pieper, Madeleine; Elger, Christian E; Helmstaedter, Christoph; Ormond, D Ryan; Schramm, Johannes; Delev, Daniel

    2016-04-01

    Resective surgery is a safe and effective treatment of drug-resistant epilepsy. If surgery has failed reoperation after careful re-evaluation may be a reasonable option. This study was to summarise the risks and benefits of reoperation in patients with epilepsy. This is a retrospective single centre study comprising clinical data, long-term seizure outcome, neuropsychological outcome and postoperative complications of patients, who had undergone a second resective epilepsy surgery from 1989 to 2009. A total of 66 patients with median follow-up of 10.3 years were included into the study. Fifty-one patients (77%) had surgery for temporal lobe epilepsy, the remaining 15 cases for extra-temporal lobe epilepsies. The most frequent histological findings were tumours (n=33, 50%), followed by dysplasia, gliosis (n=11, each) and hippocampus sclerosis (n=9). The main reasons for seizure recurrence were incomplete resection (59.1%) of the putative epileptogenic lesion. After reoperation 46 patients (69.7%) were completely seizure-free International League Against Epilepsy 1 (ILAE 1) at the last available follow-up. The neuropsychological evaluation demonstrated that repeated losses in the same cognitive domain, that is, successive changes from better to worse performance categories, were rare and that those losses after first surgery were followed by improvement rather than decline. However, reoperations lead to an increased rate of permanent neurological deficits (9%), overall surgical complications (9%) and visual field deficits (67%). Reoperation after failed resective epilepsy surgery led to approximately 70% long-time seizure freedom and reasonable neuropsychological outcome. There is an increased risk of permanent postoperative neurological deficits, which should be taken into consideration when counselling for reoperation. 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/

  1. Risk factors for reoperation after initial burr hole trephination in chronic subdural hematomas.

    Science.gov (United States)

    Schwarz, Falko; Loos, Franz; Dünisch, Pedro; Sakr, Yasser; Safatli, Diaa Al; Kalff, Rolf; Ewald, Christian

    2015-11-01

    The optimal management of chronic subdural hematomas remains a challenge. Twist drill craniotomy or burr hole trephination are considered optimal initial treatments, but the reoperation rate for hematoma recurrence and other complications is still high. Therefore, evaluation of possible risk factors for initial treatment failure is crucial. In this context, we performed a study to define a possible subpopulation that may benefit from a more invasive initial treatment regime. We retrospectively reviewed the medical charts of 193 patients with 250 chronic subdural hematomas who had undergone burr hole trephination as first-line therapy in our institution between January 2005 and October 2012. To identify risk factors for reoperation, a multivariable logistic regression analysis was performed with reoperation as the dependent variable. Surgical complications, including acute rebleeding, infection and chronic hematoma recurrence, were analyzed separately using a logistic regression model. The mean age of the cohort was 71.4 years. The male/female ratio was 137:56. Reoperation was necessary in 56 cases (29%) for recurrent hematomas and surgical complications. Predictors for reoperation for surgical complications were midline shift (odds ratio [OR] (per mm) 1.16, 95% confidence interval [CI]: 1.05-1.29, p=0.006), arterial hypertension (OR 5.44, 95% CI: 1.45-20.41, p=0.012) and bilateral hematomas (OR 4.22, 95% CI: 1.22-14.58, p=0.023). There was a trend toward a higher risk of surgically-relevant hematoma recurrence in patients with prior treatment with vitamin K antagonists (OR 1.76, 95% CI: 0.75-4.13, p=0.191). Burr hole trephination is the therapy of choice in most chronic subdural hematomas, but the rate of recurrent hematomas is high. Every hematoma should be treated individually especially in relation to midline-shift and pre-existing conditions. Further prospective studies evaluating types of treatment and hematoma density are needed. Copyright © 2015 Elsevier B

  2. Outcomes of glaucoma reoperations in the Tube Versus Trabeculectomy (TVT) Study.

    Science.gov (United States)

    Saheb, Hady; Gedde, Steven J; Schiffman, Joyce C; Feuer, William J

    2014-06-01

    To describe the incidence and outcomes of reoperations for glaucoma in the Tube Versus Trabeculectomy (TVT) Study. Cohort study of patients in a multicenter randomized clinical trial. The TVT Study enrolled 212 patients with medically uncontrolled glaucoma who had previous cataract and/or glaucoma surgery. Randomization assigned 107 patients to surgery with a tube shunt (350 mm(2) Baerveldt glaucoma implant) and 105 patients to trabeculectomy with mitomycin C (0.4 mg/mL for 4 minutes). Data were analyzed from patients who failed their assigned treatment and had additional glaucoma surgery. Outcome measures included intraocular pressure (IOP), use of glaucoma medications, visual acuity, surgical complications, and failure (IOP >21 mm Hg or not reduced by 20%, IOP ≤5 mm Hg, additional glaucoma surgery, or loss of light perception vision). Additional glaucoma surgery was performed in 8 patients in the tube group and 18 patients in the trabeculectomy group in the TVT Study, and the 5-year cumulative reoperation rate was 9% in the tube group and 29% in the trabeculectomy group (P = .025). Follow-up (mean ± SD) after additional glaucoma surgery was 28.0 ± 16.0 months in the tube group and 30.5 ± 20.4 months in the trabeculectomy group (P = .76). At 2 years after a glaucoma reoperation, IOP (mean ± SD) was 15.0 ± 5.5 mm Hg in the tube group and 14.4 ± 6.6 mm Hg in the trabeculectomy group (P = .84). The number of glaucoma medications (mean ± SD) after 2 years of follow-up was 1.1 ± 1.3 in the tube group and 1.4 ± 1.4 in the trabeculectomy group (P = .71). The cumulative probability of failure at 1, 2, 3, and 4 years after additional glaucoma surgery was 0%, 43%, 43%, and 43%, respectively, in the tube group, and 0%, 9%, 20%, and 47% in the trabeculectomy group (P = .28). Reoperations to manage complications were required in 1 patient in the tube group and 5 patients in the trabeculectomy group (P = .63). The rate of reoperation for glaucoma was higher following

  3. Laparoscopy-assisted versus transabdominal reoperation in Hirschprung's disease for residual aganglionosis and transition zone pathology after transanal pull-through.

    Science.gov (United States)

    Xia, Xue; Li, Ning; Wei, Jia; Zhang, Wen; Yu, Donghai; Zhu, Tianqi; Feng, Jiexiong

    2016-04-01

    This study aims to describe laparoscopic reoperation (LSR) and compare its outcomes with transabdominal reoperation (TAR) for treating Hirschsprung's disease (HD). Eighteen patients with HD underwent reoperation for recurring constipation due to residual aganglionosis and transition zone pathology after an initial transanal procedure (LSR, n=10; TAR, n=8). Preoperative, operative and postoperative data were collected through patient follow-ups ranging from 13 to 75months to compare operative characteristics and postoperative outcomes between the two groups. Ten patients underwent laparoscopic reoperation in our institution without major complications. On average, blood loss was significantly lower in the LSR group (mean±standard deviation, 83±32.7mL) than in the TAR group (185±69mL) (P=0.001). The LSR group had a shorter hospitalization time (12±2days) than the TAR group (15±2.1days) (P=0.02). There was no statistically significant difference in incidence of postoperative complications between the two groups. LSR is safe and technically feasible in HD for recurring constipation due to residual aganglionosis and transition zone pathology, when initial transanal procedure fails. Although RA and TZP can be cured by reoperation, great efforts should be made to diminish the necessity of reoperation. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. The Clinical Features and Predictive Risk Factors for Reoperation in Patients With Perianal Crohn Diseases; A Multi-Center Study of a Korean Inflammatory Bowel Disease Study Group

    Science.gov (United States)

    Lee, Jae Bum; Yoon, Seo-Gue; Park, Kyu Joo; Lee, Kang Young; Kim, Dae Dong; Yoon, Sang Nam

    2015-01-01

    Purpose Perianal lesions are common in Crohn disease, but their clinical course is unpredictable. Nevertheless, predicting the clinical course after surgery for perianal Crohn disease (PCD) is important because repeated operations may decrease patient's quality of life. The aim of this study was to predict the risk of reoperation in patients with PCD. Methods From September 1994 to February 2010, 377 patients with PCD were recruited in twelve major tertiary university-affiliated hospitals and two specialized colorectal hospitals in Korea. Data on the patient's demographics, clinical features, and surgical outcomes were analyzed. Results Among 377 patients, 227 patients were ultimately included in the study. Among the 227 patients, 64 patients underwent at least one reoperation. The median period of reoperation following the first perianal surgery was 94 months. Overall 3-year, 5-year, and 10-year cumulative rates of reoperation-free individuals were 68.8%, 61.2%, and 50.5%, respectively. In multivariate analysis (Cox-regression hazard model), reoperation was significantly correlated with an age of onset less than 20 years (hazard ratio [HR], 1.93; 95% confidence interval [CI], 1.07-3.48; P = 0.03), history of abdominal surgery (HR, 1.99; 95% CI, 1.08-3.64; P = 0.03), and the type of surgery. Among types of surgery, fistulotomy or fistulectomy was associated with a decreased incidence of reoperation in comparison with incision and drainage (HR, 0.19; 95% CI, 0.09-0.42; P < 0.001). Conclusion Young age of onset and a history of abdominal surgery were associated with a high risk of reoperation for PCD, and the risk of reoperation were relatively low in fistulotomy or fistulectomy procedures. PMID:26576395

  5. Reoperative aortic root replacement: Outcome in a contemporary series.

    Science.gov (United States)

    Esaki, Jiro; Leshnower, Bradley G; Binongo, Jose N; Lasanajak, Yi; McPherson, LaRonica; Thourani, Vinod H; Chen, Edward P

    2017-09-01

    Reoperative aortic root replacement is a challenging procedure associated with significant mortality and morbidity. The purpose of this study was to investigate the outcomes of reoperative aortic root replacement when performed in a number of complex clinical settings and to identify risk factors for operative mortality and long-term survival. From 2006 to 2015, 280 consecutive patients at an academic center underwent reoperative aortic root replacement after a variety of previous aortic or cardiac operations. Logistic regression and extended Cox proportional hazards regression analyses were used to determine risk factors for operative mortality and long-term survival, respectively. The mean age of patients was 52.5 ± 14.1 years. Prior operations included proximal aortic replacement in 113 patients, valve surgery in 162 patients, and coronary artery bypass grafting in 46 patients. Concomitant procedures included arch replacement in 135 patients, coronary artery bypass grafting in 68 patients, and mitral valve repair/replacement in 18 patients. Operative mortality was 14.3%. Five-year survival was 74.0%. Univariable analysis did not find previous root replacement, prior proximal aortic surgery, and concomitant arch replacement to be risk factors for operative mortality. In the multivariable analysis, chronic lung disease, prior myocardial infarction, and concomitant mitral valve surgery were risk factors for operative mortality. Age, peripheral artery disease, emergency, and concomitant mitral valve surgery were risk factors for mortality in the late phase. Reoperative aortic root replacement represents complex procedures carrying significant morbidity and mortality. Chronic lung disease, prior myocardial infarction, and concomitant mitral valve surgery were risk factors for operative mortality. Age, peripheral artery disease, emergency, and concomitant mitral valve surgery were risk factors for long-term mortality. Copyright © 2017 The American Association for

  6. Distribution of dose rates due to fallout from the Fukushima Daiichi reactor accident

    International Nuclear Information System (INIS)

    Minato, Susumu

    2011-01-01

    A number of dose rate data taken after the Fukushima Daiichi reactor accident occurred have been collected through official websites of prefectural governments. Subtracting natural background dose rates from these data, contributions due to fallout alone were evaluated. A train-borne survey was carried out to verify the accuracy of the contour map. The dose rate variation pattern obtained by the survey coincided fairly well with that of the map. (author)

  7. Neutrino energy loss rates due to key iron isotopes for core-collapse physics

    International Nuclear Information System (INIS)

    Nabi, J.-U.

    2008-07-01

    Accurate estimates of neutrino energy loss rates are needed for the study of the late stages of the stellar evolution, in particular for the cooling of neutron stars and white dwarfs. The energy spectra of neutrinos and antineutrinos arriving at the Earth can also provide useful information on the primary neutrino fluxes as well as neutrino mixing scenario. Proton-neutron quasi-particle random phase approximation (pn-QRPA) theory has recently being used for a microscopic calculation of stellar weak interaction rates of fp-shell nuclide, particularly iron isotopes, with success. Here I present the calculation of neutrino and antineutrino energy loss rates due to key iron isotopes in stellar matter using the pn-QRPA theory. The rates are calculated on a fine grid of temperature-density scale suitable for core-collapse simulators. The calculated rates are compared against earlier calculations. The neutrino cooling rates due to even-even isotopes of iron, 54,56 Fe, are in good agreement with the rates calculated using the large-scale shell model. The pn-QRPA calculated neutrino energy loss rates due to 55 Fe are enhanced roughly around an order of magnitude compared to the large-scale shell model calculation during the oxygen and silicon shell burning stages of massive stars and favor a lower entropy for the cores of massive stars. (author)

  8. Simple approximation for estimating centerline gamma absorbed dose rates due to a continuous Gaussian plume

    International Nuclear Information System (INIS)

    Overcamp, T.J.; Fjeld, R.A.

    1987-01-01

    A simple approximation for estimating the centerline gamma absorbed dose rates due to a continuous Gaussian plume was developed. To simplify the integration of the dose integral, this approach makes use of the Gaussian cloud concentration distribution. The solution is expressed in terms of the I1 and I2 integrals which were developed for estimating long-term dose due to a sector-averaged Gaussian plume. Estimates of tissue absorbed dose rates for the new approach and for the uniform cloud model were compared to numerical integration of the dose integral over a Gaussian plume distribution

  9. Gain reduction due to space charge at high counting rates in multiwire proportional chambers

    International Nuclear Information System (INIS)

    Smith, G.C.; Mathieson, E.

    1986-10-01

    Measurements with a small MWPC of gas gain reduction, due to ion space charge at high counting rates, have been compared with theoretical predictions. The quantity ln(q/q 0 )/(q/q 0 ), where (q/q 0 ) is the relative reduced avalanche charge, has been found to be closely proportional to count rate, as predicted. The constant of proportionality is in good agreement with calculations made with a modified version of the original, simplified theory

  10. An attempt to explain strength increase due to high loading rates

    International Nuclear Information System (INIS)

    Eibl, J.; Curbach, M.

    1989-01-01

    Most materials such as steel, concrete, ceramics, polymers, etc. show an increase of strength due to high loading rates. A number of mathematical equations are available to describe this behaviour. Nevertheless the physical reasons for these observations are still unknown. The common behaviour of a number of materials leads to the assumption that at least some explanations are material independent. Due to this reason the results of the research done at the Institute for Concrete Structures in Karlsruhe are presented in this paper to furnish new ideas for the material research due to dynamic loading. (orig.)

  11. Rotator cuff injuries and factors associated with reoperation

    Directory of Open Access Journals (Sweden)

    Alexandre Litchina Carvalho

    2016-06-01

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the prevalence of rotator cuff tears and describe the profile of reoperated patients, causes of repeated tendon tears, tear evolution and range of times between surgical procedures. METHOD: This was a cross-sectional study involving 604 surgical procedures performed at two regional referral hospitals between January 2006 and December 2012. After approval by the ethics committee, data describing the patients' epidemiological profile were gathered at a single time, using Cofield's classification to measure the extent of the tears, all of which underwent arthroscopic surgery. The data were entered into Epi Info 3.5.3 and were analyzed using SPSS version 18.0. RESULTS: Among the 604 surgical procedures, females were affected in more cases (351; 58.1%. When the dominant limb was the right limb, it was affected in 90% of the cases (p < 0.05. The supraspinatus tendon was affected in 574 cases (95% and the tears were of medium size in 300 cases (49.7%. Eighteen reoperations were performed (2.98% and the upper right limb was the most affected (66.6%. The cause was non-traumatic in 12 patients. The repeated tears were mostly smaller (44%, and the length of time between the two surgical procedures ranged from 6 to 298 weeks. CONCLUSION: Female gender, smaller extent in the second procedure and non-traumatic cause were found in most of the cases analyzed.

  12. Risk factors for 30-day reoperation and 3-month readmission: analysis from the Quality and Outcomes Database lumbar spine registry.

    Science.gov (United States)

    Wadhwa, Rishi K; Ohya, Junichi; Vogel, Todd D; Carreon, Leah Y; Asher, Anthony L; Knightly, John J; Shaffrey, Christopher I; Glassman, Steven D; Mummaneni, Praveen V

    2017-08-01

    OBJECTIVE The aim of this paper was to use a prospective, longitudinal, multicenter outcome registry of patients undergoing surgery for lumbar degenerative disease in order to assess the incidence and factors associated with 30-day reoperation and 90-day readmission. METHODS Prospectively collected data from 9853 patients from the Quality and Outcomes Database (QOD; formerly known as the N 2 QOD [National Neurosurgery Quality and Outcomes Database]) lumbar spine registry were retrospectively analyzed. Multivariate binomial regression analysis was performed to identify factors associated with 30-day reoperation and 90-day readmission after surgery for lumbar degenerative disease. A subgroup analysis of Medicare patients stratified by age (readmission rate was 6.3%. Multivariate analysis demonstrated that higher ASA class (OR 1.46 per class, 95% CI 1.25-1.70) and history of depression (OR 1.27, 95% CI 1.04-1.54) were factors associated with 90-day readmission. Medicare beneficiaries had a higher rate of 90-day readmissions compared with those who had private insurance (OR 1.43, 95% CI 1.17-1.76). Medicare patients readmission included higher ASA class and a history of depression. The 90-day readmission rates were higher for Medicare beneficiaries than for those who had private insurance. Medicare patients < 65 years of age were more likely to undergo reoperation within 30 days and to be readmitted within 90 days after their index surgery.

  13. Changes in alanine turnover rate due to nutritional and genetic obesity in the rat.

    Science.gov (United States)

    Yebras, M; Salvadó, J; Arola, L; Remesar, X; Segués, T

    1994-08-01

    The changes in alanine turnover were determined in Zucker rats, which were either genetically obese (fa/fa) or rendered obese by dietary treatment (cafeteria fed). The whole body rate of alanine turnover was higher in genetically obese rats than in rats in which obesity was induced by diet (cafeteria). This is possibly due to variations in the rate of the amino acid incorporation into proteins, since the rate of whole body alanine degradation is the same for both groups. Thus, the different pattern followed by alanine turnover rate in these types of obese animals reflects the differences in the nitrogen economy of these animals, pointing to a higher alanine utilization in the genetically obese animals and a conservative management of alanine in the cafeteria-fed animals.

  14. DIVIDEND PAYMENT BEHAVIOUR OF COMPANIES DUE TO CHANGE OF DIVIDEND TAX RATE IN ROMANIA

    Directory of Open Access Journals (Sweden)

    Stela JAKOVA

    2017-06-01

    Full Text Available This paper examines Romanian companies’ behaviour (listed on the Bucharest Stock Exchange to a change of dividend tax rate. Even if the number of companies which had paid dividends in 2016, for 2015 decreased to 32, compared with 34 companies from previous year, the total value of paid dividends increased with 53% comparatively with dividends paid for 2014. This can be explained through the new tax rate which has been reduced from 16% to 5%. We found that the shareholders obtain profit from two sources: due to increase of gross dividend and due to decrease of the tax rate. Moreover, the paper found also: for the companies who paid higher dividend for 2015 compared with 2014 the dividend paid for 2015 is statistically significant different than the dividend paid for 2014; for the companies who paid smallest dividend for 2015, we were not able to find any statistical difference. This means that the companies which increased the dividend for 2015, took into consideration the new legislation and they are motivated to pay more to the shareholders; companies which decreased the dividend value for 2015 is due to some internal factors.

  15. Association of postdischarge complications with reoperation and mortality in general surgery.

    Science.gov (United States)

    Kazaure, Hadiza S; Roman, Sanziana A; Sosa, Julie A

    2012-11-01

    To describe procedure-specific types, rates, and risk factors for postdischarge (PD) complications occurring within 30 days after 21 groups of inpatient general surgery procedures. Retrospective cohort study. American College of Surgeons National Surgical Quality Improvement Program 2005 through 2010 Participant Use Data Files. A total of 551,510 adult patients who underwent one of 21 groups of general surgery procedures in the inpatient setting. Postdischarge complications, reoperation, and mortality. Of 551,510 patients (mean age, 54.6 years), 16.7% experienced a complication; 41.5% occurred PD. Of the PD complications, 75.0% occurred within 14 days PD. Proctectomy (14.5%), enteric fistula repair (12.6%), and pancreatic procedures (11.4%) had the highest PD complication rates. Breast, bariatric, and ventral hernia repair procedures had the highest proportions of complications that occurred PD (78.7%, 69.4%, and 62.0%, respectively). For all procedures, surgical site complications, infections, and thromboembolic events were the most common. Occurrence of an inpatient complication increased the likelihood of a PD complication (12.5% vs 6.2% without an inpatient complication; P surgery; those whose PD complication was preceded by an inpatient complication had the highest rates of reoperation (33.7%) and death (24.7%) (all P < .001). After adjustment, PD complications were associated with procedure type, American Society of Anesthesiologists class higher than 3, and steroid use. The PD complication rates vary by procedure, are commonly surgical site related, and are associated with mortality. Fastidious, procedure-specific patient triage at discharge as well as expedited patient follow-up could improve PD outcomes.

  16. On the rate of black hole binary mergers in galactic nuclei due to dynamical hardening

    Science.gov (United States)

    Leigh, N. W. C.; Geller, A. M.; McKernan, B.; Ford, K. E. S.; Mac Low, M.-M.; Bellovary, J.; Haiman, Z.; Lyra, W.; Samsing, J.; O'Dowd, M.; Kocsis, B.; Endlich, S.

    2018-03-01

    We assess the contribution of dynamical hardening by direct three-body scattering interactions to the rate of stellar-mass black hole binary (BHB) mergers in galactic nuclei. We derive an analytic model for the single-binary encounter rate in a nucleus with spherical and disc components hosting a super-massive black hole (SMBH). We determine the total number of encounters NGW needed to harden a BHB to the point that inspiral due to gravitational wave emission occurs before the next three-body scattering event. This is done independently for both the spherical and disc components. Using a Monte Carlo approach, we refine our calculations for NGW to include gravitational wave emission between scattering events. For astrophysically plausible models, we find that typically NGW ≲ 10. We find two separate regimes for the efficient dynamical hardening of BHBs: (1) spherical star clusters with high central densities, low-velocity dispersions, and no significant Keplerian component and (2) migration traps in discs around SMBHs lacking any significant spherical stellar component in the vicinity of the migration trap, which is expected due to effective orbital inclination reduction of any spherical population by the disc. We also find a weak correlation between the ratio of the second-order velocity moment to velocity dispersion in galactic nuclei and the rate of BHB mergers, where this ratio is a proxy for the ratio between the rotation- and dispersion-supported components. Because discs enforce planar interactions that are efficient in hardening BHBs, particularly in migration traps, they have high merger rates that can contribute significantly to the rate of BHB mergers detected by the advanced Laser Interferometer Gravitational-Wave Observatory.

  17. Reoperation and readmission after clipping of an unruptured intracranial aneurysm: a National Surgical Quality Improvement Program analysis.

    Science.gov (United States)

    Dasenbrock, Hormuzdiyar H; Smith, Timothy R; Rudy, Robert F; Gormley, William B; Aziz-Sultan, M Ali; Du, Rose

    2018-03-01

    OBJECTIVE Although reoperation and readmission have been used as quality metrics, there are limited data evaluating the rate of, reasons for, and predictors of reoperation and readmission after microsurgical clipping of unruptured aneurysms. METHODS Adult patients who underwent craniotomy for clipping of an unruptured aneurysm electively were extracted from the prospective National Surgical Quality Improvement Program registry (2011-2014). Multivariable logistic regression and recursive partitioning analysis evaluated the independent predictors of nonroutine hospital discharge, unplanned 30-day reoperation, and readmission. Predictors screened included patient age, sex, comorbidities, American Society of Anesthesiologists (ASA) classification, functional status, aneurysm location, preoperative laboratory values, operative time, and postoperative complications. RESULTS Among the 460 patients evaluated, 4.2% underwent any reoperation at a median of 7 days (interquartile range [IQR] 2-17 days) postoperatively, and 1.1% required a cranial reoperation. The most common reoperation was ventricular shunt placement (23.5%); other reoperations were tracheostomy, craniotomy for hematoma evacuation, and decompressive hemicraniectomy. Independent predictors of any unplanned reoperation were age greater than 51 years and longer operative time (p ≤ 0.04). Readmission occurred in 6.3% of patients at a median of 6 days (IQR 5-13 days) after discharge from the surgical hospitalization; 59.1% of patients were readmitted within 1 week and 86.4% within 2 weeks of discharge. The most common reason for readmission was seizure (26.7%); other causes of readmission included hydrocephalus, cerebrovascular accidents, and headache. Unplanned readmission was independently associated with age greater than 65 years, Class II or III obesity (body mass index > 35 kg/m 2 ), preoperative hyponatremia, and preoperative anemia (p ≤ 0.04). Readmission was not associated with operative time

  18. Seasonal Variations in the Risk of Reoperation for Surgical Site Infection Following Elective Spinal Fusion Surgery: A Retrospective Study Using the Japanese Diagnosis Procedure Combination Database.

    Science.gov (United States)

    Ohya, Junichi; Chikuda, Hirotaka; Oichi, Takeshi; Kato, So; Matsui, Hiroki; Horiguchi, Hiromasa; Tanaka, Sakae; Yasunaga, Hideo

    2017-07-15

    A retrospective study of data abstracted from the Diagnosis Procedure Combination (DPC) database, a national representative database in Japan. The aim of this study was to examine seasonal variations in the risk of reoperation for surgical site infection (SSI) following spinal fusion surgery. Although higher rates of infection in the summer than in other seasons were thought to be caused by increasing inexperience of new staff, high temperature, and high humidity, no studies have examined seasonal variations in the risk of SSI following spinal fusion surgery in the country where medical staff rotation timing is not in summer season. In Japan, medical staff rotation starts in April. We retrospectively extracted the data of patients who were admitted between July 2010 and March 2013 from the DPC database. Patients were included if they were aged 20 years or older and underwent elective spinal fusion surgery. The primary outcome was reoperation for SSI during hospitalization. We performed multivariate analysis to clarify the risk factors of primary outcome with adjustment for patient background characteristics. We identified 47,252 eligible patients (23,659 male, 23,593 female). The mean age of the patients was 65.4 years (range, 20-101 yrs). Overall, reoperation for SSI occurred in 0.93% of the patients during hospitalization. The risk of reoperation for SSI was significantly higher in April (vs. February; odds ratio, 1.93; 95% confidence interval, 1.09-3.43, P = 0.03) as well as other known risk factors. In subgroup analysis with stratification for type of hospital, month of surgery was identified as an independent risk factor of reoperation for SSI among cases in an academic hospital, although there was no seasonal variation among those in a nonacademic hospital. This study showed that month of surgery is a risk factor of reoperation for SSI following elective spinal fusion surgery, nevertheless, in the country where medical staff rotation timing is not in

  19. Reoperative Aortic Root Replacement in Patients with Previous Aortic Root or Aortic Valve Procedures

    Directory of Open Access Journals (Sweden)

    Byung Kwon Chong

    2016-08-01

    Full Text Available Background: Generalization of standardized surgical techniques to treat aortic valve (AV and aortic root diseases has benefited large numbers of patients. As a consequence of the proliferation of patients receiving aortic root surgeries, surgeons are more frequently challenged by reoperative aortic root procedures. The aim of this study was to evaluate the outcomes of redo-aortic root replacement (ARR. Methods: We retrospectively reviewed 66 patients (36 male; mean age, 44.5±9.5 years who underwent redo-ARR following AV or aortic root procedures between April 1995 and June 2015. Results: Emergency surgeries comprised 43.9% (n=29. Indications for the redo-ARR were aneurysm (n=12, pseudoaneurysm (n=1, or dissection (n=6 of the residual native aortic sinus in 19 patients (28.8%, native AV dysfunction in 8 patients (12.1%, structural dysfunction of an implanted bioprosthetic AV in 19 patients (28.8%, and infection of previously replaced AV or proximal aortic grafts in 30 patients (45.5%. There were 3 early deaths (4.5%. During follow- up (median, 54.65 months; quartile 1–3, 17.93 to 95.71 months, there were 14 late deaths (21.2%, and 9 valve-related complications including reoperation of the aortic root in 1 patient, infective endocarditis in 3 patients, and hemorrhagic events in 5 patients. Overall survival and event-free survival rates at 5 years were 81.5%±5.1% and 76.4%±5.4%, respectively. Conclusion: Despite technical challenges and a high rate of emergency conditions in patients requiring redo-ARR, early and late outcomes were acceptable in these patients.

  20. Outcomes of Reoperative Valve Replacement in Patients with Prosthetic Valve Endocarditis: A 20-Year Experience

    Directory of Open Access Journals (Sweden)

    Young Woong Kim

    2018-02-01

    Full Text Available Background: Prosthetic valve endocarditis (PVE is a serious complication of cardiac valve replacement, and many p atients with P VE r equire r eoperation. The aim of t his study was to r eview our institutional 2 0 -year experience of surgical reoperative valve replacement in patients with PVE. Methods: A retrospective study was performed on 84 patients (mean age, 54.8±12.7 years; 51 males who were diagnosed with PVE and underwent reoperative valve replacement from January 1995 to December 2016. Results: PVE was found in 1 valve in 61 cases (72.6%, and in 2 or more valves in 23 cases (27.4%. The median follow-up duration was 47.3 months (range, 0 to 250 months. Postoperative complications occurred in 39 patients (46.4%. Reinfection occurred in 6 cases, all within 1 year. The freedom from reinfection rate at 5 years was 91.0%±3.5%. The overall survival rates at 5 and 10 years were 64.4%±5.8% and 54.3%±7.3%, respectively. In stepwise multivariable Cox proportional hazard models, older age (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.05 to 2.10; p=0.027 and cardiopulmonary bypass (CPB time (HR, 1.03; 95% CI, 1.00 to 1.0 1; p =0 . 0 33 e merged a s independent risk f actors f or d eath. Conclusion: Older age and a longer CPB time were associated with an increased risk of overall mortality in PVE patients.

  1. The time aspect of bioenergy. Climate impacts of bioenergy due to differences in carbon uptake rates

    Energy Technology Data Exchange (ETDEWEB)

    Zetterberg, Lars [IVL Swedish Environmental Research Institute, Stockholm (Sweden); Chen, Deliang [Dept. of Earth Sciences, Univ. of Gothenburg, Gothenburg (Sweden)

    2011-07-01

    This paper investigates the climate impacts from bioenergy due to how they influence carbon stocks over time and more specifically how fast combustion related carbon emissions are compensated by uptake of atmospheric carbon. A set of fuel types representing different uptake rates are investigated, namely willow, branches and tops, stumps and coal. Net emissions are defined as emissions from utilizing the fuel minus emissions from a reference case of no utilisation. In the case of forest residues, the compensating 'uptake' is avoided emissions from the reference case of leaving the residues to decompose on the ground. Climate impacts are estimated using the measures radiative forcing and global average surface temperature, which have been calculated by an energy balance climate model. We conclude that there is a climate impact from using bioenergy due to how fast the emission pulse is compensated by uptake of atmospheric carbon (or avoided emissions). Biofuels with slower uptake rates have a stronger climate impact than fuels with a faster uptake rate, assuming all other parameters equal. The time perspective over which the analysis is done is crucial for the climate impact of biofuels. If only biogenic fluxes are considered, our results show that over a 100 year perspective branches and tops are better for climate mitigation than stumps which in turn are better than coal. Over a 20 year time perspective this conclusion holds, but the differences between these fuels are relatively smaller. Establishing willow on earlier crop land may reduce atmospheric carbon, provided new land is available. However, these results are inconclusive since we haven't considered the effects, if needed, of producing the traditional agricultural crops elsewhere. The analysis is not a life cycle assessment of different fuels and does therefore not consider the use of fossil fuels for logging, transportation and refining, other greenhouse gases than carbon or energy

  2. Temporal reduction of the external gamma dose rate due to 137Cs mobility in sandy beaches

    International Nuclear Information System (INIS)

    Rizzotto, M.; Toso, J.; Velasco, H.; Belli, M.; Sansone, U.

    2009-01-01

    In the present paper the contribution to the external gamma dose rate due o 137 Cs in soil as a function of time is presented. Sampling sites were elected along the Calabria and Basilicata Regions coastal beaches (southern art of Italy) to assess the external gamma dose rate in air, 1 m above the round level. A convection-dispersion model, with constant parameters was sed to approximate the radiocesium soil vertical migration. The model was calibrated using the initial 137 Cs activity deposition in this region Chernobyl fallout) and 137 Cs activity concentration down the soil profile, measured 10 years later. The dispersion coefficient and the advection velocity values, were respectively: 2.17 cm 2 y -1 and 0.32 cm -1 . The Radionuclide Software Package (RSP), which uses a Monte Carlo simulation code, was used to determine the primary 137 Cs gamma dose contribution in air 1 m above the ground surface. The resulting 137 Cs external dose rate ranged from 0.42 nGy h -1 in 1986, to 0.05 nGy h -1 in 007. (author)

  3. Measurement of HOx· production rate due to radon decay in air

    International Nuclear Information System (INIS)

    Ding, Huiling.

    1993-08-01

    Radon in indoor air may cause the exposure of the public to excessive radioactivity. Radiolysis of water vapor in indoor air due to radon decay could produce (·OH and HO 2 ·) that may convert atmospheric constituents to compounds of lower vapor pressure. These lower vapor pressure compounds might then nucleate to form new particles in the indoor atmosphere. Chemical amplification was used to determine HO x · production rate in indoor air caused by radon decay. Average HO x · production rate was found to be (4.31±0.07) x 10 5 HO x · per Rn decay per second (Bq) 3.4 to 55.0% at 22C. This work provided G (HO x ·) -value, 7.86±0.13 No./100 eV in air by directly measuring [HO x ·] formed from the radiolysis procedure. This G value implies that HO x · produced by radon decay in air might be formed by multiple processes and may be result of positive ion-molecule reactions, primary radiolysis, and radical reactions. There is no obvious relation between HO x · production rate and relative humidity. A laser-induced fluorescence (LIF) system has been used for ·OH production rate measurement; it consists of an excimer laser, a dye laser, a frequency doubler, a gaseous fluorescence chamber, and other optical and electronic parts. This system needs to be improved to eliminate the interferences of light scattering and artificial ·OH produced from the photolysis of O 3 /H 2 O

  4. Direct SUSY dark matter detection-theoretical rates due to the spin

    International Nuclear Information System (INIS)

    Vergados, J D

    2004-01-01

    The recent WMAP data have confirmed that exotic dark matter together with the vacuum energy (cosmological constant) dominate in the flat Universe. Thus direct dark matter detection, consisting of detecting the recoiling nucleus, is central to particle physics and cosmology. Supersymmetry provides a natural dark matter candidate, the lightest supersymmetric particle (LSP). The relevant cross sections arise out of two mechanisms: (i) the coherent mode, due to the scalar interaction and (ii) the spin contribution arising from the axial current. In this paper we will focus on the spin contribution, which is expected to dominate for light targets. For both modes it is possible to obtain detectable rates, but in most models the expected rates are much lower than the present experimental goals. So one should exploit two characteristic signatures of the reaction, namely the modulation effect and in directional experiments the correlation of the event rates with the sun's motion. In standard non-directional experiments the modulation is small, less than 2 per cent. In the case of the directional event rates we would like to suggest that the experiments exploit two features of the process, which are essentially independent of the SUSY model employed, namely: (1) the forward-backward asymmetry, with respect to the sun's direction of motion, is very large and (2) the modulation is much larger, especially if the observation is made in a plane perpendicular to the sun's velocity. In this case the difference between maximum and minimum can be larger than 40 per cent and the phase of the earth at the maximum is direction dependent

  5. Prediction of Spring Rate and Initial Failure Load due to Material Properties of Composite Leaf Spring

    International Nuclear Information System (INIS)

    Oh, Sung Ha; Choi, Bok Lok

    2014-01-01

    This paper presented analysis methods for adapting E-glass fiber/epoxy composite (GFRP) materials to an automotive leaf spring. It focused on the static behaviors of the leaf spring due to the material composition and its fiber orientation. The material properties of the GFRP composite were directly measured based on the ASTM standard test. A reverse implementation was performed to obtain the complete set of in-situ fiber and matrix properties from the ply test results. Next, the spring rates of the composite leaf spring were examined according to the variation of material parameters such as the fiber angles and resin contents of the composite material. Finally, progressive failure analysis was conducted to identify the initial failure load by means of an elastic stress analysis and specific damage criteria. As a result, it was found that damage first occurred along the edge of the leaf spring owing to the shear stresses

  6. Simple expressions of the nuclear relaxation rate enhancement due to quadrupole nuclei in slowly tumbling molecules

    Energy Technology Data Exchange (ETDEWEB)

    Fries, Pascal H., E-mail: pascal-h.fries@cea.fr [Université Grenoble Alpes, INAC-SCIB, RICC, F-38000 Grenoble (France); CEA, INAC-SCIB, RICC, F-38000 Grenoble (France); Belorizky, Elie [Université Grenoble Alpes, LIPHY, F-38000 Grenoble (France); CEA, Leti-Clinatec, F-38000 Grenoble (France)

    2015-07-28

    For slowly tumbling entities or quasi-rigid lattices, we derive very simple analytical expressions of the quadrupole relaxation enhancement (QRE) of the longitudinal relaxation rate R{sub 1} of nuclear spins I due to their intramolecular magnetic dipolar coupling with quadrupole nuclei of arbitrary spins S ≥ 1. These expressions are obtained by using the adiabatic approximation for evaluating the time evolution operator of the quantum states of the quadrupole nuclei S. They are valid when the gyromagnetic ratio of the spin S is much smaller than that of the spin I. The theory predicts quadrupole resonant peaks in the dispersion curve of R{sub 1} vs magnetic field. The number, positions, relative intensities, Lorentzian shapes, and widths of these peaks are explained in terms of the following properties: the magnitude of the quadrupole Hamiltonian and the asymmetry parameter of the electric field gradient (EFG) acting on the spin S, the S-I inter-spin orientation with respect to the EFG principal axes, the rotational correlation time of the entity carrying the S–I pair, and/or the proper relaxation time of the spin S. The theory is first applied to protein amide protons undergoing dipolar coupling with fast-relaxing quadrupole {sup 14}N nuclei and mediating the QRE to the observed bulk water protons. The theoretical QRE agrees well with its experimental counterpart for various systems such as bovine pancreatic trypsin inhibitor and cartilages. The anomalous behaviour of the relaxation rate of protons in synthetic aluminium silicate imogolite nano-tubes due to the QRE of {sup 27}Al (S = 5/2) nuclei is also explained.

  7. Reoperation after radical correction tetralogy of Fallot: results and prospects

    Directory of Open Access Journals (Sweden)

    M.F. Zinkovskyi

    2017-06-01

    Full Text Available The aim – to present experience, results and prospects of repeated interventions in the remote period after radical correction of tetralogy of Fallot. Materials and methods. Results of the repeated 65 surgeries in 62 patients after radical correction of tetralogy of Fallot with long-term follow-up for the period from 1981 to 2014 are presented. The interval between the radical tetralogy of Fallot correction and re-operation ranged from 1 month to 30 years (average – 8.54 ± 6.3 years. Results. Depending on the predominance of one or other complications and its causes we observed: 1 residual defects – 25 (40.4 % cases; right ventricular dysfunction – 23 (37.0 % cases; valve pathology – 5 (8.0 % cases; other rare complications – 9 (14.6 % cases. In total, 100 complications were identified and eliminated in 62 patients. The most frequent complications that required second surgical correction were: recanalization of ventricular septal defect (36.0 %, right ventricular aneurysm (19.0 %, tricuspid valve insufficiency (13.0 %, the residual obstruction of the outflow tract of the right ventricle (9.0 %, right ventricular dysfunction caused by pulmonary valve insufficiency (6.0 % and pulmonary trunk aneurysm (5.0 %. Conclusion. Hospital mortality after surgical correction of long-term complications was 8.0 %. All discharged patients with echocardiographic evaluation revealed a positive dynamics of volume and functional parameters of the right and left ventricles

  8. Reoperation for refractory epilepsy in childhood: a second chance for selected patients.

    Science.gov (United States)

    Ramantani, Georgia; Strobl, Karl; Stathi, Angeliki; Brandt, Armin; Schubert-Bast, Susanne; Wiegand, Gert; Korinthenberg, Rudolf; Stephani, Ulrich; van Velthoven, Vera; Zentner, Josef; Schulze-Bonhage, Andreas; Bast, Thomas

    2013-10-01

    Reoperations account for >10% in pediatric epilepsy surgery cohorts, and they are especially relevant in young children with catastrophic epilepsy. To determine surgical outcomes and their predictive factors in reoperations for refractory epilepsy in childhood. We retrospectively analyzed presurgical findings, resections, and outcomes of 23 consecutive children who underwent reoperations from 2000 to 2011. Etiology included cortical dysplasia with/without glioneuronal tumor in 19 patients (83%), sole glioneuronal tumor in 2, and tuberous sclerosis and Rasmussen encephalitis in 1 each. The reasons for the failure of the initial surgery were functional considerations in 8 (35%), incorrect delineation of the epileptogenic zone in 8 (35%), and resection not performed as initially planned in 7 (30%) cases. Final procedures included 8 (35%) intralobar, 8 (35%) multilobar resections, and 7 (30%) hemispherotomies. Following reoperations, 14 (61%) patients were seizure free, 6 (26%) showed significant or worthwhile improvement, and 3 (13%) did not respond to surgery. Six of 8 patients who underwent the first resection before the age of 3 years, 6 of 8 whose first resection was limited by functional considerations, and all 7 with hemispherotomy as the final resection achieved seizure freedom after reoperation. Reoperation is particularly beneficial for selected children with refractory epilepsy associated with cortical dysplasia that did not respond to an initial limited and/or early resection but achieved seizure freedom after extensive procedures. When indicated, reoperation should be performed at the youngest possible age to profit from higher functional plasticity in compensating for neurological deficit.

  9. Risk Factors for Reoperation and Performance-Based Outcomes After Operative Fixation of Foot Fractures in the Professional Athlete: A Cross-Sport Analysis.

    Science.gov (United States)

    Singh, Sameer K; Larkin, Kevin E; Kadakia, Anish R; Hsu, Wellington K

    Professional athletes are predisposed to fractures of the foot due to large stresses placed on the lower extremity. These players are concerned with efficiently returning to play at a high level. Return-to-play rates after operative treatment have been previously reported, yet performance outcomes after such treatment are generally unknown in this population. Overall, professional athletes sustaining a foot fracture would return to play at high rates with little impact on postoperative performance or league participation. However, National Football League (NFL) athletes would have a significantly greater decline in performance due to the high-impact nature of the sport. Case series. Level 4. Athletes in the National Basketball League (NBA), NFL, Major League Baseball (MLB), and National Hockey League (NHL) undergoing operative fixation of a foot fracture were identified through a well-established protocol confirmed by multiple sources of the public record. Return-to-play rate and time to return were collected for each sport. League participation and game performance data were collected before and after surgery. Statistical analysis was performed, with significance accepted as P ≤ 0.05. A total of 77 players undergoing 84 procedures met the inclusion criteria. Overall, 98.7% (76/77) of players were able to return to play, with a median time to return across all sports of 137 days. Players returned to preoperative performance levels within 1 season of surgery. Six players (7.8%) sustained refracture requiring reoperation, all of whom were in the NBA. Percentage of games started during the season after primary operative treatment was a predictive factor for reinjury (99% vs 40%, P = 0.001). Athletes returned to play at a high rate after foot fracture fixation, with excellent postoperative performance levels, regardless of sport and fracture location. NBA athletes sustaining fifth metatarsal and navicular fractures are at greater risk of reinjury compared with other

  10. Reoperative sentinel lymph node biopsy after previous mastectomy.

    Science.gov (United States)

    Karam, Amer; Stempel, Michelle; Cody, Hiram S; Port, Elisa R

    2008-10-01

    Sentinel lymph node (SLN) biopsy is the standard of care for axillary staging in breast cancer, but many clinical scenarios questioning the validity of SLN biopsy remain. Here we describe our experience with reoperative-SLN (re-SLN) biopsy after previous mastectomy. Review of the SLN database from September 1996 to December 2007 yielded 20 procedures done in the setting of previous mastectomy. SLN biopsy was performed using radioisotope with or without blue dye injection superior to the mastectomy incision, in the skin flap in all patients. In 17 of 20 patients (85%), re-SLN biopsy was performed for local or regional recurrence after mastectomy. Re-SLN biopsy was successful in 13 of 20 patients (65%) after previous mastectomy. Of the 13 patients, 2 had positive re-SLN, and completion axillary dissection was performed, with 1 having additional positive nodes. In the 11 patients with negative re-SLN, 2 patients underwent completion axillary dissection demonstrating additional negative nodes. One patient with a negative re-SLN experienced chest wall recurrence combined with axillary recurrence 11 months after re-SLN biopsy. All others remained free of local or axillary recurrence. Re-SLN biopsy was unsuccessful in 7 of 20 patients (35%). In three of seven patients, axillary dissection was performed, yielding positive nodes in two of the three. The remaining four of seven patients all had previous modified radical mastectomy, so underwent no additional axillary surgery. In this small series, re-SLN was successful after previous mastectomy, and this procedure may play some role when axillary staging is warranted after mastectomy.

  11. Indications and Morbidity of Reoperative Thyroid Surgeries in a Military Hospital of Senegal

    Directory of Open Access Journals (Sweden)

    Abdou Sy

    2017-01-01

    Full Text Available Objectives. To describe reoperative thyroid surgeries in our department. Study Design. Retrospective cross-sectional and descriptive study at the Ouakam Military Hospital in Dakar (Senegal, over a period of eight and a half years. Methods. The study involved all records of patients who had a reoperative thyroidectomy regardless of the indication and time of the second surgery. Parameters evaluated for first and reoperative surgery were time interval between the two surgeries, operative indications, surgical procedures, intraoperative findings, pathological examination, and morbidity. Results. 30 records of patients were selected out of a total of 698 thyroidectomies (4.3%. Thyroid cancers diagnosed on first surgical specimens were the first indications of reoperations (46.67% followed by neck hematoma (20%. Completion thyroidectomy with a prophylactic central lymph nodes dissection was the most performed surgical procedure (43.33% followed by haemostasis (20%. During reoperation, we found active bleeding (20%, textiloma (6.67%, and fourth branchial cleft fistula (3.33%. The morbidity accounted for 10%: lymphorrhea, permanent hypocalcemia, and permanent recurrent nerve palsy, in one case, respectively. There were no statistically significant differences between the morbidity in patients reoperated on and the one for patients operated on once. Conclusion. We did not find an increased risk of postoperative morbidity after reintervention.

  12. Change in General Relativistic precession rates due to Lidov-Kozai oscillations in the Solar System

    Science.gov (United States)

    Sekhar, Aswin; Asher, David J.; Werner, Stephanie C.; Vaubaillon, Jeremie; Li, Gongjie

    2017-04-01

    permissible in nature. A real solar system body in this intermediate state is identified using compiled observational records from IAU-Minor Planet Center, Cometary Catalogue, IAU-Meteor Data Center and performing analytical plus numerical tests on them. This intermediate state brings up the interesting possibility of drastic changes in GR precession rates (at some points peaking to about 60 times that of Mercury's GR precession) during orbital evolution due to sungrazing and sun colliding phases induced by the LK mechanism, thus combining both these important effects in a unique and dynamically interesting way. Comet 96P/Machholz 1 stands out as the only real body identified (from our simulations) to be exhibiting these interesting traits, as well as inclination flips, in the near future. Both these phenomena complimenting and co-existing at the same time has interesting implications in the long term impact studies of small bodies in general.

  13. Dose rate effect on material aging due to radiation. [Gamma radiation

    Energy Technology Data Exchange (ETDEWEB)

    Okamoto, Shin-ichi (Radiation Center of Osaka Prefecture, Sakai (Japan)); Hayakawa, Chikara; Takeya, Chikashi

    1982-12-01

    Although many reports have been presented on the radiation aging of the organic materials for electric cables, those have been based on the experiments carried out at high dose rate near 1 x 10/sup 6/ rad/h, assuming that aging effect depends on only radiation dose. Therefore, to investigate the aging behaviour in low dose rate range is an important subject to predict their practical life time. In this report, the results of having investigated the aging behaviour of six types of materials are described, (polyethylene for general insulation purpose, chemically cross-linked polyethylene, fire-retardant chemically cross-linked polyethylene, fire-retardant ethylene-propylene rubber, fire-retardant chloro-sulfonated polyethylene for sheaths, and fire-retardant, low hydrochloric acid, special heat-resistant vinyl for insulation purpose or chloroclean). They were irradiated with /sup 60/Co ..gamma..-ray at the dose from 5 x 10/sup 3/ to 1 x 10/sup 6/ rad/h, and their deterioration was tested for the items of elongation, tensile strength, resistivity, dielectric tangent and gel fraction. The aging mechanism and dose rate effect were also considered. The dose rate effect appeared or did not appear depending on the types of materials and also their properties. The materials that showed the dose rate effect included the typical ones whose characteristics degraded with the decreasing dose rate, and the peculiar ones whose deterioration of characteristics did not appear constantly. Aging mechanism may vary in the case of high dose rate and low dose rate. Also, if the life time at respective dose rate in relatively higher dose rate region is clarified, the life time in low dose rate region may possibly be predicted.

  14. Enhancement of D-T reaction rate due to D-T contact

    International Nuclear Information System (INIS)

    Hitoki, Shigehisa; Ogasawara, Masatada; Aono, Osamu.

    1979-09-01

    The reaction rate that is appropriate for magnetized nonuniform plasma is numerically calculated to investigate the enhancement of the D-T reaction rate. Spatial separation of the guiding center distributions of D and T enhances the reaction rate. Cases of several guiding center configurations are investigated. The largest enhancement is obtained, when both guiding center distributions are delta-functions which are separated by a length that corresponds to the Gamow peak energy. As compared with the case of no separation of D and T, the maximum enhancing factors obtained are 2.3 for total reaction rate and 1.6 for local reaction rate. Cases of the guiding center distributions with finite widths are also investigated. (author)

  15. On the upper ocean turbulent dissipation rate due to microscale breakers and small whitecaps

    Science.gov (United States)

    Banner, Michael L.; Morison, Russel P.

    2018-06-01

    In ocean wave modelling, accurately computing the evolution of the wind-wave spectrum depends on the source terms and the spectral bandwidth used. The wave dissipation rate source term which spectrally quantifies wave breaking and other dissipative processes remains poorly understood, including the spectral bandwidth needed to capture the essential model physics. The observational study of Sutherland and Melville (2015a) investigated the relative dissipation rate contributions of breaking waves, from large-scale whitecaps to microbreakers. They concluded that a large fraction of wave energy was dissipated by microbreakers. However, in strong contrast with their findings, our analysis of their data and other recent data sets shows that for young seas, microbreakers and small whitecaps contribute only a small fraction of the total breaking wave dissipation rate. For older seas, we find microbreakers and small whitecaps contribute a large fraction of the breaking wave dissipation rate, but this is only a small fraction of the total dissipation rate, which is now dominated by non-breaking contributions. Hence, for all the wave age conditions observed, microbreakers make an insignificant contribution to the total wave dissipation rate in the wave boundary layer. We tested the sensitivity of the results to the SM15a whitecap analysis methodology by transforming the SM15a breaking data using our breaking crest processing methodology. This resulted in the small-scale breaking waves making an even smaller contribution to the total wave dissipation rate, and so the result is independent of the breaker processing methodology. Comparison with other near-surface total TKE dissipation rate observations also support this conclusion. These contributions to the spectral dissipation rate in ocean wave models are small and need not be explicitly resolved.

  16. Intervention analysis of introduction of rotavirus vaccine on hospital admissions rates due to acute diarrhea

    Directory of Open Access Journals (Sweden)

    Maria de Lourdes Teixeira Masukawa

    2014-10-01

    Full Text Available The aim of this study is to investigate the impact of rotavirus vaccine on hospitalization rates for acute diarrhea in children younger than 5 years old after the introduction of the vaccine in 2006. A descriptive analytical observational study was carried out of the hospitalization rates occurred between 2000 and 2011 in 22 Regional Health Centers of Paraná State, Brazil. The effect of the vaccine was assessed by applying the SARIMA/Box-Jenkins time series methodology of intervention analysis, which allows verifying the slopes of the series are different after the introduction of the vaccine and estimating the magnitude of these effects for children younger than five years of age, by age group, for each region center. It was verified a statistically significant reduction by center/month on hospitalization rates for children 1 year old and younger, with averages of 47% and 58%, respectively, in December 2011.

  17. Estimation of shutdown heat generation rates in GHARR-1 due to ...

    African Journals Online (AJOL)

    Fission products decay power and residual fission power generated after shutdown of Ghana Research Reactor-1 (GHARR-1) by reactivity insertion accident were estimated by solution of the decay and residual heat equations. A Matlab program code was developed to simulate the heat generation rates by fission product ...

  18. Isopleths of surface air concentration and surface air kerma rate due to a radioactive cloud released from a stack (3)

    International Nuclear Information System (INIS)

    Tachibana, Haruo; Kikuchi, Masamitsu; Sekita, Tsutomu; Yamaguchi, Takenori

    2004-06-01

    This report is a revised edition of 'Isopleths of Surface Air Concentration and Surface Air Absorbed Dose Rate due to a Radioactive Cloud Released from a Stack(II) '(JAERI-M 90-206) and based on the revised Nuclear Safety Guidelines reflected the ICRP1990 Recommendation. Characteristics of this report are the use of Air Karma Rate (Gy/h) instead of Air Absorbed Dose Rate (Gy/h), and the record of isopleths of surface air concentration and surface air karma rate on CD-ROM. These recorded data on CD-ROM can be printed out on paper and/or pasted on digital map by personal computer. (author)

  19. Disalignment rate coefficient of neon excited atoms due to helium atom collisions at low temperatures

    International Nuclear Information System (INIS)

    Seo, M; Shimamura, T; Furutani, T; Hasuo, M; Bahrim, C; Fujimoto, T

    2003-01-01

    Disalignment of neon excited atoms in the fine-structure 2p i levels (in Paschen notation) of the 2p 5 3p configuration is investigated in a helium-neon glow discharge at temperatures between 15 and 77 K. At several temperatures, we plot the disalignment rate as a function of the helium atom density for Ne* (2p 2 or 2p 7 ) + He(1s 2 ) collisions. The slope of this dependence gives the disalignment rate coefficient. For both collisions, the experimental data for the disalignment rate coefficient show a more rapid decrease with the decrease in temperature below 40 K than our quantum close-coupling calculations based on the model potential of Hennecart and Masnou-Seeuws (1985 J. Phys. B: At. Mol. Phys. 18 657). This finding suggests that the disalignment cross section rapidly decreases below a few millielectronvolts, in disagreement with our theoretical quantum calculations which predict a strong increase below 1 meV. The disagreement suggests that the long-range electrostatic potentials are significantly more repulsive than in the aforementioned model

  20. Preoperative Aspirin Does Not Increase Transfusion or Reoperation in Isolated Valve Surgery.

    Science.gov (United States)

    Goldhammer, Jordan E; Herman, Corey R; Berguson, Mark W; Torjman, Marc C; Epstein, Richard H; Sun, Jian-Zhong

    2017-10-01

    Preoperative aspirin has been studied in patients undergoing isolated coronary artery bypass graft surgery. However, there is a paucity of clinical data available evaluating perioperative aspirin in other cardiac surgical procedures. This study was designed to investigate the effects of aspirin on bleeding and transfusion in patients undergoing non-emergent, isolated, heart valve repair or replacement. Retrospective, cohort study. Academic medical center. A total of 694 consecutive patients having non-emergent, isolated, valve repair or replacement surgery at an academic medical center were identified. Of the 488 patients who met inclusion criteria, 2 groups were defined based on their preoperative use of aspirin: those taking (n = 282), and those not taking (n = 206) aspirin within 5 days of surgery. Binary logistic regression was used to examine relationships among demographic and clinical variables. No significant difference was found between the aspirin and non-aspirin groups with respect to the percentage receiving red blood cell (RBC) transfusion, mean RBC units transfused in those who required transfusion, massive transfusion of RBC, or amounts of fresh frozen plasma, cryoprecipitate, or platelets. Aspirin was not associated with an increase in the rate of re-exploration for bleeding (5.3% v 6.3%, p = 0.478). Major adverse cardiocerebral events (MACE), 30-day mortality, and 30-day readmission rates were not statistically different between the aspirin-and non-aspirin-treated groups. Preoperative aspirin therapy in elective, isolated, valve surgery did not result in an increase in transfusion or reoperation for bleeding and was not associated with reduced readmission rate, MACE, or 30-day mortality. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Incidence of acute postoperative infections requiring reoperation after arthroscopic shoulder surgery.

    Science.gov (United States)

    Yeranosian, Michael G; Arshi, Armin; Terrell, Rodney D; Wang, Jeffrey C; McAllister, David R; Petrigliano, Frank A

    2014-02-01

    An acute infection after arthroscopic shoulder surgery is a rare but serious complication. Previous studies estimating the incidence of infections after arthroscopic surgery have been conducted, but the majority of these had either relatively small study groups or were not specific to shoulder arthroscopic surgery. To investigate the incidence of acute infections after arthroscopic shoulder surgery and compare infection rates by age group, sex, geographic region, and specific procedures. Case series; Level of evidence, 4. A retrospective review of a large insurance company database was performed for all shoulder arthroscopic surgeries performed in the United States between 2004 and 2009 that required additional surgery for infections within 30 days. The data were stratified by sex, age group, and region. Data were also stratified for specific procedures (capsulorrhaphy, treatment for superior labrum anterior-posterior tears, claviculectomy, decompression, and rotator cuff repair) and used to assess the variation in the incidence of infections across different arthroscopic shoulder procedures. Linear regression was used to determine the significance of differences in the data from year to year. χ(2) analysis was used to assess the statistical significance of variations among all groups. Poisson regression analysis with exposure was used to determine significant differences in a pairwise comparison between 2 groups. The total number of arthroscopic shoulder surgeries performed was 165,820, and the number of infections requiring additional surgery was 450, resulting in an overall infection rate of 0.27%. The incidence of infections varied significantly across age groups (P shoulder procedures was 0.27%. The incidence was highest in elderly patients, in the South, and for rotator cuff repair. The incidence was lowest in young patients, in the Midwest, and for capsulorrhaphy. In general, shoulder arthroscopic surgery in this study population had a low rate of

  2. Rates of thoracic trauma and mortality due to accidents in Brazil

    International Nuclear Information System (INIS)

    Cury, Francisco; Baitello, Andre Luciano; Echeverria, Rodrigo Florencio; Espada, Paulo Cesar; Godoy, Jose Maria Pereira de

    2009-01-01

    To report on the causes of trauma, indexes of trauma, and mortality related to thoracic trauma in one region of Brazil. This prospective study was performed at the Regional Trauma Center in Syo Josi do Rio Preto over a 1-year period, from 1 st July 2004 to 30 th June 2005. We included all patients attending the center's emergency room with thoracic trauma and an anatomic injury scale (AIS) > - 2. We collected data using a protocol completed on arrival in hospital utilizing the AIS. We studied the types of accidents as well as the mortality and the AIS scores. Prevalence rates were calculated and the paired t-test and logistic regression were employed for the statistical analysis.There were a total of 373 casualties with AIS > - 2 and there were 45 (12%) deaths. The causes of thoracic trauma among the 373 casualties were as follows: 91 (24.4%) car crashes, 75 (20.1%) falls, 46 (12.3%) motorbike accidents, 40 (10.7%) stabbings, 22 (5.9%) accidents involving pedestrians, 21 (5.6%) bicycle accidents, 17 (4.6%) shootings, and 54 (14.5%) other types of accident. The severity of the injuries was classified according to the AIS: 224 (60%) were grade 2, 101 (27%) were grade 3, 27 (7.2%) were grade 4, 18 (4.9%) were grade 5, and 3 were (0.8%) grade 6. With respect to thoracic trauma, pedestrians involved in accidents and victims of shootings had mortality rates that were significantly higher than that of those involved in other types of accidents. Road accidents are the main cause of thoracic injury, with accidents involving pedestrians and shootings being associated with a greater death rate. (author)

  3. Killing rate of colony count by hydrodynamic cavitation due to square multi-orifice plates

    Science.gov (United States)

    Dong, Zhiyong; Zhao, Wenqian

    2018-02-01

    Currently,in water supply engineering, the conventional technique of disinfection by chlorination is employed to kill pathogenic microorganisms in raw water. However, chlorine reacts with organic compounds in water and generates disinfection byproducts (DBPs), such as trihalomethanes (THMs), haloacetic acids (HAAs) etc. These byproducts are of carcinogenic, teratogenic and mutagenic effects, which seriously threaten human health. Hydrodynamic cavitation is a novel technique of drinking water disinfection without DBPs. Effects of orifice size, orifice number and orifice layout of multi-orifice plate, cavitation number, cavitation time and orifice velocity on killing pathogenic microorganisms by cavitation were investigated experimentally in a self-developed square multi-orifice plate-type hydrodynamic cavitation device. The experimental results showed that cavitation effects increased with decrease in orifice size and increase in orifice number, cavitation time and orifice velocity. Along with lowering in cavitation number, there was an increase in Reynolds shear stress,thus enhancing the killing rate of pathogenic microorganism in raw water. In addition, the killing rate by staggered orifice layout was greater than that by checkerboard-type orifice layout.

  4. Rb-129Xe spin-exchange rates due to binary and three-body collisions at high Xe pressures

    International Nuclear Information System (INIS)

    Cates, G.D.; Fitzgerald, R.J.; Barton, A.S.; Bogorad, P.; Gatzke, M.; Newbury, N.R.; Saam, B.

    1992-01-01

    We have studied the spin relaxation of 129 Xe nuclei due to collisions with Rb atoms at Xe pressures of 245--1817 Torr. Our results can be characterized by two parameters, the Rb- 129 Xe velocity-averaged binary spin-exchange cross section left-angle σv right-angle and a rate γ M that characterizes spin relaxation due to van der Waals molecules. Our results complement earlier studies performed at Xe pressures of about 1 Torr and N 2 pressures of 10--100 Torr. This work is useful for predicting spin-exchange rates between polarized Rb atoms and 129 Xe nuclei

  5. High turnover rates of copepod fecal pellets due to Noctiluca scintillans grazing

    DEFF Research Database (Denmark)

    Kiørboe, Thomas

    2003-01-01

    Copepod fecal pellet production and vertical flux, as well as vertical distributions of copepods, fecal pellets and the heterotrophic dinoflagellate Noctiluca scintillans were monitored in an upwelling plume off the coast of Brazil during 5 d in austral spring. Less than half (20 to 45%) of the p......Copepod fecal pellet production and vertical flux, as well as vertical distributions of copepods, fecal pellets and the heterotrophic dinoflagellate Noctiluca scintillans were monitored in an upwelling plume off the coast of Brazil during 5 d in austral spring. Less than half (20 to 45...... for fecal pellets at about 0.6 l cell-1 d-1. A simple encounter model suggests that such high clearance rates are feasible. Since N. scintillans occurs at typical abundances of about 106 cells m-2 in temperate seas during spring, summer and autumn, it may contribute significantly to the recycling of rapidly...

  6. Real time monitoring automation of dose rate absorbed in air due to environmental gamma radiation

    International Nuclear Information System (INIS)

    Dominguez Ley, Orlando; Capote Ferrera, Eduardo; Carrazana Gonzalez, Jorge A.; Manzano de Armas, Jose F.; Alonso Abad, Dolores; Prendes Alonso, Miguel; Tomas Zerquera, Juan; Caveda Ramos, Celia A.; Kalber, Olof; Fabelo Bonet, Orlando; Montalvan Estrada, Adelmo; Cartas Aguila, Hector; Leyva Fernandez, Julio C.

    2005-01-01

    The Center of Radiation Protection and Hygiene (CPHR) as the head institution of the National Radiological Environmental Surveillance Network (RNVRA) has strengthened its detection and response capacity for a radiological emergency situation. The measurements of gamma dose rate at the main point of the RNVRA are obtained in real time and the CPHR receives the data coming from those points in a short time. To achieve the operability of the RNVRA it was necessary to complete the existent monitoring facilities using 4 automatic gamma probes, implementing in this way a real time measurement system. The software, GenitronProbe for obtaining the data automatically from the probe, Data Mail , for sending the data via e-mail, and Gamma Red , for receiving and processing the data in the head institution ,were developed

  7. Changes in respiration rates and biomass attributes of epilithon due to extended exposure to zinc

    International Nuclear Information System (INIS)

    Colwell, F.S.

    1986-01-01

    The purpose of this research was to determine the influence of extended dosing of zinc on the carbon cycling and biomass characteristics of freshwater epilithon. Experiments were conducted in artificial streams continuously dosed with 0.00, 0.05, or 1.00 mg Zn liter -1 for 20 to 30 days during summer and fall, 1984 and 1985. Repeated measurement of epilithon structure and function included estimates of 14 C-glucose respiration, 14 C-glutamate respiration, O 2 and CO 2 flux rates, ash-free dry weight (AFDW), protein, carbohydrate, and algal pigment concentrations, and total and zinc-tolerant colony forming units. An increase in epilithic glucose respiration per unit biomass consistently occurred 5 to 10 days after dosing with 1.0 mg Zn liter -1 was started. At the same time significantly lower epilithon biomass occurred in the high dosed streams relative to controls in 3 out of 4 studies. Although algal pigment concentrations were lowest in the high dose streams at the midpoint of the studies, the chlorophyll a-to-pheophytin a ratio remained high, indicating that the minimal algal population was not senescing in situ. After 30 days, the epilithon dosed with 1.0 mg Zn liter -1 had higher AFDW, protein, and carbohydrate concentrations than the other treatments. The development of unique epilithon communities that are acclimated to prolonged zinc exposure is evident in the eventual recolonization of the artificial surfaces, glucose respiration rates that are comparable to controls, and presence of zinc-tolerant heterotrophs

  8. Bit Error Rate Due to Misalignment of Earth Station Antenna Pointing to Satellite

    Directory of Open Access Journals (Sweden)

    Wahyu Pamungkas

    2010-04-01

    Full Text Available One problem causing reduction of energy in satellite communications system is the misalignment of earth station antenna pointing to satellite. Error in pointing would affect the quality of information signal to energy bit in earth station. In this research, error in pointing angle occurred only at receiver (Rx antenna, while the transmitter (Tx antennas precisely point to satellite. The research was conducted towards two satellites, namely TELKOM-1 and TELKOM-2. At first, measurement was made by directing Tx antenna precisely to satellite, resulting in an antenna pattern shown by spectrum analyzer. The output from spectrum analyzers is drawn with the right scale to describe swift of azimuth and elevation pointing angle towards satellite. Due to drifting from the precise pointing, it influenced the received link budget indicated by pattern antenna. This antenna pattern shows reduction of power level received as a result of pointing misalignment. As a conclusion, the increasing misalignment of pointing to satellite would affect in the reduction of received signal parameters link budget of down-link traffic.

  9. Maintenance of mesenchymal stem cells culture due to the cells with reduced attachment rate

    Directory of Open Access Journals (Sweden)

    Shuvalova N. S.

    2013-01-01

    Full Text Available Aim. The classic detachment techniques lead to changes in cells properties. We offer a simple method of cultivating the population of cells that avoided an influence on the surface structures. Methods. Mesenchymal stem cells (MSC from human umbilical cord matrix were obtained and cultivated in standard conditions. While substituting the culture media by a fresh portion, the conditioned culture medium, where the cells were maintained for three days, was transferred to other culture flacks with addition of serum and growth factors. Results. In the flacks, one day after medium transfer, we observed attached cells with typical MSC morphology. The cultures originated from these cells had the same rate of surface markers expression and clonogenic potential as those replated by standard methods. Conclusions. MSC culture, derived by preserving the cells with reduced attachment ability, actually has the properties of «parent» passage. Using this method with accepted techniques of cells reseeding would allow maintaining the cells that avoided an impact on the cell surface proteins.

  10. Thermokarst rates intensify due to climate change and forest fragmentation in an Alaskan boreal forest lowland

    Science.gov (United States)

    Lara, M.; Genet, Helene; McGuire, A. David; Euskirchen, Eugénie S.; Zhang, Yujin; Brown, Dana R. N.; Jorgenson, M.T.; Romanovsky, V.; Breen, Amy L.; Bolton, W.R.

    2016-01-01

    Lowland boreal forest ecosystems in Alaska are dominated by wetlands comprised of a complex mosaic of fens, collapse-scar bogs, low shrub/scrub, and forests growing on elevated ice-rich permafrost soils. Thermokarst has affected the lowlands of the Tanana Flats in central Alaska for centuries, as thawing permafrost collapses forests that transition to wetlands. Located within the discontinuous permafrost zone, this region has significantly warmed over the past half-century, and much of these carbon-rich permafrost soils are now within ~0.5 °C of thawing. Increased permafrost thaw in lowland boreal forests in response to warming may have consequences for the climate system. This study evaluates the trajectories and potential drivers of 60 years of forest change in a landscape subjected to permafrost thaw in unburned dominant forest types (paper birch and black spruce) associated with location on elevated permafrost plateau and across multiple time periods (1949, 1978, 1986, 1998, and 2009) using historical and contemporary aerial and satellite images for change detection. We developed (i) a deterministic statistical model to evaluate the potential climatic controls on forest change using gradient boosting and regression tree analysis, and (ii) a 30 × 30 m land cover map of the Tanana Flats to estimate the potential landscape-level losses of forest area due to thermokarst from 1949 to 2009. Over the 60-year period, we observed a nonlinear loss of birch forests and a relatively continuous gain of spruce forest associated with thermokarst and forest succession, while gradient boosting/regression tree models identify precipitation and forest fragmentation as the primary factors controlling birch and spruce forest change, respectively. Between 1950 and 2009, landscape-level analysis estimates a transition of ~15 km² or ~7% of birch forests to wetlands, where the greatest change followed warm periods. This work highlights that the vulnerability and resilience of

  11. Gamma ray heating rates due to chromium isotopes in stellar core during late stages of high mass stars (>10M⊙

    Directory of Open Access Journals (Sweden)

    Nabi Jameel-Un

    2017-01-01

    Full Text Available Gamma ray heating rates are thought to play a crucial role during the pre-supernova stage of high mass stars. Gamma ray heating rates, due to β±-decay and electron (positron capture on chromium isotopes, are calculated using proton-neutron quasiparticle random phase approximation theory. The electron capture significantly affects the lepton fraction (Ye and accelerates the core contraction. The gamma rays emitted as a result of weak processes heat the core and tend to hinder the cooling and contraction due to electron capture and neutrino emission. The emitted gamma rays tend to produce enormous entropy and set the convection to play its role at this stage. The gamma heating rates, on 50-60Cr, are calculated for the density range 10 < ρ (g.cm-3 < 1011 and temperature range 107 < T (K < 3.0×1010.

  12. What is the optimal myocardial preservation strategy at re-operation for aortic valve replacement in the presence of a patent internal thoracic artery?

    Science.gov (United States)

    Park, Chan B; Suri, Rakesh M; Burkhart, Harold M; Greason, Kevin L; Dearani, Joseph A; Schaff, Hartzell V; Sundt, Thoralf M

    2011-06-01

    The optimal myocardial preservation strategy at re-operation for aortic valve replacement (AVR) after prior coronary artery bypass grafting (CABG) in the presence of a patent internal thoracic artery (ITA) remains undefined. Patients undergoing AVR after prior CABG at our institution between 1 January 1996 and 31 December 2007 were identified; operative notes and outcomes were reviewed. Of 628 patients with prior CABG undergoing AVR with or without concomitant procedures, 427 patients had a patent ITA. In 390, management of the ITA was detailed in the operative note, including 251 in whom it was clamped and 139 in whom it was left uncontrolled. Groups were demographically similar, although re-operative CABG was more frequent in the clamped group (42% vs 23%, poptimal perfusion temperature when the ITA was left uncontrolled. Efforts to control the patent ITA at re-operation for AVR after prior CABG increase risk of injury and may actually increase operative mortality rate compared with leaving this critical graft open and perfusing the heart. Copyright © 2010 European Association for Cardio-Thoracic Surgery. All rights reserved.

  13. Net sputtering rate due to hot ions in a Ne-Xe discharge gas bombarding an MgO layer

    International Nuclear Information System (INIS)

    Ho, S.; Tamakoshi, T.; Ikeda, M.; Mikami, Y.; Suzuki, K.

    2011-01-01

    An analytical method is developed for determining net sputtering rate for an MgO layer under hot ions with low energy ( h i , above a threshold energy of sputtering, E th,i , multiplied by a yield coefficient. The threshold energy of sputtering is determined from dissociation energy required to remove an atom from MgO surface multiplied by an energy-transfer coefficient. The re-deposition rate of the sputtered atoms is calculated by a diffusion simulation using a hybridized probabilistic and analytical method. These calculation methods are combined to analyze the net sputtering rate. Maximum net sputtering rate due to the hot neon ions increases above the partial pressure of 4% xenon as E h Ne becomes higher and decreases near the partial pressure of 20% xenon as ion flux of neon decreases. The dependence due to the hot neon ions on partial pressure and applied voltage agrees well with experimental results, but the dependence due to the hot xenon ions deviates considerably. This result shows that the net sputtering rate is dominated by the hot neon ions. Maximum E h Ne (E h Ne,max = 5.3 - 10.3 eV) is lower than E th,Ne (19.5 eV) for the MgO layer; therefore, weak sputtering due to the hot neon ions takes place. One hot neon ion sputters each magnesium and each oxygen atom on the surface and distorts around a vacancy. The ratio of the maximum net sputtering rate is approximately determined by number of the ions at E h i,max multiplied by an exponential factor of -E th,i /E h i,max .

  14. Surgical results of reoperative tricuspid surgery: analysis from the Japan Cardiovascular Surgery Database†.

    Science.gov (United States)

    Umehara, Nobuhiro; Miyata, Hiroaki; Motomura, Noboru; Saito, Satoshi; Yamazaki, Kenji

    2014-07-01

    Tricuspid valve insufficiency (TI) following cardiovascular surgery causes right-side heart failure and hepatic failure, which affect patient prognosis. Moreover, the benefits of reoperation for severe tricuspid insufficiency remain unclear. We investigated the surgical outcomes of reoperation in TI. From the Japan Cardiovascular Surgery Database (JACVSD), we extracted cases who underwent surgery for TI following cardiac surgery between January 2006 and December 2011. We analysed the surgical outcomes, specifically comparing tricuspid valve replacement (TVR) and tricuspid valve plasty (TVP). Of the 167 722 surgical JACVSD registered cases, reoperative TI surgery occurred in 1771 cases, with 193 TVR cases and 1578 TVP cases. The age and sex distribution was 684 males and 1087 females, with an average age of 66.5 ± 10.8 years. The overall hospital mortality was 6.8% and was significantly higher in the TVR group than in the TVP group (14.5 vs 5.8%, respectively; P tricuspid surgery were unsatisfactory. Although TVR is a last resort for non-repairable tricuspid lesions, it carries a significant risk of surgical mortality. Improving the patient's preoperative status and opting for TVP over TVR is necessary to improve the results of reoperative tricuspid surgery. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  15. Process improvement in cardiac surgery: development and implementation of a reoperation for bleeding checklist.

    Science.gov (United States)

    Loor, Gabriel; Vivacqua, Alessandro; Sabik, Joseph F; Li, Liang; Hixson, Eric D; Blackstone, Eugene H; Koch, Colleen G

    2013-11-01

    High-performing health care organizations differentiate themselves by focusing on continuous process improvement initiatives aimed at enhancing patient outcomes. Reoperation for bleeding is an event associated with considerable morbidity risk. Hence, our primary objective was to develop and implement a formal operative checklist to reduce technical reasons for postoperative bleeding. From January 1, 2011, through June 30, 2012, 5812 cardiac surgical procedures were performed at Cleveland Clinic (Cleveland, OH). A multidisciplinary team developed a simple, easy-to-perform hemostasis checklist based on the most common sites of bleeding. An extensive educational in-service was performed before limited, then universal, checklist implementation. Geometric charts were used to track the number of cases between consecutive reoperations for bleeding. We compared these before (phase 0) and after the first limited implementation phase (phase 1) and the universal implementation phase (phase 2) of the checklist. The average number of cases between consecutive reoperations for bleeding increased from 32 in phase 0 to 53 in both phase 1 (P = .002) and phase 2 (P = .01). A substantial reduction in reoperation for bleeding cases followed implementation of a formalized hemostasis checklist. Our findings underscore the important influence of memory aids that focus attention on surgical techniques to improve patient outcomes in a complex, operative work environment. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  16. Reoperative reimplantation procedure after previous remodeling in a patient with Marfan syndrome.

    Science.gov (United States)

    Hechadi, Jawad; De Kerchove, Laurent; Vohra, Hunaid A; El Khoury, Gebrine

    2013-05-01

    A 43-year-old man with Marfan syndrome presented with recurrent aortic root dilatation and aortic regurgitation at ten years after a remodeling (Yacoub) procedure. Herein is described a reoperative valve-sparing procedure employing the reimplantation technique (David procedure) used in the treatment of this patient.

  17. Optimal Reoperation of Multi-Reservoirs for Integrated Watershed Management with Multiple Benefits

    Directory of Open Access Journals (Sweden)

    Xinyi Xu

    2014-04-01

    Full Text Available Constructing reservoirs can make more efficient use of water resources for human society. However, the negative impacts of these projects on the environment are often ignored. Optimal reoperation of reservoirs, which considers not only in socio-economic values but also environmental benefits, is increasingly important. A model of optimal reoperation of multi-reservoirs for integrated watershed management with multiple benefits was proposed to alleviate the conflict between water use and environmental deterioration. The social, economic, water quality and ecological benefits were respectively taken into account as the scheduling objectives and quantified according to economic models. River minimum ecological flows and reservoir water levels based on flood control were taken as key constraint conditions. Feasible search discrete differential dynamic programming (FS-DDDP was used to run the model. The proposed model was used in the upstream of the Nanpan River, to quantitatively evaluate the difference between optimal reoperation and routine operation. The results indicated that the reoperation could significantly increase the water quality benefit and have a minor effect on the benefits of power generation and irrigation under different hydrological years. The model can be readily adapted to other multi-reservoir systems for water resources management.

  18. Postoperative use of non-steroidal anti-inflammatory drugs in patients with anastomotic leakage requiring reoperation after colorectal resection

    DEFF Research Database (Denmark)

    Klein, Mads; Gögenur, Ismail; Rosenberg, Jacob

    2012-01-01

    To evaluate the effect of postoperative use of non-steroidal anti-inflammatory drugs (NSAIDs) on anastomotic leakage requiring reoperation after colorectal resection.......To evaluate the effect of postoperative use of non-steroidal anti-inflammatory drugs (NSAIDs) on anastomotic leakage requiring reoperation after colorectal resection....

  19. Statistical analysis of seismicity rate change in the Tokyo Metropolitan area due to the 2011 Tohoku Earthquake

    Science.gov (United States)

    Ishibe, T.; Sakai, S.; Shimazaki, K.; Satake, K.; Tsuruoka, H.; Nakagawa, S.; Hirata, N.

    2012-12-01

    We examined a relationship between the Coulomb Failure Function (ΔCFF) due to the Tohoku earthquake (March 11, 2011; MJMA 9.0) and the seismicity rate change in Tokyo Metropolitan area following March 2011. Because of large variation in focal mechanism in the Kanto region, the receiver faults for the ΔCFF were assumed to be two nodal planes of small (M ≥ 2.0) earthquakes which occurred before and after the Tohoku earthquake. The seismicity rate changes, particularly the rate increase, are well explained by ΔCFF due to the gigantic thrusting, while some other possible factors (e.g., dynamic stress changes, excess of fluid dehydration) may also contribute the rate changes. Among 30,746 previous events provided by the National Research Institute for Earth Science and Disaster Prevention (M ≥ 2.0, July 1979 - July 2003), we used as receiver faults, almost 16,000 events indicate significant increase in ΔCFF, while about 8,000 events show significant decrease. Positive ΔCFF predicts seismicity rate increase in southwestern Ibaraki and northern Chiba prefectures where intermediate-depth earthquakes occur, and in shallow crust of the Izu-Oshima and Hakone regions. In these regions, seismicity rates significantly increased after the Tohoku earthquake. The seismicity has increased since March 2011 with respect to the Epidemic Type of Aftershock Sequence (ETAS) model (Ogata, 1988), indicating that the rate change was due to the stress increase by the Tohoku earthquake. The activated seismicity in the Izu and Hakone regions rapidly decayed following the Omori-Utsu formula, while the increased rate of seismicity in the southwestern Ibaraki and northern Chiba prefectures is still continuing. We also calculated ΔCFF due to the 2011 Tohoku earthquake for the focal mechanism solutions of earthquakes between April 2008 and October 2011 recorded on the Metropolitan Seismic Observation network (MeSO-net). The ΔCFF values for the earthquakes after March 2011 show more

  20. On the Mass and Luminosity Functions of Tidal Disruption Flares: Rate Suppression due to Black Hole Event Horizons

    Science.gov (United States)

    van Velzen, S.

    2018-01-01

    The tidal disruption of a star by a massive black hole is expected to yield a luminous flare of thermal emission. About two dozen of these stellar tidal disruption flares (TDFs) may have been detected in optical transient surveys. However, explaining the observed properties of these events within the tidal disruption paradigm is not yet possible. This theoretical ambiguity has led some authors to suggest that optical TDFs are due to a different process, such as a nuclear supernova or accretion disk instabilities. Here we present a test of a fundamental prediction of the tidal disruption event scenario: a suppression of the flare rate due to the direct capture of stars by the black hole. Using a recently compiled sample of candidate TDFs with black hole mass measurements, plus a careful treatment of selection effects in this flux-limited sample, we confirm that the dearth of observed TDFs from high-mass black holes is statistically significant. All the TDF impostor models we consider fail to explain the observed mass function; the only scenario that fits the data is a suppression of the rate due to direct captures. We find that this suppression can explain the low volumetric rate of the luminous TDF candidate ASASSN-15lh, thus supporting the hypothesis that this flare belongs to the TDF family. Our work is the first to present the optical TDF luminosity function. A steep power law is required to explain the observed rest-frame g-band luminosity, {dN}/{{dL}}g\\propto {L}g-2.5. The mean event rate of the flares in our sample is ≈ 1× {10}-4 galaxy‑1 yr‑1, consistent with the theoretically expected tidal disruption rate.

  1. Reoperations following combat-related upper-extremity amputations.

    Science.gov (United States)

    Tintle, Scott M; Baechler, Martin F; Nanos, George P; Forsberg, Jonathan A; Potter, Benjamin K

    2012-08-15

    Amputation revision rates following major upper-extremity amputations have not been previously reported in a large cohort of patients. We hypothesized that the revision rates following major upper-extremity amputation were higher than the existing literature would suggest, and that surgical treatment of complications and persistent symptoms would lead to improved outcomes. We performed a retrospective analysis of a consecutive series of ninety-six combat-wounded personnel who had sustained a total of 100 major upper-extremity amputations in Operation Iraqi Freedom and Operation Enduring Freedom. Prerevision and postrevision outcome measures, including prosthesis use and type, the presence of phantom and residual limb pain, pain medication use, and return to active military duty, were identified for all patients. All amputations resulted from high-energy trauma, with 87% occurring secondary to a blast injury. Forty-two residual limbs (42%) underwent a total of 103 repeat surgical interventions. As compared with patients with all other levels of amputation, those with a transradial amputation were 4.7 (95% confidence interval [CI]: 1.75 to 12.46) times more likely to have phantom limb pain and 2.8 (95% CI: 1.04 to 7.39) times more likely to require neuropathic pain medications. In the group of patients who underwent revision surgery, regular prosthesis use increased from 19% before the revision to 87% after it (p < 0.0001). In our cohort, revision amputation to address surgical complications and persistently symptomatic residual limbs improved the patient's overall acceptance of the prosthesis and led to outcomes equivalent to those following amputations that did not require revision.

  2. Expanded calculation of weak-interaction-mediated neutrino cooling rates due to 56Ni in stellar matter

    International Nuclear Information System (INIS)

    Nabi, Jameel-Un

    2010-01-01

    An accurate estimate of the neutrino cooling rates is required in order to study the various stages of stellar evolution of massive stars. Neutrino losses from proto-neutron stars play a crucial role in deciding whether these stars would be crushed into black holes or explode as supernovae. Both pure leptonic and weak-interaction processes contribute to the neutrino energy losses in stellar matter. At low temperatures and densities, the characteristics of the early phase of presupernova evolution, cooling through neutrinos produced via the weak interaction, are important. Proton-neutron quasi-particle random phase approximation (pn-QRPA) theory has recently been used with success for the calculation of stellar weak-interaction rates of fp-shell nuclide. The lepton-to-baryon ratio (Y e ) during early phases of stellar evolution of massive stars changes substantially, mainly due to electron captures on 56 Ni. The stellar matter is transparent to the neutrinos produced during the presupernova evolution of massive stars. These neutrinos escape the site and assist the stellar core in maintaining a lower entropy. Here, an expanded calculation of weak-interaction-mediated neutrino and antineutrino cooling rates due to 56 Ni in stellar matter using the pn-QRPA theory is presented. This detailed scale is appropriate for interpolation purposes and is of greater utility for simulation codes. The calculated rates are compared with earlier calculations. During the relevant temperature and density regions of stellar matter the reported rates show few differences compared with the shell model rates and might contribute in fine-tuning of the lepton-to-baryon ratio during the presupernova phases of stellar evolution of massive stars.

  3. Complications, Reoperations, and Nutrient Deficiencies Two Years after Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Nicole Pech

    2012-01-01

    Full Text Available Background. The aim of this study was to investigate patient outcomes and nutritional deficiencies following sleeve gastrectomy (SG during a follow-up of two years. Methods. Over a period of 56 months, all consecutive patients who underwent SG were documented in this prospective, single-center, observational study. The study endpoints included operative time, complication rates, nutritional deficiencies and percentage of excess weight loss (%EWL. Results. From September 26, 2005 to May 28, 2009, 82 patients (female : male = 48 : 34 with a mean age of 43.3 years (range: 22–64 and a preoperative BMI of 52.5 kg/m² (range: 36.8–77.0 underwent SG. Major complications were observed in 9.8% of the patients, with 1 death. During follow up 51.2% of patients were supplemented with iron, 36.6% with zinc, 37.8% with calcium, 26.8% with vitamin D, 46.3% with vitamin B12 and 41.5% with folic acid. %EWL was 54.3, 65.3 and 62.6% after 6, 12 and 24 months. Conclusion. SG as a single step procedure is an effective bariatric intervention. Nutritional deficiencies after SG can be detected by routine nutritional screening. Our results show that Vitamin B12 supplementation should suggest routinely after SG.

  4. Simulation of short-term fluctuations in gamma exposure rate due to radioactive cloud released from nuclear power plant

    International Nuclear Information System (INIS)

    Ichikawa, Yoichi; Shikata, Hiroshi; Ishida, Kenji; Ohba, Tachimori.

    1981-01-01

    The measured γ-exposure rate around nuclear power plants is due mainly to natural causes and radioactive clouds emitted from the plants. An exposure calculation method based on puff model has been already proposed to identify the plant contributions and to estimate values in response to short-term fluctuations of meteorological condition and the release rate. However, the calculation method by this model consumes a lot of computer time, since the calculation requires a three-dimensional integration of the distribution of the concentration from each puff. Hence, we propose a simplified method using approximate polynominal equations and interpolations. The computer time needed for the calculation with the simplified method is reduced to 1/30 of that required by the previous method. The calculation results by simplified method are compared with those by the previous method and with the measured exposure rate less natural background. The results of two different methods are in good agreement. The calculated exposure rate is within the range from half to twice as much as the measured exposure rate less background. (author)

  5. Detection of low-level environmental exposure rates due to noble gas releases from the Muehleberg nuclear power plant

    International Nuclear Information System (INIS)

    Czarnecki, J.; Volkle, H.; Pretre, S.

    1980-01-01

    The increase of radiation doses in the vicinity of the Swiss Nuclear Power Stations due to airborne releases is generally expected to be below one mrem/year (about one percent of the natural radiation dose). To prove this expected rate, long term measurements with pressure ionization chambers in the vicinity of the Muhleberg plant (BWR) were conducted. Two of these chambers were installed at places where the greatest dose rates from the noble gas plumes were expected in the two prevailing wind directions. The local dose rates were continuously registered on magnetic tape to allow minicomputer evaluation. After the fuel change in the summer of 1976 the noble gas releases from Muhleberg dropped considerably. From that time the noble gas releases consisted of a very low continuous component and some rare short-time spike compoments resulting from turbine and reactor trips. The dose due to the low continuous component was determined by correlating the dose rates at the measuring points with the release measure--ments at the stack and with weather conditions, and by subtracting the natural background. The short noble gas spikes lasted from minutes to some hours and caused small dose rate increases which were easily measured with the ionization chambers, and usually amounted to doses of some microroentgens. By further correlating these dose peaks with wind direction and stack emission measurements, determination of short time atmospheric dilution factors for existing weather situations became possible. By this process, the very low annual environmental doses in the range of 1 mrem per year were determined. (author)

  6. High revision rate but good healing capacity of atypical femoral fractures. A comparison with common shaft fractures.

    Science.gov (United States)

    Schilcher, Jörg

    2015-12-01

    Healing of complete, atypical femoral fractures is thought to be impaired, but the evidence is weak and appears to be based on the delayed healing observed in patients with incomplete atypical fractures. Time until fracture healing is difficult to assess, therefore we compared the reoperation rates between women with complete atypical femoral fractures and common femoral shaft fractures. We searched the orthopaedic surgical registry in Östergötland County for patients with subtrochanteric and femoral shaft fractures (ICD-10 diagnosis codes S72.2, S72.3 and M84.3F) between January 1st 2007 and December 31st 2013. Out of 895 patients with surgically treated femoral shaft fractures, 511 were women 50 years of age or older. Among these we identified 24 women with atypical femoral shaft fractures, and 71 with common shaft fractures. Reoperations were performed in 6 and 5 patients, respectively, odds ratio 4.4 (95% CI 1.2 to 16.1). However, 5 reoperations in the atypical fracture group could not be ascribed to poor healing. In 3 patients the reoperation was due to a new fracture proximal to a standard intramedullary nail. In 2 patients the distal locking screws were removed due to callus formation that was deemed incomplete 5 months post-operatively. The one patient with poor healing showed faint callus formation at 5 months when the fracture was dynamised and callus remained sparse at 11 months. Among patients with common shaft fractures, 2 reoperations were performed to remove loose screws, 2 because of peri-implant fractures and 1 reoperation due to infection. Reoperation rates in patients with complete atypical femoral fractures are higher than in patients with common shaft fractures. The main reason for failure was peri-implant fragility fractures which might be prevented with the use of cephalomedullary nails at the index surgery. Fracture healing however, seems generally good. A watchful waiting approach is advocated in patients with fractures that appear to

  7. Enhancement of fatigue crack growth rates in pressure boundary materials due to light-water-reactor environments

    International Nuclear Information System (INIS)

    VanDerSluys, W.A.; Emanuelson, R.H.

    1988-01-01

    The high level of reliability required of the primary-coolant pressure boundary in a nuclear reactor system leads to a continuing interest in the interaction among the coolant, pressure boundary materials, and service loadings. One area of concern involves the possible enhancement of the growth rate of fatigue cracks due to the coolant. Advances have occurred recently toward a better understanding of the variables influencing the material/environment interactions and methods of addressing this interaction. Sulfur now appears to be one of the principal agents responsible for the observed enhancement of the fatigue crack growth rates in light-water-reactor (LWR) environments. This paper presents the results of investigations on the effect of sulfur in the steel, bulk water environment, and at the crack tip

  8. Reoperation for non-structural valvular dysfunction caused by pannus ingrowth in aortic valve prosthesis.

    Science.gov (United States)

    Oh, Se Jin; Park, Samina; Kim, Jun Sung; Kim, Kyung-Hwan; Kim, Ki Bong; Ahn, Hyuk

    2013-07-01

    The authors' clinical experience is presented of non-structural valvular dysfunction of the prosthetic aortic valve caused by pannus ingrowth during the late postoperative period after previous heart valve surgery. Between January 1999 and April 2012, at the authors' institution, a total of 33 patients underwent reoperation for increased mean pressure gradient of the prosthetic aortic valve. All patients were shown to have pannus ingrowth. The mean interval from the previous operation was 16.7 +/- 4.3 years, and the most common etiology for the previous aortic valve replacement (AVR) was rheumatic valve disease. The mean effective orifice area index (EOAI) of the previous prosthetic valve was 0.97 +/- 0.11 cm2/m2, and the mean pressure gradient on the aortic prosthesis before reoperation was 39.1 +/- 10.7 mmHg. Two patients (6.1%) died in-hospital, and late death occurred in six patients (18.2%). At the first operation, 30 patients underwent mitral or tricuspid valve surgery as a concomitant procedure. Among these operations, mitral valve replacement (MVR) was combined in 24 of all 26 patients with rheumatic valve disease. Four patients underwent pannus removal only while the prosthetic aortic valve was left in place. The mean EOAI after reoperation was significantly increased to 1.16 +/- 0.16 cm2/m2 (p pannus ingrowth was shown in patients with a small EOAI of the prosthetic aortic valve and combined MVR for rheumatic disease. As reoperation for pannus overgrowth showed good clinical outcomes, an aggressive resection of pannus and repeated AVR should be considered in symptomatic patients to avoid the complications of other cardiac diseases.

  9. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation

    DEFF Research Database (Denmark)

    Palm, Henrik; Jacobsen, Steffen; Sonne-Holm, Stig

    2007-01-01

    BACKGROUND: Reoperations after intertrochanteric fractures are often necessitated by fracture displacement following mobilization of the patient. The biomechanical complexity of the fracture, the position of the implant, and the patient's characteristics are known to influence postoperative outcome...... of the lateral femoral wall are not treated adequately with a sliding compression hip-screw device, and intertrochanteric fractures should therefore be classified according to the integrity of the lateral femoral wall, especially in randomized trials comparing fracture implants....

  10. Isopleths of surface concentration and surface exposure rate due to a radioactive cloud released from a stack

    International Nuclear Information System (INIS)

    Kobayashi, Hideo; Yabuta, Hajimu; Katagiri, Hiroshi; Obata, Kazuichi; Kokubu, Morinobu

    1982-03-01

    Various calculations are made to estimate the distributions of concentration and γ-exposure rate due to a radioactive cloud released from a point source to the atmosphere. In this report, the isopleths of concentration and γ-exposure rate which were calculated are given in graphs to enable rapid prediction of the influence of released radioactive material in the emergency situation. Recently there are facilities which are equipped with a system to display the calculation results on CRT; but such practice is rather rare. By placing the calculated isopleths of reduction scale 1/25000 or 1/50000 on the usual map, any facilities without the CRT system can readily estimate the influence of an accidental release. The graphs of isopleths are given with the release height (11 values of 0 to 200 m at about 20 m intervals) and the atmospheric stability (6 classes) as parameters. Calculations of γ-exposure rates were made using the computer code GAMPUL developed by T. Hayashi and T. Shiraishi. In the calculation of radioactive concentrations and γ-exposure rates, the vertical diffusion depths, σsub(z), exceeding 1000 m are taken to be 1000 m according to the Meteorological Guide for the Safety Analysis of Power Reactor (J.AEC). The comparison between with and without this limitation in σsub(z) is made in the case of downwind axial surface distributions. (author)

  11. Dynamics of postoperative serum cortisol after transsphenoidal surgery for Cushing's disease: implications for immediate reoperation and remission.

    Science.gov (United States)

    Mayberg, Marc; Reintjes, Stephen; Patel, Anika; Moloney, Kelley; Mercado, Jennifer; Carlson, Alex; Scanlan, James; Broyles, Frances

    2017-12-22

    OBJECTIVE Successful transsphenoidal surgery for adrenocorticotropin hormone (ACTH)-producing pituitary tumors is associated with subnormal postoperative serum cortisol levels, which may guide decisions regarding immediate reoperation. However, little is known about the detailed temporal course of changes in serum cortisol in the immediate postoperative period, and the relationship of postoperative cortisol dynamics to remission and late recurrence. METHODS A single-center retrospective cohort analysis was performed for all patients undergoing pituitary surgery from 2007 through 2015. Standardized diagnostic and treatment algorithms were applied to all patients with potential Cushing's disease (CD), including microsurgical transsphenoidal adenomectomy (TSA) by a single surgeon. All patients had serum cortisol levels drawn at 6-hour intervals for 72 hours after surgery, and were offered reoperation within 3 days for normal or supranormal postoperative cortisol levels. Primary outcomes were 6-month remission and late recurrence; secondary outcomes were persistent postoperative hypocortisolism and surgical morbidity. Discriminatory levels of postoperative serum cortisol for predicting remission were calculated at various intervals after surgery using receiver operating characteristic (ROC) curves. RESULTS Among 89 patients diagnosed with CD, 81 underwent initial TSA for a potentially curable lesion; 23 patients (25.8%) underwent an immediate second TSA. For the entire cohort, 6-month remission was achieved in 77.8% and late recurrences occurred in 9.5%, at a mean of 43.5 months. Compared with patients with a single surgery, those with an immediate second TSA had similar rates of remission (78.3% vs 77.6%) and late recurrence (5.6% vs 11.1%). The rate of hypocortisolism for patients with 2 surgeries (12/23, 52.2%) was significantly greater than that for patients with single surgeries (13/58, 22.4%; p surgery protocol. The temporal course of postoperative serum cortisol

  12. Low permanent pacemaker rates following Lotus device implantation for transcatheter aortic valve replacement due to modified implantation protocol.

    Science.gov (United States)

    Krackhardt, Florian; Kherad, Behrouz; Krisper, Maximilian; Pieske, Burkert; Laule, Michael; Tschöpe, Carsten

    2017-01-01

    Conduction disturbances requiring permanent pacemaker implantation following transcatheter aortic valve replacement (TAVR) are a common problem. Pacemaker implantation rates after TAVR appear to be higher compared to conventional aortic valve replacement. The aim of this study was to analyze whether a high annulus implantation conveys the benefit of a decreased rate of permanent pacemaker implantation while being safe and successful according to Valve Academic Research Consortium 2 (VARC2)-criteria. A total of 23 patients with symptomatic severe aortic valve stenosis, an aortic annulus of 19-27 mm and at high risk for surgery were treated with the Lotus valve. In all patients the valve was implanted in a high annulus position via femoral access. The primary device performance endpoint was VARC2-defined device success after 30 days and the primary safety endpoint was the need for permanent pacemaker implantation. The mean age was 73.23 ± 7.65 years, 46% were female, 38% were New York Heart Association class III/IV at baseline. Thirty-day follow-up data were available for all patients. The VARC2-defined device success rate after 30 days was 22/23 (96%). 2/21 (10%) patients required a newly implanted pacemaker due to 3rd degree atrioventricular block. 25% of the patients developed a new left bundle branch block after valvuloplasty or device implantation. 21 of the 23 patients (96%) had no other signs of conduction disturbances after 30 days. The approach of the modified implantation technique of Lotus TAVR device was safe and effective. The incidence of need for a permanent pacemaker following TAVR could be significantly reduced due to adopted implantation protocol.

  13. Radiation therapy rather than prior surgery reduces extent of resection during endonasal endoscopic reoperation for craniopharyngioma.

    Science.gov (United States)

    Younus, Iyan; Forbes, Jonathan A; Ordóñez-Rubiano, Edgar G; Avendano-Pradel, Rafael; La Corte, Emanuele; Anand, Vijay K; Schwartz, Theodore H

    2018-07-01

    Radiation therapy is often advocated for residual or recurrent craniopharyngioma following surgical resection to prevent local recurrence. However, radiation therapy is not always effective and may render tumors more difficult to remove. If this is the case, patients may benefit more from reoperation if gross total resection can be achieved. Nevertheless, there is little data on the impact of radiation on reoperations for craniopharyngioma. In this study, we sought to analyze whether a history of previous radiation therapy (RT) affected extent of resection in patients with recurrent craniopharyngiomas subsequently treated with reoperation via endoscopic endonasal approach (EEA). The authors reviewed a prospectively acquired database of EEA reoperations of craniopharyngiomas over 13 years at Weill Cornell, NewYork-Presbyterian Hospital. All procedures were performed by the senior author. The operations were separated into two groups based on whether the patient had surgery alone (group A) or surgery and RT (group B) prior to recurrence. A total of 24 patients (16 male, 8 female) who underwent surgery for recurrent craniopharyngioma were identified. The average time to recurrence was 7.64 ± 4.34 months (range 3-16 months) for group A and 16.62 ± 12.1 months (range 6-45 months) for group B (p < 0.05). The average tumor size at recurrence was smaller in group A (1.85 ± 0.72 cm; range 0.5-3.2) than group B (2.59 ± 0.91 cm; range 1.5-4.6; p = 0.00017). Gross total resection (GTR) was achieved in 91% (10/11) of patients in group A and 54% (7/13) of patients in group B (p = 0.047). There was a near significant trend for higher average Karnofsky performance status (KPS) score at last follow-up for group A (83 ± 10.6) compared with group B (70 ± 16.3, p = 0.056). While RT for residual or recurrent craniopharyngioma may delay time to recurrence, ability to achieve GTR with additional surgery is reduced. In the case of

  14. Determination of corrosion rate of reinforcement with a modulated guard ring electrode; analysis of errors due to lateral current distribution

    International Nuclear Information System (INIS)

    Wojtas, H.

    2004-01-01

    The main source of errors in measuring the corrosion rate of rebars on site is a non-uniform current distribution between the small counter electrode (CE) on the concrete surface and the large rebar network. Guard ring electrodes (GEs) are used in an attempt to confine the excitation current within a defined area. In order to better understand the functioning of modulated guard ring electrode and to assess its effectiveness in eliminating errors due to lateral spread of current signal from the small CE, measurements of the polarisation resistance performed on a concrete beam have been numerically simulated. Effect of parameters such as rebar corrosion activity, concrete resistivity, concrete cover depth and size of the corroding area on errors in the estimation of polarisation resistance of a single rebar has been examined. The results indicate that modulated GE arrangement fails to confine the lateral spread of the CE current within a constant area. Using the constant diameter of confinement for the calculation of corrosion rate may lead to serious errors when test conditions change. When high corrosion activity of rebar and/or local corrosion occur, the use of the modulated GE confinement may lead to significant underestimation of the corrosion rate

  15. Nonlinear Heart Rate Variability features for real-life stress detection. Case study: students under stress due to university examination.

    Science.gov (United States)

    Melillo, Paolo; Bracale, Marcello; Pecchia, Leandro

    2011-11-07

    This study investigates the variations of Heart Rate Variability (HRV) due to a real-life stressor and proposes a classifier based on nonlinear features of HRV for automatic stress detection. 42 students volunteered to participate to the study about HRV and stress. For each student, two recordings were performed: one during an on-going university examination, assumed as a real-life stressor, and one after holidays. Nonlinear analysis of HRV was performed by using Poincaré Plot, Approximate Entropy, Correlation dimension, Detrended Fluctuation Analysis, Recurrence Plot. For statistical comparison, we adopted the Wilcoxon Signed Rank test and for development of a classifier we adopted the Linear Discriminant Analysis (LDA). Almost all HRV features measuring heart rate complexity were significantly decreased in the stress session. LDA generated a simple classifier based on the two Poincaré Plot parameters and Approximate Entropy, which enables stress detection with a total classification accuracy, a sensitivity and a specificity rate of 90%, 86%, and 95% respectively. The results of the current study suggest that nonlinear HRV analysis using short term ECG recording could be effective in automatically detecting real-life stress condition, such as a university examination.

  16. A variable reaction rate model for chlorine decay in drinking water due to the reaction with dissolved organic matter.

    Science.gov (United States)

    Hua, Pei; Vasyukova, Ekaterina; Uhl, Wolfgang

    2015-05-15

    A second order kinetic model for simulating chlorine decay in bulk water due to the reaction with dissolved organic matter (DOM) was developed. It takes into account the decreasing reactivity of dissolved organic matter using a variable reaction rate coefficient (VRRC) which decreases with an increasing conversion. The concentration of reducing species is surrogated by the maximum chlorine demand. Temperature dependency, respectively, is described by the Arrhenius-relationship. The accuracy and adequacy of the proposed model to describe chlorine decay in bulk water were evaluated and shown for very different waters and different conditions such as water mixing or rechlorination by applying statistical tests. It is thus very well suited for application in water quality modeling for distribution systems. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Strength and Absorption Rate of Compressed Stabilized Earth Bricks (CSEBs Due to Different Mixture Ratios and Degree of Compaction

    Directory of Open Access Journals (Sweden)

    Abdullah Abd Halid

    2017-01-01

    Full Text Available Compressed Stabilized Earth Brick (CSEB is produced by compressing a mixture of water with three main materials such as Ordinary Portland Cement (OPC, soil, and sand. It becomes popularfor its good strength, better insulation properties, and a sustainable product due to its easy production with low carbon emission and less skilled labour required. Different types of local soils usedwill produce CSEB of different physical properties in terms of its strength, durability, and water absorption rate. This study focuses on laterite soil taken from the surrounding local area in Parit Raja, Johor, and CSEB samples are produced based on prototype brick size 100×50×30 mm. The investigations are based on four different degree of compactions (i.e. 1500, 2000, 2500, and 3000 Psi and three different mix proportion ratios of cement:sand:laterite soil (i.e. 1:1:9, 1:2:8, 1:3:7. A total of 144 CSEB samples have been tested at 7 and 28 days curing periods to determine the compressive strength (BS 3921:1985 and water absorption rate (MS 76:1972. It was found that maximum compressive strength of CSEB was 14.68 N/mm2 for mixture ratio of 1:3:7 at 2500 Psi compaction. Whereas, the minimum strengthis 6.87 N/mm2 for 1:1:9mixture ratio at 1500 Psi. Meanwhile, the lowest water absorption was 12.35% for mixture ratio of 1:2:8 at 3000 Psi; while the 1:1:9 mixture ratio at 1500 Psi gave the highest rate of 16.81%. This study affirms that the sand content in the mixture and the degree of compaction would affect the value of compressive strength and water absorption of CSEB.

  18. Percutaneous Endoscopic Lumbar Reoperation for Recurrent Sciatica Symptoms: A Retrospective Analysis of Outcomes and Prognostic Factors in 94 Patients.

    Science.gov (United States)

    Wu, Junlong; Zhang, Chao; Lu, Kang; Li, Changqing; Zhou, Yue

    2018-01-01

    Recurrent symptoms of sciatica after previous surgical intervention is a relatively common and troublesome clinical problem. Percutaneous endoscopic lumbar decompression has been proved to be an effective method for recurrent lumbar disc herniation. However, the prognostic factors and outcomes of percutaneous endoscopic lumbar reoperation (PELR) for recurrent sciatica symptoms were still unknown. The purpose of this study was to evaluate the outcomes and prognostic factors of patients who underwent PELR for recurrent sciatica symptoms. From 2009 to 2015, 94 patients who underwent PELR for recurrent sciatica symptoms were enrolled. The primary surgeries include transforaminal lumbar interbody fusion (n = 16), microendoscopic discectomy (n = 31), percutaneous endoscopic lumbar decompression (PELD, n = 17), and open discectomy (n = 30). The mean follow-up period was 36 months, and 86 (91.5%) patients had obtained at least 24 months' follow-up. Of the 94 patients with adequate follow-up, 51 (54.3%) exhibited excellent improvement, 23 (24.5%) had good improvement, and 7 (7.4%) had fair improvement according to modified Macnab criteria. The average re-recurrence rate was 9.6%, with no difference among the different primary surgery groups (PELD, 3/17; microendoscopic discectomy, 2/31; open discectomy, 3/30; transforaminal lumbar interbody fusion, 1/16). There was a trend toward greater rates of symptom recurrence in the primary group of PELD who underwent percutaneous endoscopic lumbar reoperation compared with other groups, but this did not reach statistical significance (P > 0.05). Multivariate analysis suggested that age, body mass index, and surgeon level was independent prognostic factors. Obesity (hazard ratio 13.98, 95% confidence interval 3.394-57.57; P sciatica symptoms regardless of different primary operation type. Obesity, inferior surgeon level, and patient age older than 40 years were associated with a worse prognosis. Obesity was also a strong and

  19. A rating scale is a proper method to evaluate changes in quality of life due to dry eye symptoms.

    Science.gov (United States)

    Xue, Wenwen; Xu, Xian; Zou, Haidong

    2018-02-07

    To determine which utility value assessment method is more suitable to evaluate changes in the quality of life due to dry eye symptoms. Dry eye outpatients with a presenting visual acuity of 20/25 or better in the worse-seeing eye were recruited. Presenting distance visual acuity, tear film break-up time, Schirmer I test and fluorescein were assessed. The severity of dry eye symptoms was assessed using the Ocular Surface Disease Index (OSDI), and utility values were measured using the time trade-off (TTO), standard gamble (SG1 and SG2) and rating scale (RS) methods. Different utility values were compared with each other. The most appropriate utility value method to evaluate quality-of-life changes solely due to dry eye symptoms is determined by calculating the correlation between the OSDI score and different utility values. A total of 104 patients were enrolled. The three sections of OSDI in the order of high to low scores were as follows: "environmental trigger," "eye discomfort" and "visual function." The utility scores measured with TTO, SG1, SG2 and RS were 0.95 ± 0.11, 0.96 ± 0.10, 0.99 ± 0.07 and 0.89 ± 0.10, respectively. The utility scores evaluated by the TTO, SG1, SG2 and RS methods were significantly different from each other (p eye discomfort" section scores (p dry eye symptoms.

  20. Specific absorption rate variation in a brain phantom due to exposure by a 3G mobile phone: problems in dosimetry.

    Science.gov (United States)

    Behari, J; Nirala, Jay Prakash

    2013-12-01

    A specific absorption rate (SAR) measurements system has been developed for compliance testing of personal mobile phone in a brain phantom material contained in a Perspex box. The volume of the box has been chosen corresponding to the volume of a small rat and illuminated by a 3G mobile phone frequency (1718.5 MHz), and the emitted radiation directed toward brain phantom .The induced fields in the phantom material are measured. Set up to lift the plane carrying the mobile phone is run by a pulley whose motion is controlled by a stepper motor. The platform is made to move at a pre-determined rate of 2 degrees per min limited up to 20 degrees. The measured data for induced fields in various locations are used to compute corresponding SAR values and inter comparison obtained. These data are also compared with those when the mobile phone is placed horizontally with respect to the position of the animal. The SAR data is also experimentally obtained by measuring a rise in temperature due to this mobile exposures and data compared with those obtained in the previous set. To seek a comparison with the safety criteria same set of measurements are performed in 10 g phantom material contained in a cubical box. These results are higher than those obtained with the knowledge of induced field measurements. It is concluded that SAR values are sensitive to the angular position of the moving platform and are well below the safety criteria prescribed for human exposure. The data are suggestive of having a fresh look to understand the mode of electromagnetic field -bio interaction.

  1. Combination of poroelasticity theory and constant strain rate test in modelling land subsidence due to groundwater extraction

    Science.gov (United States)

    Pham, Tien Hung; Rühaak, Wolfram; Sass, Ingo

    2017-04-01

    Extensive groundwater extraction leads to a drawdown of the ground water table. Consequently, soil effective stress increases and can cause land subsidence. Analysis of land subsidence generally requires a numerical model based on poroelasticity theory, which was first proposed by Biot (1941). In the review of regional land subsidence accompanying groundwater extraction, Galloway and Burbey (2011) stated that more research and application is needed in coupling of stress-dependent land subsidence process. In geotechnical field, the constant rate of strain tests (CRS) was first introduced in 1969 (Smith and Wahls 1969) and was standardized in 1982 through the designation D4186-82 by American Society for Testing and Materials. From the reading values of CRS tests, the stress-dependent parameters of poroelasticity model can be calculated. So far, there is no research to link poroelasticity theory with CRS tests in modelling land subsidence due to groundwater extraction. One dimensional CRS tests using conventional compression cell and three dimension CRS tests using Rowe cell were performed. The tests were also modelled by using finite element method with mixed elements. Back analysis technique is used to find the suitable values of hydraulic conductivity and bulk modulus that depend on the stress or void ratio. Finally, the obtained results are used in land subsidence models. Biot, M. A. (1941). "General theory of three-dimensional consolidation." Journal of applied physics 12(2): 155-164. Galloway, D. L. and T. J. Burbey (2011). "Review: Regional land subsidence accompanying groundwater extraction." Hydrogeology Journal 19(8): 1459-1486. Smith, R. E. and H. E. Wahls (1969). "Consolidation under constant rates of strain." Journal of Soil Mechanics & Foundations Div.

  2. Rate of shunt revision as a function of age in patients with shunted hydrocephalus due to myelomeningocele.

    Science.gov (United States)

    Dupepe, Esther B; Hopson, Betsy; Johnston, James M; Rozzelle, Curtis J; Jerry Oakes, W; Blount, Jeffrey P; Rocque, Brandon G

    2016-11-01

    OBJECTIVE It is generally accepted that cerebrospinal fluid shunts fail most frequently in the first years of life. The purpose of this study was to describe the risk of shunt failure for a given patient age in a well-defined cohort with shunted hydrocephalus due to myelomeningocele (MMC). METHODS The authors analyzed data from their institutional spina bifida research database including all patients with MMC and shunted hydrocephalus. For the entire population, the number of shunt revisions in each year of life was determined. Then the number of patients at risk for shunt revision during each year of life was calculated, thus enabling them to calculate the rate of shunt revision per patient in each year of life. In this way, the timing of all shunt revision operations for the entire clinic population and the likelihood of having a shunt revision during each year of life were calculated. RESULTS A total of 655 patients were enrolled in the spina bifida research database, 519 of whom had a diagnosis of MMC and whose mean age was 17.48 ± 11.7 years (median 16 years, range 0-63 years). Four hundred seventeen patients had had a CSF shunt for the treatment of hydrocephalus and thus are included in this analysis. There were 94 shunt revisions in the 1st year of life, which represents a rate of 0.23 revisions per patient in that year. The rate of shunt revision per patient-year initially decreased as age increased, except for an increase in revision frequency in the early teen years. Shunt revisions continued to occur as late as 43 years of age. CONCLUSIONS These data substantiate the idea that shunt revision surgeries in patients with MMC are most common in the 1st year of life and decrease thereafter, except for an increase in the early teen years. A persistent risk of shunt failure was observed well into adult life. These findings underscore the importance of routine follow-up of all MMC patients with shunted hydrocephalus and will aid in counseling patients and

  3. High recurrence rate of lymphadenitis due to nontuberculous mycobacteria and its association with concurrent Salmonella infection in Taiwan.

    Science.gov (United States)

    Hsiao, Cheng-Hsiang; Lai, Chih-Cheng; Hsueh, Po-Ren

    2014-06-01

    The objective of this study is to investigate the clinical characteristics of lymphadenitis due to nontuberculous mycobacteria (NTM) in Taiwan. We retrospectively reviewed the medical records of all patients who presented to the National Taiwan University Hospital with culture-positive NTM lymphadenitis during the period 2000-2010. Patients with concurrent extranodal involvement were excluded. From 2000 to 2010, 15 patients with lymphadenitis caused by nontuberculous mycobacteria were identified. Most patients (80%, n = 12) were infected with rapidly growing mycobacteria. Mycobacterium abscessus was the most common infective species (n = 8). Recurrence of infection involving multiple organs occurred 2-7 years after the completion of treatment in 11 (73%) patients. Five (33.3%) patients had concurrent Salmonella infections (4 patients with bacteremia and 1 patient with empyema thoracis) during the course of the disease. In Taiwanese patients, we found a high recurrence rate of NTM lymphadenitis that was closely associated with Salmonella infections. We also noted that the clinical and epidemiological manifestations of NTM lymphadenitis in Taiwan differed from their manifestations in western countries. Copyright © 2012. Published by Elsevier B.V.

  4. Benthic Uptake Rate due to Hyporheic Exchange: The Effects of Streambed Morphology for Constant and Sinusoidally Varying Nutrient Loads

    Directory of Open Access Journals (Sweden)

    Daniele Tonina

    2015-01-01

    Full Text Available Hyporheic exchange carries reactive solutes, which may include biological oxygen demand (BOD, dissolved oxygen (DO and reactive dissolved inorganic nitrogen (Nr, into the sediment, where biochemical reactions consume DO. Here, we study the impact of streambed morphology, stream-reactive solute loads and their diel oscillations on the DO benthic uptake rate (BUR due to hyporheic processes. Our model solves the hyporheic flow field and the solute transport equations analytically, within a Lagrangian framework, considering advection, longitudinal diffusion and reactions modeled as first order kinetics. The application of the model to DO field measurements over a gravel bar-pool sequence shows a good match with measured DO concentrations with an overall agreement of 58% and a kappa index of 0.46. We apply the model to investigate the effects of daily constant and sinusoidally time varying stream BOD, DO and Nr loads and of the morphodynamic parameters on BUR. Our modeling results show that BUR varies as a function of bedform size and of nutrient loads and that the hyporheic zone may consume up to 0.06% of the stream DO at the pool-riffle bedform scale. Daily oscillations of stream BOD and DO loads have small effects on BUR, but may have an important influence on local hyporheic processes and organisms’ distribution.

  5. (+)-Nootkatone and (+)-valencene from rhizomes of Cyperus rotundus increase survival rates in septic mice due to heme oxygenase-1 induction.

    Science.gov (United States)

    Tsoyi, Konstantin; Jang, Hwa Jin; Lee, Young Soo; Kim, Young Min; Kim, Hye Jung; Seo, Han Geuk; Lee, Jae Heun; Kwak, Jong Hwan; Lee, Dong-Ung; Chang, Ki Churl

    2011-10-11

    The rhizomes of Cyperus rotundus have been used as traditional folk medicine for the treatment of inflammatory diseases. However, the mechanism by which extract of rhizomes of Cyperus rotundus (ECR) elicits anti-inflammation has not been extensively investigated so far. The aim of the present study was to test whether heme oxygenase (HO)-1 induction is involved in the anti-inflammatory action of ECR. Induction of HO-1 and inhibition of inducible nitric oxide synthase (iNOS)/NO production by ECR and its 12 constituents (3 monoterpenes, 5 sesquiterpenes, and 4 aromatic compounds) were investigated using RAW264.7 cells in vitro. In addition, anti-inflammatory action of ECR and its two active ingredients (nookkatone, valencene) were confirmed in sepsis animal model in vivo. ECR increased HO-1 expression in a concentration-dependent manner, which was correlated with significant inhibition of iNOS/NO production in LPS-activated RAW264.7 cells. Among 12 compounds isolated from ECR, mostly sesquiterpenes induced stronger HO-1 expression than monoterpenes in macrophage cells. Nootkatone and valencene (sesquiterpenes) significantly inhibited iNOS expression and NO production in LPS-simulated RAW264.7 cells. Inhibition of iNOS expression by nootkatone, valencene, and ECR were significantly reduced in siHO-1 RNA transfected cells. Furthermore, all three showed marked inhibition of high mobility group box-1 (HMGB1) in LPS-activated macrophages and increased survival rates in cecal ligation and puncture (CLP)-induced sepsis in mice. Taken together, we concluded that possible anti-inflammatory mechanism of ECR is, at least, due to HO-1 induction, in which sesquiterpenes such as nootkatone and valencene play a crucial role. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  6. Estimate of the global-scale joule heating rates in the thermosphere due to time mean currents

    International Nuclear Information System (INIS)

    Roble, R.G.; Matsushita, S.

    1975-01-01

    An estimate of the global-scale joule heating rates in the thermosphere is made based on derived global equivalent overhead electric current systems in the dynamo region during geomagnetically quiet and disturbed periods. The equivalent total electric field distribution is calculated from Ohm's law. The global-scale joule heating rates are calculated for various monthly average periods in 1965. The calculated joule heating rates maximize at high latitudes in the early evening and postmidnight sectors. During geomagnetically quiet times the daytime joule heating rates are considerably lower than heating by solar EUV radiation. However, during geomagnetically disturbed periods the estimated joule heating rates increase by an order of magnitude and can locally exceed the solar EUV heating rates. The results show that joule heating is an important and at times the dominant energy source at high latitudes. However, the global mean joule heating rates calculated near solar minimum are generally small compared to the global mean solar EUV heating rates. (auth)

  7. Profiling Surgeon Performance for Breast Cancer Lumpectomy by Composite Measurement of Reoperations, Cosmetic Outcomes, and Patient Preferences.

    Science.gov (United States)

    Dunham, Annie L; Ramirez, Luis D; Vang, Choua A; Linebarger, Jared H; Landercasper, Jeffrey

    2018-07-01

    Patients want information to search for destination of care for breast-conserving surgery (BCS). To inform patients wanting a lumpectomy, we aimed to develop a pilot project that communicated composite quality measure (QM) results using a '4-star' rating system. Two patient-centered QMs were included in the model-reoperation rate (ROR) and cosmetic outcome (COSM). A prospective database was reviewed for stage 0-3 patients undergoing initial lumpectomy by three surgeons from 2010 to 2015. Self-reported COSM was assessed by survey. Multivariate analyses were used to test for interactions between surgeon and other variables known to influence RORs and COSMs. Models of surgeon profiling were developed that summed the ROR and COSM performance scores, then reported results using a Centers for Medicare and Medicaid Services (CMS) star-type system. Functionality for a patient to 'weight' the importance of the ratio of ROR:COSM before profiling was introduced. The unadjusted ROR for stage 1-3 patients for three surgeons was 9.5, 13.0, and 16.3%, respectively (p = 0.179) [overall rate 10.4% (38/366)]. After risk adjustment, differences between surgeons were observed for RORs, but not COSMs. Overall, patients reported excellent, good, fair, and poor COSMs of 55, 30, 11 and 4%, respectively. Composite star scores reflected differences in performance by surgeon, which could increase, or even disappear, dependent on the patient's weighting of the ROR:COSM ratio. Composite measures of performance can be developed that allow patients to input their weighted preferences and values into surgeon profiling before they consider a destination of care for BCS.

  8. A scenario for impacts of water availability loss due to climate change on riverine fish extinction rates

    OpenAIRE

    Tedesco, Pablo; Oberdorff, Thierry; Cornu, Jean-François; Beauchard, O.; Brosse, S.; Durr, H. H.; Grenouillet, G.; Leprieur, F.; Tisseuil, Clément; Zaiss, Rainer; Hugueny, Bernard

    2013-01-01

    1. Current models estimating impact of habitat loss on biodiversity in the face of global climate change usually project only percentages of species committed to extinction' on an uncertain time-scale. Here, we show that this limitation can be overcome using an empirically derived background extinction rate-area' curve to estimate natural rates and project future rates of freshwater fish extinction following variations in river drainage area resulting from global climate change.2. Based on fu...

  9. Effects of high repetition rate and beam size on hard tissue damage due to subpicosecond laser pulses

    International Nuclear Information System (INIS)

    Kim, Beop-Min; Feit, Michael D.; Rubenchik, Alexander M.; Joslin, Elizabeth J.; Eichler, Juergen; Stoller, Patrick C.; Da Silva, Luiz B.

    2000-01-01

    We report the effects of the repetition rate and the beam size on the threshold for ultrashort laser pulse induced damage in dentin. The observed results are explained as cumulative thermal effects. Our model is consistent with the experimental results and explains the dependence of the threshold on repetition rate, beam size, and exposure time. (c) 2000 American Institute of Physics

  10. Reoperation for rhegmatogenous retinal detachment as quality indicator for disease management:

    DEFF Research Database (Denmark)

    Hajari, Javad N; Christensen, Ulrik; Kiilgaard, Jens Folke

    2015-01-01

    PURPOSE: To establish a quality indicator that could be used in optimizing treatment for rhegmatogenous retinal detachment (RRD). METHODS: The Danish National Patient Registry was used to identify surgery conducted in Denmark for RRD in the period 01 January 2001-31 December 2009. Cases were...... identified by diagnosis and surgical codes. RESULTS: A total of 6522 cases were operated for a primary RRD in the study period, and 22% (1434 patients) were reoperated for a redetachment. A Cox regression analysis showed that the risk of redetachment was equal to or less than detachment on the fellow eye 1...... year after primary surgery with techniques not using silicone oil. The same was true 1.5 years after surgery for techniques using silicone oil. Based on this, we established a quality indicator defining failure as the need for operation for redetachment within 1 year from initial surgery when using...

  11. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation

    DEFF Research Database (Denmark)

    Palm, Henrik; Jacobsen, Steffen; Sonne-Holm, Stig

    2007-01-01

    BACKGROUND: Reoperations after intertrochanteric fractures are often necessitated by fracture displacement following mobilization of the patient. The biomechanical complexity of the fracture, the position of the implant, and the patient's characteristics are known to influence postoperative outcome....... We investigated the importance of an intact lateral femoral wall as a factor in postoperative fracture displacement after fixation with a sliding compression hip screw. METHODS: Two hundred and fourteen consecutive patients with an intertrochanteric fracture were treated with a 135 degrees sliding...... compression hip screw with a four-hole side-plate between 2002 and 2004. The fractures were classified on preoperative radiographs according to the AO/OTA classification system. The status of the greater and lesser trochanters, the integrity of the lateral femoral wall, and the position of the implant were...

  12. Morbid obesity increases risk of morbidity and reoperation in resection of benign cranial nerve neoplasms.

    Science.gov (United States)

    Murphy, Meghan E; McCutcheon, Brandon A; Kerezoudis, Panagiotis; Porter, Amanda; Rinaldo, Lorenzo; Shepherd, Daniel; Rayan, Tarek; Maloney, Patrick R; Carter, Bob S; Bydon, Mohamad; Gompel, Jamie J Van; Link, Michael J

    2016-09-01

    Obesity has been associated with increased risk for postoperative CSF leak in patients with benign cranial nerve tumors. Other measures of postoperative morbidity associated with obesity have not been well characterized. Patients enrolled in the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) from 2007 to 2013 with a diagnosis code of a benign neoplasm of a cranial nerve were included. The primary outcome of postoperative morbidity was analyzed as well as secondary outcomes of readmission and reoperation. The main covariate of interest was body mass index (BMI). A total of 561 patients underwent surgery for a benign cranial nerve neoplasm between 2007 and 2013. Readmission data, available for 2012-2013(n=353), revealed hydrocephalus, facial nerve injury, or CSF leak requiring readmission or reoperation occurred in 0.85%, 1.42%, and 3.12%, respectively. Composite morbidity included wound complications, infection, respiratory insufficiency, transfusion requirement, stroke, venous thromboembolism, coma and cardiac arrest. On multivariable analysis patients with class I (BMI 30-34.9) and II (BMI 35-39.9) obesity showed trends towards increasing return to operating room, though not significant, but there was no trend for composite complications in class I and II obesity patients. However, class III obesity, BMI≥40, was associated with increased odds of composite morbidity (OR 4.40, 95% CI 1.24-15.88) and return to the operating room (OR 5.97, 95% CI 1.20-29.6) relative to patients with a normal BMI, 18.5-25. Obesity is an independent and important risk factor for composite morbidity in resection of benign cranial nerve neoplasms, and as such, merits discussion during preoperative counseling. Copyright © 2016 Elsevier B.V. All rights reserved.

  13. Numerical simulation of fatigue crack growth rate and crack retardation due to an overload using a cohesive zone model

    NARCIS (Netherlands)

    Silitonga, S.; Maljaars, J.; Soetens, F.; Snijder, H.H.

    2014-01-01

    In this work, a numerical method is pursued based on a cohesive zone model (CZM). The method is aimed at simulating fatigue crack growth as well as crack growth retardation due to an overload. In this cohesive zone model, the degradation of the material strength is represented by a variation of the

  14. SU-F-T-301: Planar Dose Pass Rate Inflation Due to the MapCHECK Measurement Uncertainty Function

    International Nuclear Information System (INIS)

    Bailey, D; Spaans, J; Kumaraswamy, L; Podgorsak, M

    2016-01-01

    Purpose: To quantify the effect of the Measurement Uncertainty function on planar dosimetry pass rates, as analyzed with Sun Nuclear Corporation analytic software (“MapCHECK” or “SNC Patient”). This optional function is toggled on by default upon software installation, and automatically increases the user-defined dose percent difference (%Diff) tolerance for each planar dose comparison. Methods: Dose planes from 109 IMRT fields and 40 VMAT arcs were measured with the MapCHECK 2 diode array, and compared to calculated planes from a commercial treatment planning system. Pass rates were calculated within the SNC analytic software using varying calculation parameters, including Measurement Uncertainty on and off. By varying the %Diff criterion for each dose comparison performed with Measurement Uncertainty turned off, an effective %Diff criterion was defined for each field/arc corresponding to the pass rate achieved with MapCHECK Uncertainty turned on. Results: For 3%/3mm analysis, the Measurement Uncertainty function increases the user-defined %Diff by 0.8–1.1% average, depending on plan type and calculation technique, for an average pass rate increase of 1.0–3.5% (maximum +8.7%). For 2%, 2 mm analysis, the Measurement Uncertainty function increases the user-defined %Diff by 0.7–1.2% average, for an average pass rate increase of 3.5–8.1% (maximum +14.2%). The largest increases in pass rate are generally seen with poorly-matched planar dose comparisons; the MapCHECK Uncertainty effect is markedly smaller as pass rates approach 100%. Conclusion: The Measurement Uncertainty function may substantially inflate planar dose comparison pass rates for typical IMRT and VMAT planes. The types of uncertainties incorporated into the function (and their associated quantitative estimates) as described in the software user’s manual may not accurately estimate realistic measurement uncertainty for the user’s measurement conditions. Pass rates listed in published

  15. SU-F-T-301: Planar Dose Pass Rate Inflation Due to the MapCHECK Measurement Uncertainty Function

    Energy Technology Data Exchange (ETDEWEB)

    Bailey, D [Northside Hospital Cancer Institute, Atlanta, GA (United States); Spaans, J; Kumaraswamy, L; Podgorsak, M [Roswell Park Cancer Institute, Buffalo, NY (United States)

    2016-06-15

    Purpose: To quantify the effect of the Measurement Uncertainty function on planar dosimetry pass rates, as analyzed with Sun Nuclear Corporation analytic software (“MapCHECK” or “SNC Patient”). This optional function is toggled on by default upon software installation, and automatically increases the user-defined dose percent difference (%Diff) tolerance for each planar dose comparison. Methods: Dose planes from 109 IMRT fields and 40 VMAT arcs were measured with the MapCHECK 2 diode array, and compared to calculated planes from a commercial treatment planning system. Pass rates were calculated within the SNC analytic software using varying calculation parameters, including Measurement Uncertainty on and off. By varying the %Diff criterion for each dose comparison performed with Measurement Uncertainty turned off, an effective %Diff criterion was defined for each field/arc corresponding to the pass rate achieved with MapCHECK Uncertainty turned on. Results: For 3%/3mm analysis, the Measurement Uncertainty function increases the user-defined %Diff by 0.8–1.1% average, depending on plan type and calculation technique, for an average pass rate increase of 1.0–3.5% (maximum +8.7%). For 2%, 2 mm analysis, the Measurement Uncertainty function increases the user-defined %Diff by 0.7–1.2% average, for an average pass rate increase of 3.5–8.1% (maximum +14.2%). The largest increases in pass rate are generally seen with poorly-matched planar dose comparisons; the MapCHECK Uncertainty effect is markedly smaller as pass rates approach 100%. Conclusion: The Measurement Uncertainty function may substantially inflate planar dose comparison pass rates for typical IMRT and VMAT planes. The types of uncertainties incorporated into the function (and their associated quantitative estimates) as described in the software user’s manual may not accurately estimate realistic measurement uncertainty for the user’s measurement conditions. Pass rates listed in published

  16. Reoperative aortic valve replacement in the octogenarians-minimally invasive technique in the era of transcatheter valve replacement

    NARCIS (Netherlands)

    Kaneko, Tsuyoshi; Loberman, Dan; Gosev, Igor; Rassam, Fadi; McGurk, Siobhan; Leacche, Marzia; Cohn, Lawrence

    2014-01-01

    Objective: Reoperative aortic valve replacement (re-AVR) in octogenarians is considered high risk and therefore might be indicated for transcatheter AVR. The minimally invasive technique for re-AVR limits dissection and might benefit this patient population. We report the outcomes of re-AVR in

  17. Enhancement of fatigue crack growth rates in pressure boundary materials due to light-water-reactor environments

    International Nuclear Information System (INIS)

    Van Der Sluys, W.A.; Emanuelson, R.H.

    1987-01-01

    Sulfur now appears to be one of the principal agents responsible for the observed enhancement of the fatigue crack growth rates in light-water-reactor (LWR) environments. This paper presents the results of investigations on the effect of sulfur in the steel, in the bulk water environment, and at the crack tip. A time-based format of data presentation is used in this paper along with the conventional crack growth rate based on cycle format. The time-based format is a useful method of data presentation. When presented in the conventional format, an apparent substantial amount of scatter in the data is eliminated and the data fall within a relatively narrow scatter band. This model permits extrapolation from the frequency and ΔK regions where experiments were conducted into previously unexplored regions. (orig./GL)

  18. Heart-rate sensitive optical coherence angiography for measuring vascular changes due to posttraumatic brain injury in mice

    Science.gov (United States)

    Tremoleda, Jordi L.; Alvarez, Karl; Aden, Abdirahman; Donnan, Robert; Michael-Titus, Adina T.; Tomlins, Peter H.

    2017-12-01

    Traumatic brain injury (TBI) results in direct vascular disruption, triggering edema, and reduction in cerebral blood flow. Therefore, understanding the pathophysiology of brain microcirculation following TBI is important for the development of effective therapies. Optical coherence angiography (OCA) is a promising tool for evaluating TBI in rodent models. We develop an approach to OCA that uses the heart-rate frequency to discriminate between static tissue and vasculature. This method operates on intensity data and is therefore not phase sensitive. Furthermore, it does not require spatial overlap of voxels and thus can be applied to pre-existing datasets for which oversampling may not have been explicitly considered. Heart-rate sensitive OCA was developed for dynamic assessment of mouse microvasculature post-TBI. Results show changes occurring at 5-min intervals within the first 50 min of injury.

  19. Measurement of the exposure rate due to low energy x-rays emitted from video display terminals

    International Nuclear Information System (INIS)

    Campos, L.L.

    1988-01-01

    Thermoluminescent dosimeters of CaSO 4 :Dy have been used to measure the low energy x-rays emitted from Video Display Terminals (VDTs). For each terminal, three points were measured with five dosimeters at each point. The points were at distances of 5 and 50 cm in front of the screen and at 65 cm with an angle of approximately 50 0 . The last two positions approximate to positions of the lenses of the eye and the gonads respectively. A survey of 50 VDTs at a distance of 5 cm from the screen resulted in exposure rates nearly fifteen times below the exposure rate of 0.5 mR h -1 (0.129 μC kg -1 h -1 ) which is the limit recommended by the International Atomic Energy Agency (IAEA), Safety Series No. 9 (1967) Basic Safety Standards for Radiation Protection. (author)

  20. Laparoscopic reoperation with total fundoplication for failed Heller myotomy: is it a possible option? Personal experience and review of literature.

    Science.gov (United States)

    Rossetti, Gianluca; del Genio, Gianmattia; Maffettone, Vincenzo; Fei, Landino; Brusciano, Luigi; Limongelli, Paolo; Pizza, Francesco; Tolone, Salvatore; Di Martino, Maria; del Genio, Federica; del Genio, Alberto

    2009-01-01

    Laparoscopic Heller myotomy with antireflux procedure seems the procedure of choice in the treatment of patients with esophageal achalasia. Persistent or recurrent symptoms occur in 10% to 20% of patients. Few reports on reoperation after failed Heller myotomy have been published. No author has reported the realization of a total fundoplication in these patient groups. The aim of this study is to evaluate the efficacy of laparoscopic reoperation with the realization of a total fundoplication after failed Heller myotomy for esophageal achalasia. From 1992 to December 2007, 5 out of a series of 242 patients (2.1%), along with 2 patients operated elsewhere, underwent laparoscopic reintervention for failed Heller myotomy. Symptoms leading to reoperation included persistent dysphagia in 3 patients, recurrent dysphagia in another 3, and heartburn in 1 patient. Mean time from the first to the second operation was 49.7 months (range, 4-180 months). Always, the intervention was completed via a laparoscopic approach and a Nissen-Rossetti fundoplication was realized or left in place after a complete Heller myotomy. Mean operative time was 160 minutes (range, 60-245 minutes). Mean postoperative hospital stay was 3.1 +/- 1.5 days. No major morbidity or mortality occurred. At a mean follow-up of 16.1 months, reoperation must be considered successful in 5 out of 7 patients (71.4%). The dysphagia DeMeester score fell from 2.71 +/- 0.22 to 0.91 +/- 0.38 postoperatively. The regurgitation score changed from 2.45 +/- 0.34 to 0.68 +/- 0.23. Laparoscopic reoperation for failed Heller myotomy with the realization of a total fundoplication is safe and is associated with good long-term results if performed by an experienced surgeon in a center with a long tradition of esophageal surgery.

  1. The risk of disabling, surgery and reoperation in Crohn's disease - A decision tree-based approach to prognosis.

    Science.gov (United States)

    Dias, Cláudia Camila; Pereira Rodrigues, Pedro; Fernandes, Samuel; Portela, Francisco; Ministro, Paula; Martins, Diana; Sousa, Paula; Lago, Paula; Rosa, Isadora; Correia, Luis; Moura Santos, Paula; Magro, Fernando

    2017-01-01

    Crohn's disease (CD) is a chronic inflammatory bowel disease known to carry a high risk of disabling and many times requiring surgical interventions. This article describes a decision-tree based approach that defines the CD patients' risk or undergoing disabling events, surgical interventions and reoperations, based on clinical and demographic variables. This multicentric study involved 1547 CD patients retrospectively enrolled and divided into two cohorts: a derivation one (80%) and a validation one (20%). Decision trees were built upon applying the CHAIRT algorithm for the selection of variables. Three-level decision trees were built for the risk of disabling and reoperation, whereas the risk of surgery was described in a two-level one. A receiver operating characteristic (ROC) analysis was performed, and the area under the curves (AUC) Was higher than 70% for all outcomes. The defined risk cut-off values show usefulness for the assessed outcomes: risk levels above 75% for disabling had an odds test positivity of 4.06 [3.50-4.71], whereas risk levels below 34% and 19% excluded surgery and reoperation with an odds test negativity of 0.15 [0.09-0.25] and 0.50 [0.24-1.01], respectively. Overall, patients with B2 or B3 phenotype had a higher proportion of disabling disease and surgery, while patients with later introduction of pharmacological therapeutic (1 months after initial surgery) had a higher proportion of reoperation. The decision-tree based approach used in this study, with demographic and clinical variables, has shown to be a valid and useful approach to depict such risks of disabling, surgery and reoperation.

  2. Lodging Resistance of Japonica Rice (Oryza Sativa L.): Morphological and Anatomical Traits due to top-Dressing Nitrogen Application Rates.

    Science.gov (United States)

    Zhang, Wujun; Wu, Longmei; Wu, Xiaoran; Ding, Yanfeng; Li, Ganghua; Li, Jingyong; Weng, Fei; Liu, Zhenghui; Tang, She; Ding, Chengqiang; Wang, Shaohua

    2016-12-01

    Lodging in rice production often limits grain yield and quality by breaking or bending stems. Excessive nitrogen (N) fertilizer rates are the cause of poor lodging resistance in rice, but little is known about the effect of top-dressing N application rates on the mechanical strength of japonica rice plants, especially how the anatomical structure in culms is affected by N. In this study, field experiments on two japonica rice varieties with three top-dressing N application rates, 0 kg N ha(-1) (LN), 135 kg N ha(-1) (MN), and 270 kg N ha(-1) (HN) as urea, were conducted. Wuyunjing23, a lodging-resistant japonica rice cultivar and W3668, a lodging-susceptible japonica rice cultivar were used. The lodging index, breaking strength, morphological and anatomical traits in culms were measured in this study. The visual lodging rate in japonica rice differed remarkably between genotypes and top-dressing N treatments. The higher lodging index of rice plants was primarily attributed to the weak breaking strength of the lower internodes. The longer elongated basal internodes were responsible for higher plant height and a higher lodging index. Correlation analysis showed that breaking strength was significantly and positively correlated with the thickness of the mechanical tissue but was significantly and negatively correlated with the inner diameter of the major axis (b2). With increasing top-dressing N rates, the sclerenchyma cells of the mechanical tissues and the vascular bundles of the Wuyunjing23 cultivar varied little. The plant height, inner diameter of the minor axis (a2) and b2 increased significantly, but the area of the large vascular bundle (ALVB) and the area of the small vascular bundle (ASVB) decreased significantly and resulted in lower stem strength and a higher lodging index under higher top-dressing N conditions. The culm diameter of the W3668 cultivar increased slightly with no significant difference, and the sclerenchyma cells in the mechanical

  3. Risk factors affecting unplanned reoperation after laparoscopic gastrectomy for gastric cancer: experience from a high-volume center.

    Science.gov (United States)

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

    2017-10-01

    To evaluate the risk factors affecting unplanned reoperation (URO) after laparoscopic gastrectomy (LAG) for gastric cancer (GC) and establish a model to predict URO preoperatively. Between May 2007 and December 2014, we prospectively collected and retrospectively analyzed the data of 2608 GC patients who underwent LAG. Among them, 2580 patients not requiring an URO were defined as the Non-URO group, and 28 patients requiring an URO were defined as the URO group. Univariate, multivariate, and bootstrap analyses were performed to determine the independent predictors for URO, and a nomogram was constructed to preoperatively predict the rate of URO after LAG. Of the 2608 patients, the URO rate was 1.1% (28/2608) within the 30-day hospitalization. The mean URO time interval to first operation was 5.6 ± 5.5 (0.10-18.5) days. The main causes requiring URO were intraabdominal bleeding (57.1%), anastomotic bleeding (17.9%), anastomotic leakage (7.1%), and intraabdominal infection (7.1%). Compared to the Non-URO group, the URO group had a significantly longer hospital stay (p 70 years (odds ratio (OR) = 2.232, 95% confidence interval (CI) = 1.023-4.491, p = 0.028), male gender (OR = 32.983, 95% CI 1.405-25.343 × 10 6 , p = 0.027), and body mass index (BMI) > 25 kg/m 2 (OR = 2.550, 95% CI 1.017-5.398, p = 0.012) were independent risk factors for URO. A multivariable nomogram model for predicting URO exhibited a strong optimism-adjusted discrimination (concordance index, 0.687). No significant correlation was noted between the URO rate and operative period by Spearman analysis (r = 0.012, p = 0.548). Age > 70 years, Male, and BMI > 25 kg/m 2 were independent risk factors for URO. Based on the three risk factors, we developed a simple and practical nomogram to predict URO preoperatively, which might aid surgeons in reducing the URO rate when planning to perform LAG for GC.

  4. Low post-glacial rebound rates in the Weddell Sea due to Late Holocene ice-sheet readvance

    Science.gov (United States)

    Bradley, Sarah L.; Hindmarsh, Richard C. A.; Whitehouse, Pippa L.; Bentley, Michael J.; King, Matt A.

    2015-03-01

    Many ice-sheet reconstructions assume monotonic Holocene retreat for the West Antarctic Ice Sheet, but an increasing number of glaciological observations infer that some portions of the ice sheet may be readvancing, following retreat behind the present-day margin. A readvance in the Weddell Sea region can reconcile two outstanding problems: (i) the present-day widespread occurrence of seemingly stable ice streams grounded on beds that deepen inland; and (ii) the inability of models of glacial isostatic adjustment to match present-day uplift rates. By combining a suite of ice loading histories that include a readvance with a model of glacial isostatic adjustment we report substantial improvements to predictions of present-day uplift rates, including reconciling one problematic observation of land sinking. We suggest retreat behind present grounding lines occurred when the bed was lower, and isostatic recovery has since led to shallowing, ice sheet re-grounding and readvance. The paradoxical existence of grounding lines in apparently unstable configurations on reverse bed slopes may be resolved by invoking the process of unstable advance, in accordance with our load modelling.

  5. Increases to Inferred Rates of Planetesimal Accretion due to Thermohaline Mixing in Metal-accreting White Dwarfs

    Science.gov (United States)

    Bauer, Evan B.; Bildsten, Lars

    2018-06-01

    Many isolated, old white dwarfs (WDs) show surprising evidence of metals in their photospheres. Given that the timescale for gravitational sedimentation is astronomically short, this is taken as evidence for ongoing accretion, likely of tidally disrupted planetesimals. The rate of such accretion, {\\dot{M}}acc}, is important to constrain, and most modeling of this process relies on assuming an equilibrium between diffusive sedimentation and metal accretion supplied to the WD’s surface convective envelope. Building on the earlier work of Deal and collaborators, we show that high {\\dot{M}}acc} models with only diffusive sedimentation are unstable to thermohaline mixing and that models that account for the enhanced mixing from the active thermohaline instability require larger accretion rates, sometimes reaching {\\dot{M}}acc}≈ {10}13 {{g}} {{{s}}}-1 to explain observed calcium abundances. We present results from a grid of MESA models that include both diffusion and thermohaline mixing. These results demonstrate that both mechanisms are essential for understanding metal pollution across the range of polluted WDs with hydrogen atmospheres. Another consequence of active thermohaline mixing is that the observed metal abundance ratios are identical to accreted material.

  6. Oral antibody to interleukin-10 reduces growth rate depression due to Eimeria spp. infection in broiler chickens.

    Science.gov (United States)

    Sand, Jordan M; Arendt, Maria K; Repasy, Alec; Deniz, Gűlay; Cook, Mark E

    2016-02-01

    Eimeria spp. must be controlled in floor-reared poultry to prevent the onset of coccidiosis. Here we use an oral antibody to chicken IL-10 to prevent growth depression due to Eimeria spp. infection. Egg antibody directed against an antigenic peptide of IL-10 was produced in laying hens and measured using an ELISA. In the first experiment, egg yolk powder containing antibody to chicken IL-10 (vlpramqt conjugate) (anti-IL-10 yolk powder) was fed at 3.4 g/kg feed to determine growth response following mixed Eimeria spp. challenge. Chicks were fed either anti-IL-10 antibodies or control antibodies and challenged (d3) with either sterile saline or a 10× attenuated Eimeria spp. vaccine. Control-fed and Eimeria-challenged chicks grew 8.8% slower than those challenged with saline (P < 0.04), whereas anti-IL-10-fed Eimeria challenged chicks were not different from untreated controls. In the second trial a dose response was performed with doses of either 0 (control antibody), 0.34-, or 3.4-g anti-IL-10 yolk powder/kg feed. Control-fed, Eimeria-challenged chicks grew 10.6% slower than control saline-challenged chicks (P < 0.05); however, anti-IL-10-fed chicks fed either dose of anti-IL-10 were not different from saline-challenged chicks. Finally, the effect of anti-IL-10 on acquired immunity was investigated. Chicks were fed control or anti-IL-10 yolk powder and vaccinated with a 1× dose of Eimeria vaccine at d 3. After 14 d, antibody was removed from the diet. Chicks were either saline or 10× Eimeria challenged at d 17. We found that the anti-IL-10-fed chickens did not show a reduction in growth due to challenge; hence anti-IL-10 does not appear to affect adaptive immunity during the primary immunization. Overall, use of an antibody to IL-10 is a novel method in preventing adverse effects of Eimeria spp. infection in poultry. © 2016 Poultry Science Association Inc.

  7. Comparison and analysis of reoperations in two different treatment protocols for trochanteric hip fractures - postoperative technical complications with dynamic hip screw, intramedullary nail and Medoff sliding plate.

    Science.gov (United States)

    Paulsson, Johnny; Stig, Josefine Corin; Olsson, Ola

    2017-08-24

    In treatment of unstable trochanteric fractures dynamic hip screw and Medoff sliding plate devices are designed to allow secondary fracture impaction, whereas intramedullary nails aim to maintain fracture alignment. Different treatment protocols are used by two similar Swedish regional emergency care hospitals. Dynamic hip screw is used for fractures considered as stable within the respective treatment protocol, whereas one treatment protocol (Medoff sliding plate/dynamic hip screw) uses biaxial Medoff sliding plate for unstable pertrochanteric fractures and uniaxial Medoff sliding plate for subtrochanteric fractures, the second (intramedullary nail/dynamic hip screw) uses intramedullary nail for subtrochanteric fractures and for pertrochanteric fractures with intertrochanteric comminution or subtrochanteric extension. All orthopedic surgeries are registered in a regional database. All consecutive trochanteric fracture operations during 2011-2012 (n = 856) and subsequent technical reoperations (n = 40) were derived from the database. Reoperations were analysed and classified into the categories adjustment (percutaneous removal of the locking screw of the Medoff sliding plate or the intramedullary nail, followed by fracture healing) or minor, intermediate (reosteosynthesis) or major (hip joint replacement, Girdlestone or persistent nonunion) technical complications. The relative risk of intermediate or major technical complications was 4.2 (1.2-14) times higher in unstable pertrochanteric fractures and 4.6 (1.1-19) times higher in subtrochanteric fractures with treatment protocol: intramedullary nail/dynamic hip screw, compared to treatment protocol: Medoff sliding plate/dynamic hip screw. Overall rates of intermediate and major technical complications in unstable pertrochanteric and subtrochanteric fractures were with biaxial Medoff sliding plate 0.68%, with uniaxial Medoff sliding plate 1.4%, with dynamic hip screw 3.4% and with intramedullary nail 7.2%. The

  8. Low post-glacial rebound rates in the Weddell Sea due to Late Holocene ice-sheet readvance

    Science.gov (United States)

    Bradley, Sarah L.; Hindmarsh, Richard C. A.; Whitehouse, Pippa; Bentley, Michael J.; King, Matt

    2014-05-01

    The Holocene deglaciation of West Antarctica resulted in widespread ice surface lowering. While many ice-sheet reconstructions generally assume a monotone Holocene retreat for the West Antarctica Ice sheet (WAIS) [Ivins et al., 2013; Peltier, 2004; Whitehouse et al., 2012], an increasing number of glaciological observations infer it is readvancing, following retreat behind the present-day margin[Siegert et al., 2013]. We will show that a readvance in the Weddell Sea region can reconcile two outstanding problems: (i) the present-day widespread occurrence of seemingly stable ice-streams grounded on beds that deepen inland in apparent contradiction to theory [Schoof, 2007]; and (ii) the inability of models of Glacial Isostatic Adjustment (GIA) to match present-day uplift rates [Whitehouse et al., 2012]. Combining a suite of ice loading histories that include a readvance with a model of GIA provides significant improvements to predictions of present-day uplift rates, and we are able to reproduce previously unexplained observations of subsidence in the southern sector of the Weddell Sea. We hypothesize that retreat behind present grounding lines occurred when the bed was lower, and isostatic recovery led to shallowing, ice sheet re-grounding and readvance. We will conclude that some sections of the current WAIS grounding line that are theoretically unstable, may be advancing and that the volume change of the WAIS may have been more complex in the Late Holocene than previously posited. This revised Holocene ice-loading history would have important implications for the GIA correction applied to Gravity Recovery and Climate Experiment (GRACE) data, likely resulting in a reduction in the GIA correction and a smaller estimate of present-day ice mass loss within the Weddell Sea region of the WAIS. Ivins, E. R., T. S. James, J. Wahr, E. J. O. Schrama, F. W. Landerer, and K. M. Simon (2013), Antarctic contribution to sea level rise observed by GRACE with improved GIA correction

  9. Two-Body Orbit Expansion Due to Time-Dependent Relative Acceleration Rate of the Cosmological Scale Factor

    Directory of Open Access Journals (Sweden)

    Lorenzo Iorio

    2014-01-01

    Full Text Available By phenomenologically assuming a slow temporal variation of the percent acceleration rate S̈S -1 of the cosmic scale factor S(t, it is shown that the orbit of a local binary undergoes a secular expansion. To first order in the power expansion of S̈S -1 around the present epoch t0, a non-vanishing shift per orbit (Δr of the two-body relative distance r occurs for eccentric trajectories. A general relativistic expression, which turns out to be cubic in the Hubble parameter H0 at the present epoch, is explicitly calculated for it in the case of matter-dominated epochs with Dark Energy. For a highly eccentric Oort comet orbit with period Pb ≈ 31 Myr, the general relativistic distance shift per orbit turns out to be of the order of (Δr ≈ 70 km. For the Large Magellanic Cloud, assumed on a bound elliptic orbit around the Milky Way, the shift per orbit is of the order of (Δr ≈ 2–4 pc. Our result has a general validity since it holds in any cosmological model admitting the Hubble law and a slowly varying S̈S-1(t. More generally, it is valid for an arbitrary Hooke-like extra-acceleration whose “elastic” parameter κ is slowly time-dependent, irrespectively of the physical mechanism which may lead to it. The coefficient κ1 of the first-order term of the power expansion of κ(t can be preliminarily constrained in a model-independent way down to a κ1 ≲ 2 x 10-13 year-3 level from latest Solar System’s planetary observations. The radial velocities of the double lined spectroscopic binary ALPHA Cen AB yield κ1 ≲ 10-8 year-3.

  10. Aesthetic refinements and reoperative procedures following 370 consecutive DIEP and SIEA flap breast reconstructions: important considerations for patient consent.

    Science.gov (United States)

    Enajat, Morteza; Smit, Jeroen M; Rozen, Warren M; Hartman, Ed H M; Liss, Anders; Kildal, Morten; Audolfsson, Thorir; Acosta, Rafael

    2010-06-01

    Breast reconstruction often requires multiple operations. In addition to potential complications requiring reoperation, additional procedures are frequently essential in order to complete the reconstructive process, with aesthetic outcome and breast symmetry shown to be the most important factors in patient satisfaction. Despite the importance of these reoperations in decision-making and the consent process, a thorough review of the need for such operations has not been definitively explored. A review of 370 consecutive autologous breast reconstructions (326 patients) was undertaken, comprising 365 deep inferior epigastric artery perforator (DIEP) flaps and 5 superficial inferior epigastric artery (SIEA) flaps. The need for additional procedures for either complications or aesthetic refinement following initial breast reconstruction was assessed. Overall, there was an average of 1.06 additional interventions for every patient carried out after primary reconstructive surgery. Of 326 patients, 46 underwent early postoperative operations for surgical complications (0.17 additional operations per patient as a consequence of complications). Procedures for aesthetic refinement included those performed on the reconstructed breast, contralateral breast, or abdominal donor site. Procedures for aesthetic refinement included nipple reconstruction, nipple-areola complex tattooing, dog-ear correction, liposuction, lipofilling, scar revision, mastopexy, and reduction mammaplasty. While DIEP flap surgery for breast reconstruction provides favorable results, patients frequently require additional procedures to improve aesthetic outcomes. The need for reoperation is an important part of the consent process prior to reconstructive surgery, and patients should recognize the likelihood of at least one additional procedure following initial reconstruction.

  11. Generalized peritonitis requiring re-operation after leakage of omental patch repair of perforated peptic ulcer.

    Science.gov (United States)

    Maghsoudi, Hemmat; Ghaffari, Alireza

    2011-01-01

    Peptic ulcer perforations are a common emergency, but available literature is silent on the exact definition, incidence, management, and complications of peritonitis due to omental patch leakage. Retrospective data were collected on 422 patients who underwent omental patch repair of perforated peptic ulcer between March 20, 1999 and March 20, 2006. The definitive diagnosis of perforated peptic ulcer and omental patch leakage was obtained at surgery. Seventeen (4%) patients experienced generalized peritonitis due to omental patch leakage. Mean age was 60.6 years. Mortality rate was 29.4%, and the mean hospital stay was 23.6 days. Delay in surgical approach, shock on admission, and age were all significantly associated with increased mortality. Peritonitis due to omental patch leakage can result in significant morbidity and mortality. The most common causes of omental patch leakage and operative procedures were unknown and reinsertion of omentum, respectively. Factors such as shock on admission or delayed surgery, have significantly contributed to fatal outcomes and need careful attention.

  12. Disparities in total knee replacement: Population losses in quality-adjusted life years due to differential offer, acceptance, and complication rates for Black Americans.

    Science.gov (United States)

    Kerman, Hannah M; Smith, Savannah R; Smith, Karen C; Collins, Jamie E; Suter, Lisa G; Katz, Jeffrey N; Losina, Elena

    2018-01-24

    Total knee replacement (TKR) is an effective treatment for end-stage knee osteoarthritis (OA). American racial minorities undergo fewer TKRs than Whites. We estimated quality-adjusted life years (QALYs) lost for Black knee OA patients due to differences in TKR offer, acceptance, and complication rates. We used the Osteoarthritis Policy Model, a computer simulation of knee OA, to predict QALY outcomes for Black and White knee OA patients with and without TKR. We estimated per-person QALYs gained from TKR as the difference between QALYs with current TKR use and QALYs when no TKR was performed. We estimated average, per-person QALY losses in Blacks as the difference between QALYs gained with White rates of TKR and QALYs gained with Black rates of TKR. We calculated population-level QALY losses by multiplying per-person QALY losses by the number of persons with advanced knee OA. Finally, we estimated QALYs lost specifically due to lower TKR offer and acceptance and higher complications among Black knee OA patients. Black men and women gain 64,100 QALYs from current TKR use. With white offer and complications rates, they would gain an additional 72,000 QALYs. Because these additional gains are unrealized, we call this a loss of 72,000 QALYs. Black Americans lose 67,500 QALYs because of lower offer, 15,800 QALYs because of lower acceptance, and 2,600 QALYs because of higher complications. Black Americans lose 72,000 QALYs due to disparities in TKR offer and complication rates. Programs to decrease disparities in TKR use are urgently needed. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  13. Long-term effectiveness of localization studies and intraoperative parathormone monitoring in patients undergoing reoperative parathyroidectomy for persistent or recurrent hyperparathyroidism.

    Science.gov (United States)

    Parikh, Punam P; Farra, Josefina C; Allan, Bassan J; Lew, John I

    2015-07-01

    Reoperative parathyroidectomy (RPTX) for persistent or recurrent hyperparathyroidism is associated with a high rate of operative failure. The long-term effectiveness of RPTX using localization studies and intraoperative parathormone monitoring (IPM) was examined. Retrospective analysis of prospectively collected data from patients undergoing targeted RPTX with IPM for persistent or recurrent hyperparathyroidism was performed. Persistent hyperparathyroidism was defined as elevated calcium and parathormone (PTH) levels above normal range less than 6 months after parathyroidectomy. Recurrent hyperparathyroidism was defined as elevated calcium and PTH levels greater than 6 months after successful parathyroidectomy. Sensitivity and positive predictive value (PPV) for sestamibi, surgeon-performed ultrasound, intraoperative PTH dynamics, and surgical outcomes were evaluated. Of the 1,064 patients, 69 patients underwent 72 RPTXs with localizing studies and IPM. Sestamibi (n = 69) had a sensitivity of 74% and a PPV of 83%, whereas surgeon-performed ultrasound (n = 38) had a sensitivity of 55% and a PPV of 76%. IPM had a sensitivity of 100% and a PPV of 98%. An intraoperative PTH drop greater than or equal to 50% was predictive of operative success (P < .01). Overall, operative success and recurrence were 94% and 1.4%, with a mean patient follow-up of 59 ± 12.8 months. RPTX can be performed in a targeted approach using preoperative localization studies and IPM, leading to a low rate of complications and a high rate of long-term operative success. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. A randomized clinical trial of the effect of intensive versus non-intensive counselling on discontinuation rates due to bleeding disturbances of three long-acting reversible contraceptives.

    Science.gov (United States)

    Modesto, Waleska; Bahamondes, M Valeria; Bahamondes, Luis

    2014-07-01

    Does intensive counselling before insertion and throughout the first year of use have any influence on discontinuation rates due to unpredictable menstrual bleeding in users of three long-acting reversible contraceptives (LARCs)? Intensive counselling had a similar effect to routine counselling in terms of discontinuation rates due to unpredictable menstrual bleeding in new users of the contraceptives. Contraceptive efficacy and satisfaction rates are very high with LARCs, including the etonogestrel (ENG)-releasing implant, the levonorgestrel-releasing intrauterine system (LNG-IUS) and the TCu380A intrauterine device (IUD). However, unpredictable menstrual bleeding constitutes the principal reason for premature discontinuation, particularly in the cases of the ENG-implant and the LNG-IUS. A randomized clinical trial was conducted between 2011 and 2013, and involved 297 women: 98 ENG-implant users, 99 LNG-IUS users and 100 TCu380A IUD users. Women accepting each contraceptive method were randomized into two groups after the women chose their contraceptive method. Group I received routine counselling at the clinic, including information on safety, efficacy and side effects, as well as what to expect regarding bleeding disturbances. Group II received 'intensive counselling'. In addition to the information provided to those in Group I, these women also received leaflets on their chosen method and were seen by the same three professionals, the most experienced at the clinic, throughout the year of follow-up. These three professionals went over all the information provided at each consultation. Women in both groups were instructed to return to the clinic after 45 (±7) days and at 6 and 12 (±1) months after insertion. They were instructed to record all bleeding episodes on a menstrual calendar specifically provided for this purpose. Additionally, satisfaction with the method was evaluated by a questionnaire completed by the women after 12 months of use of the

  15. Modification of erbium photoluminescence decay rate due to ITO layers on thin films of SiO{sub 2}:Er doped with Si-nanoclusters

    Energy Technology Data Exchange (ETDEWEB)

    Wojdak, M., E-mail: m.wojdak@ucl.ac.uk [Department of Electronic and Electrical Engineering, University College London, Torrington Place, London WC1E 7JE (United Kingdom); Jayatilleka, H. [Department of Electronic and Electrical Engineering, University College London, Torrington Place, London WC1E 7JE (United Kingdom); Department of Electrical and Computer Engineering, University of Toronto, 10 King' s College Road, Toronto, Ontario, Canada M5S 3G4 (Canada); Shah, M. [Department of Electronic and Electrical Engineering, University College London, Torrington Place, London WC1E 7JE (United Kingdom); Kenyon, A.J., E-mail: t.kenyon@ucl.ac.uk [Department of Electronic and Electrical Engineering, University College London, Torrington Place, London WC1E 7JE (United Kingdom); Gourbilleau, F.; Rizk, R. [Centre de Recherche sur les Ions, les Matériaux et la Photonique (CIMAP), ENSICAEN, CNRS, CEA/IRAMIS, Université de Caen, 14050 CAEN cedex (France)

    2013-04-15

    During the fabrication of MOS light emitting devices, the thin film of active material is usually characterized by photoluminescence measurements before electrical contacts are deposited. However, the presence of a conductive contact layer can alter the luminescent properties of the active material. The local optical density of states changes due to the proximity of luminescent species to the interface with the conductive medium (the top electrode), and this modifies the radiative rate of luminescent centers within the active layer. In this paper we report enhancement of the observed erbium photoluminescence rate after deposition of indium tin oxide contacts on thin films of SiO{sub 2}:Er containing silicon nanoclusters, and relate this to Purcell enhancement of the erbium radiative rate. -- Highlights: ► We studied photoluminescence of Er in SiO{sub 2} thin films doped with Si nanoclusters. ► Presence of ITO layer on the top enhances photoluminescence decay rate of Er. ► The effect depends on the thickness of active film. ► Radiative rate change in proximity of ITO layer was calculated theoretically. ► The calculation results are compared with the experiment and discussed.

  16. Preliminary Assessment of the Impact on Reactor Vessel dpa Rates Due to Installation of a Proposed Low Enriched Uranium (LEU) Core in the High Flux Isotope Reactor (HFIR)

    Energy Technology Data Exchange (ETDEWEB)

    Daily, Charles R. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2015-10-01

    An assessment of the impact on the High Flux Isotope Reactor (HFIR) reactor vessel (RV) displacements-per-atom (dpa) rates due to operations with the proposed low enriched uranium (LEU) core described by Ilas and Primm has been performed and is presented herein. The analyses documented herein support the conclusion that conversion of HFIR to low-enriched uranium (LEU) core operations using the LEU core design of Ilas and Primm will have no negative impact on HFIR RV dpa rates. Since its inception, HFIR has been operated with highly enriched uranium (HEU) cores. As part of an effort sponsored by the National Nuclear Security Administration (NNSA), conversion to LEU cores is being considered for future HFIR operations. The HFIR LEU configurations analyzed are consistent with the LEU core models used by Ilas and Primm and the HEU balance-of-plant models used by Risner and Blakeman in the latest analyses performed to support the HFIR materials surveillance program. The Risner and Blakeman analyses, as well as the studies documented herein, are the first to apply the hybrid transport methods available in the Automated Variance reduction Generator (ADVANTG) code to HFIR RV dpa rate calculations. These calculations have been performed on the Oak Ridge National Laboratory (ORNL) Institutional Cluster (OIC) with version 1.60 of the Monte Carlo N-Particle 5 (MCNP5) computer code.

  17. High rates of regimen change due to drug toxicity among a cohort of South Indian adults with HIV infection initiated on generic, first-line antiretroviral treatment.

    Science.gov (United States)

    Sivadasan, Ajith; Abraham, O C; Rupali, Priscilla; Pulimood, Susanne A; Rajan, Joyce; Rajkumar, S; Zachariah, Anand; Kannangai, Rajesh; Kandathil, Abraham Joseph; Sridharan, G; Mathai, Dilip

    2009-05-01

    To determine the rates, reasons and predictors of treatment change of the initial antiretroviral treatment (ART) regimen in HIV-infected south Indian adults. In this prospective cohort study, ART-naive adults initiated on generic, fixed dose combination ART as per the National AIDS Control Organization guidelines were followed up at an academic medical center. Treatment change was defined as any event which necessitated a change in or discontinuation of the initial ART regimen. Two hundred and thirty persons with HIV infection (males 74.8% and median age 37 years) were followed up for median duration of 48 weeks. The majority (98.7%) had acquired HIV infection through the heterosexual route. Most (70.4%) had advanced IV infection (WHO clinical stage 3 or 4) and 78% had CD4+ T-lymphocyte counts below 200 cells/microL. The initial ART regimens used were: Lamivudine (3TC) with Stavudine (d4T) (in 76%) or Azidothymidine (AZT) and Nevirapine (NVP) (in 86%) or Efavirenz (EFV). The cumulative incidence of treatment change was 39.6% (91 patients). Drug toxicity (WHO grade 3 or 4) was the reason for treatment change among 62 (27%) (incidence rate 35.9/100 person-years). The most common toxicities were attributable to the thymidine analogue nucleoside reverse transcriptase inhibitors (NRTIs), d4T and AZT [lactic acidosis (8.7%), anemia (7%) and peripheral neuropathy (5.2%)]. The other toxicities were rash (3.9%) and hepatitis (1.3%) due to NVP. The mortality (4.6/100 person-years) and disease progression rates (4.1/100 person-years) were low. The ART regimens used in this study were effective in decreasing disease progression and death. However, they were associated with high rates of drug toxicities, particularly those attributable to thymidine analogue NRTI. As efforts are made to improve access to ART, treatment regimens chosen should not only be potent, but also safe.

  18. Influence of cooling rate in planar thermally assisted magnetic random access memory: Improved writeability due to spin-transfer-torque influence

    International Nuclear Information System (INIS)

    Chavent, A.; Ducruet, C.; Portemont, C.; Creuzet, C.; Alvarez-Hérault, J.; Vila, L.; Sousa, R. C.; Prejbeanu, I. L.; Dieny, B.

    2015-01-01

    This paper investigates the effect of a controlled cooling rate on magnetic field reversal assisted by spin transfer torque (STT) in thermally assisted magnetic random access memory. By using a gradual linear decrease of the voltage at the end of the write pulse, the STT decays more slowly or at least at the same rate as the temperature. This condition is necessary to make sure that the storage layer magnetization remains in the desired written direction during cooling of the cell. The influence of the write current pulse decay rate was investigated on two exchange biased synthetic ferrimagnet (SyF) electrodes. For a NiFe based electrode, a significant improvement in writing reproducibility was observed using a gradual linear voltage transition. The write error rate decreases by a factor of 10 when increasing the write pulse fall-time from ∼3 ns to 70 ns. For comparison, a second CoFe/NiFe based electrode was also reversed by magnetic field assisted by STT. In this case, no difference between sharp and linear write pulse fall shape was observed. We attribute this observation to the higher thermal stability of the CoFe/NiFe electrode during cooling. In real-time measurements of the magnetization reversal, it was found that Ruderman-Kittel-Kasuya-Yosida (RKKY) coupling in the SyF electrode vanishes for the highest pulse voltages that were used due to the high temperature reached during write. As a result, during the cooling phase, the final state is reached through a spin-flop transition of the SyF storage layer

  19. Automation of the monitoring in real time of the absorbed dose rate in air due to the environmental gamma radiation in Cuba

    International Nuclear Information System (INIS)

    Dominguez L, O.; Capote F, E.; Carrazana G, J.A.; Manzano de Armas, J.F.; Alonso A, D.; Prendes A, M.; Zerquera, J.T.; Caveda R, C.A.; Kalberg, O.; Fabelo B, O.; Montalvan E, A.; Cartas A, H.; Leyva F, J.C.

    2006-01-01

    The Center of Protection and Hygiene of the Radiations (CPHR) like center rector of the National Net of Environmental Radiological Surveillance (RNVRA), it has strengthened their detection capacity and of answer before a situation of radiological emergency. The measurements of the absorbed dose rate in air due to the environmental gamma radiation in the main stations of the Net are obtained in real time and the CPHR receives the data coming from these posts at one time relatively short. To improve the operability of the RNVRA it was necessary to complete the facilities of existent monitoring using 4 automatic measurement stations with probes of gamma detection, implementing in this way a measurement system on real time. On the other hand the software were developed: GenironProbeFech, to obtain the data of the probes, DataMail for the shipment of the same ones by electronic mail and GammaRed that receives and processes the data in the rector center. (Author)

  20. Dose rates as a function of time due to postulated radionuclide releases from the U.S. Yucca Mountain high-level radioactive waste repository

    International Nuclear Information System (INIS)

    Moeller, Dade W.; Sun, Lin-Shen C.; Cherry, Robert

    2008-01-01

    The Yucca Mountain repository, which is located in a remote area in the State of Nevada, is being constructed for the long-term care and disposal of spent nuclear fuel and vitrified high-level radioactive waste. In accordance with U.S. law, the U.S. Environmental Protection Agency (USEPA) promulgated Standards that limit the dose rates to members of the public due to the consumption of ground water, alone, and the consumption of ground water plus agricultural products irrigated with the contaminated ground water, and other exposures, such as those from external sources and the inhalation of airborne radioactive materials. As part of this exercise, the USEPA identified eight specific radionuclides to which their Standards are to apply. These are: 14 C, 99 Tc, 129 I, 226 Ra, 228 Ra, 237 Np, 239 Pu, and 241 Am. For purposes of the associated dose rate estimates, a range of conservative assumptions have been applied, all of which are designed to assure that the estimated dose rates are well above what might be expected under 'real-world' conditions. As a first step, it was assumed that: (1) at 10 4 year after repository closure, a fractional release of 10 -5 of the entire repository radionuclide inventory occurred; (2) the only prior reduction in the inventory was that due to radioactive decay; and (3) the sole path of exposure to neighboring population groups was through the consumption of 2 L d -1 of contaminated ground water. The accompanying analyses revealed that, of the eight radionuclides, only 226 Ra, 237 Np, and 239 Pu, will represent a significant source of dose at that time. To provide perspective and insights, the next step was to estimate the committed effective dose rates for all eight radionuclides based on an assumed fractional release each year of 10 -5 of the inventory from the time of repository closure up through the 10 6 year. For purposes of providing perspective, it was assumed that each dose rate estimate was independent, that is, no releases

  1. The influence of the cigarette smoke pollution and ventilation rate on alpha-activities per unit volume due to radon and its progeny

    International Nuclear Information System (INIS)

    Misdaq, M.A.; Flata, K.

    2003-01-01

    Alpha and beta activities per unit volume air due to radon, thoron and their decay products were evaluated in the air of various cafe rooms polluted by cigarette smoke. Both CR-39 and LR-115 type II solid state nuclear track detectors (SSNTD) were used. Equilibrium factors between radon and its progeny and thoron and its daughters have been evaluated in the air of the studied cafe rooms. The committed equivalent doses due to short-lived radon decay products were determined in different regions of the respiratory tract of non-smoker members of the public. The influence of cigarette smoke pollution, ventilation rate and exposure time on committed equivalent dose in the respiratory systems of non-smokers was investigated. Committed equivalent doses ranged from 1.15x10 -11 -2.7x10 -7 Sv.y -1 /h of exposure in the extrathoracic region and from 0.8x10 -12 -1.7x10 -8 Sv.y -1 /h of exposure in the thoracic region of the respiratory tract of non-smokers

  2. Errors in Computing the Normalized Protein Catabolic Rate due to Use of Single-pool Urea Kinetic Modeling or to Omission of the Residual Kidney Urea Clearance.

    Science.gov (United States)

    Daugirdas, John T

    2017-07-01

    The protein catabolic rate normalized to body size (PCRn) often is computed in dialysis units to obtain information about protein ingestion. However, errors can manifest when inappropriate modeling methods are used. We used a variable volume 2-pool urea kinetic model to examine the percent errors in PCRn due to use of a 1-pool urea kinetic model or after omission of residual urea clearance (Kru). When a single-pool model was used, 2 sources of errors were identified. The first, dependent on the ratio of dialyzer urea clearance to urea distribution volume (K/V), resulted in a 7% inflation of the PCRn when K/V was in the range of 6 mL/min per L. A second, larger error appeared when Kt/V values were below 1.0 and was related to underestimation of urea distribution volume (due to overestimation of effective clearance) by the single-pool model. A previously reported prediction equation for PCRn was valid, but data suggest that it should be modified using 2-pool eKt/V and V coefficients instead of single-pool values. A third source of error, this one unrelated to use of a single-pool model, namely omission of Kru, was shown to result in an underestimation of PCRn, such that each ml/minute Kru per 35 L of V caused a 5.6% underestimate in PCRn. Marked overestimation of PCRn can result due to inappropriate use of a single-pool urea kinetic model, particularly when Kt/V <1.0 (as in short daily dialysis), or after omission of residual native kidney clearance. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  3. Trends in Hospitalization and Mortality Rates Due to Acute Cardiovascular Disease in Castile and León, 2001 to 2015.

    Science.gov (United States)

    López-Messa, Juan B; Andrés-de Llano, Jesús M; López-Fernández, Laura; García-Cruces, Jesús; García-Crespo, Julio; Prieto González, Miryam

    2018-02-01

    To analyze hospitalization and mortality rates due to acute cardiovascular disease (ACVD). We conducted a cross-sectional study of the hospital discharge database of Castile and León from 2001 to 2015, selecting patients with a principal discharge diagnosis of acute myocardial infarction (AMI), unstable angina, heart failure, or acute ischemic stroke (AIS). Trends in the rates of hospitalization/100 000 inhabitants/y and hospital mortality/1000 hospitalizations/y, overall and by sex, were studied by joinpoint regression analysis. A total of 239 586 ACVD cases (AMI 55 004; unstable angina 15 406; heart failure 111 647; AIS 57 529) were studied. The following statistically significant trends were observed: hospitalization: ACVD, upward from 2001 to 2007 (5.14; 95%CI, 3.5-6.8; P < .005), downward from 2011 to 2015 (3.7; 95%CI, 1.0-6.4; P < .05); unstable angina, downward from 2001 to 2010 (-12.73; 95%CI, -14.8 to -10.6; P < .05); AMI, upward from 2001 to 2003 (15.6; 95%CI, 3.8-28.9; P < .05), downward from 2003 to 2015 (-1.20; 95%CI, -1.8 to -0.6; P < .05); heart failure, upward from 2001 to 2007 (10.70; 95%CI, 8.7-12.8; P < .05), upward from 2007 to 2015 (1.10; 95%CI, 0.1-2.1; P < .05); AIS, upward from 2001 to 2007 (4.44; 95%CI, 2.9-6.0; P < .05). Mortality rates: downward from 2001 to 2015 in ACVD (-1.16; 95%CI, -2.1 to -0.2; P < .05), AMI (-3.37, 95%CI, -4.4 to -2, 3, P < .05), heart failure (-1.25; 95%CI, -2.3 to -0.1; P < .05) and AIS (-1.78; 95%CI, -2.9 to -0.6; P < .05); unstable angina, upward from 2001 to 2007 (24.73; 95%CI, 14.2-36.2; P < .05). The ACVD analyzed showed a rising trend in hospitalization rates from 2001 to 2015, which was especially marked for heart failure, and a decreasing trend in hospital mortality rates, which were similar in men and women. These data point to a stabilization and a decline in hospital mortality, attributable to established prevention measures. Copyright © 2017 Sociedad Española de Cardiología. Published by

  4. Vaginal native tissue repair versus transvaginal mesh repair for apical prolapse: how utilizing different methods of analysis affects the estimated trade-off between reoperation for mesh exposure/erosion and reoperation for recurrent prolapse.

    Science.gov (United States)

    Dieter, Alexis A; Willis-Gray, Marcella G; Weidner, Alison C; Visco, Anthony G; Myers, Evan R

    2015-05-01

    Informed decision-making about optimal surgical repair of apical prolapse with vaginal native tissue (NT) versus transvaginal mesh (TVM) requires understanding the balance between the potential "harm" of mesh-related complications and the potential "benefit" of reducing prolapse recurrence. Synthesis of data from observational studies is required and the current literature shows that the average follow-up for NT repair is significantly longer than for TVM repair. We examined this harm/benefit balance. We hypothesized that using different methods of analysis to incorporate follow-up time would affect the balance of outcomes. We used a Markov state transition model to estimate the cumulative 24-month probabilities of reoperation for mesh exposure/erosion or for recurrent prolapse after either NT or TVM repair. We used four different analytic approaches to estimate probability distributions ranging from simple pooled proportions to a random effects meta-analysis using study-specific events per patient-time. As variability in follow-up time was accounted for better, the balance of outcomes became more uncertain. For TVM repair, the incremental ratio of number of operations for mesh exposure/erosion per single reoperation for recurrent prolapse prevented increased progressively from 1.4 to over 100 with more rigorous analysis methods. The most rigorous analysis showed a 70% probability that TVM would result in more operations for recurrent prolapse repair than NT. Based on the best available evidence, there is considerable uncertainty about the harm/benefit trade-off between NT and TVM for apical prolapse repair. Future studies should incorporate time-to-event analyses, with greater standardization of reporting, in order to better inform decision-making.

  5. Survival and freedom from aortic valve-related reoperation after valve-sparing aortic root replacement in 1015 patients.

    Science.gov (United States)

    Kari, Fabian A; Doll, Kai-Nicolas; Hemmer, Wolfgang; Liebrich, Markus; Sievers, Hans-Hinrich; Richardt, Doreen; Reichenspurner, Hermann; Detter, Christian; Siepe, Matthias; Czerny, Martin; Beyersdorf, Friedhelm

    2016-04-01

    The aim of this study was to characterize mortality and aortic valve replacement after valve-sparing aortic root replacement (V-SARR) in a multicentre cohort. Between 1994 and 2014, 1015 patients had V-SARR with (n = 288, 28%) or without cusp/commissure repair (n = 727, 72%) at the centres of Lübeck (n = 343, 34%), Stuttgart (n = 346, 34%), Hamburg (n = 109, 11%) and Freiburg (n = 217, 21%), Germany. Comparative survival of an age- and gender-matched general population was calculated. Log-rank tests and multiple logistic regression were used to identify risk factors. The mean follow-up was 5.2 ± 3.9 years. Cumulative follow-up comprised 2933 patient-years. Early survival was 98%. NYHA status and aneurysm size were predictive of death during mid-term follow-up (P = 0.025). Freedom from aortic valve replacement was 90% at 8 years, with the type of V-SARR (root remodelling, David II) being a risk factor (P = 0.015). Bicuspid aortic valve (P = 0.26) and initial valve function (P = 0.4) did not impact reoperation. The need of additional valve repair (cusps/commissures) was not linked to reoperation: freedom from aortic valve replacement at 8 years was 84% if cusp repair was performed versus 90% if V-SARR alone was performed (P = 0.218). Marfan syndrome had no impact on survival or on aortic valve replacement. Mid-term survival of patients after V-SARR is comparable with that of a matched general population. The regurgitant bicuspid aortic valve is a favourable substrate for V-SARR. Prophylactic surgery should be performed before symptoms or large aneurysms are present to achieve optimal mid-term outcomes. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  6. [Directions for reoperation of patients with Björk-Shiley convexo-concave valve prosthesis, based on long-term experience].

    Science.gov (United States)

    Yamaki, F; Nakano, K; Endo, M; Hashimoto, A; Koyanagi, H

    1994-02-01

    Although a high incidence of strut fracture of the Björk-Shiley convexo-concave (C-C) valve prosthesis has been reported, it is still controversial whether the prosthesis functioning normally should be replaced electively. To clarify our policy for this issue, we reviewed 28 patients who had undergone mitral valve replacement with a C-C valve prosthesis, and evaluated long-term results according to STS guidelines. The incidence of valve-related complications expressed as % patient-year were; structural deterioration 0.30, nonstructural dysfunction 0.30, thromboembolism 1.20. There were no thrombosed valves, anticoagulant-related hemorrhage or prosthetic valve endocarditis. The actuarial free rate after valve replacement with the C-C at 10 years, constructed by the Kaplan-Meier method, were compared with those with St. Jude Medical (SJM) valve prosthesis. (1) Actuarial survival: 77.9 vs 87.3 (NS), (2) Reoperation-free: 91.6 vs 98.0 (p valve-related complications: 71.2 vs 77.7 (NS). The long-term results with the C-C were compatible to those with a SJM valve prosthesis. However, if a strut fracture occurs, it is very difficult to save the patient's life. The hospital mortality of re-replacement of valve prosthesis during the last 10 years, at our institute, was 2.6%, which is almost equal to the cumulative risk of strut fracture of the C-C valve after 10 years (3.0%).(ABSTRACT TRUNCATED AT 250 WORDS)

  7. Low resting metabolic rate in exercise-associated amenorrhea is not due to a reduced proportion of highly active metabolic tissue compartments.

    Science.gov (United States)

    Koehler, Karsten; Williams, Nancy I; Mallinson, Rebecca J; Southmayd, Emily A; Allaway, Heather C M; De Souza, Mary Jane

    2016-08-01

    Exercising women with menstrual disturbances frequently display a low resting metabolic rate (RMR) when RMR is expressed relative to body size or lean mass. However, normalizing RMR for body size or lean mass does not account for potential differences in the size of tissue compartments with varying metabolic activities. To explore whether the apparent RMR suppression in women with exercise-associated amenorrhea is a consequence of a lower proportion of highly active metabolic tissue compartments or the result of metabolic adaptations related to energy conservation at the tissue level, RMR and metabolic tissue compartments were compared among exercising women with amenorrhea (AMEN; n = 42) and exercising women with eumenorrheic, ovulatory menstrual cycles (OV; n = 37). RMR was measured using indirect calorimetry and predicted from the size of metabolic tissue compartments as measured by dual-energy X-ray absorptiometry (DEXA). Measured RMR was lower than DEXA-predicted RMR in AMEN (1,215 ± 31 vs. 1,327 ± 18 kcal/day, P < 0.001) but not in OV (1,284 ± 24 vs. 1,252 ± 17, P = 0.16), resulting in a lower ratio of measured to DEXA-predicted RMR in AMEN (91 ± 2%) vs. OV (103 ± 2%, P < 0.001). AMEN displayed proportionally more residual mass (P < 0.001) and less adipose tissue (P = 0.003) compared with OV. A lower ratio of measured to DXA-predicted RMR was associated with lower serum total triiodothyronine (ρ = 0.38, P < 0.001) and leptin (ρ = 0.32, P = 0.004). Our findings suggest that RMR suppression in this population is not the result of a reduced size of highly active metabolic tissue compartments but is due to metabolic and endocrine adaptations at the tissue level that are indicative of energy conservation.

  8. Numerical analysis of specific absorption rate in the human head due to a 13.56 MHz RFID-based intra-ocular pressure measurement system

    International Nuclear Information System (INIS)

    Hirtl, Rene; Schmid, Gernot

    2013-01-01

    A modern wireless intra-ocular pressure monitoring system, based on 13.56 MHz inductively coupled data transmission, was dosimetrically analyzed with respect to the specific absorption rate (SAR) induced inside the head and the eye due to the electromagnetic field exposure caused by the reader antenna of the transmission system. The analysis was based on numerical finite difference time domain computations using a high resolution anatomical eye model integrated in a modern commercially available anatomical model of a male head. Three different reader antenna configurations, a 7-turn elliptic (30 mm × 50 mm) antenna at 12 mm distance from the eye, a flexible circular antenna (60 mm diameter, 8 turns on 2 mm substrate) directly attached to the skin, and a circular 7-turn antenna (30 mm diameter at 12 mm distance to the eye) were analyzed, respectively. Possible influences of the eye-lid status (closed or opened) and the transponder antenna contained in a contact lens directly attached to the eye were taken into account. The results clearly demonstrated that for typical reader antenna currents required for proper data transmission, the SAR values remain far below the limits for localized exposure of the head, as defined by the International Commission for Non-Ionizing Radiation Protection. Particularly the induced SAR inside the eye was found to be substantially (orders of magnitudes for typical reader antenna currents in the order of 1 A turn) below values which have been reported to be critical with respect to thermally induced adverse health effects in eye tissues. (note)

  9. Psychological, behavioral, and weight-related aspects of patients undergoing reoperative bariatric surgery after gastric band: comparison with primary surgery patients.

    Science.gov (United States)

    Conceição, Eva; Pinto-Bastos, Ana; de Lourdes, Marta; Brandão, Isabel; Teixeira, Cristina; Machado, Paulo P P

    2018-02-15

    Patients experiencing insufficient weight loss or weight regain in their first bariatric surgery may represent a high-risk group with greater problematic eating and general psychopathology levels, which may compromise the success of a reoperative procedure. This study seeks to describe and compare disordered eating-related psychological and behavioral features of primary and reoperative surgery candidates after gastric band. Hospital center and university in Portugal. The baseline (preoperative) data from a longitudinal observational study are presented. Patients were interviewed by trained psychologists to identify binge-eating episodes and grazing and responded to a set of self-report measures: disordered eating, grazing, negative urgency, depression, anxiety, and stress. Two hundred twenty-five patients were undergoing primary surgery, and 166 were undergoing reoperative (REOP group) surgery. The groups did not differ in body mass index preoperatively, but the REOP group had greater weight suppression (t 387 = -5.35, P = .001), higher highest (t 387 = -3.40, P = .001) and lower lowest body mass index (t 381 = 2.22, P = .03). The main reasons for reoperative surgery were weight regain/poor weight loss (42.8%) or medical complications (32.5%). REOP patients with objective binge eating reported a higher frequency of these episodes (t 47 = 2.15, P = .04). No significant difference was found for the self-report measures assessed (only shape concern was higher for REOP group, F 1,216 = 8.30, Psurgeries, the differences in binge eating and weight-related variables may associate with postoperative difficulties. The link between binge eating, weight suppression, and weight gain found in other samples suggests that patients undergoing reoperative surgery may be at increased risk for poor weight outcomes. Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  10. Comparison of the predictions of the LQ and CRE models for normal tissue damage due to biologically targeted radiotherapy with exponentially decaying dose rates

    International Nuclear Information System (INIS)

    O'Donoghue, J.A.; West of Schotland Health Boards, Glasgow

    1989-01-01

    For biologically targeted radiotherapy organ dose rates may be complex functions of time, related to the biodistribution kinetics of the delivery vehicle and radiolabel. The simples situation is where dose rates are exponentially decaying functions of time. Two normal tissue isoeffect models enable the effects of exponentially decaying dose rates to be addressed. These are the extension of the linear-quadratic model and the cumulative radiation effect model. This communication will compare the predictions of these models. (author). 14 refs.; 1 fig

  11. Reoperation of Anastomotic Stricture after Oesophageal Atresia Repair: An Uncommon Event

    Directory of Open Access Journals (Sweden)

    A L Azakpa

    2017-01-01

    Full Text Available Oesophageal atresia is a common malformation in which the survival rate in developed countries is around 90%, while its mortality remains very high in developing countries. Oesophageal stricture post-oesophageal atresia repair is traditionally treated by non-surgical approach. However, surgical resection of the oesophageal stricture may be necessary after the failure of dilations. We report one case of refractory oesophageal stricture post-EA repair in a 3-year-old girl, who underwent oesophageal atresia Type III repair at 11-day-old. We performed an end-to-end oesophageal anastomosis with tracheal oesophageal fistula closure by extra-pleural approach. The patient was lost to follow-up for 3 years. She was seen later for anastomotic oesophageal stricture with the failure of oesophageal dilatations. Surgical resection of oesophageal stricture was performed with end-to-end oesophageal anastomosis.

  12. Successfull expansion of renewable energies due to reimbursement rates. Companies demand safety of investment; Erfolgreicher Ausbau Erneuerbarer Energien dank Einspeiseverguetung. Unternehmen fordern Investitionssicherheit

    Energy Technology Data Exchange (ETDEWEB)

    Kunz, Claudia (comp.)

    2012-06-22

    Quota systems for the promotion of renewable energy sources are inferior to the reimbursement rates such as the German Renewable Energy Law (EEG). The reimbursement rates have been proven to be efficient and effective. Therefore companies demand no dismissal of the EEG because a dismissal reduces the security of investment and thwarts the expansion of renewable energies.

  13. Reaction of atomic bromine with acetylene and loss rate of atmospheric acetylene due to reaction with OH, Cl, O, and Br

    Science.gov (United States)

    Payne, W. A.; Nava, D. F.; Brunning, J.; Stief, L. J.

    1986-01-01

    The first-order, diffusion, and bimolecular rate constants for the reaction Br + C2H2 yields C2H3Br are evaluated. The rate constants are measured at 210, 248, 298, and 393 K and at pressures between 15-100 torr Ar using flash photolysis combined with time-resolved detection of atomic bromine via Br resonance radiation. It is observed that the reaction is not affected by pressure or temperature and the bimolecular constant = (4.0 + or - 0.8) x 10 to the -15th cu cm/sec with an error of two standard deviations. The C2H2 + Br reaction rates are compared with reactions of C2H2 with Cl, OH, NH2, and H. The loss rates for atmospheric C2H2 for reactions with OH, Cl, O, and Br are calculated as a function of altitude.

  14. Wii, Kinect, and Move. Heart Rate, Oxygen Consumption, Energy Expenditure, and Ventilation due to Different Physically Active Video Game Systems in College Students

    OpenAIRE

    SCHEER, KRISTA S.; SIEBRANT, SARAH M.; BROWN, GREGORY A.; SHAW, BRANDON S.; SHAW, INA

    2014-01-01

    Nintendo Wii, Sony Playstation Move, and Microsoft XBOX Kinect are home video gaming systems that involve player movement to control on-screen game play. Numerous investigations have demonstrated that playing Wii is moderate physical activity at best, but Move and Kinect have not been as thoroughly investigated. The purpose of this study was to compare heart rate, oxygen consumption, and ventilation while playing the games Wii Boxing, Kinect Boxing, and Move Gladiatorial Combat. Heart rate, o...

  15. [High complication rate after surgical treatment of ankle fractures].

    Science.gov (United States)

    Bjørslev, Naja; Ebskov, Lars; Lind, Marianne; Mersø, Camilla

    2014-08-04

    The purpose of this study was to determine the quality and re-operation rate of the surgical treatment of ankle fractures at a large university hospital. X-rays and patient records of 137 patients surgically treated for ankle fractures were analyzed for: 1) correct classification according to Lauge-Hansen, 2) if congruity of the ankle joint was achieved, 3) selection and placement of the hardware, and 4) the surgeon's level of education. Totally 32 of 137 did not receive an optimal treatment, 11 were re-operated. There was no clear correlation between incorrect operation and the surgeon's level of education.

  16. Due diligence

    International Nuclear Information System (INIS)

    Sanghera, G.S.

    1999-01-01

    The Occupational Health and Safety (OHS) Act requires that every employer shall ensure the health and safety of workers in the workplace. Issues regarding the practices at workplaces and how they should reflect the standards of due diligence were discussed. Due diligence was described as being the need for employers to identify hazards in the workplace and to take active steps to prevent workers from potentially dangerous incidents. The paper discussed various aspects of due diligence including policy, training, procedures, measurement and enforcement. The consequences of contravening the OHS Act were also described

  17. A practical approach to estimate emission rates of indoor air pollutants due to the use of personal combustible products based on small-chamber studies.

    Science.gov (United States)

    Szulejko, Jan E; Kim, Ki-Hyun

    2016-02-01

    As emission rates of airborne pollutants are commonly measured from combusting substances placed inside small chambers, those values need to be re-evaluated for the possible significance under practical conditions. Here, a simple numerical procedure is investigated to extrapolate the chamber-based emission rates of formaldehyde that can be released from various combustible sources including e-cigarettes, conventional cigarettes, or scented candles to their concentration levels in a small room with relatively poor ventilation. This simple procedure relies on a mass balance approach by considering the masses of pollutants emitted from source and lost through ventilation under the assumption that mixing occurs instantaneously in the room without chemical reactions or surface sorption. The results of our study provide valuable insights into re-evaluation procedure of chamber data to allow comparison between extrapolated and recommended values to judge the safe use of various combustible products in confined spaces. If two scented candles with a formaldehyde emission rate of 310 µg h(-1) each were lit for 4 h in a small 20 m(3) room with an air change rate of 0.5 h(-1), then the 4-h (candle lit) and 8-h (up to 8 h after candle lighting) TWA [FA] were determined to be 28.5 and 23.5 ppb, respectively. This is clearly above the 8-h NIOSH recommended exposure limit (REL) time weighted average of 16 ppb. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Effects on stratospheric moistening by rates of change of aerosol optical depth and ozone due to solar activity in extra-tropics

    Science.gov (United States)

    Saha, U.; Maitra, A.

    2014-11-01

    The solar-induced changes in ozone and aerosol optical depth have relative effects on stratospheric moistening at upper troposphere/lower stratosphere region. Wavelet-based multi-scale principal component analysis technique has been applied to de-noise component of quasi-biennial oscillation and El Niño-Southern Oscillation from ozone and aerosol optical depth variations. Rate of change of aerosol optical depth sharply increases indicating a positive gradient whereas rate of change of ozone sharply decreases indicating a negative gradient with solar activity during the years 2004-2010. It is also observed that with increase of rate of change of aerosol optical depth, there is a sharp increase of stratospheric moistening caused by enhanced deep convection. On the contrary, with the increase of stratospheric moistening, there is a sharp decrease of rate of change of ozone resulting in a cross-over between the two parameters. An increase in aerosol optical depth may cause a significant increase in the gradient of vertical temperature profile, as well as formation of cloud condensation nuclei, clouds and hence rainfall. This may lead to formation of strong convective system in the atmosphere that is essential for vertical transfer of water vapour in the tropics percolating tropical tropopause layer and depleting stratospheric ozone in the extra-tropics.

  19. Decrease in Survival Rate of Colorectal Cancer Patients Due to Insertion of a Single Guanine Base in Promoter Sequences of Matrix Metalloproteinase-1 Gene (in Tehran Population

    Directory of Open Access Journals (Sweden)

    Z Hojati

    2009-01-01

    Full Text Available Introduction: Insertion or deletion of a guanine in -1607 at promoter region of matrix metalloproteinase-1 enzyme creates two allelic types for this gene in the population: 2G and 1G, respectively. 2G allele contains an extra binding site for ETS transcription factors that this may increase the level of gene expression. Therefore, aim of this study was investigation of the single Guanine insertion in the promoter gene and its association with colorectal cancer patient survival rate and tumor progression. Methods: Blood samples from 150 colorectal patients and 100 cases were extracted. The mean follow-up was 25 months (12-36 months. Cases and patients were genotyped using genomic DNA extraction and PCR-RFLP. Results: Colorectal cancer patients were divided in two groups; with activity of metastasis (M+ and without activity of metastasis (M-. 2G allele in metastasis group (55% showed more frequency rather than controls (23%. Survival analyses showed that 3 years survival patients rate in the patients without metastasis activity carrying 1G allele (homo and heterozygote was 81% and for 2G homozygote is 66% (p=0.04. The survival rate dependent to cancer was 90% and 71%, respectively (P=0.01. Conclusion: According to the results, it seems that patients carrying 1G allele show a better survival rate dependent on cancer as compared to patients who do not carry this allele.

  20. Wii, Kinect, and Move. Heart Rate, Oxygen Consumption, Energy Expenditure, and Ventilation due to Different Physically Active Video Game Systems in College Students.

    Science.gov (United States)

    Scheer, Krista S; Siebrant, Sarah M; Brown, Gregory A; Shaw, Brandon S; Shaw, Ina

    Nintendo Wii, Sony Playstation Move , and Microsoft XBOX Kinect are home video gaming systems that involve player movement to control on-screen game play. Numerous investigations have demonstrated that playing Wii is moderate physical activity at best, but Move and Kinect have not been as thoroughly investigated. The purpose of this study was to compare heart rate, oxygen consumption, and ventilation while playing the games Wii Boxing, Kinect Boxing, and Move Gladiatorial Combat. Heart rate, oxygen consumption, and ventilation were measured at rest and during a graded exercise test in 10 males and 9 females (19.8 ± 0.33 y, 175.4 ± 2.0 cm, 80.2 ± 7.7 kg,). On another day, in a randomized order, the participants played Wii Boxing, K inect Boxing, and Move Gladiatorial Combat while heart rate, ventilation, and oxygen consumption were measured. There were no differences in heart rate (116.0 ± 18.3 vs. 119.3 ± 17.6 vs. 120.1 ± 17.6 beats/min), oxygen consumption (9.2 ± 3.0 vs. 10.6 ± 2.4 vs. 9.6 ± 2.4 ml/kg/min), or minute ventilation (18.9 ± 5.7 vs. 20.8 ± 8.0 vs. 19.7 ± 6.4 L/min) when playing Wii boxing, Kinect boxing, or Move Gladiatorial Combat (respectively). Playing Nintendo Wii Boxing, XBOX Kinect Boxing, and Sony PlayStation Move Gladiatorial Combat all increase heart rate, oxygen consumption, and ventilation above resting levels but there were no significant differences between gaming systems. Overall, playing a "physically active" home video game system does not meet the minimal threshold for moderate intensity physical activity, regardless of gaming system.

  1. Causes and indications for reoperation in valve replacement and coronary artery bypass graft (CABG in 915 patients in cardiac surgery department in Imam Khomeini Hospital, 1374-77

    Directory of Open Access Journals (Sweden)

    Radmehr H

    2001-08-01

    Full Text Available Valvular and coronary artery disease are among the most important causes of disability and death in the world and Iran as well. Every year, half a million death because of these diseases is reported in United State. The incidence of degenerative and valvular diseases of heart is increasing. Considering the industrialization of our country, the incidence of these kind of problems are increasing as well. In this study, there is an attempt to recognize the causes of cardiac surgery. We conducted a retrospective study in 915 cardiac surgery patients (630 CABG and 285 valve replacement from 1374 to 1377. In CABG patients, there were 46 cases of reoperation (78.3 percent male 21.7 percent female. The most reoperations for bleeding was less than 24 hours in 90.3 percent. In valvular patients the causes of reoperation were: A Valvular complications (female/male=3/1, B Non valvular complications (female/male=1/3. The most common nonvalvular complication was bleeding (66.6 percent. The most common valvular complication was bioprosthetic valve degeneration. The meantime between two operation in valvular complications was 11.8 years. In all cases (915 the incidence of bleeding was 3.8 percent, mediastinitis 0.8 percent, cardiac tamponade 0.8 percent and GI bleeding 0.5 percent.

  2. Absorbed Dose Rate Due to Intake of Natural Radionuclides by Tilapia Fish (Tilapia nilotica,Linnaeus, 1758) Estimated Near Uranium Mining at Caetité, Bahia, Brazil

    Science.gov (United States)

    Pereira, Wagner de S.; Kelecom, Alphonse; Py Júnior, Delcy de Azevedo

    2008-08-01

    The uranium mining at Caetité (Uranium Concentrate Unit—URA) is in its operational phase. Aiming to estimate the radiological environmental impact of the URA, a monitoring program is underway. In order to preserve the biota of the deleterious effects from radiation and to act in a pro-active way as expected from a licensing body, the present work aims to use an environmental protection methodology based on the calculation of absorbed dose rate in biota. Thus, selected target organism was the Tilapia fish (Tilapia nilotica, Linnaeus, 1758) and the radionuclides were: uranium (U-238), thorium (Th-232), radium (Ra-226 and Ra-228) and lead (Pb-210). As, in Brazil there are no radiation exposure limits adopted for biota the value proposed by the Department of Energy (DOE) of the United States of 3.5×103 μGy y-1 has been used. The derived absorbed dose rate calculated for Tilapia was 2.51×100 μGy y-1, that is less than 0.1% of the dose limit established by DOE. The critical radionuclide was Ra-226, with 56% of the absorbed dose rate, followed by U-238 with 34% and Th-232 with 9%. This value of 0.1% of the limit allows to state that, in the operational conditions analyzed, natural radionuclides do not represent a radiological problem to biota.

  3. Absorbed dose rate due to intake of natural radionuclides by Tilapia fish (Tilapia nilotica, Linnaeus, 1758) estimated near uranium anomaly at Santa Quiteria, Ceara, Brazil

    International Nuclear Information System (INIS)

    Pereira, Wagner de; Kelecom, Alphonse; Py Junior, Delcy de Azevedo

    2007-01-01

    The uranium mining at Santa Quiteria (Santa Quiteria Unit - USQ) is in its environmental licensing phase. Aiming to estimate the radiological environmental impact of the USQ, a monitoring program is underway. However, radioprotection of biota is not explicitly mentioned in Brazilian norms. In order to preserve the biota of the deleterious effects from radiation and to behave in a pro-active way as expected by licensing organs, the present work aims to use an environmental protection methodology, based on the calculation of absorbed dose rate in biota. Thus, selected biomarker was the fish tilapia (Tilapia nilotica, Linnaeus, 1758) and the radionuclides were: uranium (U-238), thorium (Th-232), radium (Ra-226 and Ra-228) and lead (Pb-210). Since there are no exposition limits for biota, in Brazil, the value proposed by the Department of Energy (DOE) of the United States of 3.5 x 10 3 μGy/y has been used. The derived absorbed dose rate calculated for tilapia was 2.76 x 10 0 μGy/y, that is less than 0.1 % of the limit established by DOE. The critical radionuclide was U-238, with 99% of the absorbed dose rate. This value of 0.1% of the limit allows to state that in pre-operational conditions analyzed natural radionuclides do not represent a radiological problem to the biota. (author)

  4. Absorbed dose rate due to intake of natural radionuclides by Tilapia fish (Tilapia nilotica, Linnaeus, 1758) estimated near uranium anomaly at Santa Quiteria, Ceara, Brazil

    Energy Technology Data Exchange (ETDEWEB)

    Pereira, Wagner de [Industrias Nucleares do Brasil S.A. (INB), Pocos de Caldas, MG (Brazil). Coordenacao de Protecao Radiologica. Unidade de Tratamento de Minerios], E-mail: wspereira@inb.gov.br; Kelecom, Alphonse [Universidade Federal Fluminense (UFF), Niteroi, RJ (Brazil). Programa de Pos-graduacao em Ciencia Ambiental; Py Junior, Delcy de Azevedo [Industrias Nucleares do Brasil S.A. (INB), Caetite, BA (Brazil). Coordenacao de Protecao Radiologica. Unidade de Concentrado de Uranio], E-mail: Delcy@inb.gov.br

    2007-07-01

    The uranium mining at Santa Quiteria (Santa Quiteria Unit - USQ) is in its environmental licensing phase. Aiming to estimate the radiological environmental impact of the USQ, a monitoring program is underway. However, radioprotection of biota is not explicitly mentioned in Brazilian norms. In order to preserve the biota of the deleterious effects from radiation and to behave in a pro-active way as expected by licensing organs, the present work aims to use an environmental protection methodology, based on the calculation of absorbed dose rate in biota. Thus, selected biomarker was the fish tilapia (Tilapia nilotica, Linnaeus, 1758) and the radionuclides were: uranium (U-238), thorium (Th-232), radium (Ra-226 and Ra-228) and lead (Pb-210). Since there are no exposition limits for biota, in Brazil, the value proposed by the Department of Energy (DOE) of the United States of 3.5 x 10{sup 3} {mu}Gy/y has been used. The derived absorbed dose rate calculated for tilapia was 2.76 x 10{sup 0} {mu}Gy/y, that is less than 0.1 % of the limit established by DOE. The critical radionuclide was U-238, with 99% of the absorbed dose rate. This value of 0.1% of the limit allows to state that in pre-operational conditions analyzed natural radionuclides do not represent a radiological problem to the biota. (author)

  5. Absorbed Dose Rate Due to Intake of Natural Radionuclides by Tilapia Fish (Tilapia nilotica,Linnaeus, 1758) Estimated Near Uranium Mining at Caetite, Bahia, Brazil

    International Nuclear Information System (INIS)

    Pereira, Wagner de S; Kelecom, Alphonse; Azevedo Py Junior, Delcy de

    2008-01-01

    The uranium mining at Caetite (Uranium Concentrate Unit--URA) is in its operational phase. Aiming to estimate the radiological environmental impact of the URA, a monitoring program is underway. In order to preserve the biota of the deleterious effects from radiation and to act in a pro-active way as expected from a licensing body, the present work aims to use an environmental protection methodology based on the calculation of absorbed dose rate in biota. Thus, selected target organism was the Tilapia fish (Tilapia nilotica, Linnaeus, 1758) and the radionuclides were: uranium (U-238), thorium (Th-232), radium (Ra-226 and Ra-228) and lead (Pb-210). As, in Brazil there are no radiation exposure limits adopted for biota the value proposed by the Department of Energy (DOE) of the United States of 3.5x10 3 μGy y -1 has been used. The derived absorbed dose rate calculated for Tilapia was 2.51x10 0 μGy y -1 , that is less than 0.1% of the dose limit established by DOE. The critical radionuclide was Ra-226, with 56% of the absorbed dose rate, followed by U-238 with 34% and Th-232 with 9%. This value of 0.1% of the limit allows to state that, in the operational conditions analyzed, natural radionuclides do not represent a radiological problem to biota

  6. The solar Lithium problem: is the explanation due solely to mixing or also to the e-capture decay rate of 7Be?

    Science.gov (United States)

    Vescovi, Diego; Busso, Maurizio; Palmerini, Sara; Trippella, Oscar

    2018-01-01

    The nucleosynthesis of 7Li is one of the most crucial problems in nuclear as- trophysics, as its observations in several sites are hard to be explained. Concerning the Sun, the most common interpretations of the low Li abundance invoke either burning in early stages or non-convective mixing below the envelope. Here we apply a diffusive mechanism of mixing, together with a recent estimate of the rate for e-captures on 7Be, to establish whether the solar Li destruction should be attributed to purely pre-Main Se- quence (MS) nuclear processes or if the coupling of mixing and nucleosynthesis on the MS can account for it. Our preliminary results indicate that, whether Li survives the pre- MS phase, the changes of the 7Be e--capture rate do not affect its production/destruction. The low Li abundance should then depend only on diffusion processes from the bottom of the convective envelope to the lowerlying tachocline zone. We suggest that, if diffusive processes occurred over the age of the Sun, they required diffusive mass transfers of a few 10-13 M⊙/yr to explain the Li drop. This is a high estimate: future works will tell us if it is realistic or not. In this second case, pre-MS burning would remain the only alternative.

  7. Methodology for setting the reference levels in the measurements of the dose rate absorbed in air due to the environmental gamma radiation

    International Nuclear Information System (INIS)

    Dominguez Ley, Orlando; Capote Ferrera, Eduardo; Caveda Ramos, Celia; Alonso Abad, Dolores

    2008-01-01

    Full text: The methodology for setting the reference levels of the measurements of the gamma dose rate absorbed in the air is described. The registration level was obtained using statistical methods. To set the alarm levels, it was necessary to begin with certain affectation level, which activates the investigation operation mode when being reached. It is was necessary to transform this affectation level into values of the indicators selected to set the appearance of an alarm in the network, allowing its direct comparison and at the same time a bigger operability of this one. The affectation level was assumed as an effective dose of 1 mSv/y, which is the international dose limit for public. The conversion factor obtained in a practical way as a consequence of the Chernobyl accident was assumed, converting the value of annual effective dose into values of effective dose rate in air. These factors are the most important in our work, since the main task of the National Network of Environmental Radiological Surveillance of the Republic of Cuba is detecting accidents with a situations regional affectation, and this accident is precisely an example of pollution at this scale. The alarm level setting was based on the results obtained in the first year of the Chernobyl accident. For this purpose, some transformations were achieved. In the final results, a correction factor was introduced depending on the year season the measurement was made. It was taken into account the influence of different meteorological events on the measurement of this indicator. (author)

  8. Age spectrometry of infant death rates as a probe of immunity: Identification of two peaks due to viral and bacterial diseases respectively

    Science.gov (United States)

    Berrut, Sylvie; Richmond, Peter; Roehner, Bertrand M.

    2017-11-01

    After birth, setting up an effective immune system is a major challenge for all living organisms. In this paper we show that this process can be explored by using the age-specific infant death rate as a kind of sensor. This is made possible because, as shown by the authors in Berrut et al. (2016), between birth and a critical age tc, for all mammals the death rate decreases with age as a smooth hyperbolic function. For humans tc is equal to 10 years. It turns out that for some causes of deaths and specific ages the hyperbolic fall displays temporary spikes which, it is assumed, correspond to specific events in the organism's response to exogenous factors. One of these spikes occurs 10 days after birth and there is another at the age of 300 days. It is shown that the first spike is related to viral infections whereas the second is related to bacterial diseases. By going back to former time periods during which infant mortality was much higher than it is currently, one gets a magnified view of these peaks. They give us useful information about how an organism adapts to new conditions. Apart from the reaction to pathogens, the same methodology can be used to study the response to changes in other external conditions, e.g. temperature or oxygen level.

  9. Familial prostate cancer has a more aggressive course than sporadic prostate cancer after treatment for localized disease, mainly due to a higher rate of distant metastases

    International Nuclear Information System (INIS)

    Kupelian, Patrick A.; Klein, Eric A.; Suh, John H; Kupelian, Varant A.

    1997-01-01

    Purpose: We had already established that familial prostate cancer, defined as prostate cancer diagnosed in a father or brother, was an independent predictor of biochemical failure after treatment for localized disease. Our aim was to determine whether differences in outcome could be observed with respect to clinical failures (either local or distant) between the two forms of prostate cancer. Methods: Of the 1685 consecutive cases with localized prostate carcinoma treated between 1986 and 1996, patients with the following were excluded from the present study: no pretreatment Prostatic Specific Antigen (iPSA) level (n=54), no biopsy Gleason score (bGS) (n=25), adjuvant or neoadjuvant treatment (n=234), no available follow-up PSA level (n=30). We also excluded 617 patients who did not have a minimum of 3 years potential follow-up. The analysis was performed on 725 cases. Radiotherapy (RT) was the primary treatment in 330 patients and radical prostatectomy (RP) in 395 patients. Five percent had clinical stage T3 disease (n=37). Positive family history was defined as the presence of prostate cancer in a first degree relative (father or brother). The outcomes of interest were biochemical relapse-free survival (bRFS), clinical relapse-free survival (cRFS), local relapse-free survival (locRFS), distant relapse-free survival (dRFS). We used proportional hazards to analyze the effect of family history and other potential confounding variables (i.e. age, race, treatment modality, stage, biopsy GS, and iPSA levels) on treatment outcome. We included pathologic findings (extracapsular extension, seminal vesicle involvement, surgical margin involvement, and lymph node metastases) in a separate analysis for RP patients. Results: The median follow-up was 45 months. Eight percent of all cases (n=57) had a positive family history. The 5-year bRFS rates for patients with negative and positive family history were 54% and 38%, respectively (p<0.001). The 5-year cRFS rates for patients

  10. Calculus of radiolytic products generation in water due to alpha radiation. Determination of the spent nuclear fuels matrix alteration rate Determination of velocity of spent fuel matrix

    International Nuclear Information System (INIS)

    Quinones, J.; Serrano, J.; Diaz Arocas, P.; Rodriguez Almazan, J. L.; Bruno, J.; Cera, E.; Merino, J.; Esteban, J. A.; Martinez-Esparza, A.

    2000-01-01

    The generation of radiolytic products as a result of alpha radiation in the surface of the spent fuel is a key process in order to understand how the it becomes degraded in repository conditions. The present work has established a radiolytic model based on a set of reactions involving fuel oxidation-dissolution and radiolytic products recombination. It also includes the decrease of the dose rates as the main alpha emitters decay away. Four cases, with varying parameters of the system, have been assessed. The results show a decrease in both the concentration of the radiolytic products in the gap water and the degradation of the fuel matrix. It has been estimated that in the period of the evaluation (10''6 years) up to 52% of the pellet is altered in the conservative cases, whereas only 11% is altered in the realistic cases. No significant differences were observed when the carbonates reactions were included in the system. (Author)

  11. Apolipoprotein CIII overexpression exacerbates diet-induced obesity due to adipose tissue higher exogenous lipid uptake and retention and lower lipolysis rates.

    Science.gov (United States)

    Raposo, Helena F; Paiva, Adriene A; Kato, Larissa S; de Oliveira, Helena C F

    2015-01-01

    Hypertriglyceridemia is a common type of dyslipidemia found in obesity. However, it is not established whether primary hyperlipidemia can predispose to obesity. Evidences have suggested that proteins primarily related to plasma lipoprotein transport, such as apolipoprotein (apo) CIII and E, may significantly affect the process of body fat accumulation. We have previously observed an increased adiposity in response to a high fat diet (HFD) in mice overexpressing apoCIII. Here, we examined the potential mechanisms involved in this exacerbated response of apoCIII mice to the HFD. We measured body energy balance, tissue capacity to store exogenous lipids, lipogenesis and lipolysis rates in non-transgenic and apoCIII overexpressing mice fed a HFD during two months. Food intake, fat excretion and whole body CO2 production were similar in both groups. However, the adipose tissue mass (45 %) and leptin plasma levels (2-fold) were significantly greater in apoCIII mice. Lipogenesis rates were similar, while exogenous lipid retention was increased in perigonadal (2-fold) and brown adipose tissues (40 %) of apoCIII mice. In addition, adipocyte basal lipolysis (55 %) and in vivo lipolysis index (30 %) were significantly decreased in apoCIII mice. A fat tolerance test evidenced delayed plasma triglyceride clearance and greater transient availability of non-esterified fatty acids (NEFA) during the post-prandial state in the apoCIII mice plasma. Thus, apoCIII overexpression resulted in increased NEFA availability to adipose uptake and decreased adipocyte lipolysis, favoring lipid enlargement of adipose depots. We propose that plasma apoCIII levels represent a new risk factor for diet-induced obesity.

  12. SAROTA: application of specific absorption rate (SAR) and over-the-air (OTA) data for the characterization of the real-life exposure due to mobile phones

    International Nuclear Information System (INIS)

    Monebhurrun, Vikass

    2013-01-01

    The RF exposure level of a mobile phone is quantified by the measurement of the specific absorption rate (SAR) under laboratory conditions. The SAR which is measured while the mobile phone is operated at maximum power level does not reflect the real-life exposure scenario since the mobile phone typically re-adjusts its power level and frequency depending on the quality of the communication link with the nearest base station. The choice of a low RF exposure device based on the comparison of the relative SAR values of mobile phones can be misleading. The real-life RF exposure also depends on the over-the-air (OTA) performance of the mobile phone. Taken independently, the two sets of data do not allow a straightforward comparison of the global RF performance amongst mobile phones. A unique and simple parameter denoted as the SAROTA index is proposed for the characterization of mobile phones with regard to both RF exposure and OTA performance. The SAROTA index provides the real-life exposure index of the mobile phone.

  13. CT-Guided Percutaneous Drainage of Infected Collections Due to Gastric Leak After Sleeve Gastrectomy for Morbid Obesity: Initial Experience

    International Nuclear Information System (INIS)

    Kelogrigoris, M.; Sotiropoulou, E.; Stathopoulos, K.; Georgiadou, V.; Philippousis, P.; Thanos, L.

    2011-01-01

    This study was designed to evaluate the efficacy and safety of computed tomography (CT)-guided drainage in treating infected collections due to gastric leak after laparoscopic sleeve gastrectomy for morbid obesity. From January 2007 to June 2009, 21 patients (9 men and 12 women; mean age, 39.2 (range, 26–52) years) with infected collections due to gastric leak after laparoscopic sleeve gastrectomy for morbid obesity underwent image-guided percutaneous drainage. All procedures were performed using CT guidance and 8- to 12-Fr pigtail drainage catheters. Immediate technical success was achieved in all 21 infected collections. In 18 of 21 collections, we obtained progressive shrinkage of the collection with consequent clinical success (success rate 86%). In three cases, the abdominal fluid collection was not resolved, and the patients were reoperated. Among the 18 patients who avoided surgery, 2 needed replacement of the catheter due to obstruction. No major complications occurred during the procedure. The results of our study support that CT-guided percutaneous drainage is an effective and safe method to treat infected abdominal fluid collections due to gastric leak in patients who had previously underwent laparoscopic sleeve gastrectomy for morbid obesity. It may be considered both as a preparatory step for surgery and a valuable alternative to open surgery. Failure of the procedure does not, however, preclude a subsequent surgical operation.

  14. Influence of body mass index on short-term subjective improvement and risk of reoperation after mid-urethral sling surgery

    DEFF Research Database (Denmark)

    Weltz, Vibeke; Guldberg, Rikke; Larsen, Michael D.

    2018-01-01

    Introduction and hypothesis: The objective was to evaluate the impact of body mass index (BMI) on the subjective improvement and risk of reoperation after first-time mid-urethral sling surgery. Methods: Data were retrieved from the national Danish Urogynaecological Database, including women...... was defined as any new surgical procedure for stress urinary incontinence performed within the study period. Results: During the study period, 6,414 mid-urethral sling procedures were performed; 80.0% of these women filled out both pre- and post-surgical International Consultation on Incontinence...

  15. Correlation between relative rates of hospital treatment or death due to ischaemic heart disease (IHD) and of IHD-related medication among socio-occupational and economic activities groups in Denmark, 1996-2005

    DEFF Research Database (Denmark)

    Hannerz, Harald; Dalhoff, Kim; Burr, Hermann

    2014-01-01

    Standardised Hazard Ratios (SHR) for hospital treatment or death due to IHD and SHR for purchase of prescriptions for medicine that may prevent IHD from (re)occurring, among socio-occupational and economic activities groups in Denmark. The SHR were based on a 10-year prospective follow-up of 2 million people.......74 for the economic activities groups). We observed, however, one markedly contradictive result; the industrial group entitled 'general practitioner, dentists etc.' was associated both with significantly high rates of medicine usage (SHR = 1.15, 95% CI: 1.12-1.19) and significantly low rates of hospital treatment...... or death due to IHD (SHR = 0.80, 95% CI: 0.71-0.91). CONCLUSION: Apart from a few caveats, the strong correlations obtained in the present study signify that purchase of a prescription for IHD-related medication is a usable risk indicator for IHD in the working population of Denmark. The usage of medicine...

  16. Evaluation Of Factors Influencing On Causes Of Prosthetic Valve Re-operation And Early Postoperative Survival Tehran Emam hospital (1991-2001

    Directory of Open Access Journals (Sweden)

    Rahmani Reaza

    2003-06-01

    Full Text Available Prosthetic valve re-operation has greater mortality and morbidity than primary valve replacement. By recognition of factors influencing on causes of redo operation and preoperative survival, one can select appropriate prosthesis at primary valve replacement and when operation performed at appropriate time, surgical risk can be reduced."nMethods and Materials: Two hundred patients that underwent prosthetic valve re-operation from October 1991 through November 2001 were included in this study. There were 68 men and 132 women with the mean age of 42:tl 1.8 years. Structural failure was the commonest cause of bio-prosthesis replacement (93%. Valve thrombosis was the common cause of mechanical valve replacement (32%. Age younger Than 50 (P= 0.01 and interval after the first implantation more than 10 years (P= 0.01 affected bio-prosthesis degeneration."nResults: Atrial fibrillation (P<0.01, Older age especially more than 40 (P<0.05 and mitral position (P<0.01 affected mechanical valve thrombosis. Cross clamp time (P= 0.005, Tricuspid insufficiency (P = 0.001, NYHA IV (P = 0.005 and emergent operation (P= 0.001 were independent determinants of hospital mortality."nConclusion: In conclusion, in patients with more than 10-years life expectancy and age younger than 50, mechanical valve can be selected for primary valve replacement. If operation performed before patients reach deteriorated condition, preoperative survival would be excellent.

  17. Being on sick leave due to heart failure: self-rated health, encounters with healthcare professionals and social insurance officers and self-estimated ability to return to work.

    Science.gov (United States)

    Nordgren, Lena; Söderlund, Anne

    2015-01-01

    Younger people with heart failure often experience poor self-rated health. Furthermore, poor self-rated health is associated with long-term sick leave and disability pension. Socio-demographic factors affect the ability to return to work. However, little is known about people on sick leave due to heart failure. The aim of this study was to investigate associations between self-rated health, mood, socio-demographic factors, sick leave compensation, encounters with healthcare professionals and social insurance officers and self-estimated ability to return to work, for people on sick leave due to heart failure. This population-based investigation had a cross-sectional design. Data were collected in Sweden in 2012 from two official registries and from a postal questionnaire. In total, 590 subjects, aged 23-67, responded (response rate 45.8%). Descriptive statistics, correlation analyses (Spearman bivariate analysis) and logistic regression analyses were used to investigate associations. Poor self-rated health was strongly associated with full sick leave compensation (OR = 4.1, p health was moderately associated with low income (OR =  .6, p =  .003). Good self-rated health was strongly associated with positive encounters with healthcare professionals (OR = 3.0, p =  .022) and to the impact of positive encounters with healthcare professionals on self-estimated ability to return to work (OR = 3.3, p work imposes reduced quality of life. Positive encounters with healthcare professionals and social insurance officers can be supportive when people with heart failure struggle to remain in working life.

  18. Modeling of the Nano- and Picoseismicity Rate Changes Resulting from Static Stress Triggering due to Small (MW2.2) Event Recorded at Mponeng Deep Gold Mine, South Africa

    Science.gov (United States)

    Kozlowska, M.; Orlecka-Sikora, B.; Kwiatek, G.; Boettcher, M. S.; Dresen, G. H.

    2014-12-01

    Static stress changes following large earthquakes are known to affect the rate and spatio-temporal distribution of the aftershocks. Here we utilize a unique dataset of M ≥ -3.4 earthquakes following a MW 2.2 earthquake in Mponeng gold mine, South Africa, to investigate this process for nano- and pico- scale seismicity at centimeter length scales in shallow, mining conditions. The aftershock sequence was recorded during a quiet interval in the mine and thus enabled us to perform the analysis using Dietrich's (1994) rate and state dependent friction law. The formulation for earthquake productivity requires estimation of Coulomb stress changes due to the mainshock, the reference seismicity rate, frictional resistance parameter, and the duration of aftershock relaxation time. We divided the area into six depth intervals and for each we estimated the parameters and modeled the spatio-temporal patterns of seismicity rates after the stress perturbation. Comparing the modeled patterns of seismicity with the observed distribution we found that while the spatial patterns match well, the rate of modeled aftershocks is lower than the observed rate. To test our model, we used four metrics of the goodness-of-fit evaluation. Testing procedure allowed rejecting the null hypothesis of no significant difference between seismicity rates only for one depth interval containing the mainshock, for the other, no significant differences have been found. Results show that mining-induced earthquakes may be followed by a stress relaxation expressed through aftershocks located on the rupture plane and in regions of positive Coulomb stress change. Furthermore, we demonstrate that the main features of the temporal and spatial distribution of very small, mining-induced earthquakes at shallow depths can be successfully determined using rate- and state-based stress modeling.

  19. Mitral stenosis due to pannus overgrowth after rigid ring annuloplasty.

    Science.gov (United States)

    Oda, Takeshi; Kato, Seiya; Tayama, Eiki; Fukunaga, Shuji; Akashi, Hidetoshi; Aoyagi, Shigeaki

    2010-03-01

    Although mitral stenosis (MS) due to pannus overgrowth after mitral valve repair for rheumatic mitral regurgitation (MR) is not uncommon, it is extremely rare in relation to non-rheumatic mitral regurgitation. Whilst it has been suggested that the rigid annuloplasty ring induces pannus overgrowth in the same manner as the flexible ring, to date only in cases using the flexible ring has pannus formation been confirmed by a pathological examination after redo surgery. The case is described of a woman who had undergone mitral valve repair using a 28 mm rigid ring three years previously because of non-rheumatic MR, and subsequently suffered from MS due to pannus formation over the annuloplasty ring. To the present authors' knowledge, this is the first report of MS due to pannus formation after mitral valve repair using a rigid annuloplasty ring to treat non-rheumatic MR documented at reoperation.

  20. Economic Effects of Reservoir Re-operation Policy in the Rio Grande/Bravo for Sustainable Human and Environmental Water Management

    Science.gov (United States)

    Ortiz Partida, J. P.; Sandoval Solis, S.; Lane, B.

    2015-12-01

    A central challenge of integrated water management is the design and implementation of policies to allocate water to both humans and the environment in a sustainable manner. This study uses the results from a reach-scale water-planning model to quantify and compare the economic benefits of two water management policies: (1) a business as usual (Baseline) policy and (2) a proposed reservoir re-operation policy to provide environmental flows (EFs). Results show that the EF policy would increase water supply profit, slightly decrease recreational activities profit, and reduce costs from flood damage and environmental restoration compared to the Baseline policy. In addition to supporting ecological objectives, the proposed EF policy would increase the economic benefits of water management objectives.

  1. Minimally invasive right lateral thoracotomy without aortic cross-clamping: an attractive alternative to repeat sternotomy for reoperative mitral valve surgery.

    Science.gov (United States)

    Umakanthan, Ramanan; Petracek, Michael R; Leacche, Marzia; Solenkova, Nataliya V; Eagle, Susan S; Thompson, Annemarie; Ahmad, Rashid M; Greelish, James P; Ball, Stephen K; Hoff, Steven J; Absi, Tarek S; Balaguer, Jorge M; Byrne, John G

    2010-03-01

    The study aim was to determine the safety and benefits of minimally invasive mitral valve surgery without aortic cross-clamping for mitral valve surgery after previous cardiac surgery. Between January 2006 and August 2008, a total of 90 consecutive patients (38 females, 52 males; mean age 66 +/- 9 years) underwent minimally invasive mitral valve surgery after having undergone previous cardiac surgery. Of these patients, 80 (89%) underwent mitral valve replacement and 10 (11%) mitral valve repair utilizing a small (5 cm) right lateral thoracotomy along the 4th or 5th intercostal space under fibrillatory arrest (mean temperature 28 +/- 2 degrees C). The predicted mortality, calculated using the Society of Thoracic Surgeons (STS) algorithm, was compared to the observed mortality. The mean ejection fraction was 45 +/- 13%, mean NYHA class 3 +/- 1, while 66 patients (73%) had previous coronary artery bypass grafting and 37 (41%) had previous valve surgery. Twenty-six patients (29%) underwent non-elective surgery. Cardiopulmonary bypass was instituted through axillary (n = 19), femoral (n = 70) or direct use aortic (n = 1) cannulation. Operative mortality was 2% (2/90), lower than the STS-predicted mortality of 7%. Three patients (3%) developed acute renal failure postoperatively, one patient (1%) required new-onset hemodialysis, and one (1%) developed postoperative stroke. No patients developed postoperative myocardial infarction. The mean postoperative packed red blood cell transfusion requirement at 48 h was 2 +/- 3 units. Minimally invasive right thoracotomy without aortic cross-clamping is an excellent alternative to conventional redo-sternotomy for reoperative mitral valve surgery. The present study confirmed that this technique is safe and effective in reducing operative mortality in high-risk patients undergoing reoperative cardiac surgery.

  2. Pancreaticojejunal bridge-anastomosis: a novel option for surgeon to preserve pancreatic body and tail in urgent reoperation for intra-abdominal massive hemorrhage after pancreaticoduodenectomy.

    Science.gov (United States)

    Xu, Jin; Dai, Xianwei; Bu, Xianmin; Gao, Feng; Zhang, Xiaobo

    2010-10-01

    Postoperative intra-abdominal massive bleeding is a rare and life-threatening complication associated with pancreaticoduodenectomy. Completion pancreatectomy (CP) was usually performed during reexploration for the complication. The management could decrease the complications, such as the pancreatic leakage or intraluminal infection after reexploration, but could increase mortality during the perioperative period. It also could result in loss of pancreatic function forever. This study evaluated an alternative surgical management for intra-abdominal massive hemorrhage to prevent pancreas function, simplify the surgical processes, and decrease the mortality of relaparotomy. Outcome after pancreaticojejunal bridge-anastomosis (PJBA) performed between January 2006 and June 2009 was compared with that after CP performed between February 1984 and December 2005. Between February 1984 and June 2009, 963 patients underwent the Whipple procedure (PD) or pylorus-preserving pancreaticoduodectomy (PPPD). Pancreatic leakage occurred in 103 patients (10.7%); 22 cases (21.4%) developed into intra-abdominal massive bleeding. Nonsurgical procedures of transarterial embolization (TAE) were performed in ten (45.45%) patients, of whom one died (10%). Twelve (54.55%) underwent reoperation. Five had CP with one death (20%). Pancreatic remnant was preserved by pancreaticojejunal bridge-anastomosis (PJBA) in seven patients with no deaths. The reexploration time was 340 +/- 48.2 min vs. 247.9 +/- 40.8 min (P endocrine insufficiency ("brittle" diabetes) and diarrhea (exocrine insufficiency). There were no evidences of exocrine and endocrine insufficiency in patients with PJBA. Pancreaticojejunal bridge-anastomosis is an easy, simple, and safe procedure for intra-abdominal massive hemorrhage associated with pancreaticoduodenectomy. It could decrease the mortality of reoperation and preserve the pancreatic function.

  3. Do perceived job insecurity and annoyance due to air and noise pollution predict incident self-rated poor health? A prospective analysis of independent and joint associations using a German national representative cohort study.

    Science.gov (United States)

    Riedel, Natalie; Loerbroks, Adrian; Bolte, Gabriele; Li, Jian

    2017-01-23

    Current economic and social change has contributed to increasing job insecurity and traffic-related pollution in residential areas. Both job insecurity and exposure to noise and air pollution are known determinants of population health and can concur in peoples' lives. This may hold true particularly for socially disadvantaged subpopulations. Nevertheless, the potential independent and joint links of those exposures to health have been rarely examined so far. We aimed to contribute to the scarce body of evidence. Information on perceived job insecurity and exposures to noise and air pollution as expressed by annoyance as well as on self-rated health were gathered from 2 waves of the population-based German Socio-Economic Panel (2009 and 2011, N=6544). We performed multivariable Poisson regression to examine the independent and joint risk of poor health in 2011 by perceived job insecurity and annoyance due to noise and air pollution in 2009. After the 2-year follow-up in 2011, 571 (8.7%) participants rated their health as poor. The risk of reporting incident poor health was increased by roughly 40% in employees reporting high versus low perceived job insecurity and annoyance due to noise and air pollution, respectively. This risk increased when both exposures were present at higher levels (risk ratio=1.95 (1.49 to 2.55)). Work-related and environmental exposures may accumulate and have a joint health impact. Elaboration on the link between occupational and residential exposures is warranted in the light of their concurrence and their implications for health inequities. 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/.

  4. Influence of heat transfer on walls due to aerosol decomposition rate in the containment building of nuclear power plants during heavy incidents; Einfluss des Waermeuebergangs an Waenden auf die Aerosolabbaurate im Sicherheitsbehaelter von Kernkraftwerken bei schweren Stoerfaellen

    Energy Technology Data Exchange (ETDEWEB)

    Braun, T.

    2004-07-01

    Today, German nuclear power plants are leading in safety standards worldwide. Increasing potentials arise continuously along with improvements in technology. One of these potentials is the best-estimate simulation of fission product transport in case of a severe accident. A main part of the fission products is allocated on aerosols. Therefore, the aerosol behavior before containment leakage is important for the radioactive source term to the environment. Having a good knowledge about the main aerosol phenomena, it is possible to simulate them numerically. This enables to develop and test safety measures to limit damages before accidents occur. Within this study, the main aerosol phenomena have been ascertained and accordingly classified into formation, transport and reduction. On this basis, simulations of one- and multi-component aerosol experiments of the KAEVER series have been performed with the COCOSYS code. Due to an overprediction of the computed volume condensation rate, the results showed an overestimation of the reduction rate of insoluble aerosols. The reason was found to be the underestimation of the wall condensation rate. Based on an additional plain thermal hydraulic multi compartment experiment, these uncertainties in the wall heat transfer correlations were investigated in detail. The results show a strong dependency between the wall condensation rate and the convective heat transfer, resp. the characteristic length. In case of mainly forced convection, correct values for the characteristic length led to an underestimation of the calculated heat transfer coefficients. The analysis of the heat transfer models show an inconsistency in the coupling of free and forced convection. Therefore, an improved and consistent convection model has been developed and implemented. Both models have been tested on different experiments. Although the new model shows only minor improvements, it could be proven that the influence for forced convection is significant

  5. Injury due to thorotrast

    International Nuclear Information System (INIS)

    Mori, Takesaburo

    1976-01-01

    A synthetic study was performed on some of those to whom Thorotrast had been injected, in Japan. In the epidemiological study of 147 war woundeds to whom Thorotrast had been injected, it was noted that the Thorotrast injection increased the mortality rate and the incidences of malignant hepatic tumor, liver cirrhosis, and hematological diseases. Clinical study of 44 of them showed that the Thorotrast injection resulted in liver and hematopoietic hypofunctions. Analysis of the dissection of the injected area in 118 cases showed malignant hepatic tumor in 63.5%, liver cirrhosis in 14.4% and hematological diseases in 10.2%. The total of the three types of disease was 88.1%. Histological classification showed that of the malignant hepatic tumors due to Thorotrast, hepatobiliary cancer and hemangioendothelioma of the liver were frequent. By the comparison of the absorbed dose in the liver of the malignant hepatic tumors due to Thorotrast with that of the cancers developed in animal experiments, it was noted that the carcinogenic dose was a mean of 2,000 - 3,000 rad by accumulated dose. It was elucidated that carcinogenesis and fibrination were primary in injury due to Thorotrast, i.e., late injury due to Thorotrast, and that the increase in the accumulated dose in rogans and the increase of the local dose due to the gigantic growth of Thorotrast granules in organs greatly influenced carninogenesis and fibrination. (Chiba, N.)

  6. Preoperative radiotherapy and local excision of rectal cancer with immediate radical re-operation for poor responders

    International Nuclear Information System (INIS)

    Bujko, Krzysztof; Richter, Piotr; Kolodziejczyk, Milena; Nowacki, Marek P.; Kulig, Jan; Popiela, Tadeusz; Gach, Tomasz; Oledzki, Janusz; Sopylo, Rafal; Meissner, Wiktor; Wierzbicki, Ryszard; Polkowski, Wojciech; Kowalska, Teresa; Stryczynska, Grazyna; Paprota, Krzysztof

    2009-01-01

    Background and purpose: To report an early analysis of prospective study exploring preoperative radiotherapy and local excision in rectal cancer. Materials and methods: Mucosa at tumour edges was tattooed. Patients with cT1-3N0 tumour <3-4 cm were treated with either 5 x 5 Gy + 4 Gy boost (N = 31) or chemoradiation (50.4 Gy + 5.4 Gy boost, 1.8 Gy per fraction + 5-fluorouracyl and leucovorin; N = 13). Thirteen patients from the short-course group were unfit for chemotherapy. The interval from radiation to full-thickness local excision was 6 weeks. The protocol called for conversion to a transabdominal surgery in case of ypT2-3 disease or positive margin. Results: The postoperative complications requiring hospitalization were recorded in 9% of patients. The rate of pathological complete response was 41%. The rate of patients requiring conversion was 34%; however, 18% actually underwent conversion and the remaining 16% refused or were unfit. During the 14 months of median follow-up, local recurrence was detected in 7% of patients and all underwent salvage surgery. Of 19 patients in whom initially anterior resection was likely, 16% had abdominoperineal resection performed for a conversion or as a rescue procedure. Conclusion: Our study suggests that the short-course radiation prior to local excision is a treatment option for high-risk patients.

  7. Violência e desigualdade social: mortalidade por homicídios e condições de vida em Salvador, Brasil Violence and social inequalities: mortality rates due to homicides and life conditions in Salvador, Brazil

    Directory of Open Access Journals (Sweden)

    Adriana C Macedo

    2001-12-01

    used to define a four-category variable related to living conditions. Mortality rates due to homicide and the relative risk regarding the lowest living condition area were calculated for each social stratum. The 95% confidence intervals were calculated using the Confidence Interval Analysis software. RESULTS: The highest mortality rates due to homicide were seen in the poorest areas. The relative risk due to homicide for the lowest and the highest living condition areas was statistically significant at 5% level and ranged from 2.9 to 5.1. CONCLUSIONS: The data show a strong association between social inequalities and homicide in this urban area, emphasizing the importance of crime reduction programs.

  8. Potential for post-closure radionuclide redistribution due to biotic intrusion: aboveground biomass, litter production rates, and the distribution of root mass with depth at material disposal area G, Los Alamos National Laboratory

    International Nuclear Information System (INIS)

    French, Sean B.; Christensen, Candace; Jennings, Terry L.; Jaros, Christopher L.; Wykoff, David S.; Crowell, Kelly J.; Shuman, Rob

    2008-01-01

    Low-level radioactive waste (LLW) generated at the Los Alamos National Laboratories (LANL) is disposed of at LANL's Technical Area (T A) 54, Material Disposal Area (MDA) G. The ability of MDA G to safely contain radioactive waste during current and post-closure operations is evaluated as part of the facility's ongoing performance assessment (PA) and composite analysis (CA). Due to the potential for uptake and incorporation of radio nuclides into aboveground plant material, the PA and CA project that plant roots penetrating into buried waste may lead to releases of radionuclides into the accessible environment. The potential amount ofcontamination deposited on the ground surface due to plant intrusion into buried waste is a function of the quantity of litter generated by plants, as well as radionuclide concentrations within the litter. Radionuclide concentrations in plant litter is dependent on the distribution of root mass with depth and the efficiency with which radionuclides are extracted from contaminated soils by the plant's roots. In order to reduce uncertainties associated with the PA and CA for MDA G, surveys are being conducted to assess aboveground biomass, plant litter production rates, and root mass with depth for the four prominent vegetation types (grasses, forbs, shrubs and trees). The collection of aboveground biomass for grasses and forbs began in 2007. Additional sampling was conducted in October 2008 to measure root mass with depth and to collect additional aboveground biomass data for the types of grasses, forbs, shrubs, and trees that may become established at MDA G after the facility undergoes final closure, Biomass data will be used to estimate the future potential mass of contaminated plant litter fall, which could act as a latent conduit for radionuclide transport from the closed disposal area. Data collected are expected to reduce uncertainties associated with the PA and CA for MDA G and ultimately aid in the assessment and subsequent

  9. Planar scintigraphy with 123I/99mTc-sestamibi, 99mTc-sestamibi SPECT/CT, 11C-methionine PET/CT, or selective venous sampling before reoperation of primary hyperparathyroidism?

    Science.gov (United States)

    Schalin-Jäntti, Camilla; Ryhänen, Eeva; Heiskanen, Ilkka; Seppänen, Marko; Arola, Johanna; Schildt, Jukka; Väisänen, Mika; Nelimarkka, Lassi; Lisinen, Irina; Aalto, Ville; Nuutila, Pirjo; Välimäki, Matti J

    2013-05-01

    All patients with primary hyperparathyroidism should undergo localization studies before reoperation, but it is not known which method is most accurate. The purpose of this prospective study was to compare the performance of planar scintigraphy with (123)I/(99m)Tc-sestamibi, (99m)Tc-sestamibi SPECT (SPECT/CT), (11)C-methionine PET/CT, and selective venous sampling (SVS) in persistent primary hyperparathyroidism. Twenty-one patients referred for reoperation of persistent hyperparathyroidism were included and investigated with (123)I/(99m)Tc-sestamibi, SPECT/CT (n = 19), (11)C-methionine PET/CT, and SVS (n = 18) before reoperation. All patients had been operated on 1-2 times previously because of hyperparathyroidism. The results of the localization studies were compared with operative findings, histology, and biochemical cure. Eighteen (86%) of 21 patients were biochemically cured. Nineteen parathyroid glands (9 adenomas, 1 atypical adenoma, and 9 hyperplastic glands) were removed from 17 patients, and 1 patient who was biochemically cured had an unclear histology result. The accuracy for localizing a pathologic parathyroid gland to the correct side of the neck was 59% (95% confidence interval [CI], 36%-79%) for (123)I/(99m)Tc-sestamibi, 19% (95% CI, 5%-42%) for SPECT/CT, 65% (95% CI, 43%-84%) for (11)C-methionine PET/CT, and 40% (95% CI, 19%-65%) for SVS (P hyperparathyroidism and is recommended as first-line imaging before reoperation. (11)C-methionine PET/CT provides valuable additional information if (123)I/(99m)Tc-sestamibi scan results remain negative. (99m)Tc-sestamibi SPECT/CT and SVS provide no additional information, compared with the combined results of (123)I/(99m)Tc-sestamibi and (11)C-methionine PET/CT imaging.

  10. Flow Rate Capacity Reduction Due to Temporal and Dynamic Processes in Large Pipelines. Study with Field Measurements; Efectos dinamicos y temporales en la reduccion de la capacidad de conduccion en grandes acueductos. Estudio con medidas en prototipo

    Energy Technology Data Exchange (ETDEWEB)

    Carmona Paredes, Rafael; Ortiz Nunez, Luis Alfonso; Sanchez Huerta, Alejandro [Universidad Nacional Autonoma de Mexico (Mexico)

    2002-06-01

    More than 15 years of operation have show that some water transport pressurized pipelines change their flow rate capacity faster than expected due to normal roughness increase. As explained by the tubular pinch effects, the radial migration of suspended particles in a flow can produce a high concentration close to the pipe wall. The non-uniform particle concentration leads to higher velocities at the center of the tube, equivalent to a reduced hydraulic section that increases the head losses. A model to explain field measurements at the Chapala-Guadalajara Aqueduct is proposed that suggests to hydraulic engineers to be more distrustful when using traditional head loss formulas to analyze water transport pipelines. [Spanish] La perdida de la capacidad de conduccion es un grave problema en la operacion de grandes acueductos. Mas de 15 anos de estudios y de inspeccion directa al interior de las tuberias de varios sistemas de abastecimiento de agua potable han mostrado el desarrollo de capas de material fino fuertemente adheridas a la pared de los tubos. En algunos casos, la variacion de la perdida de carga no ha podido ser explicada con los modelos tradicionales de crecimiento de la rugosidad interna, por lo que para explicar de forma adecuada las mediciones de campo realizadas en el acueducto Chapala-Guadalajara ha sido necesario incorporar de manera simultanea fenomenos dinamicos y temporales. Con base en el fecto de elongacion tubular (o tubular pinch effect), descrito por otros autores, mas observaciones directas al interior de las tuberias, en este trabajo se plantea como una posible de la disminucion de capacidad de conduccion en el acueducto Chapala-Guadalajara un cambio aparente en la seccion efectiva del flujo, originado por la migracion radial hacia la pared del tubo de las particulas suspendidas en el agua. El modelo que propone reproduce las medidas en campo con diferencias menores al 10% e invita a reflexionar sobre las practicas convencionales para

  11. Use of selective serotonin reuptake inhibitors and risk of re-operation due to post-surgical bleeding in breast cancer patients: a Danish population-based cohort study

    DEFF Research Database (Denmark)

    Gärtner, Rune; Cronin-Fenton, Deirdre; Hundborg, Heidi Holmager

    2010-01-01

    Selective serotonin reuptake inhibitors (SSRI) decrease platelet-function, which suggests that SSRI use may increase the risk of post-surgical bleeding. Few studies have investigated this potential association.......Selective serotonin reuptake inhibitors (SSRI) decrease platelet-function, which suggests that SSRI use may increase the risk of post-surgical bleeding. Few studies have investigated this potential association....

  12. Results of Attempts to Prevent Departure and/or Pilot-Induced Oscillations (PIO) Due to Actuator Rate Limiting in Highly-Augmented Fighter Flight Control Systems (HAVE FILTER)

    National Research Council Canada - National Science Library

    Chapa, Michael

    1999-01-01

    The objective of this effort was to evaluate the effects of software rate limiting the pilot command with and without a software pre-filter on a highly-augmented fighter aircraft flight control system...

  13. Extremely fast increase in the organic loading rate during the co-digestion of rapeseed oil and sewage sludge in a CSTR--characterization of granules formed due to CaO addition to maintain process stability.

    Science.gov (United States)

    Kasina, M; Kleyböcker, A; Michalik, M; Würdemann, H

    2015-01-01

    In a co-digestion system running with rapeseed oil and sewage sludge, an extremely fast increase in the organic loading rate was studied to develop a procedure to allow for flexible and demand-driven energy production. The over-acidification of the digestate was successfully prevented by calcium oxide dosage, which resulted in granule formation. Mineralogical analyses revealed that the granules were composed of insoluble salts of long chain fatty acids and calcium and had a porous structure. Long chain fatty acids and calcium formed the outer cover of granules and offered interfaces on the inside thereby enhancing the growth of biofilms. With granule size and age, the pore size increased and indicated degradation of granular interfaces. A stable biogas production up to the organic loading rate of 10.4 kg volatile solids m(-3) d(-1) was achieved although the hydrogen concentration was not favorable for propionic acid degradation. However, at higher organic loading rates, unbalanced granule formation and degradation were observed. Obviously, the adaption time for biofilm growth was too short to maintain the balance, thereby resulting in a low methane yield.

  14. Similar failure rate in immediate post-operative weight bearing versus protected weight bearing following meniscal repair on peripheral, vertical meniscal tears.

    Science.gov (United States)

    Perkins, Bryan; Gronbeck, Kyle R; Yue, Ruixian Alexander; Tompkins, Marc A

    2017-08-16

    Post-operative weight bearing after meniscal repair is a point of debate among physicians. This study sought to evaluate whether patients adhering to an immediate WBAT rehabilitation programme have a higher failure rate compared to those adhering to a more traditional, protected, NWB status following meniscal repair. The null hypothesis was that there would be no difference in failure between the two groups. A retrospective review of meniscal repair patients greater than 5 years from surgery was performed for patients receiving meniscal repair treatment. Patients were categorized by post-surgical weight-bearing status, either NWB or WBAT, and then analysed for failure of repair. Failure was defined as re-operation on the torn meniscus. The study controlled for variables including age at surgery, sex, height, weight, and BMI, classification of tear type, acuity of the tear, repair location (medial or lateral), repair location within the meniscus, repair technique, and concomitant procedures. Re-operations were performed in 61 of 157 patients [38.9%]. There was no difference between weight-bearing groups for failure of meniscus repair (n.s.). The tears were acute vertical tears located in the posterior horn and body. For the 61 patients with re-operation, the average time to re-operation was 2.2 years with 10 [16%] > 5 years from surgery, 17 [28%] 2-5 years from surgery, and 34 [56%] bearing groups for rate of re-operation (n.s.). Weight bearing as tolerated after meniscal repair for peripheral, vertical tears does not result in a higher failure rate than traditional, non-weight bearing over a five-year follow-up period. The clinical relevance is that, based on these data, it may be appropriate to allow weight bearing as tolerated following meniscal repair of peripheral, vertical tears. Retrospective cohort study, Level III.

  15. Increased Release of Mercury from Dental Amalgam Fillings due to Maternal Exposure to Electromagnetic Fields as a Possible Mechanism for the High Rates of Autism in the Offspring: Introducing a Hypothesis

    Directory of Open Access Journals (Sweden)

    Mortazavi Gh.

    2016-03-01

    Full Text Available According to the World Health Organization (WHO, factors such as growing electricity demand, ever-advancing technologies and changes in social behaviour have led to steadily increasing exposure to man-made electromagnetic fields. Dental amalgam fillings are among the major sources of exposure to elemental mercury vapour in the general population. Although it was previously believed that low levels are mercury (i.g. release of mercury from dental amalgam is not hazardous, now numerous data indicate that even very low doses of mercury cause toxicity. There are some evidence indicating that perinatal exposure to mercury is significantly associated with an increased risk of developmental disorders such as autism spectrum disorders (ASD and attention-deficit hyperactivity disorder (ADHD. Furthermore, mercury can decrease the levels of neurotransmitters dopamine, serotonin, noreprenephrine, and acetylcholine in the brain and cause neurological problems. On the other hand, a strong positive correlation between maternal and cord blood mercury levels is found in some studies. We have previously shown that exposure to MRI or microwave radiation emitted by common mobile phones can lead to increased release of mercury from dental amalgam fillings. Moreover, when we investigated the effects of MRI machines with stronger magnetic fields, our previous findings were confirmed. As a strong association between exposure to electromagnetic fields and mercury level has been found in our previous studies, our findings can lead us to this conclusion that maternal exposure to electromagnetic fields in mothers with dental amalgam fillings may cause elevated levels of mercury and trigger the increase in autism rates. Further studies are needed to have a better understanding of the possible role of the increased mercury level after exposure to electromagnetic fields and the rate of autism spectrum disorders in the offspring.

  16. Diplopia due to Dacryops

    Directory of Open Access Journals (Sweden)

    Rahmi Duman

    2013-01-01

    Full Text Available Dacryops is a lacrimal ductal cyst. It is known that it can cause globe displacement, motility restriction, and proptosis because of the mass effect. Diplopia due to dacryops has not been reported previously. Here, we present a 57-year-old man with binocular horizontal diplopia that occurred during left direction gaze due to dacryops.

  17. Habitat reclamation plan to mitigate for the loss of habitat due to oil and gas production activities under maximum efficient rate, Naval Petroleum Reserve No. 1, Kern County, California

    International Nuclear Information System (INIS)

    Anderson, D.C.

    1994-11-01

    Activities associated with oil and gas development under the Maximum Efficiency Rate (MER) from 1975 to 2025 will disturb approximately 3,354 acres. Based on 1976 aerial photographs and using a dot grid methodology, the amount of land disturbed prior to MER is estimated to be 3,603 acres. Disturbances on Naval Petroleum Reserve No. 1 (NPR-1) were mapped using 1988 aerial photography and a geographical information system. A total of 6,079 acres were classified as disturbed as of June, 1988. The overall objective of this document is to provide specific information relating to the on-site habitat restoration program at NPRC. The specific objectives, which relate to the terms and conditions that must be met by DOE as a means of protecting the San Joaquin kit fox from incidental take are to: (1) determine the amount and location of disturbed lands on NPR-1 and the number of acres disturbed as a result of MER activities, (2) develop a long term (10 year) program to restore an equivalent on-site acres to that lost from prior project-related actions, and (3) examine alternative means to offset kit fox habitat loss

  18. Studies on the radioactive contamination due to nuclear detonations V. The radioactive contamination of human body by Sr{sup 90} and Cs{sup 137} and its correlation with the fallout rate and ground deposition

    Energy Technology Data Exchange (ETDEWEB)

    Nishiwaki, Yasushi [Nuclear Reactor Laboratory, Tokyo Institute of Technology, Tokyo (Japan); Nuclear Reactor Laboratoroy, Kinki University, Fuse City, Osaka Precture (Japan)

    1961-11-25

    About 60 bone samples were analysed for Sr 90 during the period from January 1957 to July 1959. The highest average concentration was found to be about 1 S.U for the age group of 5 to 10 years old. However since most of the cases are more or less pathological ones after long period of hospitalization the results may not be considered to be the representative values for the average normal person. The highest concentration among the cases whose past history is known was 175 S.U. or roughly, about 2 S.U. During the period of observation occasionally we have found higher concentration than 2 S.U, in the bone samples of a few cases obtained from the crematory. However, since the past history of these cases is not known, it is not clear whether they depended on the rainwater or on the brown ice with much higher contamination than the white rice. In view of these findings it may not be to, much to assume that the concentration of Sr 90 in te bones of the average normal children might reach 2 S.U c corresponding to the cumulative ground deposition and the fallout rate. The concentration of Cs whose physical half-life is very much similar to Sr 90 was in the range of about 30 - 100 cesium unit in 1957 to early 1958. However, during the period from 1958 to early 1959 the concentration of Cs 137 in come of the organs of the human body has been reported to be about two to three times higher on the average in Tokyo than the above value in 1957.

  19. Rate of spontaneous voiding recovery after acute urinary retention due to bed rest in the hospital setting in a non-urological population clinical study of the relationship between lower limbs and bladder function

    Directory of Open Access Journals (Sweden)

    Paulo Rodrigues

    Full Text Available Abstract Objectives To understand the clinical relationship between lower limbs functions and the recovery of spontaneous voiding after an acute urinary retention (AUR in older patients admitted to hospitals for non-urological causes using clinical parameters. Materials and Methods 56 adult patients (32 men; mean age: 77.9 ± 8.3 and 24 women; mean age 82.1 ± 4.6 with AUR were prospectively followed with validated Physical Performance Mobility Exam (PPME instrument to evaluate the relationship between the recovery of mobility capacity and spontaneous voiding. After a short period of permanent bladder drainage patients started CIC along evaluation by PPME during hospitalization and at 7, 15, 30 60, 90, and 180 days of discharge. Mann-Whitney U, chi-square test and ANOVA tests were used. Results All patients were hospitalized for at least 15 days (Median 26.3 ± 4.1 days. Progressive improvement on mobility scale measured by PPME was observed after leaving ICU and along the initial 7 days of hospitalization but with a deterioration if hospitalization extends beyond 15 days (p<0.03. Prolonged hospital stay impairs mobility in all domains (p<0.05 except step-up and transfer skills (p<0.02 although a recovery rate on spontaneous voiding persistented. Restoration of spontaneous voiding was accompanied by improvement on mobility scale (p<0.02. Recovery of spontaneous voiding was markedly observed after discharging the hospital. All patients recovered spontaneous voiding until 6 months of follow-up. Conclusions Recovery to spontaneous voiding after acute urinary retention in the hospital setting may be anticipated by evaluation of lower limbs function measured by validated instruments.

  20. Studies on the radioactive contamination due to nuclear detonations V. The radioactive contamination of human body by Sr90 and Cs137 and its correlation with the fallout rate and ground deposition

    International Nuclear Information System (INIS)

    Nishiwaki, Yasushi

    1961-01-01

    About 60 bone samples were analysed for Sr 90 during the period from January 1957 to July 1959. The highest average concentration was found to be about 1 S.U for the age group of 5 to 10 years old. However since most of the cases are more or less pathological ones after long period of hospitalization the results may not be considered to be the representative values for the average normal person. The highest concentration among the cases whose past history is known was 175 S.U. or roughly, about 2 S.U. During the period of observation occasionally we have found higher concentration than 2 S.U, in the bone samples of a few cases obtained from the crematory. However, since the past history of these cases is not known, it is not clear whether they depended on the rainwater or on the brown ice with much higher contamination than the white rice. In view of these findings it may not be to, much to assume that the concentration of Sr 90 in te bones of the average normal children might reach 2 S.U c corresponding to the cumulative ground deposition and the fallout rate. The concentration of Cs whose physical half-life is very much similar to Sr 90 was in the range of about 30 - 100 cesium unit in 1957 to early 1958. However, during the period from 1958 to early 1959 the concentration of Cs 137 in come of the organs of the human body has been reported to be about two to three times higher on the average in Tokyo than the above value in 1957

  1. Panhypopituitarism Due to Hemochromatosis

    OpenAIRE

    Mesut Özkaya; Kadir Gis; Ali Çetinkaya

    2013-01-01

    Hemochromatosis is an iron storage disease. Panhypopituitarism is a clinical condition in which the anterior pituitary hormones are deficient. Herein, we report a rare case of panhypopituitarism due to hemochromatosis. Turk Jem 2013; 17: 125-6

  2. Deference and Due Process

    OpenAIRE

    Vermeule, Cornelius Adrian

    2015-01-01

    In the textbooks, procedural due process is a strictly judicial enterprise; although substantive entitlements are created by legislative and executive action, it is for courts to decide independently what process the Constitution requires. The notion that procedural due process might be committed primarily to the discretion of the agencies themselves is almost entirely absent from the academic literature. The facts on the ground are very different. Thanks to converging strands of caselaw ...

  3. O espectro da reoperação em cirurgia de coronária The spectrum os re-operation in coronary surgery

    Directory of Open Access Journals (Sweden)

    Jarbas J Dinkhuysen

    1989-04-01

    ção, angioplastia mal sucedida e presença de mamária prévia não causaram impacto decisivo na morbidade e na mortalidade desta série (P > 0,05.The authors present the results obtained in the first 30 day P.O. of 204 patients who underwent reoperations for coronary atherosclerosis. The interval between first and second operation varied from 1 month to 16.5 years. There was also two small groups of patients of third intervention and with associated cardiac lesions. The basic strategy consisted on anticoagulation, the aplication of the mammary arteries (one or two whenever possible, and revascularization as complete as possible. Most patients showed uneventfull evolution and a quarter of them presented some kind of non-fatal complication with good response to specific therapeutic measures. The overall mortality was about 9%. Patients with atherosclerotic lesions in native coronary circulation presented the greater morbidity, but in those with atherosclerotic lesions both in the grafts and coronary native circulation, the mortality was higher. Contrary to expectation, the younger group showed higher mortality, and the older group presented higher morbidity. The aplication of the IMA's on the reintervention does not add morbidity or mortality, but the concomitant correction of the associated cardiac pathologies represented a higher risk in the procedure. Recent myocardial infarction influenced also morbidity. The third intervention, failure transluminal angioplastic coronary dilatation and the presence of previous IMA does not exert deleterious impact on the morbidity or mortality.

  4. Preoperative Radiotherapy and Wide Resection for Soft Tissue Sarcomas: Achieving a Low Rate of Major Wound Complications with the Use of Flaps. Results of a Single Surgical Team.

    Science.gov (United States)

    Chan, Lester Wai Mon; Imanishi, Jungo; Grinsell, Damien Glen; Choong, Peter

    2017-01-01

    Surgery in combination with radiotherapy (RT) has become the standard of care for most soft tissue sarcomas. The choice between pre- and postoperative RT is controversial. Preoperative RT is associated with a 32-35% rate of major wound complications (MWC) and 16-25% rate of reoperation. The role of vascularized soft tissue "flaps" in reducing complications is unclear. We report the outcomes of patients treated with preoperative RT, resection, and flap reconstruction. 122 treatment episodes involving 117 patients were retrospectively reviewed. All patients were treated with 50.4 Gy of external beam radiation. Surgery was performed at 4-8 weeks after completion of RT by the same combination of orthopedic oncology and plastic reconstructive surgeon. Defects were reconstructed with 64 free and 59 pedicled/local flaps. 30 (25%) patients experienced a MWC and 17 (14%) required further surgery. 20% of complications were exclusively related to the donor site. There was complete or partial loss of three flaps. There was no difference in the rate of MWC or reoperation for complications with respect to age, sex, tumor site, previous unplanned excision, tumor grade, depth, and type of flap. Tumor size ≥8 cm was associated with a higher rate of reoperation (11/44 vs 6/78; P  = 0.008) but the rate of MWC was not significant (16/44 vs 14/78; P  = 0.066). The use of soft tissue flaps is associated with a low rate of MWC and reoperation. Our results suggest that a high rate of flap usage may be required to observe a reduction in complication rates.

  5. Preoperative Radiotherapy and Wide Resection for Soft Tissue Sarcomas: Achieving a Low Rate of Major Wound Complications with the Use of Flaps. Results of a Single Surgical Team

    Directory of Open Access Journals (Sweden)

    Lester Wai Mon Chan

    2018-01-01

    Full Text Available BackgroundSurgery in combination with radiotherapy (RT has become the standard of care for most soft tissue sarcomas. The choice between pre- and postoperative RT is controversial. Preoperative RT is associated with a 32–35% rate of major wound complications (MWC and 16–25% rate of reoperation. The role of vascularized soft tissue “flaps” in reducing complications is unclear. We report the outcomes of patients treated with preoperative RT, resection, and flap reconstruction.Patients and methods122 treatment episodes involving 117 patients were retrospectively reviewed. All patients were treated with 50.4 Gy of external beam radiation. Surgery was performed at 4–8 weeks after completion of RT by the same combination of orthopedic oncology and plastic reconstructive surgeon. Defects were reconstructed with 64 free and 59 pedicled/local flaps.Results30 (25% patients experienced a MWC and 17 (14% required further surgery. 20% of complications were exclusively related to the donor site. There was complete or partial loss of three flaps. There was no difference in the rate of MWC or reoperation for complications with respect to age, sex, tumor site, previous unplanned excision, tumor grade, depth, and type of flap. Tumor size ≥8 cm was associated with a higher rate of reoperation (11/44 vs 6/78; P = 0.008 but the rate of MWC was not significant (16/44 vs 14/78; P = 0.066.ConclusionThe use of soft tissue flaps is associated with a low rate of MWC and reoperation. Our results suggest that a high rate of flap usage may be required to observe a reduction in complication rates.

  6. Anaphylaxis due to caffeine

    OpenAIRE

    Sugiyama, Kumiya; Cho, Tatsurai; Tatewaki, Masamitsu; Onishi, Shogo; Yokoyama, Tatsuya; Yoshida, Naruo; Fujimatsu, Takayoshi; Hirata, Hirokuni; Fukuda, Takeshi; Fukushima, Yasutsugu

    2015-01-01

    We report a rare case of anaphylaxis due to caffeine intake. A 27-year-old woman suffered her first episode of anaphylaxis and a positive skin prick test suggested that the anaphylaxis was due to an IgE-mediated hypersensitivity reaction to caffeine. She was diagnosed with caffeine allergy and has not had an allergic reaction after avoiding foods and drinks containing caffeine. Although caffeine is known to have antiallergic effects, this case shows that caffeine can be an allergen and cause ...

  7. Human due diligence.

    Science.gov (United States)

    Harding, David; Rouse, Ted

    2007-04-01

    Most companies do a thorough job of financial due diligence when they acquire other companies. But all too often, deal makers simply ignore or underestimate the significance of people issues in mergers and acquisitions. The consequences are severe. Most obviously, there's a high degree of talent loss after a deal's announcement. To make matters worse, differences in decision-making styles lead to infighting; integration stalls; and productivity declines. The good news is that human due diligence can help companies avoid these problems. Done early enough, it helps acquirers decide whether to embrace or kill a deal and determine the price they are willing to pay. It also lays the groundwork for smooth integration. When acquirers have done their homework, they can uncover capability gaps, points of friction, and differences in decision making. Even more important, they can make the critical "people" decisions-who stays, who goes, who runs the combined business, what to do with the rank and file-at the time the deal is announced or shortly thereafter. Making such decisions within the first 30 days is critical to the success of a deal. Hostile situations clearly make things more difficult, but companies can and must still do a certain amount of human due diligence to reduce the inevitable fallout from the acquisition process and smooth the integration. This article details the steps involved in conducting human due diligence. The approach is structured around answering five basic questions: Who is the cultural acquirer? What kind of organization do you want? Will the two cultures mesh? Who are the people you most want to retain? And how will rank-and-file employees react to the deal? Unless an acquiring company has answered these questions to its satisfaction, the acquisition it is making will be very likely to end badly.

  8. Non-operative diagnosis - effect on repeat-operation rates in the UK breast screening programme

    International Nuclear Information System (INIS)

    Wallis, M.G.; Cheung, S.; Kearins, O.; Lawrence, G.M.

    2009-01-01

    Non-operative diagnosis rates in the UK breast screening programme have improved dramatically from 48.8% in 1994/95 (only nine units achieved the then minimum standard of 70%) to 94% in 2005/06 (only seven units failed to achieve the target of 90%). Preoperative and operative history of all 120,550 women diagnosed with screen-detected breast cancer in the UK between April 1994 and March 2006 was derived from different national databases. In 2005/06, 2,790 (17.8%) of the 15,688 women having surgery needed two or more operations. In 2001/02 (non-operative diagnosis rate 87%), the re-operation rate was 23.8% (2,377 of 9,969). Extrapolation backwards to 1994/95 (non-operative diagnosis rate 48.8%) suggests a re-operation rate of 62%. Analysis over the 4 years from April 2002 (n=34,198) demonstrates that 4,089 (12%) women with a correct non-operative diagnosis of invasive disease required additional surgery compared to 1,166 (48%) of women who were under-staged (diagnosed as non-invasive based on core biopsy, but actually suffering from invasive disease). Failure to achieve a non-operative diagnosis of invasive disease (n=1,542) or non-invasive disease (n=2,247) resulted in re-operation rates of 65 and 43% respectively. Given the impact of not having a diagnosis pre-operatively, or of under-staging invasive carcinoma, it seems timely to introduce more sophisticated standards. (orig.)

  9. Acesso transeptal vertical ampliado em reoperações valvares mitrais com átrio esquerdo pequeno Extended vertical transseptal approach in mitral valve reoperation with a small left atrium

    Directory of Open Access Journals (Sweden)

    Walter Vosgrau Fagundes

    2004-03-01

    Full Text Available OBJETIVO: Avaliar a abordagem transeptal vertical ampliada em reoperações da valva mitral com átrio esquerdo pequeno. MÉTODO: De janeiro de 2001 a dezembro de 2002, 15 pacientes portadores de doença valvar mitral com indicação de reintervenção cirúrgica, átrio esquerdo pequeno (menor ou igual a 4,0 cm e fibrilação atrial crônica, foram submetidos à abordagem transeptal vertical ampliada da valva mitral. Nove pacientes (pt eram do sexo feminino. A idade variou de 22 a 48 anos. As indicações cirúrgicas foram: disfunção de prótese mitral (seis pt; insuficiência mitral (cinco pt e dupla lesão mitral (quatro pt. Três pacientes apresentavam insuficiência aórtica associada e um pt, insuficiência tricúspide. Nove (60% pacientes encontravam-se em ICC CF III da NYHA e seis (40%, em CF IV. RESULTADOS: A exposição do aparelho valvar mitral foi excelente. O tempo de circulação extracorpórea variou de 65 a 150 min (média = 95min. Foram implantadas próteses em todos os pacientes (15 mitrais, três aórticas e um tricúspide. A mortalidade hospitalar foi de 6,7%, com um óbito devido a baixo débito cardíaco e falência de múltiplos órgãos. Um (6,7% paciente apresentou broncopneumonia na fase hospitalar. Dez pacientes permaneceram com fibrilação atrial, três pt reverteram para ritmo sinusal e um evoluiu com ritmo juncional. A permanência hospitalar média foi de 8,2 dias. Doze (85,7% pacientes encontram-se em CF I e dois (14,3% em CF II. A curva atuarial de sobrevida é de 92,5 % em 22 meses de seguimento. CONCLUSÃO: A técnica cirúrgica empregada proporciona excelente visibilização do aparelho valvar mitral, com baixo índice de complicações.OBJECTIVE: To evaluate the efficacy of the extended vertical transseptal approach in mitral valve reoperation with a small left atrium. METHOD: From January 2001 to December 2002, 15 patients with previous mitral operations, small left atrium and atrial fibrillation

  10. Technical Due Diligence

    DEFF Research Database (Denmark)

    Jensen, Per Anker; Varano, Mattia

    2011-01-01

    carried out for buyers or sellers involved in real estate transactions. It can also be part of mergers including real estate and other assets or part of facilities management outsourcing. This paper is based on a case study and an interview survey of companies involved in TDD consulting in Denmark......Technical Due Diligence (TDD) as an evaluation of the performance of constructed facilities has become an important new field of practice for consultants. Before the financial crisis started in autumn 2008 it represented the fastest growing activity in some consulting companies. TDD is mostly...... and Italy during 2009. The research identifies the current practice and compares it with the recommended practice in international guidelines. The current practice is very diverse and could in many cases be improved by a more structured approach and stricter adherence to international guidelines. However...

  11. Comparative randomized study on the efficaciousness of treatment of BOO due to BPH in patients with prostate up to 100 gr by endoscopic gyrus prostate resection versus open prostatectomy. Preliminary data.

    Science.gov (United States)

    Giulianelli, Roberto; Brunori, Stefano; Gentile, Barbara Cristina; Vincenti, Giorgio; Nardoni, Stefano; Pisanti, Francesco; Shestani, Teuta; Mavilla, Luca; Albanesi, Luca; Attisani, Francesco; Mirabile, Gabriella; Schettini, Manlio

    2011-06-01

    With the advent of medical management and minimally techniques for benign prostate hypeplasia (BPH), invasive surgical procedures such open prostatectomy (OPSU) have become less common, although selected patients may still benefit from open prostatectomy. Aim of this study was to evaluate efficacy and safety of Bipolar TURP (Gyrus electro surgical system) versus standard open prostatectomy in patients with lower urinary tract symptoms (LUTS) due to bladder outlet obstruction (BOO) with markedly enlarged glands refractory to medical therapy. From January 2003 to January 2004, 140 patients affected by mild-severe LUTS, secondary to BOO from BPH, refractory to medical therapy, with markedly enlarged glands, were randomized in two groups (1:1), and subjected to open prostatectomy (OPSU) carried out with traditional method (Bracci Thechnique) versus transurethral resection of the prostate (TURP) utilizing the bipolar methodology. Preoperative work-up included IPSS, IIEF-5 and Qol questionnaires. All patients were submitted to uroflowmetry, transrectal ultrasound (TRUS), measurament of postvoidal residual urine and PSA determination. IPSS, IIEF-5 and Qol, uroflowmetry, TRUS, measurement of post-voidal residual urine, PSA determination and number of reoperations were evaluated at 1, 3, 6, 12, 18, 24, 30 and 36 months. Operative time, resected tissue weight and perioperative complications were also registered. Total post-operative catheter time, total postoperative hospital stay, haemoglobin loss were recorded in the 2 groups. Comparative data on IPSS symptom score, IIEF-5 and Qol, PSA, peak urinary flow rates and post-void residual urine volume in the 2 groups were similar but showed a significative improvement with respect to baseline value. Postoperative haemoglobin levels, postoperative catheterization, hospital stay and 3-yr overall surgical re-treatment-free rate were significantly better in the Bipolar group. In the treatment of LUTS due to bladder outlet

  12. Avaliação dos resultados das reoperações de pacientes com lesões do manguito rotador Evaluation of the results from reoperations on patients with rotator cuff lesions

    Directory of Open Access Journals (Sweden)

    Alberto Naoki Miyazaki

    2011-01-01

    Full Text Available OBJETIVOS: Avaliar o resultado do tratamento cirúrgico, por via aberta ou artroscópica, dos pacientes com recidiva sintomática da lesão do manguito rotador. MÉTODOS: Foram avaliados 30 pacientes entre dezembro de 1990 e julho de 2007 submetidos a um novo procedimento cirúrgico pelo Grupo de Cirurgia de Ombro e Cotovelo do Departamento de Ortopedia e Traumatologia da Santa Casa de São Paulo - Pavilhão Fernandinho Simonsen devido à deiscência da sutura do manguito rotador. Foram incluídos pacientes com recidivas sintomáticas da lesão e com tempo de seguimento mínimo pós-operatório de 24 meses. RESULTADOS: Pelos critérios de avaliação da UCLA, 21 (70% pacientes tiveram resultados excelentes e bons; nove (30% pacientes tiveram resultados regulares e ruins. CONCLUSÃO: O tratamento cirúrgico, por via aberta e artroscópica, das recidivas da lesão do manguito rotador tende a apresentar resultados piores que o reparo primário. Neste estudo, obtivemos 70% de resultados excelentes e bons. A presença de lesões extensas na segunda operação tende a evoluir com um maior número de resultados insatisfatórios. No nosso estudo, obtivemos melhores resultados com a cirurgia realizada por via artroscópica em comparação com a via aberta.OBJECTIVES: To assess the results from open or arthroscopic surgical treatment on patients with symptomatic recurrence of rotator cuff injuries. METHODS: Between December 1990 and July 2007, 30 patients were assessed and underwent reoperation performed by the Shoulder and Elbow Surgery Group of the Department of Orthopedics and Traumatology, Fernandinho Simonsen Wing, Santa Casa de São Paulo, because of dehiscence of the rotator cuff suture. The study included patients with symptomatic recurrence of the injury and with at least 24 months of postoperative follow- up. RESULTS: According to the UCLA evaluation criteria, 21 patients (70% showed excellent or good outcomes; and nine patients (30% showed fair

  13. Study on closed pressure vessel test. Effect of heat rate, sample weight and vessel size on pressure rise due to thermal decomposition; Mippeigata atsuryoku yoki shiken ni kansuru kenkyu. Atsuryoku hassei kyodo ni oyobosu kanetsusokudo, shiryoryo oyobi youki saizu no eikyo

    Energy Technology Data Exchange (ETDEWEB)

    Aoki, Kenji.; Akutsu, Yoshiaki.; Arai, Mitsuru.; Tamura, Masamitsu. [The University of Tokyo, Tokyo (Japan). School of Engineering

    1999-02-28

    We have attempted to devise a new closed pressure vessel test apparatus in order to evaluate the violence of thermal decomposition of self-reactive materials and have examined some influencing factors, such as heat rate, sample weight, filling factor (sample weight/vessel size) and vessel size on Pmax (maximum pressure rise) and dP/dt (rate of pressure rise) due to their thermal decomposition. As a result, the following decreasing orders of Pmax and dP/dt were shown. Pmax: ADCA>BPZ>AIBN>TCP dP/dt: AIBN>BPZ>ADCA>TCP Moreover, Pmax was not almost influenced by heat rate, while dP/dt increased with an increase in heat rate in the case of BPZ. Pmax and dP/dt increased with an increase in sample weight and the degree of increase depended on the kinds of materials. In addition, it was shown that Pmax and dP/dt increased with an increase in vessel size at a constant filling factor. (author)

  14. Qubit dephasing due to quasiparticle tunneling

    Energy Technology Data Exchange (ETDEWEB)

    Zanker, Sebastian; Marthaler, Michael; Schoen, Gerd [Institut fuer Theoretische Festkoerperphysik, Karlsruhe Institute of Technology, D-76128 Karlsruhe (Germany)

    2015-07-01

    We study dephasing of a superconducting qubit due to quasiparticle tunneling through a Josephson junction. While qubit decay due to tunneling processes is well understood within a golden rule approximation, pure dephasing due to BCS quasiparticles gives rise to a divergent golden rule rate. We calculate qubit dephasing due to quasiparticle tunneling beyond lowest order approximation in coupling between qubit and quasiparticles. Summing up a certain class of diagrams we show that qubit dephasing due to purely longitudinal coupling to quasiparticles leads to dephasing ∝ exp(-x(t)) where x(t) ∝ t{sup 3/2} for short time scales and x(t) ∝ tlog(t) for long time scales.

  15. A comparison of revision and rerupture rates of ACL reconstruction between autografts and allografts in the skeletally immature.

    Science.gov (United States)

    Nelson, Ian R; Chen, Jason; Love, Rebecca; Davis, Brent R; Maletis, Gregory B; Funahashi, Tadashi T

    2016-03-01

    Anterior cruciate ligament reconstructions (ACLRs) in skeletally immature patients are increasing. The purpose of this study is to describe the demographics, graft usage, revision, and re-operation rates in skeletally immature ACLRs in the Kaiser Permanente healthcare system. Skeletally immature patients (type; bone-patellar-tendon-bone (BPTB) autograft, hamstring autograft, and any type of allograft. Age, gender, body mass index (BMI), and race were evaluated as confounders. Cox proportional hazard models stratified by surgeon were used to analyse the risk of revision and re-operation. A total of 534 primary ACLR cases were evaluated with a mean follow-up of 2.9 years. The majority were hamstring autografts (n = 388, 72.7%), male (n = 339, 63.9%), and White (n = 232, 43.4%). Median age was 14.9 years, and median BMI was 21.9 kg/m(2). There were 44 (8.2%) aseptic revisions and 48 (9.0%) same-knee re-operations. The incidence rate for revision was BPTB autograft 5.5%, hamstring autograft 7.5%, and allograft 13.2%. After adjusting for confounders and surgeon clustering effect, the risk of aseptic revision and revision between allograft and hamstring autograft did not reach statistical significance. Graft selection differs in skeletally immature patients with a preponderance of surgeries being performed with hamstring tendon autografts. High revision rates were identified for all graft types used, though differences in revision rates across different graft types did not reach statistical significance. Surgeons should be aware of high rates of revision in this skeletally immature young population, although type of graft used did not appear to make a difference. III.

  16. Automation of the monitoring in real time of the absorbed dose rate in air due to the environmental gamma radiation in Cuba; Automatizacion del monitoreo en tiempo real de la tasa de dosis absorbida en aire debido a la radiacion gamma ambiental en Cuba

    Energy Technology Data Exchange (ETDEWEB)

    Dominguez L, O; Capote F, E; Carrazana G, J A; Manzano de Armas, J F; Alonso A, D; Prendes A, M; Zerquera, J T; Caveda R, C A [CPHR, Calle 20, No. 4113 e/41 y 47, Playa, La Habana, 11300, A.P. 6195 C.P. 10600 (Cuba); Kalberg, O [Swedish Radiation Protection Institute (SSI) (Sweden); Fabelo B, O; Montalvan E, A [CIAC, Camaguey (Cuba); Cartas A, H [CEAC, Cienfuegos (Cuba); Leyva F, J C [CISAT (Cuba)

    2006-07-01

    The Center of Protection and Hygiene of the Radiations (CPHR) like center rector of the National Net of Environmental Radiological Surveillance (RNVRA), it has strengthened their detection capacity and of answer before a situation of radiological emergency. The measurements of the absorbed dose rate in air due to the environmental gamma radiation in the main stations of the Net are obtained in real time and the CPHR receives the data coming from these posts at one time relatively short. To improve the operability of the RNVRA it was necessary to complete the facilities of existent monitoring using 4 automatic measurement stations with probes of gamma detection, implementing in this way a measurement system on real time. On the other hand the software were developed: GenironProbeFech, to obtain the data of the probes, DataMail for the shipment of the same ones by electronic mail and GammaRed that receives and processes the data in the rector center. (Author)

  17. Rate theory

    International Nuclear Information System (INIS)

    Maillard, S.; Skorek, R.; Maugis, P.; Dumont, M.

    2015-01-01

    This chapter presents the basic principles of cluster dynamics as a particular case of mesoscopic rate theory models developed to investigate fuel behaviour under irradiation such as in UO 2 . It is shown that as this method simulates the evolution of the concentration of every type of point or aggregated defect in a grain of material. It produces rich information that sheds light on the mechanisms involved in microstructure evolution and gas behaviour that are not accessible through conventional models but yet can provide for improvements in those models. Cluster dynamics parameters are mainly the energetic values governing the basic evolution mechanisms of the material (diffusion, trapping and thermal resolution). In this sense, the model has a general applicability to very different operational situations (irradiation, ion-beam implantation, annealing) provided that they rely on the same basic mechanisms, without requiring additional data fitting, as is required for more empirical conventional models. This technique, when applied to krypton implanted and annealed samples, yields a precise interpretation of the release curves and helps assess migration mechanisms and the krypton diffusion coefficient, for which data is very difficult to obtain due to the low solubility of the gas. (authors)

  18. High failure rate after internal fixation and beneficial outcome after arthroplasty in treatment of displaced femoral neck fractures in patients between 55 and 70 years.

    Science.gov (United States)

    Bartels, Stefan; Gjertsen, Jan-Erik; Frihagen, Frede; Rogmark, Cecilia; Utvåg, Stein Erik

    2018-02-01

    Background and purpose - The treatment of patients between 55 and 70 years with displaced intracapsular femoral neck fracture remains controversial. We compared internal fixation (IF), bipolar hemiarthroplasty (HA) and total hip arthroplasty (THA) in terms of mortality, reoperations and patient-reported outcome by using data from the Norwegian Hip Fracture Register. Patients and methods - We included 2,713 patients treated between 2005 and 2012. 1,111 patients were treated with IF, 1,030 with HA and 572 patients with THA. Major reoperations (defined as re-osteosynthesis, secondary arthroplasty, exchange, or removal of prosthesis components and Girdlestone procedure), patient-reported outcome measures (satisfaction, pain, and health-related quality of life (EQ5D) after 4 and 12 months), 1-year mortality, and change in treatment methods over the study period were investigated. Results - Major reoperations occurred in 27% after IF, 3.8% after HA and 2.8% after THA. 549 patients (20% of total study population) answered both questionnaires. Compared with IF, patients treated with THA were more satisfied after 4 and 12 months, reported less pain after 4 months and 12 months, had a higher EQ5D-index score after 4 months and 12 months, and EQ-VAS score after 4 months. Compared with IF, patients treated with HA were more satisfied and reported less pain after 4 months. EQ5D-index and EQ-VAS were similar. Patients treated with HA had higher 1-year mortality and had more comorbidities than both the THA and IF group. All these differences were statistically and clinically significant. Interpretation - This study showed high reoperation rate after IF and better patient-reported outcome after both THA and HA with medium follow-up. Patients selected for HA represented a frailer group than patients treated with THA or IF.

  19. Lumbar radiculopathy due to unilateral facet hypertrophy following lumbar disc hernia operation: a case report.

    Science.gov (United States)

    Kökeş, Fatih; Günaydin, Ahmet; Aciduman, Ahmet; Kalan, Mehmet; Koçak, Halit

    2007-10-01

    To present a radiculopathy case due to unilateral facet hypertrophy developing three years after a lumbar disc hernia operation. A fifty two-year-old female patient, who had been operated on for a left L5-S1 herniated lumbar disc three years ago, was hospitalized and re-operated with a diagnosis of unilateral facet hypertrophy. She had complaints of left leg pain and walking restrictions for the last six months. Left Straight Leg Raising test was positive at 40 degrees , left ankle dorsiflexion muscle strength was 4/5, left Extensor Hallucis Longus muscle strength was 3/5, and left Achilles reflex was hypoactive. Lumbar spinal Magnetic Resonance Imaging revealed left L5-S1 facet hypertrophy. Lumbar radiculopathy due to lumbar facet hypertrophy is a well-known neurological condition. Radicular pain develops during the late postoperative period following lumbar disc hernia operations that are often related to recurrent disc herniation or to formation of post-operative scar tissue. In addition, it can be speculated that unilateral facet hypertrophy, which may develop after a disc hernia operation, might also be one of the causes of radiculopathy.

  20. Safety of greenlight photoselective vaporisation of prostate in lower urinary tract symptoms due to benign prostatic hyperplasia in patients using anticoagulants due to cardiovascular comorbidities

    Directory of Open Access Journals (Sweden)

    Basri Cakiroglu

    2015-07-01

    Full Text Available Lasers have been used in the management of benign prostatic hyperplasia for the last two decades. To be comparable, they should reduce or avoid the immediate and long-term complications of transurethral resection of the prostate (TURP or open prostatectomy (OP, especially bleeding and need for blood transfusion. Although Holmium laser treatment of the prostate was compared frequently in terms of cardiovascular safety with TURP or OP, photoselective vaporisation of the prostate (PVP was not largely evaluated. In this article we analyzed the current literature to see if there is convincing data to support the observation of some authors that use of PVP is associated with increased safety in patients on anticoagulants with cardiovascular comorbidities. With this purpose a Medline search between January 2004 to March 2013 was performed using evidence obtained from randomised trials, well-designed controlled studies without randomisation, individual cohort studies, individual case control studies and case reports Results: In the last 10 years, several case-control and cohort studies have demonstrated the efficacy of PVP as well as its safety in patients with cardiovascular comorbidities using anticoagulants. The results confirmed the overall lower perioperative and postoperative morbidity of PVP, whereas the efficacy was comparable to TURP in the short term, despite a higher reoperation rate. Conclusion: Although it is still developing, PVP with KTP or LBO seems to be a promising alternative to both TURP and OP in terms of cardiovascular safety and in patients using anticoagulants.

  1. Opening the Internal Hematoma Membrane Does Not Alter the Recurrence Rate of Chronic Subdural Hematomas: A Prospective Randomized Trial.

    Science.gov (United States)

    Unterhofer, Claudia; Freyschlag, Christian F; Thomé, Claudius; Ortler, Martin

    2016-08-01

    Factors determining the recurrence of chronic subdural hematomas (CSDHs) are not clear. Whether opening the so-called internal hematoma membrane is useful has not been investigated. To investigate whether splitting the inner hematoma membrane influences the recurrence rate in patients undergoing burr-hole craniotomy for CSDH. Fifty-two awake patients undergoing surgery for 57 CSDHs were prospectively randomized to either partial opening of the inner hematoma membrane (group A) or not (group B) after enlarged burr-hole craniotomy and hematoma evacuation. Drainage was left in situ for several days postoperatively. Groups were comparable with regard to demographic, clinical, and imaging variables. Outcome was assessed after 3-6 weeks for the combined outcome variable of reoperation or residual hematoma of one third or more of the original hematoma thickness. Fourteen patients underwent reoperation for clinical deterioration or residual hematoma during follow-up (n = 6 in group A, 21%; n = 8 in group B, 28 %) (P = 0.537). Residual hematoma of ≥ one third not requiring surgery was present in 7 patients in group A (25%) and 10 patients in group B (36%) (P = 0.383). The overall cumulative failure rate (reoperation or hematoma thickness ≥ one third) was 13/28 (46%) in group A and 18/28 in group B (P = 0.178; relative risk, 0.722 [95% confidence interval, 0.445-1.172]; absolute risk reduction -16% [95% confidence interval, -38% to 8%]). Opening the internal hematoma membrane does not alter the rate of patients requiring revision surgery and the number of patients showing a marked residual hematoma 6 weeks after evacuation of a CSDH. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Low anastomotic leak rate after colorectal surgery: a single-centre study.

    Science.gov (United States)

    Jones, O M; John, S K P; Horseman, N; Lawrance, R J; Fozard, J B J

    2007-10-01

    Anastomotic leak after colorectal surgery is a serious event associated with significant morbidity and mortality. There is little consensus regarding 'acceptable' rates of leakage, however. This study describes the experience of anastomotic leakage after both elective and emergency colorectal surgery in a district general hospital. A prospectively collected database of all patients with a diagnosis of colorectal cancer in a single hospital formed the basis of the study. Leak was defined as breakdown of the anastomosis contributing to death or requiring reoperation or reintervention. A total of 949 patients underwent surgery with an anastomosis between 1996 and 2004, including 331 patients treated with anterior resection. Anastomotic leaks requiring reoperation occurred in eight patients (0.8%). Thirty-day and in-hospital mortality was 4%. A very low rate of anastomotic leakage after colorectal surgery is possible in a district general hospital setting. Given the impact of anastomotic leakage on function, tumour recurrence and long-term survival, it should be considered as a marker of surgical quality when evaluating surgical performance.

  3. Weibel instability due to inverse bremsstrahlung absorption

    International Nuclear Information System (INIS)

    Bendib, A.; Bendib, K.; Bendib, A.; Bendib, K.; Sid, A.; Bendib, K.

    1997-01-01

    A new Weibel source due to the inverse bremsstrahlung absorption is presented. It has been shown that in homogeneous plasmas, this mechanism may drive strong collisionless Weibel modes with growth rates of order of γ∼10 11 s -1 and negligible group velocities. In the laser-produced plasmas, for short laser wavelengths (λ L 10 14 W/cm 2 ), this Weibel source is most efficient as the ones due to the heat flux and the plasma expansion. The useful scaling law of the convective e-foldings, with respect to the laser and the plasma parameters, is also derived. copyright 1997 The American Physical Society

  4. Surgical skill and complication rates after bariatric surgery.

    Science.gov (United States)

    Birkmeyer, John D; Finks, Jonathan F; O'Reilly, Amanda; Oerline, Mary; Carlin, Arthur M; Nunn, Andre R; Dimick, Justin; Banerjee, Mousumi; Birkmeyer, Nancy J O

    2013-10-10

    Clinical outcomes after many complex surgical procedures vary widely across hospitals and surgeons. Although it has been assumed that the proficiency of the operating surgeon is an important factor underlying such variation, empirical data are lacking on the relationships between technical skill and postoperative outcomes. We conducted a study involving 20 bariatric surgeons in Michigan who participated in a statewide collaborative improvement program. Each surgeon submitted a single representative videotape of himself or herself performing a laparoscopic gastric bypass. Each videotape was rated in various domains of technical skill on a scale of 1 to 5 (with higher scores indicating more advanced skill) by at least 10 peer surgeons who were unaware of the identity of the operating surgeon. We then assessed relationships between these skill ratings and risk-adjusted complication rates, using data from a prospective, externally audited, clinical-outcomes registry involving 10,343 patients. Mean summary ratings of technical skill ranged from 2.6 to 4.8 across the 20 surgeons. The bottom quartile of surgical skill, as compared with the top quartile, was associated with higher complication rates (14.5% vs. 5.2%, Pbariatric surgeons varied widely, and greater skill was associated with fewer postoperative complications and lower rates of reoperation, readmission, and visits to the emergency department. Although these findings are preliminary, they suggest that peer rating of operative skill may be an effective strategy for assessing a surgeon's proficiency.

  5. 38 CFR 4.58 - Arthritis due to strain.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Arthritis due to strain... FOR RATING DISABILITIES Disability Ratings The Musculoskeletal System § 4.58 Arthritis due to strain. With service incurred lower extremity amputation or shortening, a disabling arthritis, developing in...

  6. Generalized peritonitis due to perforated diverticulitis: Hartmann's procedure or primary anastomosis?

    Science.gov (United States)

    Trenti, Loris; Biondo, Sebastiano; Golda, Thomas; Monica, Millan; Kreisler, Esther; Fraccalvieri, Domenico; Frago, Ricardo; Jaurrieta, Eduardo

    2011-03-01

    Hartmann's procedure (HP) still remains the most frequently performed procedure for diffuse peritonitis due to perforated diverticulitis. The aims of this study were to assess the feasibility and safety of resection with primary anastomosis (RPA) in patients with purulent or fecal diverticular peritonitis and review morbidity and mortality after single stage procedure and Hartmann in our experience. From January 1995 through December 2008, patients operated for generalized diverticular peritonitis were studied. Patients were classified into two main groups: RPA and HP. A total of 87 patients underwent emergency surgery for diverticulitis complicated with purulent or diffuse fecal peritonitis. Sixty (69%) had undergone HP while RPA was performed in 27 patients (31%). At the multivariate analysis, RPA was associated with less post-operative complications (P clinical anastomotic leakage and needed re-operation. RPA can be safely performed without adding morbidity and mortality in cases of diffuse diverticular peritonitis. HP should be reserved only for hemodynamically unstable or high-risk patients. Specialization in colorectal surgery improves mortality and raises the percentage of one-stage procedures.

  7. [Dehydration due to "mouth broken"].

    Science.gov (United States)

    Meijler, D P M; van Mossevelde, P W J; van Beek, R H T

    2012-09-01

    Two children were admitted to a medical centre due to dehydration after an oral injury and the extraction of a tooth. One child complained of "mouth broken". Dehydration is the most common water-electrolyte imbalance in children. Babies and young children are prone to dehydration due to their relatively large body surface area, the high percentage extracellular fluid, and the limited ability of the kidneys to conserve water. After the removal ofa tooth, after an oral trauma or in case of oral discomfort, a child is at greater risk of dehydration by reduced fluid and food intake due to oral pain and/or discomfort and anxiety to drink. In those cases, extra attention needs to be devoted to the intake of fluids.

  8. Ratings Revisited

    DEFF Research Database (Denmark)

    Lai, Signe Sophus

    2015-01-01

    tværs af medier og platforme, forskudt i tid og on-demand. This article focuses on audience ratings, which have functioned as the central ‘currency’ informing the media trade. It discusses changes to the production and accuracy of audience ratings at a time when established standards are being...

  9. Absenteeism due to sickness in coal miners

    Energy Technology Data Exchange (ETDEWEB)

    Szymczykiewicz, K.

    1980-01-01

    During two consecutive years sickness absence of 8005 miners from two pit coal mines (A and B) of different geological structure and mechanization degree was analysed. It was found that in mine ''A'' 37% had no sick leaves, whereas in mine ''B''--28%. Absence rate was similar in both mines (though the miners' work and living conditions differed), i.e. 5.21% in mine ''A'', and 5.98% in mine ''B''. Thus work and living conditions do not determine general sickness absence rate. The highest absence in both mines was that of miners frequently falling ill for a long time (approx. 5.5% miners). For the group the number of work disablement days was 28.8 and 26.7, respectively. Underground miners' sickness absence was higher than that of surface workers, the rate being 3.8 and 4.0 and 1.1 and 2.1, respectively. The highest absence was that of miners travelling to work on motor cycles (7.1 and 7.3) and bicycles (6.4 and 6.7). Those working regularly in the first shift were more frequently absent from work than those working in different shifts. Miners living in worse conditions had higher absence rate than those living in flats of a higher standard. Also elderly employees and those having children represented a higher absence rate. The highest absence rate was that of workers having four children, the lowest--that of single persons. In addition, specific absence rate of men, especially due to respiratory and circulatory system diseases, was found to be enhanced by smoking. Absence rate of smokers was 2--3 times higher than that of non-smokers.

  10. Teacher Dismissal and Due Process.

    Science.gov (United States)

    Leichner, Edward C.; Blackstone, Sidney

    1977-01-01

    This article addresses due process requirements in the nonrenewal and dismissal of tenured and nontenured teachers. The Georgia Fair Dismissal Law is used as a basis for discussing the grounds for teacher dismissal. Dismissal grounds discussed are 1) incompetency; 2) insubordination; 3) willful neglect of duties; 4) immorality; 5) inciting,…

  11. Due Process Hearing Case Study

    Science.gov (United States)

    Bateman, David F.

    2009-01-01

    William is 9 years of age, residing with his parent within the boundaries of an unnamed district ("the District"). As a student with autism he is eligible for special education programming and services. There was one issue presented for this due process hearing: What was the appropriate program and placement for him for the 2008-2009 school year?…

  12. Autoerotic death due to electrocution

    Directory of Open Access Journals (Sweden)

    Piotr Arkuszewski

    2014-08-01

    Full Text Available Autoerotic death is a very rare case in forensic medicine. It is usually caused by asphyxia, but other reasons are also possible. Herein we present a case of autoerotic death due to electrocution caused by a self-made electrical device. The device was constructed to increase sexual feelings through stimulation of the scrotal area.

  13. Dose due to 40K

    International Nuclear Information System (INIS)

    Escareno J, E.; Vega C, H. R.

    2011-10-01

    The dose due to 40 K has been estimated. Potassium is one of the most abundant elements in nature, being approximately 2% of the Earth's crust. Potassium has three isotopes 39 K, 40 K and 41 K, two are stable while 40 K is radioactive with a half life of 1.2x10 9 years; there is 0.0117% 40 K-to-K ratio. Potassium plays an important role in plants, animals and humans growth and reproduction. Due to the fact that K is an essential element for humans, 40 K is the most abundant radioisotope in human body. In order to keep good health conditions K must be intake at daily basis trough food and beverages, however when K in ingested above the requirements produce adverse health effects in persons with renal, cardiac and hypertension problems or suffering diabetes. In 89.3% 40 K decays to 40 C through β-decay, in 10.3% decays through electronic capture and emitting 1.46 MeV γ-ray. K is abundant in soil, construction materials, sand thus γ-rays produced during 40 K decay contribute to external dose. For K in the body practically all 40 K decaying energy is absorbed by the body; thus 40 K contributes to total dose in humans and it is important to evaluate its contribution. In this work a set of 40 K sources were prepared using different amounts of KCl salt, a γ-ray spectrometer with a NaI(Tl) was characterized to standardized the sources in order to evaluate the dose due to 40 K. Using thermoluminescent dosemeters the dose due to 40 K was measured and related to the amount of 40 K γ-ray activity. (Author)

  14. Depressive disorder due to craniopharyngioma.

    Science.gov (United States)

    Spence, S A; Taylor, D G; Hirsch, S R

    1995-01-01

    Secondary causes of depression are legion, and must always be considered in patients presenting with features atypical of primary idiopathic depressive disorder. The case described is that of a middle-aged woman presenting initially with a major depressive disorder who was subsequently found to have a craniopharyngioma, leading to a revised diagnosis of mood disorder due to the tumour. Some features of the presentation might have led to earlier diagnosis had their localizing significance been recognized. Diencephalic lesions should always be considered in patients presenting with the hypersomnic-hyperphagic variant of depressive disorder. Images Figure 1 PMID:8544149

  15. Maculopathy due to drug inhalation.

    Science.gov (United States)

    Asensio-Sánchez, V M; Gonzalez-Buendia, L; Marcos-Fernández, M

    2014-08-01

    A case of maculopathy due to "poppers" is described. Poppers is a drug composed of various forms of alkyl nitrite. A 39 year-old man, who had been using poppers for years, was seen in the clinic with phosphenes, reduced visual acuity and central scotoma. The SD-OCT in the right eye showed disruption at the level of the IS/OS junction line. The SD-OCT scan in the left eye showed an outer rectangular retinal hole and an outer retinal cyst. Copyright © 2012 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  16. Anaphylaxis Due to Head Injury

    Directory of Open Access Journals (Sweden)

    Bruner, Heather C.

    2015-05-01

    Full Text Available Both anaphylaxis and head injury are often seen in the emergency department, but they are rarely seen in combination. We present a case of a 30-year-old woman who presented with anaphylaxis with urticaria and angioedema following a minor head injury. The patient responded well to intramuscular epinephrine without further complications or airway compromise. Prior case reports have reported angioedema from hereditary angioedema during dental procedures and maxillofacial surgery, but there have not been any cases of first-time angioedema or anaphylaxis due to head injury. [West J Emerg Med. 2015;16(3:435–437.

  17. Anaphylaxis due to head injury.

    Science.gov (United States)

    Bruner, Heather C; Bruner, David I

    2015-05-01

    Both anaphylaxis and head injury are often seen in the emergency department, but they are rarely seen in combination. We present a case of a 30-year-old woman who presented with anaphylaxis with urticaria and angioedema following a minor head injury. The patient responded well to intramuscular epinephrine without further complications or airway compromise. Prior case reports have reported angioedema from hereditary angioedema during dental procedures and maxillofacial surgery, but there have not been any cases of first-time angioedema or anaphylaxis due to head injury.

  18. DYSTOCIA DUE TO SOFT TISSUE

    Science.gov (United States)

    DeCarle, Donald W.

    1954-01-01

    In dystocia caused by abnormal conditions of the soft parts, the etiologic changes may be either in the genital tissues or in adjacent soft structures. Broadly, the conditions causing the difficulty may be grouped as follows: (1) anomalies or congenital modifications; (2) tumors; (3) modifications due to age, accident or surgical operations; (4) modification of the expulsive forces; (5) abnormalities of the products of conception. Often in such circumstances cesarean section is necessary. Sometimes when tumor is present it can be removed before it interferes with delivery, but decision to excise the growth must be guided by such factors as the location of the lesion and the stage of gestation. This would determine to what extent the maintenance of pregnancy would be jeopardized by surgical intervention before term. PMID:13190430

  19. Single fatherhood due to cancer.

    Science.gov (United States)

    Yopp, Justin M; Rosenstein, Donald L

    2012-12-01

    Cancer is a leading cause of widowed fatherhood in the USA. Fathers whose spouses have died from cancer constitute a potentially vulnerable population as they adjust to their role as sole or primary caregiver while managing their own grief and that of their children. The importance of addressing the psychological needs of widowed fathers is underscored by data showing that father's coping and emotional availability are closely tied to their bereaved children's mental health. Surprisingly, scant attention has been given to the phenomenon of widowed fatherhood with virtually no clinical resources or research studies devoted to fathers who have lost their wives to cancer. This commentary highlights key challenges facing this underserved population of widowers and calls for development of research agendas and clinical interventions for single fathers due to cancer. Copyright © 2011 John Wiley & Sons, Ltd.

  20. Occupational injuries due to violence.

    Science.gov (United States)

    Hales, T; Seligman, P J; Newman, S C; Timbrook, C L

    1988-06-01

    Each year in the United States, an estimated 800 to 1,400 people are murdered at work, and an unknown number of nonfatal injuries due to workplace violence occur. Based on Ohio's workers' compensation claims from 1983 through 1985, police officers, gasoline service station employees, employees of the real estate industry, and hotel/motel employees were found to be at the highest risk for occupational violent crime (OVC) injury and death. Grocery store employees, specifically those working in convenience food stores, and employees of the real estate industry had the most reported rapes. Four previously unidentified industries at increased risk of employee victimization were described. Identification of industries and occupations at high risk for crime victimization provides the opportunity to focus preventive strategies to promote employee safety and security in the workplace.

  1. APPENDICULAR INVAGINATION DUE TO ENDOMETRIOSIS

    Directory of Open Access Journals (Sweden)

    Vasja Kruh

    2003-12-01

    Full Text Available Background. Invagination of the vermiform appendix is a very rare occurrence. We summarize epidemiologic and etiologic factors, types of classification, symtomatology, diagnostic features and treatment.Patients and treatment. The authors present 49-years old female with long-standing abdominal pains, who came in our hospital due to acute exacerbation with sever abdominal pain. Because of progressive symptoms and sensitivity in the right-lower abdominal quadrant a diagnostic laparoscopy was performed. An anomaly of cecum and the absence of appendix vermiformis have forced us to proceed with laparotomy in McBurnay point. After cecotomy an invaginated gangrenous appendix was found. The histological examination revealed endometriosis.Conclusions. By presenting this extremely rare pathology we also want to emphasize the important role of diagnostic laparoscopy in front of acute abdomen.

  2. External exposure due to natural radiation (KINKI)

    International Nuclear Information System (INIS)

    1978-01-01

    A field survey of exposure rates due to natural radiation has been conducted throughout the Kinki district of Japan during both September and October 1973. In each location, measurements of exposures at one to fifteen sites, one of where contained 5 stations at least, were made. A total of 143 sites were measured. Observations were made using a spherical ionization chamber and several scintillation surveymeters. The spherical plastic ionization chamber of which inner diameter and wall thickness are 200 mm and 3 mm (acrylate) respectively has adequate sensitivity for field survey. The chamber was used as a standard of apparatus, but it is difficult to use the apparatus in all locations only by the apparatus, so that a surveymeter with a NaI(Tl) 1''phi x 1'' scintillator was used for regular measurements. Two types of surveymeters, the one with a 2''phi x 2'' NaI(Tl) scintillator and the other with a 3''phi x 3'' NaI(Tl) scintillator, were used as auxiliary devices. Both the chamber and the surveymeter were used in 20 sites and their readings were compared for drawing a relationship between them. Practically the direct reading of the surveymeter were reduced into the corresponding value of the plastic chamber through the relationship of linear proportion. Systematic error at calibration ( 60 Co) and reading error (rodoh) of the plastic chamber were within +-6% (maximum over all error) and within +-3.5% (standard error for 6μ R/hr) respectively. Reading error of the surveymeter is about +-3% (standard error for 6μ R/hr). Measurements in open bare field were made at one meter above the ground and outdoor gamma-rays exposure rates (μ R/hr) were due to cosmic rays as well as terrestrial radiation, as it may be considered that the contribution of fallout due to artificial origin was very small. (J.P.N.)

  3. Streamflow ratings

    Science.gov (United States)

    Holmes, Robert R.; Singh, Vijay P.

    2016-01-01

    Autonomous direct determination of a continuous time series of streamflow is not economically feasible at present (2014). As such, surrogates are used to derive a continuous time series of streamflow. The derivation process entails developing a streamflow rating, which can range from a simple, single-valued relation between stage and streamflow to a fully dynamic one-dimensional model based on hydraulics of the flow.

  4. [Nephropathy due to Puumala hantavirus].

    Science.gov (United States)

    Dandolo, A; Prajs, N; Lizop, M

    2014-12-01

    Hemorrhagic fever with renal syndrome (HFRS) is due to an infection by the virus of the Hantavirus genus. Rodent hosts of Hantavirus are present in restricted areas in France; consequently, there are ecological niches and microepidemics of human Hantavirus infections. A HFRS case was diagnosed in the Paris region. The 11-year-old child had an acute debut fever-persistent despite antipyretic medication-asthenia, headache, abdominal pain, myalgia, thrombocytopenia, as well as renal failure with proteinuria. The diagnosis was made with a relevant clinical history and the specific serology of Puumala hantavirus. Therefore, a kidney biopsy was not necessary. What was interesting was the diagnostic approach because of the difference between the place and time of contamination and where the child became ill and developed the symptoms. The child was infected by Puumala hantavirus in Les Ardennes, a high-risk area, but became ill in the Paris region, an area with no prevalence. We review Hantavirus infections in France and its differential diagnosis. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  5. Cellulitis Due to Salmonella infantis.

    Directory of Open Access Journals (Sweden)

    Satish R Patil

    2013-01-01

    Full Text Available Bacteria of the genus Salmonella are highly adapted for the growth in both humans and animals and cause a wide spectrum of disease. The growth of Serotypes S. typhi and S. paratyphi is restricted to human hosts, in whom these organisms cause enteric (typhoid fever. The remaining Serotypes (non typhoidal Salmonella or NTS can colonize the gastrointestinal tracts of the broad range of animals, including mammals, reptiles, birds and insects. The usual clinical presentation of non-typhoidal salmonellae (NTS infection is self limited gastroenteritis; however bacteremia and focal extra intestinal infection may occur. However salmonella localization to the skin presenting as cutaneous ulceration is regarded as a rare event. Rates of morbidity and mortality associated with NTS are highest among the elderly, infants, and immunocompromised individuals, including those with hemoglobinopathies, HIV infection, or infections that cause blockade of the reticuloendothelial system. We isolated S.infantis in 50 years old man with left leg cellulitis. The serotype was confirmed at Central Research Institute, Kasauli.

  6. Degradation of insulating ceramics due to irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Kobayashi, Tomohiro; Terai, Takayuki; Yoneoka, Toshiaki; Tanaka, Satoru [Tokyo Univ. (Japan). Faculty of Engineering

    1996-10-01

    Radiation-induced electrical degradation was investigated on single crystal alumina under 2.2 MeV electron irradiation with a dose rate of 5.7 x 10{sup 5} Gy/s and an electrical field of 1.6 x 10{sup 5} V/m at 773 K. After irradiation, electrical resistivity both on the surface and in the bulk decreased in the temperature range of 300 to 773 K. Substantial resistivity decreased from the initial value due to the irradiation, the degradation ratio was much smaller than the case of poly-crystalline specimens. On the other hands, surface resistivity decreased with increasing temperature for measurement with an abrupt change by 4 orders of magnitude around 600 K, and it showed thermal hysteresis. (author)

  7. Achieving low anastomotic leak rates utilizing clinical perfusion assessment.

    Science.gov (United States)

    Kream, Jacob; Ludwig, Kirk A; Ridolfi, Timothy J; Peterson, Carrie Y

    2016-10-01

    Anastomotic leak after colorectal resection increases morbidity, mortality, and in the setting of cancer, increases recurrences rates and reduces survival odds. Recent reports suggest that fluorescence evaluation of perfusion after colorectal anastomosis creation is associated with low anastomotic leak rates (1.4%). The purpose of this work was to evaluate whether a similar low anastomotic leak rate after left-sided colorectal resections could be achieved using standard assessment of blood flow to the bowel ends. We performed a retrospective chart review at an academic tertiary referral center, evaluating 317 consecutive patients who underwent a pelvic anastomosis after sigmoid colectomy, left colectomy, or low anterior resection. All operations were performed by a single surgeon from March 2008 to January 2015 with only standard clinical measures used to assess perfusion to the bowel ends. The primary outcome measure was the anastomotic leak rate as diagnosed by clinical symptoms, exam, or routine imaging. The average patient age was 59.7 years with an average body mass index of 28.8 kg/m(2). Rectal cancer (128, 40.4%) was the most common indication for operation while hypertension (134, 42.3%) was the most common comorbidity. In total, 177 operations were laparoscopic (55.8%), 13 were reoperative resections (4.1%), and 108 were protected with a loop ileostomy (34.1%). Preoperative chemotherapy was administered to 25 patients (7.9%) while preoperative chemo/radiation was administered to 64 patients (20.2%). The anastomotic leak rate was 1.6% (5/317). Our data suggests that standard, careful evaluation of adequate blood flow via inspection and confirmation of pulsatile blood flow to the bowel ends and meticulous construction of the colorectal or coloanal anastomoses can result in very low leak rates, similar to the rate reported when intraoperative imaging is used to assess perfusion. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Total gastrectomy due to ferric chloride intoxication.

    Science.gov (United States)

    Menéndez, A Mesut; Abramson, Leonardo; Vera, Raúl A; Duza, Guillermo E; Palermo, Mariano

    2015-09-01

    The ferric chloride intoxication is frequently caused by accident. Its toxicity is generally underrated, which can lead to fatal evolution or irreversible consequences. In this case, the caustic condition of the substance is related to the toxic properties of iron. A 36-year-old male patient arrives by ambulance indicating sensory deterioration. He presents erosive injuries in the buccal cavity and in the oropharynx, brownish teeth and metabolic acidosis. Toxicology tests and ferritin blood dosage are requested, which show a result from 1400 mg/dl. The symptoms are interpreted as acute iron intoxication. Due to the unfavorable evolution of his condition, an abdominal and pelvic CT scan are performed, which show extensive pneumoperitoneum and free fluid in the abdominal cavity. An exploratory laparotomy, a total gastrectomy with esophagostomy and feeding jejunostomy, washing and drainage due to perforated gastric necrosis caused by caustic ingestion are performed. In our country, there is a high rate of intoxication caused by iron compounds, although it is not statistically measured. Nevertheless, the ferric chloride intoxication is extremely infrequent. The ingestion of this product leads to complications, which are associated with the iron concentration and its condition as a caustic agent. The surgical indications in the presence of intoxication caused by iron compounds are: stomach evacuation of iron, gastric necrosis, perforation or peritonitis and stenosis. Early or prophylactic gastrectomy is contraindicated. However, if complications that require immediate surgical intervention arise, there should be no hesitation and the corresponding procedure should be performed.

  9. Endothelial damage due to air pollution

    Directory of Open Access Journals (Sweden)

    Livio Dei Cas

    2010-05-01

    Full Text Available The first human deaths due to air pollution were recorded in the mid-20th century. There were 6,000 cases of illness recorded in Donora, Pennsylvania, in 1948 and 20,000 in London in 1952; 15 and 4,000 cases of death, respectively, were allegedly ascribed to air pollution. Since then, many countries have adopted standards of air quality in order to protect environmental and human health, although the quality of the air in some industrialized countries remains worrying. Emerging countries in the Far East and South America are also cause for concern because of the growth in the population, industrialization and transport. The WHO World Health Report 2002 estimated that air pollutants, particularly PM10, are associated with a mortality rate of 5% for cancer of the respiratory system, 2% for cardiovascular diseases and about 1% for respiratory tract infections. These estimates consider the mortality but not the morbidity rate, which would increase proportionally the number of cases of these pathologies, despite the difficulty in evaluation.

  10. Rate of revisions or conversion after bariatric surgery over 10 years in the state of New York.

    Science.gov (United States)

    Altieri, Maria S; Yang, Jie; Nie, Lizhou; Blackstone, Robin; Spaniolas, Konstantinos; Pryor, Aurora

    2018-04-01

    A primary measure of the success of a procedure is the whether or not additional surgery may be necessary. Multi-institutional studies regarding the need for reoperation after bariatric surgery are scarce. The purpose of this study is to evaluate the rate of revisions/conversions (RC) after 3 common bariatric procedures over 10 years in the state of New York. University Hospital, involving a large database in New York State. The Statewide Planning and Research Cooperative System database was used to identify all patients undergoing laparoscopic adjustable gastric banding (LAGB), sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB) between 2004 and 2010. Patients were followed for RC to other bariatric procedures for at least 4 years (up to 2014). Multivariable cox proportional hazard regression analysis was performed to identify risk factors for additional surgery after each common bariatric procedure. Multivariable logistic regression was used to check the factors associated with having ≥2 follow-up procedures. There were 40,994 bariatric procedures with 16,444 LAGB, 22,769 RYGB, and 1781 SG. Rate of RC was 26.0% for LAGB, 9.8% for SG, and 4.9% for RYGB. Multiple RC ( = />2) were more common for LAGB (5.7% for LAGB, .5% for RYGB, and .2% for LSG). Band revision/replacements required further procedures compared with patients who underwent conversion to RYGB/SG (939 compared with 48 procedures). Majority of RC were not performed at initial institution (68.2% of LAGB patients, 75.9% for RYGB, 63.7% of SG). Risk factors for multiple procedures included surgery type, as LAGB was more likely to have multiple RC. Reoperation was common for LAGB, but less common for RYGB (4.9%) and SG (9.8%). RC rate are almost twice after SG than after RYGB. LAGB had the highest rate (5.7%) of multiple reoperations. Conversion was the procedure of choice after a failed LAGB. Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  11. Durability of mitral valve repair for mitral regurgitation due to degenerative mitral valve disease.

    Science.gov (United States)

    David, Tirone E

    2015-09-01

    Degenerative diseases of the mitral valve (MV) are the most common cause of mitral regurgitation in the Western world and the most suitable pathology for MV repair. Several studies have shown excellent long-term durability of MV repair for degenerative diseases. The best follow-up results are obtained with isolated prolapse of the posterior leaflet, however even with isolated prolapse of the anterior leaflet or prolapse of both leaflets the results are gratifying, particularly in young patients. The freedom from reoperation on the MV at 15 years exceeds 90% for isolated prolapse of the posterior leaflet and it is around 70-85% for prolapse of the anterior leaflet or both leaflets. The degree of degenerative change in the MV also plays a role in durability of MV repair. Most studies have used freedom from reoperation to assess durability of the repair but some studies that examined valve function late after surgery suggest that recurrent mitral regurgitation is higher than estimated by freedom from reoperation. We can conclude that MV repair for degenerative mitral regurgitation is associated with low probability of reoperation for up to two decades after surgery. However, almost one-third of the patients develop recurrent moderate or severe mitral regurgitation suggesting that surgery does not arrest the degenerative process.

  12. Laparoscopic treatment of colovesical fistulas due to complicated colonic diverticular disease: a systematic review.

    Science.gov (United States)

    Cirocchi, R; Cochetti, G; Randolph, J; Listorti, C; Castellani, E; Renzi, C; Mearini, E; Fingerhut, A

    2014-10-01

    Colovesical fistulas originating from complicated sigmoid diverticular disease are rare. The primary aim of this review was to evaluate the role of laparoscopic surgery in the treatment of this complication. The secondary aim was to determine the best surgical treatment for this disease. A systematic search was conducted for studies published between 1992 and 2012 in PubMed, the Cochrane Register of Controlled Clinical Trials, Scopus, and Publish or Perish. Studies enrolling adults undergoing fully laparoscopic, laparoscopic-assisted, or hand-assisted laparoscopic surgery for colovesical fistula secondary to complicated sigmoid diverticular disease were considered. Data extracted concerned the surgical technique, intraoperative outcomes, and postoperative outcomes based on the Cochrane Consumers and Communication Review Group's template. Descriptive statistics were reported according to the PRISMA statement. In all, 202 patients from 25 studies were included in this review. The standard treatment was laparoscopic colonic resection and primary anastomosis or temporary colostomy with or without resection of the bladder wall. Operative time ranged from 150 to 321 min. It was not possible to evaluate the conversion rate to open surgery because colovesical fistulas were not distinguished from other types of enteric fistulas in most of the studies. One anastomotic leak after bowel anastomosis was reported. There was zero mortality. Few studies conducted follow-up longer than 12 months. One patient required two reoperations. Laparoscopic treatment of colovesical fistulas secondary to sigmoid diverticular disease appears to be a feasible and safe approach. However, further studies are needed to establish whether laparoscopy is preferable to other surgical approaches.

  13. Readmissions due to traffic accidents at a general hospital.

    Science.gov (United States)

    Paiva, Luciana; Monteiro, Damiana Aparecida Trindade; Pompeo, Daniele Alcalá; Ciol, Márcia Aparecida; Dantas, Rosana Aparecida Spadotti; Rossi, Lídia Aparecida

    2015-01-01

    to verify the occurrence and the causes of hospital readmissions within a year after discharge from hospitalizations due to traffic accidents. victims of multiple traumas due to traffic accidents were included, who were admitted to an Intensive Care Unit. Sociodemographic data, accident circumstances, body regions affected and cause of readmission were collected from the patient histories. among the 109 victims of traffic accidents, the majority were young and adult men. Most hospitalizations due to accidents involved motorcycle drivers (56.9%). The causes of the return to the hospital were: need to continue the surgical treatment (63.2%), surgical site infection (26.3%) and fall related to the physical sequelae of the trauma (10.5%). The rehospitalization rate corresponded to 174/1,000 people/year. the hospital readmission rate in the study population is similar to the rates found in other studies. Victims of severe limb traumas need multiple surgical procedures, lengthier hospitalizations and extended rehabilitation.

  14. Calculus of radiolytic products generation in water due to alpha radiation. Determination of the spent nuclear fuels matrix alteration rate Determination of velocity of spent fuel matrix; Calculo de la generacion de productos radioliticos en agua por radiacion {alpha}. Determinacion de la velocidad de alteracion de la matriz del combustible nuclear gastado

    Energy Technology Data Exchange (ETDEWEB)

    Quinones, J.; Serrano, J.; Diaz Arocas, P.; Rodriguez Almazan, J. L. [Ciemat. Madrid (Spain); Bruno, J.; Cera, E.; Merino, J.; Esteban, J. A.; Martinez-Esparza, A. [Enresa. Madrid (Spain)

    2000-07-01

    The generation of radiolytic products as a result of alpha radiation in the surface of the spent fuel is a key process in order to understand how the it becomes degraded in repository conditions. The present work has established a radiolytic model based on a set of reactions involving fuel oxidation-dissolution and radiolytic products recombination. It also includes the decrease of the dose rates as the main alpha emitters decay away. Four cases, with varying parameters of the system, have been assessed. The results show a decrease in both the concentration of the radiolytic products in the gap water and the degradation of the fuel matrix. It has been estimated that in the period of the evaluation (10''6 years) up to 52% of the pellet is altered in the conservative cases, whereas only 11% is altered in the realistic cases. No significant differences were observed when the carbonates reactions were included in the system. (Author)

  15. 75 FR 9257 - SBA Lender Risk Rating System

    Science.gov (United States)

    2010-03-01

    ... Liquidation Rate; 3. Gross Delinquency Rate; 4. Gross Past-Due Rate; 5. Six (6) Month Net Flow Indicator; 6.... The statistical analysis performed showed that incorporating the Portfolio Size/Age component improved...) Month Delinquency Rate; 3. Gross Delinquency Rate; 4. Gross Past-Due Rate; 5. Average Small Business...

  16. Gastric Necrosis due to Acute Massive Gastric Dilatation

    Directory of Open Access Journals (Sweden)

    Ibrahim Aydin

    2013-01-01

    Full Text Available Gastric necrosis due to acute massive gastric dilatation is relatively rare. Vascular reasons, herniation, volvulus, acute gastric dilatation, anorexia, and bulimia nervosa play a role in the etiology of the disease. Early diagnosis and treatment are highly important as the associated morbidity and mortality rates are high. In this case report, we present a case of gastric necrosis due to acute gastric dilatation accompanied with the relevant literature.

  17. Gastric Necrosis due to Acute Massive Gastric Dilatation.

    Science.gov (United States)

    Aydin, Ibrahim; Pergel, Ahmet; Yucel, Ahmet Fikret; Sahin, Dursun Ali; Ozer, Ender

    2013-01-01

    Gastric necrosis due to acute massive gastric dilatation is relatively rare. Vascular reasons, herniation, volvulus, acute gastric dilatation, anorexia, and bulimia nervosa play a role in the etiology of the disease. Early diagnosis and treatment are highly important as the associated morbidity and mortality rates are high. In this case report, we present a case of gastric necrosis due to acute gastric dilatation accompanied with the relevant literature.

  18. Amplitude growth due to random, correlated kicks

    International Nuclear Information System (INIS)

    Michelotti, L.; Mills, F.

    1989-03-01

    Historically, stochastic processes, such as gas scattering or stochastic cooling, have been treated by the Fokker-Planck equation. In this approach, usually considered for one dimension only, the equation can be considered as a continuity equation for a variable which would be a constant of the motion in the absence of the stochastic process, for example, the action variable, I = ε/2π for betatron oscillations, where ε is the area of the Courant-Snyder ellipse, or energy in the case of unbunched beams, or the action variable for phase oscillations in case the beam is bunched. A flux, /Phi/, including diffusive terms can be defined, usually to second order. /Phi/ = M 1 F(I) + M 2 ∂F/∂I + /hor ellipsis/. M 1 and M 2 are the expectation values of δI and (δI) 2 due to the individual stochastic kicks over some period of time, long enough that the variance of these quantities is sufficiently small. Then the Fokker-Planck equation is just ∂F/∂I + ∂/Phi//∂I = 0. In many cases those where the beam distribution has already achieved its final shape, it is sufficient to find the rate of increase of by taking simple averages over the Fokker-Planck equation. At the time this work was begun, there was good knowledge of the second moment for general stochastic processes due to stochastic cooling theory, but the form of the first moment was known only for extremely wideband processes. The purposes of this note are to derive an expression relating the expected single particle amplitude growth to the noise autocorrelation function and to obtain, thereby, the form of M 1 for narrow band processes. 4 refs

  19. Finanční due diligence

    OpenAIRE

    Slonka, Tomáš

    2015-01-01

    Thesis on financial due diligence focuses on the use of due diligence in practice. The aim of this work is to determine the risk for the investor and the calculation of the target company with and without conducting due diligence, thus finding out the added value of due diligence.

  20. 5 CFR 732.301 - Due process.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Due process. 732.301 Section 732.301...) NATIONAL SECURITY POSITIONS Due Process and Reporting § 732.301 Due process. When an agency makes an... any determination. (b) Comply with all applicable administrative due process requirements, as provided...

  1. Bronchus anastomosis after sleeve resection for lung cancer: does the suture technique have an impact on postoperative complication rate?

    Science.gov (United States)

    Palade, Emanuel; Holdt, Holger; Passlick, Bernward

    2015-06-01

    Bronchoplastic resections emerged as an alternative to pneumonectomy for patients with impaired pulmonary function and have gained popularity due to a marked decrease in morbidity and at least similar oncological outcome. Actual guidelines recommend sleeve resections whenever technically feasible, even in cases with adequate pulmonary reserve for pneumonectomy, in order to maximally preserve functional lung parenchyma. Various suture techniques were described; the existing evidence, however, is insufficient to recommend one of them as standard. The aim of this study was to compare two suture techniques for bronchus repair after sleeve resection. Two groups of patients from two separate institutions were retrospectively analysed. In Group A (n = 20), the anastomosis was performed with a running suture at the membranous part and an interrupted suture for the rest of the circumference. In Group B (n = 40), a telescoping continuous suture was used. Intra- and postoperative findings directly related to the anastomosis were compared. The parameters were assessed as absolute numbers and percentages; the statistical significance was determined using Pearson's χ(2) test for categorical variables and Student's t-test for continuous data (P resection type (predominance of the right upper lobe for Group B), the groups were comparable regarding patient characteristics. The intraoperative anastomotic assessment revealed: patency 100% in both groups, initial air tightness (100 vs 82.5%; P = 0.047) and buttressing 85 vs 5%. No suture revision was necessary in both groups. The analysis of anastomosis-related morbidity revealed no significant difference: atelectasis (1 in Group A and 2 in Group B; P = 1), reversible anastomotic changes (0 vs 2; P = 0.309), early stenosis (0 vs 0), bronchopleural fistula (1 vs 0; P = 0.154), bronchovascular fistula (0 vs 0), late stenosis (1 vs 0; P = 0.119) and reoperations (15 vs 5%; P = 0.186). The operative mortality rate was similar (2 vs 3; P

  2. Estimating Discount Rates

    Directory of Open Access Journals (Sweden)

    Laurence Booth

    2015-04-01

    Full Text Available Discount rates are essential to applied finance, especially in setting prices for regulated utilities and valuing the liabilities of insurance companies and defined benefit pension plans. This paper reviews the basic building blocks for estimating discount rates. It also examines market risk premiums, as well as what constitutes a benchmark fair or required rate of return, in the aftermath of the financial crisis and the U.S. Federal Reserve’s bond-buying program. Some of the results are disconcerting. In Canada, utilities and pension regulators responded to the crash in different ways. Utilities regulators haven’t passed on the full impact of low interest rates, so that consumers face higher prices than they should whereas pension regulators have done the opposite, and forced some contributors to pay more. In both cases this is opposite to the desired effect of monetary policy which is to stimulate aggregate demand. A comprehensive survey of global finance professionals carried out last year provides some clues as to where adjustments are needed. In the U.S., the average equity market required return was estimated at 8.0 per cent; Canada’s is 7.40 per cent, due to the lower market risk premium and the lower risk-free rate. This paper adds a wealth of historic and survey data to conclude that the ideal base long-term interest rate used in risk premium models should be 4.0 per cent, producing an overall expected market return of 9-10.0 per cent. The same data indicate that allowed returns to utilities are currently too high, while the use of current bond yields in solvency valuations of pension plans and life insurers is unhelpful unless there is a realistic expectation that the plans will soon be terminated.

  3. Economic evaluation of water loss saving due to the biological ...

    African Journals Online (AJOL)

    This paper focuses on water loss saving as the benefit derived from biological control of this plant between 1990 and 2013 at New Year's Dam, Alicedale, Eastern Cape, South Africa. Estimates of water loss due to evapotranspiration from water hyacinth vary significantly; therefore, the study used three different rates, high, ...

  4. 2007 Wholesale Power Rate Schedules : 2007 General Rate Schedule Provisions.

    Energy Technology Data Exchange (ETDEWEB)

    United States. Bonneville Power Administration.

    2006-11-01

    This schedule is available for the contract purchase of Firm Power to be used within the Pacific Northwest (PNW). Priority Firm (PF) Power may be purchased by public bodies, cooperatives, and Federal agencies for resale to ultimate consumers, for direct consumption, and for Construction, Test and Start-Up, and Station Service. Rates in this schedule are in effect beginning October 1, 2006, and apply to purchases under requirements Firm Power sales contracts for a three-year period. The Slice Product is only available for public bodies and cooperatives who have signed Slice contracts for the FY 2002-2011 period. Utilities participating in the Residential Exchange Program (REP) under Section 5(c) of the Northwest Power Act may purchase Priority Firm Power pursuant to the Residential Exchange Program. Rates under contracts that contain charges that escalate based on BPA's Priority Firm Power rates shall be based on the three-year rates listed in this rate schedule in addition to applicable transmission charges. This rate schedule supersedes the PF-02 rate schedule, which went into effect October 1, 2001. Sales under the PF-07 rate schedule are subject to BPA's 2007 General Rate Schedule Provisions (2007 GRSPs). Products available under this rate schedule are defined in the 2007 GRSPs. For sales under this rate schedule, bills shall be rendered and payments due pursuant to BPA's 2007 GRSPs and billing process.

  5. River flooding due to intense precipitation

    International Nuclear Information System (INIS)

    Lin, James C.

    2014-01-01

    River stage can rise and cause site flooding due to local intense precipitation (LIP), dam failures, snow melt in conjunction with precipitation or dam failures, etc. As part of the re-evaluation of the design basis as well as the PRA analysis of other external events, the likelihood and consequence of river flooding leading to the site flooding need to be examined more rigorously. To evaluate the effects of intense precipitation on site structures, the site watershed hydrology and pond storage are calculated. To determine if river flooding can cause damage to risk-significant systems, structures, and components (SSC), water surface elevations are analyzed. Typically, the amount and rate of the input water is determined first. For intense precipitation, the fraction of the rainfall in the watershed drainage area not infiltrated into the ground is collected in the river and contributes to the rise of river water elevation. For design basis analysis, the Probable Maximum Flood (PMF) is evaluated using the Probable Maximum Precipitation (PMP) based on the site topography/configuration. The peak runoff flow rate and water surface elevations resulting from the precipitation induced flooding can then be estimated. The runoff flow hydrograph and peak discharge flows can be developed using the synthetic hydrograph method. The standard step method can then be used to determine the water surface elevations along the river channel. Thus, the flood water from the local intense precipitation storm and excess runoff from the nearby river can be evaluated to calculate the water surface elevations, which can be compared with the station grade floor elevation to determine the effects of site flooding on risk-significant SSCs. The analysis needs to consider any possible diversion flow and the effects of changes to the site configurations. Typically, the analysis is performed based on conservative peak rainfall intensity and the assumptions of failure of the site drainage facilities

  6. Nanoscale hotspots due to nonequilibrium thermal transport

    International Nuclear Information System (INIS)

    Sinha, Sanjiv; Goodson, Kenneth E.

    2004-01-01

    Recent experimental and modeling efforts have been directed towards the issue of temperature localization and hotspot formation in the vicinity of nanoscale heat generating devices. The nonequilibrium transport conditions which develop around these nanoscale devices results in elevated temperatures near the heat source which can not be predicted by continuum diffusion theory. Efforts to determine the severity of this temperature localization phenomena in silicon devices near and above room temperature are of technological importance to the development of microelectronics and other nanotechnologies. In this work, we have developed a new modeling tool in order to explore the magnitude of the additional thermal resistance which forms around nanoscale hotspots from temperatures of 100-1000K. The models are based on a two fluid approximation in which thermal energy is transferred between ''stationary'' optical phonons and fast propagating acoustic phonon modes. The results of the model have shown excellent agreement with experimental results of localized hotspots in silicon at lower temperatures. The model predicts that the effect of added thermal resistance due to the nonequilibrium phonon distribution is greatest at lower temperatures, but is maintained out to temperatures of 1000K. The resistance predicted by the numerical code can be easily integrated with continuum models in order to predict the temperature distribution around nanoscale heat sources with improved accuracy. Additional research efforts also focused on the measurements of the thermal resistance of silicon thin films at higher temperatures, with a focus on polycrystalline silicon. This work was intended to provide much needed experimental data on the thermal transport properties for micro and nanoscale devices built with this material. Initial experiments have shown that the exposure of polycrystalline silicon to high temperatures may induce recrystallization and radically increase the thermal

  7. Magnetic sheath effect on the gross and net erosion rates due to impurities

    Science.gov (United States)

    Mellet, N.; Pégourié, B.; Martin, C.; Gunn, J. P.; Bufferand, H.; Roubin, P.

    2016-02-01

    Simulations of impurity trajectories in deuterium plasmas in the vicinity of the surface are performed by taking into account the magnetic sheath in conditions relevant for ITER and WEST. We show that the magnetic sheath has a strong effect on the average impact angle of impurities in divertor conditions and that it can lead to an increase of ≈ 60% at the gross erosion maximum for neon (Ne+4) compared to the case when only the cyclotron motion is considered. The evaluation of the net erosion has been undertaken by retaining local redeposition of tungsten (W). We investigate how it is affected by the sheath magnetic potential profile. The largest effect is however observed when an energy distribution is considered. In this case the number of particles that manage to exit the sheath is larger as it is dominated by the more energetic particles. The comparison with other work is also discussed. The application to a scenario of the WEST project is finally performed, which exhibits a moderate, however non negligible, erosion of the plasma facing components.

  8. Point kernel technique for calculating dose rates due to cobalt-60 hot particles

    International Nuclear Information System (INIS)

    Thornhill, M.J.; McCarthy, J.T.; Morrissette, R.R.; Leach, B.N.

    1989-01-01

    This paper reports on a computer code called BETA that has been developed by health physicists at the Vermont Yankee Nuclear Power Station which accounts for the mass and size of hot particles of Cobalt-60, and therefore corrects the Loevinger-based dose calculation for self-absorption

  9. Error rate degradation due to switch crosstalk in large modular switched optical networks

    DEFF Research Database (Denmark)

    Saxtoft, Christian; Chidgey, P.

    1993-01-01

    A theoretical model of an optical network incorporating wavelength selective elements, amplifiers, couplers and switches is presented. The model is used to evaluate a large modular switch optical network that provides the capability of adapting easily to changes in network traffic requirements. T....... The network dimensions are shown to be limited by the optical crosstalk in the switch matrices and by the polarization dependent loss in the optical components...

  10. Spin Rate of Asteroid (54509) 2000 PH5 Increasing Due to the YORP Effect

    Czech Academy of Sciences Publication Activity Database

    Taylor, P.A.; Margot, J. L.; Vokrouhlický, D.; Scheeres, D.J.; Pravec, Petr; Lowry, S.C.; Fitzsimmons, A.; Nolan, M. C.; Ostro, S. J.; Benner, L. A. M.; Giorgini, J. D.; Magri, C.

    2007-01-01

    Roč. 316, č. 5822 (2007), s. 274-277 ISSN 0036-8075 Grant - others:GA ČR(CZ) GA205/99/0255 Institutional research plan: CEZ:AV0Z10030501 Keywords : asteroids rotation * near-Earth objects * radar observations Subject RIV: BN - Astronomy, Celestial Mechanics, Astrophysics Impact factor: 26.372, year: 2007

  11. Dose rate received by Pernambuco population due to nuclear medicine exams between 2000-2004

    International Nuclear Information System (INIS)

    Araujo, A.R.; Khoury, H.J.

    2008-01-01

    This study aims to evaluate the diagnostic procedures using in Nuclear medicine of the State of Pernambuco, a state located in northeastern Brazil, from 2000 to 2004 in order to provide subsidies to establish the reference levels in Brazil

  12. Morbidity rate due to renal malformations in patients from Las Tunas province

    Directory of Open Access Journals (Sweden)

    Silvio Laffita Estévez

    2015-09-01

    Full Text Available Background: The urogenital congenital malformations represent the first place within the genetic malformations in the province of Las Tunas.Objective: To characterize the renal congenital malformations in pediatric patients of the herein mentioned province, from 2010 to 2014.Methods: A descriptive study was carried out with 283 paediatric patients with renal and urinary tract congenital malformation, in the province and period herein stated. The variables included: sex, clinical manifestations, more frequent malformations, which of them needed surgical treatment, the positive results of the radiological studies, and the malformations that developed into chronic renal failure. The data were analyzed according to descriptive statistics.Results: The male sex represented a 63,96 %. A 57,95 % of the children were asymptomatic. Within the congenital malformations ectasia prevailed with a 49,47 %. 100 % of the cases with a compromise of the ureteovesiccal union, ureterocele and shell of the posterior urethra, 78 % of the patients with stenosis of the ureteropyelic union and 4,76 % of the patients with vesicoureteric reflux needed surgical treatment. The radiological studies were highly positive. 1,41 % of the patients developed chronic renal failure.Conclusions: Most of the patients with renal and urinary tract congenital malformations were diagnosed before the 5 years of age. Only four patients developed chronic renal failure.

  13. THE ANALYSIS OF POPULATION MORBIDITY RATE DUE TO INCREASED ENERGY DEMAND

    Directory of Open Access Journals (Sweden)

    Perticas Diana

    2012-07-01

    Full Text Available Sustainable development as general acceptance is that form of ensuring the bio-socio-economic needs of the present generation without affecting the existence and development opportunities for the generations to come. Secondary, the concept refers to the protection of the environment that is at present greatly affected by externalities of the socio-economic activity of previous and present generations. As it is shown in this paper the negative effects of the environmental pollution records higher and higher values in a short period of time of which we analyze their impact on population health, focusing on the situation of Romania. I started the analysis from the assumptions that the health of an organism is a normal physical and physiological state, being the opposite of the concept disease. The most common diseases are: hereditary, infectious, internal, infantile, autoimmune, allergic, socio-professional, tumorous, degenerative diseases etc. Of these infant, allergic, tumorous and autoimmune diseases are mainly generated by environmental pollution. Extremely special, regarding the incidence of harmful environmental factors, are the socio-professional diseases or of civilization that are represented by those diseases that are more common in industrialized countries than in the so called third world. In respect to air pollution-generated illnesses with products resulting from burning fossil fuels are highlighted respiratory diseases, immunological diseases, benign and malignant neoplasm of the airways and also dermatitis. Most activities follow sooner or later to increase welfare. Economic growth, environmental protection as well as fulfilling social needs of individuals are only a few elements that lead to the increase of population welfare. If we accept the above mentioned things, then it means that promoting the realisation of sustainable development based on clean and renewable resources and the rationally using the conventional ones is an objective to be supported and of course achieved.

  14. Moisture Risk in Unvented Attics Due to Air Leakage Paths

    Energy Technology Data Exchange (ETDEWEB)

    Prahl, D.; Shaffer, M.

    2014-11-01

    IBACOS completed an initial analysis of moisture damage potential in an unvented attic insulated with closed-cell spray polyurethane foam. To complete this analysis, the research team collected field data, used computational fluid dynamics to quantify the airflow rates through individual airflow (crack) paths, simulated hourly flow rates through the leakage paths with CONTAM software, correlated the CONTAM flow rates with indoor humidity ratios from Building Energy Optimization software, and used Warme und Feuchte instationar Pro two-dimensional modeling to determine the moisture content of the building materials surrounding the cracks. Given the number of simplifying assumptions and numerical models associated with this analysis, the results indicate that localized damage due to high moisture content of the roof sheathing is possible under very low airflow rates. Reducing the number of assumptions and approximations through field studies and laboratory experiments would be valuable to understand the real-world moisture damage potential in unvented attics.

  15. Moisture Risk in Unvented Attics Due to Air Leakage Paths

    Energy Technology Data Exchange (ETDEWEB)

    Prahl, D. [IBACOS, Inc., Pittsburgh, PA (United States); Shaffer, M. [IBACOS, Inc., Pittsburgh, PA (United States)

    2014-11-01

    IBACOS completed an initial analysis of moisture damage potential in an unvented attic insulated with closed-cell spray polyurethane foam. To complete this analysis, the research team collected field data, used computational fluid dynamics to quantify the airflow rates through individual airflow (crack) paths, simulated hourly flow rates through the leakage paths with CONTAM software, correlated the CONTAM flow rates with indoor humidity ratios from Building Energy Optimization software, and used Wärme und Feuchte instationär Pro two-dimensional modeling to determine the moisture content of the building materials surrounding the cracks. Given the number of simplifying assumptions and numerical models associated with this analysis, the results indicate that localized damage due to high moisture content of the roof sheathing is possible under very low airflow rates. Reducing the number of assumptions and approximations through field studies and laboratory experiments would be valuable to understand the real-world moisture damage potential in unvented attics.

  16. Particle resuspension due to human walking

    International Nuclear Information System (INIS)

    Mana, Zakaria

    2014-01-01

    In nuclear facilities, during normal operations in controlled areas, workers could be exposed to radioactive aerosols (1 μm ≤ dp ≤ 10 μm). One of the airborne contamination sources is particles that are initially seeded on the floor and could be removed by workers while they are walking. During the outage of EDF nuclear facilities, there is a resuspension of some radionuclides in aerosol form (1 μm ≤ dp ≤ 10 μm). Since the number of co-activity will increase in reactors buildings of EDF, it becomes important to understand particle resuspension due to the activity of the operators to reduce their radiation exposure. The purpose of this Ph.D thesis is to quantify the resuspension of particles due to the progress of operators on a contaminated soil. Thus, the approach is to combine an aerodynamic resuspension model with numerical calculations of flow under a shoe, and then to characterize experimentally some input parameters of the model (particle diameter, adhesion forces, shoes motion). The resuspension model Rock'n'Roll proposed by Reeks and Hall (2001) was chosen because it describes physically the resuspension mechanism and because it is based on the moment of forces applied to a particle. This model requires two input parameters such as friction velocity and adhesion forces distribution applied on each particle. Regarding the first argument, numerical simulations were carried on using the ANSYS CFX software applied to a safety shoe in motion (digitized by 3D CAO); the mapping of friction velocity shows values of about 1 m.s -1 for an angular average velocity of 200 degrees.s -1 . As regards the second parameter, AFM (Atomic Force Microscopy) measurements were carried out with alumina and cobalt oxide particles in contact with epoxy surfaces representative of those encountered in EDF power plants. AFM provides the distribution of adhesion forces and reveals a much lower value than what can be calculated theoretically using JKR model (Johnson

  17. Peritoneal tuberculosis due to Mycobacterium caprae

    Directory of Open Access Journals (Sweden)

    T. Nebreda

    2016-01-01

    Full Text Available The incidence of tuberculosis in humans due to Mycobacterium caprae is very low and is almost confined to Europe. We report a case of a previously healthy 41-year-old Moroccan with a 6 month history of abdominal pain, weight loss, fatigue and diarrhea. A diagnosis of peritoneal tuberculosis due to M. caprae was made.

  18. Constitutional Due Process and Educational Administration.

    Science.gov (United States)

    Uerling, Donald F.

    1985-01-01

    Discusses substantive and procedural due process as required by the United States Constitution and interpreted by the Supreme Court, with particular reference to situations arising in educational environments. Covers interests protected by due process requirements, the procedures required, and some special considerations that may apply. (PGD)

  19. Procedural Due Process Rights in Student Discipline.

    Science.gov (United States)

    Pressman, Robert; Weinstein, Susan

    To assist administrators in understanding procedural due process rights in student discipline, this manual draws together hundreds of citations and case summaries of federal and state court decisions and provides detailed commentary as well. Chapter 1 outlines the general principles of procedural due process rights in student discipline, such as…

  20. Exchange rate policy under sovereign default risk

    OpenAIRE

    Schabert, Andreas

    2011-01-01

    We examine monetary policy options for a small open economy where sovereign default might occur due to intertemporal insolvency. Under interest rate policy and floating exchange rates the equilibrium is indetermined. Under a fixed exchange rate the equilibrium is uniquely determined and independent of sovereign default.

  1. 18 CFR 284.10 - Rates.

    Science.gov (United States)

    2010-04-01

    ... of the Natural Gas Act. (3) Differentiation due to time and distance. Any rate filed for service... Subpart G of this part, it may not charge, in a transaction involving its marketing affiliate, a rate that is lower than the highest rate it charges in any transaction not involving its marketing affiliate...

  2. 38 CFR 4.129 - Mental disorders due to traumatic stress.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Mental disorders due to... SCHEDULE FOR RATING DISABILITIES Disability Ratings Mental Disorders § 4.129 Mental disorders due to traumatic stress. When a mental disorder that develops in service as a result of a highly stressful event is...

  3. Turbulent momentum transport due to neoclassical flows

    International Nuclear Information System (INIS)

    Lee, Jungpyo; Barnes, Michael; Parra, Felix I; Belli, Emily; Candy, Jeff

    2015-01-01

    Intrinsic toroidal rotation in a tokamak can be driven by turbulent momentum transport due to neoclassical flow effects breaking a symmetry of turbulence. In this paper we categorize the contributions due to neoclassical effects to the turbulent momentum transport, and evaluate each contribution using gyrokinetic simulations. We find that the relative importance of each contribution changes with collisionality. For low collisionality, the dominant contributions come from neoclassical particle and parallel flows. For moderate collisionality, there are non-negligible contributions due to neoclassical poloidal electric field and poloidal gradients of density and temperature, which are not important for low collisionality. (paper)

  4. Readmissions due to traffic accidents at a general hospital

    Directory of Open Access Journals (Sweden)

    Luciana Paiva

    2015-08-01

    Full Text Available AbstractObjective: to verify the occurrence and the causes of hospital readmissions within a year after discharge from hospitalizations due to traffic accidents.Methods: victims of multiple traumas due to traffic accidents were included, who were admitted to an Intensive Care Unit. Sociodemographic data, accident circumstances, body regions affected and cause of readmission were collected from the patient histories.Results: among the 109 victims of traffic accidents, the majority were young and adult men. Most hospitalizations due to accidents involved motorcycle drivers (56.9%. The causes of the return to the hospital were: need to continue the surgical treatment (63.2%, surgical site infection (26.3% and fall related to the physical sequelae of the trauma (10.5%. The rehospitalization rate corresponded to 174/1,000 people/year.Conclusion: the hospital readmission rate in the study population is similar to the rates found in other studies. Victims of severe limb traumas need multiple surgical procedures, lengthier hospitalizations and extended rehabilitation.

  5. Study on the import dues system

    Energy Technology Data Exchange (ETDEWEB)

    Woo, Sung Keun [LG-Caltex Oil Co., Seoul (Korea)

    2000-04-01

    Since October 1979, Korea had implemented a petroleum project fund dues system to actively prepare for unstable international petroleum condition. However, as the size of operating a petroleum project fund was bigger and the influence of government on this fund became powerful, it was inserted in the government tax revenues as a {sup S}pecial account for energy and resource project{sup i}n March 1994 and its name was changed to import dues. In this study, it discusses the facts of import dues system, which exists only in Korea, and its policy directions since this system has been reviewed due to the economic development, liberalization of petroleum industry and inequity between alternative energy sources. 4 tabs.

  6. Occurrence of pneumomediastinum due to dental procedures.

    Science.gov (United States)

    Aslaner, Mehmet Ali; Kasap, Gül Nihal; Demir, Cihat; Akkaş, Meltem; Aksu, Nalan M

    2015-01-01

    The occurrence of pneumomediastinum and massive subcutaneous emphysema due to dental procedures is quite rare. We present a case of pneumomediastinum and massive subcutaneous emphysema that occurred during third molar tooth extraction with air-turbine handpiece.

  7. Greenhouse effect due to atmospheric nitrous oxide

    Science.gov (United States)

    Yung, Y. L.; Wang, W. C.; Lacis, A. A.

    1976-01-01

    The greenhouse effect due to nitrous oxide in the present atmosphere is about 0.8 K. Increase in atmospheric N2O due to perturbation of the nitrogen cycle by man may lead to an increase in surface temperature as large as 0.5 K by 2025, or 1.0 K by 2100. Other climatic effects of N2O are briefly discussed.

  8. System-theoretic analysis of due-time performance in production systems

    OpenAIRE

    Jacobs David; Meerkov Semyon M.

    1995-01-01

    Along with the average production rate, the due-time performance is an important characteristic of manufacturing systems. Unlike the production rate, the due-time performance has received relatively little attention in the literature, especially in the context of large volume production. This paper is devoted to this topic. Specifically, the notion of due-time performance is formalized as the probability that the number of parts produced during the shipping period reaches the required shipme...

  9. Due diligence duties for an environmental liability

    International Nuclear Information System (INIS)

    Huebsch, M.

    2000-04-01

    Jurisdiction turned out well to create a basic ruling for due diligence duties. These due diligence duties are high standards for the law of torts (outside of contracts) within the Austrian civil law and represent a liability-extension for the holder of the source of danger. They establish an action for injunction in particular for preventing (further) damages. Therewith due diligence duties get a general sense in the range of a civil law for environmental liability. The responsible holder of a danger zone will therefore influence his way of acting to protect potential victims and the environment. The burden of proof is on the plaintiff (victims) under the Civil Code. Victims have specific sources of danger including high endangering special facilities in their argumentation with the so-called prima-facie-proof or first-appearance-proof. A turning back of the presentation of evidence to the polluter is wrong. The polluter himself has a continuing liability for dangerous activities and his clerks in the case of an extremely high danger of damage. All due diligence duties can be arranged in three areas: in information-, danger-avoidance- and danger-prevention-duties. The determination of range and essence of the duties has to be adjusted to each individual case. The range of the specific danger area is the essential link. The intensity of due diligence duties is increasing with the size of danger in the way of a movable system depending on the protected interest. Due diligence duties have to be kept within reasonable limits with two criterions: necessarity and demand. Proportionality of actions is a third criterion to avoid exaggeration of due diligence duties to obtain an effective protection for victims including the environment. (author)

  10. Peroral endoscopic myotomy (POEM): feasible as reoperation following Heller myotomy.

    Science.gov (United States)

    Vigneswaran, Yalini; Yetasook, Amy K; Zhao, Jin-Cheng; Denham, Woody; Linn, John G; Ujiki, Michael B

    2014-06-01

    The purpose of this study was to demonstrate the feasibility of performing peroral endoscopic myotomy (POEM) in the management of recurrent achalasia after failed myotomy. Eight patients presented to our institution between October 2010 and June 2013 with recurrent/persistent symptoms after prior laparoscopic Heller myotomy. Three patients underwent redo laparoscopic Heller myotomy, and five patients consented to redo myotomy with POEM. Demographics were similar between the groups with exception of age (POEM 69.5 vs. laparoscopic Heller myotomy (LHM) 34.5, p = 0.003). Preoperative Eckardt scores, motility, and prior interventions were not significantly different. Three patients who underwent POEM and two who underwent laparoscopic Heller myotomy had prior fundoplication. There was one perforation identified after laparoscopic Heller myotomy and one patient with persistent subcutaneous emphysema after POEM. Both POEM and laparoscopic Heller myotomy demonstrated significant improvement in symptoms and Eckardt scores at average follow-up of approximately 5 months (p myotomy even in the presence of prior fundoplication. The procedure can be performed safely using a similar technique as for primary myotomy with the exception of creating the myotomy laterally along the right side of the esophagus and lesser curvature avoiding the previous anterior myotomy.

  11. Reoperative bariatric surgery for treatment of type 2 diabetes mellitus.

    Science.gov (United States)

    Yan, Jingliang; Cohen, Ricardo; Aminian, Ali

    2017-08-01

    Primary bariatric surgery has been proven to be effective in weight loss and improvement of weight-related metabolic co-morbidities. However, a small proportion of patients after bariatric surgery either have persistent hyperglycemia or relapse after initial remission of their metabolic disease. Revisional bariatric surgery has been evaluated extensively for weight recidivism and postoperative complications. However, there has not been any high-level evidence validating the utility of revisional bariatric surgery on recurrent metabolic diseases, especially diabetes. In this review of 30 studies, we aimed to summarize the evidence and determine whether revisional surgery can have a positive impact on metabolic diseases that were not reversed by initial bariatric intervention. Overall, 14-38% of patients had residual diabetes at the time of revisional surgery. Depending on the index surgery and subsequent reconstruction, revisions induced 20-80% additional excess weight loss, or further decrease of body mass index by 10-30%. Improvement of diabetes was seen in 65-100% of patients. Specifically, conversion to Roux-en-Y gastric bypass (RYGB) yielded improvement of diabetes in 79%, 72%, and 62% of patients who previously had vertical banded gastroplasty (VBG), adjustable gastric banding (AGB), or sleeve gastrectomy (SG), respectively. Converting AGB to SG improved diabetes in 65% of patients, and SG to duodenal switch improved diabetes in 79% of patients. Revision of the gastric pouch or stoma in RYGB yielded improvement of diabetes in 79% of patients. Further clinical and mechanistic research is needed to better delineate the role of revisional bariatric surgery in patients with residual metabolic disease. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  12. Plasma diffusion due to magnetic field fluctuations

    International Nuclear Information System (INIS)

    Okuda, H.; Lee, W.W.; Lin, A.T.

    1979-01-01

    Plasma diffusion due to magnetic field fluctuations has been studied in two dimensions for a plasma near thermal equilibrium and when the fluctuations are suprathermal. It is found that near thermal equilibrium electron diffusion varies as B -2 when the collisionless skin depth is greater than the thermal electron gyroradius and is generally smaller than the diffusion due to collisions or electrostatic fluctuations for a low-β plasma. When the suprathermal magnetic fluctuation exists because of macroscopic plasma currents, electron diffusion is enhanced due to the coalescence of current filaments and magnetic islands. Magnetic field energy is found to condense to the longest wavelength available in the system and stays there longer than the electron diffusion time scale

  13. Paraneoplastic Cushing Syndrome Due To Wilm's Tumor.

    Science.gov (United States)

    Faizan, Mahwish; Manzoor, Jaida; Saleem, Muhammad; Anwar, Saadia; Mehmood, Qaiser; Hameed, Ambreen; Ali, Agha Shabbir

    2017-05-01

    Paraneoplastic syndromes are rare disorders that are triggered by an altered immune system response to neoplasm. Paraneoplastic syndromes may be the first or the most prominent manifestations of cancer. Wilm's tumor is the most frequent pediatric renal malignancy and usually presents with abdominal mass. Unusual presentations like acquired von Willebrand disease, sudden death due to pulmonary embolism and Cushing syndrome have been described in the literature. Cushing syndrome, as the presenting symptom of a malignant renal tumor in children, is a very rare entity. Few case reports are available in the literature exploring the option of preoperative chemotherapy as well as upfront nephrectomy. We report a rare case of paraneoplastic Cushing syndrome due to a Wilm's tumor. Based on gradual decrease of postoperative weight, blood pressure, serum adrenocorticotropic hormone, and plasma cortisol levels, along with histological confirmation of Wilm's tumor, paraneoplastic Cushing syndrome due to Wilm's tumor was confirmed.

  14. Paraneoplastic cushing syndrome due to wilm's tumor

    International Nuclear Information System (INIS)

    Faizan, M.; Anwar, S.; Hameed, A.; Manzoor, J.; Saleem, M.; Mehmood, Q.; Ali, A. S.

    2017-01-01

    Paraneoplastic syndromes are rare disorders that are triggered by an altered immune system response to neoplasm. Paraneoplastic syndromes may be the first or the most prominent manifestations of cancer. Wilm's tumor is the most frequent pediatric renal malignancy and usually presents with abdominal mass. Unusual presentations like acquired von Willebrand disease, sudden death due to pulmonary embolism and Cushing syndrome have been described in the literature. Cushing syndrome, as the presenting symptom of a malignant renal tumor in children, is a very rare entity. Few case reports are available in the literature exploring the option of preoperative chemotherapy as well as upfront nephrectomy. We report a rare case of paraneoplastic Cushing syndrome due to a Wilm's tumor. Based on gradual decrease of postoperative weight, blood pressure, serum adrenocorticotropic hormone, and plasma cortisol levels, alongwith histological confirmation of Wilm's tumor, paraneoplastic Cushing syndrome due to Wilm's tumor was confirmed. (author)

  15. Chemical equilibration due to heavy Hagedorn states

    International Nuclear Information System (INIS)

    Greiner, C; Koch-Steinheimer, P; Liu, F M; Shovkovy, I A; Stoecker, H

    2005-01-01

    A scenario of heavy resonances, called massive Hagedorn states, is proposed which exhibits a fast (t ∼ 1 fm/c) chemical equilibration of (strange) baryons and anti-baryons at the QCD critical temperature T c . For relativistic heavy ion collisions this scenario predicts that hadronization is followed by a brief expansion phase during which the equilibration rate is higher than the expansion rate, so that baryons and antibaryons reach chemical equilibrium before chemical freeze-out occurs

  16. Conducting financial due diligence of medical practices.

    Science.gov (United States)

    Louiselle, P

    1995-12-01

    Many healthcare organizations are acquiring medical practices in an effort to build more integrated systems of healthcare products and services. This acquisition activity must be approached cautiously to ensure that medical practices being acquired do not have deficiencies that would jeopardize integration efforts. Conducting a thorough due diligence analysis of medical practices before finalizing the transaction can limit the acquiring organizations' legal and financial exposure and is a necessary component to the acquisition process. The author discusses the components of a successful financial due diligence analysis and addresses some of the risk factors in a practice acquisition.

  17. Environmental impact due to nuclear power plants

    International Nuclear Information System (INIS)

    Kellermann, O.; Balfanz, H.P.

    1975-01-01

    The environmental impact due to nuclear power plants is smaller than that due to fossil-fired power plants. The risks of the nuclear power plant operation are determined by the quantity and the probability of the release of radioactive materials. According to the value, the risks of normal operation can be compared to the accident risks. An attempt should be made to effectively reduce the remaining risk at unfavourable sites with the emphasis on accidents with larger effects than design basis accidents. (orig./LH) [de

  18. Heart rate index

    DEFF Research Database (Denmark)

    Haedersdal, C; Pedersen, F H; Svendsen, J H

    1992-01-01

    after the myocardial infarction. A significant correlation (Spearman's correlation coefficient rs, p less than 0.05) was found between LVEF at rest and the following variables assessed at exercise test: 1) the heart rate at rest, 2) rise in heart rate, 3) ratio between maximal heart rate and heart rate...... at rest, 4) rise in systolic blood pressure, 5) rate pressure product at rest, 6) rise in rate pressure product, 7) ratio (rHR) between maximal rate pressure product and rate pressure product at rest, 8) total exercise time. The heart rate was corrected for effects caused by age (heart index (HR...

  19. System-theoretic analysis of due-time performance in production systems

    Directory of Open Access Journals (Sweden)

    David Jacobs

    1995-01-01

    Full Text Available Along with the average production rate, the due-time performance is an important characteristic of manufacturing systems. Unlike the production rate, the due-time performance has received relatively little attention in the literature, especially in the context of large volume production. This paper is devoted to this topic. Specifically, the notion of due-time performance is formalized as the probability that the number of parts produced during the shipping period reaches the required shipment size. This performance index is analyzed for both lean and mass manufacturing environments. In particular, it is shown that, to achieve a high due-time performance in a lean environment, the production system should be scheduled for a sufficiently small fraction of its average production rate. In mass production, due-time performance arbitrarily close to one can be achieved for any scheduling practice, up to the average production rate.

  20. Breast abscess due to Actinomyces europaeus.

    Science.gov (United States)

    Silva, W A; Pinheiro, A M; Jahns, B; Bögli-Stuber, K; Droz, S; Zimmerli, S

    2011-06-01

    Actinomyces europaeus was first described in 1997 as a new species causing predominantly skin and soft-tissue infections. Mastitis due to A. europaeus is an unusual condition. This article reports a case of primary breast abscess caused by A. europaeus in a postmenopausal woman.

  1. Freezing of Water Droplet due to Evaporation

    Science.gov (United States)

    Satoh, Isao; Fushinobu, Kazuyoshi; Hashimoto, Yu

    In this study, the feasibility of cooling/freezing of phase change.. materials(PCMs) due to evaporation for cold storage systems was experimentally examined. A pure water was used as the test PCM, since the latent heat due to evaporation of water is about 7 times larger than that due to freezing. A water droplet, the diameter of which was 1-4 mm, was suspended in a test cell by a fine metal wire (O. D.= 100μm),and the cell was suddenly evacuated up to the pressure lower than the triple-point pressure of water, so as to enhance the evaporation from the water surface. Temperature of the droplet was measured by a thermocouple, and the cooling/freezing behavior and the temperature profile of the droplet surface were captured by using a video camera and an IR thermo-camera, respectively. The obtained results showed that the water droplet in the evacuated cell is effectively cooled by the evaporation of water itself, and is frozen within a few seconds through remarkable supercooling state. When the initial temperature of the droplet is slightly higher than the room temperature, boiling phenomena occur in the droplet simultaneously with the freezing due to evaporation. Under such conditions, it was shown that the degree of supercooling of the droplet is reduced by the bubbles generated in the droplet.

  2. Six questions about translational due diligence.

    Science.gov (United States)

    Selinger, Evan

    2010-04-28

    To maintain stable respect and support, translational research must be guided by appropriate ethical, social, legal, and political concerns and carry out culturally competent practices. Considering six key questions concerning due diligence will enable the translational research community to examine critically how it approaches these endeavors.

  3. Contract Law, Due Process, and the NCAA.

    Science.gov (United States)

    Dickerson, Jaffe D.; Chapman, Mayer

    1978-01-01

    The NCAA has enjoyed almost total freedom from judicial scrutiny of its rules, procedures, and official acts in large part because of its private nature as an unincorporated association. The function of the NCAA, California State University, Hayward v NCAA, and due process of the student-athlete are discussed. (MLW)

  4. Facial nerve palsy due to birth trauma

    Science.gov (United States)

    Seventh cranial nerve palsy due to birth trauma; Facial palsy - birth trauma; Facial palsy - neonate; Facial palsy - infant ... An infant's facial nerve is also called the seventh cranial nerve. It can be damaged just before or at the time of delivery. ...

  5. [Severe, subacute axonal polyneuropathy due to hypophosphatemia].

    NARCIS (Netherlands)

    Eijk, J.J.J. van; Abdo, W.F.; Deurwaarder, E. den; Zwarts, M.J.; Warrenburg, B.P.C. van de

    2010-01-01

    A 46-year-old man receiving tube feeding because of anorexia and weight loss developed progressive neurological symptoms initially resembling Guillain-Barre syndrome. Eventually axonal neuropathy due to severe hypophosphatemia was diagnosed. Hypophosphatemia can be caused by the so-called refeeding

  6. Supraventricular Tachycardia Atackt Due to Losewieght Drug

    Directory of Open Access Journals (Sweden)

    Murat Yalcin

    2016-01-01

    Full Text Available Obesity is an important health problem. Treatment of obesity includes diet, exercise and drugs. Some of these drugs are out of prescription. Advers effects of these drugs have not been known. In this report; we present a case with supraventricular tachycardia attack due to loseweight drug containing mangostana (mango, hibiscus, citrus mate, L-karnitin, guarana.

  7. When Pregnancy Goes Past Your Due Date

    Science.gov (United States)

    ... due date determined? • What is postterm pregnancy? • What causes a postterm pregnancy? • What are the risks associated with postterm pregnancy? • ... longer than 42 weeks is called “postterm.” What causes a postterm pregnancy? The causes of postterm pregnancy are unknown, but ...

  8. Craniopharyngioma with hyperprolactinaemia due to a prolactinoma.

    Science.gov (United States)

    Wheatley, T; Clark, J D; Stewart, S

    1986-01-01

    A case is presented in which a histologically proven prolactin secreting pituitary macroadenoma was associated with a large suprasellar craniopharyngioma. The pre-operative prolactin concentration was 8180 mU/l. Although hyperprolactinaemia up to 3000 mU/l in patients with a craniopharyngioma is usually due to stalk compression, greater values may indicate an associated prolactinoma. Images PMID:3794737

  9. Nuclear potentials due to pion exchange

    International Nuclear Information System (INIS)

    Robillota, M.R.

    1984-01-01

    The two, three and four nucleon potentials due to the exchange of pions can be accurately calculated by means of chiral symmetry. The comparison of the dynamical content of these potentials allow us to understand the geometrical origin of the hierarchy existing among them. (Author) [pt

  10. Internal dosimetric evaluation due to uranium aerosols

    International Nuclear Information System (INIS)

    Garcia Aguilar Juan; Delgado Avila Gustavo

    1991-01-01

    The present work has like object to carry out the internal dosimetric evaluation to the occupationally exposed personnel, due to the inhalation of aerosols of natural uranium and enriched in the pilot plant of nuclear fuel production of the National Institute of Nuclear Research

  11. Spinal cord compression due to metastases

    International Nuclear Information System (INIS)

    Azevedo, C.M. de; Matushita, J.P.K.; Silva, M.A.F. da; Koch, H.A.

    1986-01-01

    A study of 20 patients with medullary compression syndrome due to lesions not related to the central nervous system is presented. Plain films of the spine and myelography are made to determine the level of osseous involvement, the level of the spinal block and to planning radiotherapy. (Author) [pt

  12. Ophthalmoplegia, Dysphonia and Tetraparesis Due to Guillain ...

    African Journals Online (AJOL)

    Guillain-Barre's syndrome (GBS) or inflammatory/post-infectious acute polyradiculoneuropathy is due to demyelination of nerves, causing a progressive paresis or paralysis. It usually begins in the legs and sometimes goes up to the respiratory muscles and cranial nerves. The exact mechanism of GBS occurrance is still ...

  13. Freight economic vulnerabilities due to flooding events.

    Science.gov (United States)

    2016-12-01

    Extreme weather events, and flooding in particular, have been occurring more often and with increased severity over the past decade, and there is reason to expect this trend will continue in the future due to a changing climate. Flooding events can u...

  14. Due diligence responsibilities of the professional geologist

    International Nuclear Information System (INIS)

    Hobbs, G.W.

    1991-01-01

    Whether in the role of independent consultant or company employee, a geologist has certain professional obligations in the evaluation of an oil and gas submittal from a third party. 'Due diligence' is the term used to describe the analysis of an investment opportunity. Due diligence involves a multidisciplinary examination of both the technical and business aspects of a submittal. In addition to the obvious geological considerations, prospect evaluations should include relevant details about the specific technical documentation reviewed, information sources, and how the data were verified. Full disclosure of ownership, technical risks, and negative aspects of the prospect should be included along with the positive elements. After the geological analysis is completed, the economic merits of the prospect should be analyzed, incorporating all lease burdens and terms of participation into the calculations. Estimated exploration, development, and operating costs, together with projected annual production, cash flow, and reserves must be examined as to their reasonableness. Finally, the due diligence review should include a thorough check on the reputation, financial condition, technical and managerial expertise, and prior track record of the operator. Bank, trade, legal, and prior partner references should be contacted. The successful professional geologist in today's competitive world must have multidisciplinary skills. A solid background in geology and geophysics, a basic understanding of the principles of petroleum engineering and economics, and the wits of a private eye are needed for good due diligence work

  15. Dysphagia due to diffuseidiopathic skeletal hyperostosis (DISH ...

    African Journals Online (AJOL)

    Diffuse idiopathic skeletal hyperostosis (DISH) or Forestier's disease isa form of degenerative arthritiswith unique spinal and extra spinal manifestations. Dysphagia due to DISH is uncommon but when present DISH should be suspected. Surgical decompression can relieve some of the symptoms. We report a case of a 60 ...

  16. Recurrent poststernotomy mediastinitis due to histoplasmosis: The ...

    African Journals Online (AJOL)

    This report describes the first case of surgical site infection due to Histoplasma capsulatum. A 4 year-old presented with recurrent thoracotomy surgical site infection (SSI) requiring multiple debridements until the correct diagnosis was performed. This case illustrates the critical role of histopathology in early recognition of ...

  17. [Treatment of macroglossia due to acromegaly].

    NARCIS (Netherlands)

    Alons, K.; Berge, S.J.; Rieu, P.N.M.A.; Meijer, G.J.

    2010-01-01

    A 61-years-old woman had macroglossia due to acromegaly with complaints of dyspneu at a lying sleeping position and complaints of speech and dysphagia. At the age of 55 years she was diagnosed with acromegaly induced by a adenoma of the pituitary gland, which had been removed surgically. The

  18. Plagiarism Due to Misunderstanding: Online Instructor Perceptions

    Science.gov (United States)

    Greenberger, Scott; Holbeck, Rick; Steele, John; Dyer, Thomas

    2016-01-01

    Plagiarism is an ongoing problem in higher education. This problem exists in both online and face-to-face modalities. The literature indicates that there are three ways higher education institutions define plagiarism, which includes theft, deception, and misunderstanding. Plagiarism due to misunderstanding has received less attention in the…

  19. Systemic contact dermatitis due to nickel

    Directory of Open Access Journals (Sweden)

    Taruli Olivia

    2015-08-01

    Full Text Available Introduction: Systemic contact dermatitis (SCD is a systemic reactivation of a previous allergic contact dermatitis. The initial exposure may usually be topical, followed by oral, intravenous or inhalation exposure leading to a systemic hypersensitivity reaction. A case of a 27 year-old male with SCD due to nickel is reported Case Report: A 27 year-old male presented with recurrent pruritic eruption consist of deep seated vesicles on both palmar and left plantar since 6 months before admission. This complaint began after patient consumed excessive amounts of chocolate, canned food, and beans. The patient worked as a technician in a food factory. History of allergy due to nickel was acknowledged since childhood. The clinical presentation was diffuse deep seated vesicles, and multiple erythematous macules to plaques, with collarette scale. Patch test using the European standard showed a +3 result to nickel. The patient was diagnosed as systemic contact dermatitis due to nickel. The treatments were topical corticosteroid and patient education of avoidance of both contact and systemic exposure to nickel. The patient showed clinical improvement after 2 weeks. Discussion: SCD was diagnosed due to the history of massive consumption of food containing nickel in a patient who had initial sensitization to nickel, with clinical features and the patch test result. Advice to be aware of nickel and its avoidance is important in SCD management.

  20. AFT Chief Promises Due-Process Reform

    Science.gov (United States)

    Sawchuk, Stephen

    2010-01-01

    The president of the American Federation of Teachers (AFT), Randi Weingarten, is putting the sensitive issue of due process on the education reform table, with a pledge to work with districts to streamline the often-cumbersome procedures for dismissing teachers who fail to improve their performance after receiving help and support. She has also…

  1. Spatial pattern and temporal trend of mortality due to tuberculosis

    Directory of Open Access Journals (Sweden)

    Ana Angélica Rêgo de Queiroz

    2018-05-01

    Full Text Available ABSTRACT Objectives: To describe the epidemiological profile of mortality due to tuberculosis (TB, to analyze the spatial pattern of these deaths and to investigate the temporal trend in mortality due to tuberculosis in Northeast Brazil. Methods: An ecological study based on secondary mortality data. Deaths due to TB were included in the study. Descriptive statistics were calculated and gross mortality rates were estimated and smoothed by the Local Empirical Bayesian Method. Prais-Winsten’s regression was used to analyze the temporal trend in the TB mortality coefficients. The Kernel density technique was used to analyze the spatial distribution of TB mortality. Results: Tuberculosis was implicated in 236 deaths. The burden of tuberculosis deaths was higher amongst males, single people and people of mixed ethnicity, and the mean age at death was 51 years. TB deaths were clustered in the East, West and North health districts, and the tuberculosis mortality coefficient remained stable throughout the study period. Conclusions: Analyses of the spatial pattern and temporal trend in mortality revealed that certain areas have higher TB mortality rates, and should therefore be prioritized in public health interventions targeting the disease.

  2. Radiation dose distributions due to sudden ejection of cobalt device

    International Nuclear Information System (INIS)

    Abdelhady, Amr

    2016-01-01

    The evaluation of the radiation dose during accident in a nuclear reactor is of great concern from the viewpoint of safety. One of important accident must be analyzed and may be occurred in open pool type reactor is the rejection of cobalt device. The study is evaluating the dose rate levels resulting from upset withdrawal of co device especially the radiation dose received by the operator in the control room. Study of indirect radiation exposure to the environment due to skyshine effect is also taken into consideration in order to evaluate the radiation dose levels around the reactor during the ejection trip. Microshield, SHLDUTIL, and MCSky codes were used in this study to calculate the radiation dose profiles during cobalt device ejection trip inside and outside the reactor building. - Highlights: • This study aims to calculate the dose rate profiles after cobalt device ejection from open-pool-type reactor core. • MicroShield code was used to evaluate the dose rates inside the reactor control room. • McSKY code was used to evaluate the dose rates outside the reactor building. • The calculated dose rates for workers are higher than the permissible limits after 18 s from device ejection.

  3. Warming can boost denitrification disproportionately due to altered oxygen dynamics.

    Directory of Open Access Journals (Sweden)

    Annelies J Veraart

    Full Text Available BACKGROUND: Global warming and the alteration of the global nitrogen cycle are major anthropogenic threats to the environment. Denitrification, the biological conversion of nitrate to gaseous nitrogen, removes a substantial fraction of the nitrogen from aquatic ecosystems, and can therefore help to reduce eutrophication effects. However, potential responses of denitrification to warming are poorly understood. Although several studies have reported increased denitrification rates with rising temperature, the impact of temperature on denitrification seems to vary widely between systems. METHODOLOGY/PRINCIPAL FINDINGS: We explored the effects of warming on denitrification rates using microcosm experiments, field measurements and a simple model approach. Our results suggest that a three degree temperature rise will double denitrification rates. By performing experiments at fixed oxygen concentrations as well as with oxygen concentrations varying freely with temperature, we demonstrate that this strong temperature dependence of denitrification can be explained by a systematic decrease of oxygen concentrations with rising temperature. Warming decreases oxygen concentrations due to reduced solubility, and more importantly, because respiration rates rise more steeply with temperature than photosynthesis. CONCLUSIONS/SIGNIFICANCE: Our results show that denitrification rates in aquatic ecosystems are strongly temperature dependent, and that this is amplified by the temperature dependencies of photosynthesis and respiration. Our results illustrate the broader phenomenon that coupling of temperature dependent reactions may in some situations strongly alter overall effects of temperature on ecological processes.

  4. Real Property Tax Rates

    Data.gov (United States)

    Montgomery County of Maryland — The Levy Year 2012 real property tax rate dataset reflects all the rates per $100 set each year by the County Council. These rates are applied to the assessed value...

  5. Variable-Rate Premiums

    Data.gov (United States)

    Pension Benefit Guaranty Corporation — These interest rates are used to value vested benefits for variable rate premium purposes as described in PBGC's regulation on Premium Rates (29 CFR Part 4006) and...

  6. Alcohol Prices and Mortality Due to Liver Cirrhosis

    Directory of Open Access Journals (Sweden)

    Jon P. Nelson

    2015-06-01

    Full Text Available This study estimates a reduced-form regression model for mortality rates due to alcoholic liver diseases, with alcohol prices and income as explanatory variables. Panel data cover the years 2000-2010 for 21 member countries of the European Union. In the reduced form, prices affect mortality rates indirectly through the demand for alcohol, while income has potential direct and indirect effects. Country and time fixed effects are used to control for other factors that influence alcohol consumption and mortality. Special attention is paid to outliers in the data, and final results are based on the MS-estimator for robust regressions. Regression results for alcohol prices and income are sensitive to adjustments for stationary data and down-weighting of outliers and other influential data points. Final results indicate that alcohol prices do not affect mortality rates due to chronic liver diseases. Empirical results in the study do not lend support to broad price-based approaches to alcohol policy.

  7. Physiological growth hormone replacement and rate of recurrence of craniopharyngioma: the Genentech National Cooperative Growth Study.

    Science.gov (United States)

    Smith, Timothy R; Cote, David J; Jane, John A; Laws, Edward R

    2016-10-01

    OBJECTIVE The object of this study was to establish recurrence rates in patients with craniopharyngioma postoperatively treated with recombinant human growth hormone (rhGH) as a basis for determining the risk of rhGH therapy in the development of recurrent tumor. METHODS The study included 739 pediatric patients with craniopharyngioma who were naïve to GH upon entering the Genentech National Cooperative Growth Study (NCGS) for treatment. Reoperation for tumor recurrence was documented as an adverse event. Cox proportional-hazards regression models were developed for time to recurrence, using age as the outcome and enrollment date as the predictor. Patients without recurrence were treated as censored. Multivariate logistic regression was used to examine the incidence of recurrence with adjustment for the amount of time at risk. RESULTS Fifty recurrences in these 739 surgically treated patients were recorded. The overall craniopharyngioma recurrence rate in the NCGS was 6.8%, with a median follow-up time of 4.3 years (range 0.7-6.4 years.). Age at the time of study enrollment was statistically significant according to both Cox (p = 0.0032) and logistic (p craniopharyngioma after surgery in children, but long-term follow-up of GH-treated patients is required to establish a true natural history in the GH treatment era.

  8. Damping in accelerators due to classical radiation

    International Nuclear Information System (INIS)

    Mills, F.E.

    1962-01-01

    The rates of change of the magnitudes of the adiabatic invariants is calculated in the case of a Hamiltonian system subjected to generalized non conservative forces. These results are applied to the case of the classical radiation of electrons in an accelerator or storage ring. The resulting expressions for the damping rates of three independent oscillation modes suggest structures which are damping in all three modes, while at the same time allowing 'strong focussing' and the attendant strong momentum compaction. (author)

  9. Nest mortality of sagebrush songbirds due to a severe hailstorm

    Science.gov (United States)

    Hightower, Jessica N.; Carlisle, Jason D.; Chalfoun, Anna D.

    2018-01-01

    Demographic assessments of nesting birds typically focus on failures due to nest predation or brood parasitism. Extreme weather events such as hailstorms, however, can also destroy eggs and injure or kill juvenile and adult birds at the nest. We documented the effects of a severe hailstorm on 3 species of sagebrush-associated songbirds: Sage Thrasher (Oreoscoptes montanus), Brewer's Sparrow (Spizella breweri), and Vesper Sparrow (Pooecetes gramineus), nesting at eight 24 ha study plots in central Wyoming, USA. Across all plots, 17% of 128 nests failed due to the hailstorm; however, all failed nests were located at a subset of study plots (n = 3) where the hailstorm was most intense, and 45% of all nests failures on those plots were due to hail. Mortality rates varied by species, nest architecture, and nest placement. Nests with more robust architecture and those sited more deeply under the shrub canopy were more likely to survive the hailstorm, suggesting that natural history traits may modulate mortality risk due to hailstorms. While sporadic in nature, hailstorms may represent a significant source of nest failure to songbirds in certain locations, especially with increasing storm frequency and severity forecasted in some regions with ongoing climate change.

  10. Physicians in transition: practice due diligence.

    Science.gov (United States)

    Paterick, Timothy E

    2013-01-01

    The landscape of healthcare is changing rapidly. That landscape is now a business model of medicine. That rapid change resulting in a business model is affecting physicians professionally and personally. The new business model of medicine has led to large healthcare organizations hiring physicians as employees. The role of a physician as an employee has many limitations in terms of practice and personal autonomy. Employed physicians sign legally binding employment agreements that are written by the legal team working for the healthcare organization. Thus physicians should practice due diligence before signing the employment agreement. "Due diligence" refers to the care a reasonable person should take before entering into an agreement with another party. That reasonable person should seek expertise to represent his or her interests when searching a balanced agreement between the physician and organization.

  11. POET: Planetary Orbital Evolution due to Tides

    Science.gov (United States)

    Penev, Kaloyan

    2014-08-01

    POET (Planetary Orbital Evolution due to Tides) calculates the orbital evolution of a system consisting of a single star with a single planet in orbit under the influence of tides. The following effects are The evolutions of the semimajor axis of the orbit due to the tidal dissipation in the star and the angular momentum of the stellar convective envelope by the tidal coupling are taken into account. In addition, the evolution includes the transfer of angular momentum between the stellar convective and radiative zones, effect of the stellar evolution on the tidal dissipation efficiency, and stellar core and envelope spins and loss of stellar convective zone angular momentum to a magnetically launched wind. POET can be used out of the box, and can also be extended and modified.

  12. Sciatica due to pelvic hematoma: case report

    Directory of Open Access Journals (Sweden)

    Kocaman Umit

    2016-12-01

    Full Text Available Sciatica is defined as pain in the sciatic nerve distribution. The most common reason of sciatica is radiculopathy due to lumbar disc hernia. Other causes can be congenital, acquired, infectious, neoplastic, or inflammatory. The piriformis syndrome is another cause. The pain starts in an insidious manner when the cause of sciatica is an extraspinal tumor. It is intermittent at first but a constant and progressive pain that does not decrease with position or rest gradually develops in all patients. The possibility of an intraabdominal or pelvic mass should always be considered and the relevant tests requested when the cause of the sciatica cannot be explained. We present an 83-year-old male who presented with non-traumatic and non-vascular lumbosacral plexopathy due to a large hematoma in the left adductor muscle following the use of warfarin sodium.

  13. Band magnetism due to f-electrons

    International Nuclear Information System (INIS)

    Brodsky, M.B.; Trainor, R.J.

    1976-01-01

    Specific heat data illustrate several types of itinerant or band magnetism in actinide intermetallic compounds. The results show ferromagnetic spin fluctuations in UAl 2 with T/sub sf/ equals 25K, itinerant antiferromagnetism in NpSn 3 with T/sub N/ equals 9.5K and itinerant ferromagnetism in NpOs 2 with T/sub C/ equals 7.9K. Specific heat studies of dilute U/sub 1-x/Th/sub x/Al 2 show the theoretically predicted modifications due to impurity scattering in a spin fluctuation system. For NpSn 3 it is possible to show the BCS nature of the transition due to the gap formation

  14. Eosinophilic ascites due to severe eosinophilic ileitis

    Directory of Open Access Journals (Sweden)

    Setia Namrata

    2010-01-01

    Full Text Available Background: There is a broad etiology for effusion eosinophilia that includes allergic, reactive, infectious, immune, neoplastic, and idiopathic causes. We report and describe the cytomorphologic findings of a rare case of eosinophilic ascites due to severe eosinophilic ileitis. Case Presentation: A 17-year-old male manifested acutely with eosinophilic ascites due to severe biopsy-proven subserosal eosinophilic ileitis. Isolated peritoneal fluid submitted for cytologic evaluation revealed that 65% eosinophils were present in a bloody background. The patient responded to corticosteroids, with complete resolution of his ascites. Conclusion: Eosinophilic gastroenteritis with subserosal involvement should be added to the list of causes for eosinophils in peritoneal fluid. The finding of eosinophilic ascites, with appropriate clinical and laboratory findings, may warrant the need to perform laparoscopic intestinal biopsies to confirm the diagnosis.

  15. Eosinophilic ascites due to severe eosinophilic ileitis.

    Science.gov (United States)

    Setia, Namrata; Ghobrial, Peter; Liron, Pantanowitz

    2010-09-17

    There is a broad etiology for effusion eosinophilia that includes allergic, reactive, infectious, immune, neoplastic, and idiopathic causes. We report and describe the cytomorphologic findings of a rare case of eosinophilic ascites due to severe eosinophilic ileitis. A 17-year-old male manifested acutely with eosinophilic ascites due to severe biopsy-proven subserosal eosinophilic ileitis. Isolated peritoneal fluid submitted for cytologic evaluation revealed that 65% eosinophils were present in a bloody background. The patient responded to corticosteroids, with complete resolution of his ascites. Eosinophilic gastroenteritis with subserosal involvement should be added to the list of causes for eosinophils in peritoneal fluid. The finding of eosinophilic ascites, with appropriate clinical and laboratory findings, may warrant the need to perform laparoscopic intestinal biopsies to confirm the diagnosis.

  16. Transport due to ion pressure gradient turbulence

    International Nuclear Information System (INIS)

    Connor, J.W.

    1986-01-01

    Turbulent transport due to the ion pressure gradient (or temperature drift) instability is thought to be significant when etasub(i)=d(ln Tsub(i))/d(ln n)>1. The invariance properties of the governing equations under scale transformations are used to discuss the characteristics of this turbulence. This approach not only clarifies the relationships between earlier treatments but also, in certain limits, completely determines the scaling properties of the fluctuations and the consequent thermal transport. (author)

  17. Phonic Attenuation due to Screen-Barriers

    Directory of Open Access Journals (Sweden)

    Vasile Bacria

    2011-10-01

    Full Text Available The technique of noise decreasing admits two basic approaches: an active approach and a passive one. In the frame of passive method one can count the employment of screen-barriers. In this paper we present some considerations on sound attenuation due to screen-barriers emphasizing the elements which influence it. The elucidation of these elements is made by measurements. The obtained results can be applied in every other practical situation concerning the protection against noise.

  18. Dose due to {sup 40}K

    Energy Technology Data Exchange (ETDEWEB)

    Escareno J, E.; Vega C, H. R., E-mail: edmundoej@hotmail.com [Universidad Autonoma de Zacatecas, Unidad Academica de Estudios Nucleares, Calle Cipres No. 10, Fracc. La Penuela, 98068 Zacatecas (Mexico)

    2011-10-15

    The dose due to {sup 40}K has been estimated. Potassium is one of the most abundant elements in nature, being approximately 2% of the Earth's crust. Potassium has three isotopes {sup 39}K, {sup 40}K and {sup 41}K, two are stable while {sup 40}K is radioactive with a half life of 1.2x10{sup 9} years; there is 0.0117% {sup 40}K-to-K ratio. Potassium plays an important role in plants, animals and humans growth and reproduction. Due to the fact that K is an essential element for humans, {sup 40}K is the most abundant radioisotope in human body. In order to keep good health conditions K must be intake at daily basis trough food and beverages, however when K in ingested above the requirements produce adverse health effects in persons with renal, cardiac and hypertension problems or suffering diabetes. In 89.3% {sup 40}K decays to {sup 40}C through {beta}-decay, in 10.3% decays through electronic capture and emitting 1.46 MeV {gamma}-ray. K is abundant in soil, construction materials, sand thus {gamma}-rays produced during {sup 40}K decay contribute to external dose. For K in the body practically all {sup 40}K decaying energy is absorbed by the body; thus {sup 40}K contributes to total dose in humans and it is important to evaluate its contribution. In this work a set of {sup 40}K sources were prepared using different amounts of KCl salt, a {gamma}-ray spectrometer with a NaI(Tl) was characterized to standardized the sources in order to evaluate the dose due to {sup 40}K. Using thermoluminescent dosemeters the dose due to {sup 40}K was measured and related to the amount of {sup 40}K {gamma}-ray activity. (Author)

  19. Growth impairment due to transient hypercortisolism.

    Science.gov (United States)

    Armour, K; Chalew, S; Kowarski, A A

    1986-01-01

    Cushing's syndrome in childhood is generally recognized by classical features such as truncal obesity, striae, easy bruising, moon facies, hypertension and growth retardation. Exceptionally, Cushing's syndrome has been reported to present as growth failure alone. We diagnosed transient hypercortisolism in 6 children who had poor growth as their only presenting abnormality. The 6 children all had integrated concentrations of cortisols (IC-F) (14.1 +/- 1.7 micrograms/dl; mean +/- 1 SD) which exceeded the IC-F in healthy children and adults (5.7 +/- 1.5 micrograms/dl; P less than 0.001). The IC-F of these 6 index cases overlapped the range of IC-F in patients with pathologically proven Cushing's syndrome (20.2 +/- 4.7 micrograms/dl). Four of the 6 patients were treated with human growth hormone for 8 months and showed a marked improvement in their growth rates. Four patients have entered puberty and are growing at normal rates. Three of the 6 children had normal repeat IC-Fs, subsequently, at a time they had normal growth rates. In 1-1/2 to 3 years of follow-up, none of the patients developed any other stigmata of Cushing's syndrome. We conclude that transient hypercortisolism, documented by the IC-F, may cause growth failure without other symptoms of Cushing's syndrome. Growth hormone therapy may improve the growth rate of these children at the time of their poor growth.

  20. Bacteremia due to Aeromonas hydrophila in Acute Lymphoblastic Leukemia

    International Nuclear Information System (INIS)

    Fatima, A.; Afridi, F.I.; Farooqi, B.J.; Qureshi, A.; Hussain, A.

    2013-01-01

    Aeromonas hydrophila (A. hydrophila) is a low virulent organism but may cause devastating fatal infections in immunocompromised host especially in liver cirrhosis. It is rarely reported to cause septicemia in a patient with Acute Lymphoblastic Leukemia (ALL). The mortality rate of septicemia due to A. hydrophila is 29% to 73%. We report a case of 59-year-old female patient who was a known case of ALL, presented with the complaints of fever, lethargy and generalized weakness for one month. After taking blood samples for investigations, empirical antimicrobial therapy was started. She did not improve after 48 hours of therapy. Meanwhile blood culture revealed pure growth of A. hydrophila. After sensitivity report was available, ciprofloxacin was started. Patient became afebrile after 48 hours of treatment with ciprofloxacin. It is very vital to correctly identified and treat bacteremia due to A. hydrophila especially in the underlying leukemic patient. (author)

  1. [Work days lost due to health problems in industry].

    Science.gov (United States)

    Yano, Sylvia Regina Trindade; Santana, Vilma Sousa

    2012-05-01

    This cross-sectional study estimated the prevalence of work days lost due to health problems and associated factors among industrial workers. The study population was a simple random cluster sample of 3,403 workers from 16 to 65 years of age in the city of Salvador, Bahia State, Brazil. Data were collected with individual home interviews. Among industrial workers, one-year prevalence of work days lost to health problems was 12.5%, of which 5.5% were directly work-related and 4.1% aggravated by work. There were no statistically significant differences when compared to other worker categories. Self-perceived workplace hazards, history of work-related injury, and poor self-rated health were associated with work days lost due to work-related injuries/diseases. The findings showed that work days lost are common among both industrial and non-industrial workers, thereby affecting productivity and requiring prevention programs.

  2. Contamination Effects Due to Space Environmental Interactions

    Science.gov (United States)

    Chen, Philip T.; Paquin, Krista C. (Technical Monitor)

    2001-01-01

    Molecular and particulate contaminants are commonly generated from the orbital spacecraft operations that are under the influence of the space environment. Once generated, these contaminants may attach to the surfaces of the spacecraft or may remain in the vicinity of the spacecraft. In the event these contaminants come to rest on the surfaces of the spacecraft or situated in the line-of-sight of the observation path, they will create various degrees of contamination effect which may cause undesirable effects for normal spacecraft operations, There will be circumstances in which the spacecraft may be subjected to special space environment due to operational conditions. Interactions between contaminants and special space environment may alter or greatly increase the contamination effect due to the synergistic effect. This paper will address the various types of contamination generation on orbit, the general effects of the contamination on spacecraft systems, and the typical impacts on the spacecraft operations due to the contamination effect. In addition, this paper will explain the contamination effect induced by the space environment and will discuss the intensified contamination effect resulting from the synergistic effect with the special space environment.

  3. Rating Movies and Rating the Raters Who Rate Them.

    Science.gov (United States)

    Zhou, Hua; Lange, Kenneth

    2009-11-01

    The movie distribution company Netflix has generated considerable buzz in the statistics community by offering a million dollar prize for improvements to its movie rating system. Among the statisticians and computer scientists who have disclosed their techniques, the emphasis has been on machine learning approaches. This article has the modest goal of discussing a simple model for movie rating and other forms of democratic rating. Because the model involves a large number of parameters, it is nontrivial to carry out maximum likelihood estimation. Here we derive a straightforward EM algorithm from the perspective of the more general MM algorithm. The algorithm is capable of finding the global maximum on a likelihood landscape littered with inferior modes. We apply two variants of the model to a dataset from the MovieLens archive and compare their results. Our model identifies quirky raters, redefines the raw rankings, and permits imputation of missing ratings. The model is intended to stimulate discussion and development of better theory rather than to win the prize. It has the added benefit of introducing readers to some of the issues connected with analyzing high-dimensional data.

  4. Embrittlement of zircaloy cladding due to oxygen uptake (CBRTTL)

    International Nuclear Information System (INIS)

    Reymann, G.A.

    1979-02-01

    A model for embrittlement of zircaloy due to oxygen uptake at high temperatures is described. The model defines limits for oxygen content and temperature which, if exceeded, give rise to zircaloy cladding which is sufficiently embrittled to cause failure either on quenching or normal handling following a transient. A significant feature of this model is that the onset of embrittlement is dependent on the cooling rate. A distinction is made between slow and fast cooling, with the boundary at 100 K/s. The material property correlations and computer subcodes described in MATPRO are developed for use in Light Water Reactor (LWR) codes

  5. Transport of runaway and thermal electrons due to magnetic microturbulence

    International Nuclear Information System (INIS)

    Mynick, H.E.; Strachan, J.D.

    1981-01-01

    The ratio of the runaway electron confinement to thermal electron energy confinement is derived for tokamaks where both processes are determined by free streaming along stochastic magnetic field lines. The runaway electron confinement is enhanced at high runaway electron energies due to phase averaging over the magnetic perturbations when the runaway electron drift surfaces are displaced from the magnetic surfaces. Comparison with experimental data from LT-3, Ormak, PLT, ST, and TM-3 indicates that magnetic stochasticity may explain the relative transport rates of runaways and thermal electron energy

  6. Radiological risks due to intrusion into a deep bedrock repository

    International Nuclear Information System (INIS)

    Nordlinder, S.; Bergstroem, U.; Edlund, O.

    1999-01-01

    The Swedish concept for disposal of high-level waste is a deep (500 m) bedrock repository (SFL) protected by multiple barriers that isolate the waste from the environment for such a long time that the physical decay will cause a substantial reduction of the radioactivity. The aim of concentration and isolation of high-level waste is to reduce the radiation risk. Intrusion in the repository may introduce a small residual risk to individuals. A risk analysis was performed comprising dose assessment and probabilities of occurrence. Intrusions may be considered to take place either due to conscious actions or by actions without any knowledge about the repository. For conscious intrusion it may be assumed that there will be enough knowledge to manage the radiation situation in a professional manner. Several reasons for making inadvertent intrusion are possible. Independently of the purpose, the most probable initial way of coming into contact with the radioactive material is by deep drilling. Examples of causes for drilling could be general scientific purposes or exploitation of geothermal energy. Dose assessments were made for intrusion due to inclined drilling directly into a canister, and drilling near an initially malfunctioning canister from which radionuclides have leaked into the groundwater. For the former case, external pathways were considered due to exposure from a core of the canister with fuel and contaminated bore dust. The most common drilling method is with water flushing for removal of bore dust, which will not cause any substantial transfer of radionuclides to air. For the second case, it was assumed that there was a well in the vicinity. The only pathway considered was therefore consumption of water because it dominates the exposure. The highest dose rates to man were, as expected, obtained by drilling into the canister. Dose rates decrease with time after closure. During the first time the relatively short-lived radionuclides Cs-137 and Sr-90 give

  7. Subcutaneous phaeohyphomycosis due to Pyrenochaeta romeroi mimicking a synovial cyst

    Directory of Open Access Journals (Sweden)

    Aurelien Dinh

    2016-08-01

    Full Text Available Opportunistic subcutaneous fungal infections are increasing nowadays due to the growing number of medical conditions causing immunosuppression, especially organ transplant. The incidence rate of subcutaneous phaeohyphomycosis is very low. Most studies found are case reports. They showed a wide variation of clinical presentations. Pyrenochaeta romeroi, a fungus from the Dematiaceae group is a saprophyte found in soil and plants and a possible causative agent of phaeohyphomycosis. We present a rare case of subcutaneous phaeohyphomycosis caused by P. romeroi mimicking a synovial cyst in a diabetic patient.

  8. Interest rate derivatives

    DEFF Research Database (Denmark)

    Svenstrup, Mikkel

    This Ph.D. thesis consists of four self-contained essays on valuation of interest rate derivatives. In particular derivatives related to management of interest rate risk care are considered.......This Ph.D. thesis consists of four self-contained essays on valuation of interest rate derivatives. In particular derivatives related to management of interest rate risk care are considered....

  9. Magnetic Field Fluctuations Due to Diel Vertical Migrations of Zooplankton

    Science.gov (United States)

    Dean, C.; Soloviev, A.

    2016-12-01

    Dean et al. (2016) have indicated that at high zooplankton concentrations, diel vertical migrations (DVM) cause velocity fluctuations and a respective increase of the dissipation rate of turbulent kinetic energy (TKE). In this work, we used a 3D non-hydrostatic computational fluid dynamics model with Lagrangian particle injections (a proxy for migrating organisms) via a discrete phase model to simulate the effect of turbulence generation by DVM. We tested a range of organism concentrations from 1000 to 10,000 organisms/m3. The simulation at an extreme concentration of zooplankton showed an increase in dissipation rate of TKE by two to three orders of magnitude during DVM over background turbulence, 10-8 W kg-1. At lower concentrations (Frank, J. Wood, 2016: Biomixing due to diel vertical migrations of zooplankton. Ocean Modelling 98, 51-64.

  10. Airline Quality Rating 1996

    OpenAIRE

    Bowen, Brent D.; Headley, Dean E.

    1996-01-01

    The Airline Quality Rating (AQR) was developed and first announced in early 1991 as an objective method of comparing airline performance on combined multiple factors important to consumers. Development history and calculation details for the AQR rating system are detailed in The Airline Quality Rating issued in April, 1991, by the National Institute for Aviation Research at Wichita State University. This current report, Airline Quality Rating 1996, contains monthly Airline Quality Rating scor...

  11. Spin relaxation in quantum dots due to electron exchange with leads.

    Science.gov (United States)

    Vorontsov, A B; Vavilov, M G

    2008-11-28

    We calculate spin relaxation rates in lateral quantum dot systems due to electron exchange between dots and leads. Using rate equations, we develop a theoretical description of the experimentally observed electric current in the spin blockade regime of double quantum dots. A single expression fits the entire current profile and describes the structure of both the conduction peaks and the suppressed ("valley") region. Extrinsic rates calculated here have to be taken into account for accurate extraction of intrinsic relaxation rates due to the spin-orbit and hyperfine spin scattering mechanisms from spin blockade measurements.

  12. Modeling gamma radiation dose in dwellings due to building materials.

    Science.gov (United States)

    de Jong, Peter; van Dijk, Willem

    2008-01-01

    A model is presented that calculates the absorbed dose rate in air of gamma radiation emitted by building materials in a rectangular body construction. The basis for these calculations is formed by a fixed set of specific absorbed dose rates (the dose rate per Bq kg(-1) 238U, 232Th, and 40K), as determined for a standard geometry with the dimensions 4 x 5 x 2.8 m3. Using the computer codes Marmer and MicroShield, correction factors are assessed that quantify the influence of several room and material related parameters on the specific absorbed dose rates. The investigated parameters are the position in the construction; the thickness, density, and dimensions of the construction parts; the contribution from the outer leave; the presence of doors and windows; the attenuation by internal partition walls; the contribution from building materials present in adjacent rooms; and the effect of non-equilibrium due to 222Rn exhalation. To verify the precision, the proposed method is applied to three Dutch reference dwellings, i.e., a row house, a coupled house, and a gallery apartment. The averaged difference with MCNP calculations is found to be 4%.

  13. SUPPRESSION OF DIELECTRONIC RECOMBINATION DUE TO FINITE DENSITY EFFECTS

    International Nuclear Information System (INIS)

    Nikolić, D.; Gorczyca, T. W.; Korista, K. T.; Ferland, G. J.; Badnell, N. R.

    2013-01-01

    We have developed a general model for determining density-dependent effective dielectronic recombination (DR) rate coefficients in order to explore finite-density effects on the ionization balance of plasmas. Our model consists of multiplying by a suppression factor those highly-accurate total zero-density DR rate coefficients which have been produced from state-of-the-art theoretical calculations and which have been benchmarked by experiment. The suppression factor is based upon earlier detailed collision-radiative calculations which were made for a wide range of ions at various densities and temperatures, but used a simplified treatment of DR. A general suppression formula is then developed as a function of isoelectronic sequence, charge, density, and temperature. These density-dependent effective DR rate coefficients are then used in the plasma simulation code Cloudy to compute ionization balance curves for both collisionally ionized and photoionized plasmas at very low (n e = 1 cm –3 ) and finite (n e = 10 10 cm –3 ) densities. We find that the denser case is significantly more ionized due to suppression of DR, warranting further studies of density effects on DR by detailed collisional-radiative calculations which utilize state-of-the-art partial DR rate coefficients. This is expected to impact the predictions of the ionization balance in denser cosmic gases such as those found in nova and supernova shells, accretion disks, and the broad emission line regions in active galactic nuclei.

  14. Pneumonia due to Enterobacter cancerogenus infection.

    Science.gov (United States)

    Demir, Tülin; Baran, Gamze; Buyukguclu, Tuncay; Sezgin, Fikriye Milletli; Kaymaz, Haci

    2014-11-01

    Enterobacter cancerogenus (formerly known as CDC Enteric Group 19; synonym with Enterobacter taylorae) has rarely been associated with human infections, and little is known regarding the epidemiology and clinical significance of this organism. We describe a community-acquired pneumonia case in a 44-year-old female due to E. cancerogenus. Identification and antimicrobial susceptibility of the microorganism was performed by the automatized VITEK 2 Compact system (bioMerieux, France). The clinical case suggests that E. cancerogenus is a potentially pathogenic microorganism in determined circumstances; underlying diseases such as bronchial asthma, empiric antibiotic treatment, wounds, diagnostic, or therapeutic instruments.

  15. Traumatic oesophageal perforation due to haematoma

    DEFF Research Database (Denmark)

    Grønhøj Larsen, Christian; Brandt, Bodil

    2014-01-01

    . Three explanations postulated to be the cause for late perforation which might be due to esophageal wall ischemia from pressure built up between the hematoma, azygos vein and the lower part of thoracic trachea; or could be an immediate rupture walled-off until the patient became symptomatic......; or the intramural hematoma gradually lysed and causing late perforation. CONCLUSION: Although extremely rare, an oesophageal haematoma and late complications must be considered in patients on anti-coagulant therapy following blunt thoracic trauma and complaining only of chest pain....

  16. Particle transport due to magnetic fluctuations

    International Nuclear Information System (INIS)

    Stoneking, M.R.; Hokin, S.A.; Prager, S.C.; Fiksel, G.; Ji, H.; Den Hartog, D.J.

    1994-01-01

    Electron current fluctuations are measured with an electrostatic energy analyzer at the edge of the MST reversed-field pinch plasma. The radial flux of fast electrons (E>T e ) due to parallel streaming along a fluctuating magnetic field is determined locally by measuring the correlated product e B r >. Particle transport is small just inside the last closed flux surface (Γ e,mag e,total ), but can account for all observed particle losses inside r/a=0.8. Electron diffusion is found to increase with parallel velocity, as expected for diffusion in a region of field stochasticity

  17. Questa è la storia di due ragazzi

    Directory of Open Access Journals (Sweden)

    Maria Lombardo

    2015-07-01

    Full Text Available Questa è la storia di due ragazzi per i quali le speranze di riuscita in una professione artistica come quella dell’attore - già difficile per chiunque - in percentuale erano una su dieci. Forse zero. E invece ce l’hanno fatta: uno a Parigi, l’altro a Roma. Entrambi di colore, entrambi di umili origini, arrivati in Europa come tanti, centinaia di migliaia, nel loro caso non da clandestini. Le storie di Bakary e Federico mostrano come il talento e la fortuna possano vincere le avversità, l’emarginazione, i pregiudizi.

  18. Stretch due to Penile Prosthesis Reservoir Migration

    Directory of Open Access Journals (Sweden)

    E. Baten

    2016-03-01

    Full Text Available A 43-year old patient presented to the emergency department with stretch, due to impossible deflation of the penile prosthesis, 4 years after successful implant. A CT-scan showed migration of the reservoir to the left rectus abdominis muscle. Refilling of the reservoir was inhibited by muscular compression, causing stretch. Removal and replacement of the reservoir was performed, after which the prosthesis was well-functioning again. Migration of the penile prosthesis reservoir is extremely rare but can cause several complications, such as stretch.

  19. Lasing without inversion due to cooling subsystem

    International Nuclear Information System (INIS)

    Shakhmuratov, R.N.

    1997-01-01

    The new possibility of inversionless lasing is discussed. We have considered the resonant interaction of a two-level system (TLS) with photons and the adiabatic interaction with an ensemble of Bose particles. It is found out that a TLS with equally populated energy levels amplifies the coherent light with Stokes-shifted frequency. This becomes possible as photon emission is accompanied by Bose particles excitation. The energy flow from the TLS to the photon subsystem is realized due to the Bose subsystem being at finite temperature and playing the cooler role. The advantage of this new lasing principle is discussed. It is shown that lasing conditions strongly differ from conventional ones

  20. Bronchopleural cutaneous fistula due to Eikenella corrodens.

    Science.gov (United States)

    Wong, Kin-Sun; Huang, Yhu-Chering

    2005-01-01

    The aim of this paper is to review the subject and to report on and discuss a case of bronchopleural cutaneous fistula due to Eikenella corrodens. A 16-year-old girl was brought to our hospital with fever and blood-tinged sputum 2 weeks prior to her admission. She suffered from neurologic sequelae of herpetic encephalitis and had been bed-ridden since 5 years of age. A longitudinal paraspinal soft mass had been noted in the previous week by her mother. She had been given oral feeding despite frequent choking for the past few years. On palpation, the mass can be squeezed to follow the least resistance of subcutaneous space longitudinally extending to the lower thoracic region. Chest computed tomography scan revealed right lower lobe necrotizing pneumonitis and a pleuro-cutaneous fistula leading to the subcutaneous air locules. A protracted course of antibiotics was prescribed and subcutaneous air trapping decreased in size over 8 weeks. Eikenella corrodens has increasingly been implicated as a potential causative pathogen in pleuropulmonary infections. Pleuro-cutaneous fistula and abscess formation complicating empyema and necrotizing pneumonitis due to E. corrodens infection have not been reported. A bulging thoracic subcutaneous lesion waxes and wanes with respiration suggest the possibility of a pleruo-cutaneous fistula. Treatment of Eikenella empyema using antibiotics without surgical decortication requires a prolonged course of antibiotic therapy.

  1. Nonconvulsive status epilepticus due to ifosfamide.

    Science.gov (United States)

    Kilickap, Saadettin; Cakar, Mustafa; Onal, Ibrahim K; Tufan, Abdurrahman; Akoglu, Hadim; Aksoy, Sercan; Erman, Mustafa; Tekuzman, Gulten

    2006-02-01

    To report 2 cases of nonconvulsive status epilepticus (NCSE) following infusion of ifosfamide. Two patients who received ifosfamide-containing chemotherapy developed NCSE. One woman received ifosfamide 1000 mg/m2 (1 h infusion on days 1-5); confusion, lethargy, and speech deterioration developed on day 3. The second patient developed similar symptoms on day 3 of treatment with 2500 mg/m2. Both patients responded to intravenous administration of diazepam 10 mg and were given levetiracetam as maintenance therapy. The severity and presentation of central nervous system toxicity due to ifosfamide varies greatly and involves a spectrum ranging from subclinical electroencephalogram changes to coma. NCSE, an epileptic disorder in which typical convulsive activity is absent, has previously been reported in only 4 patients receiving ifosfamide. Levetiracetam may be used for maintenance antiepileptic therapy after diazepam administration. Among the many presentations of ifosfamide neurotoxicity, clinicians should consider NCSE as a possible explanation for changes in consciousness in a patient receiving this agent. An objective causality assessment by use of the Naranjo probability scale revealed that NCSE due to ifosfamide was probable.

  2. Road Accident due to a Pancreatic Insulinoma

    Science.gov (United States)

    Parisi, Amilcare; Desiderio, Jacopo; Cirocchi, Roberto; Grassi, Veronica; Trastulli, Stefano; Barberini, Francesco; Corsi, Alessia; Cacurri, Alban; Renzi, Claudio; Anastasio, Fabio; Battista, Francesca; Pucci, Giacomo; Noya, Giuseppe; Schillaci, Giuseppe

    2015-01-01

    Abstract Insulinoma is a rare pancreatic endocrine tumor, typically sporadic and solitary. Although the Whipple triad, consisting of hypoglycemia, neuroglycopenic symptoms, and symptoms relief with glucose administration, is often present, the diagnosis may be challenging when symptoms are less typical. We report a case of road accident due to an episode of loss of consciousness in a patient with pancreatic insulinoma. In the previous months, the patient had occasionally reported nonspecific symptoms. During hospitalization, endocrine examinations were compatible with an insulin-producing tumor. Abdominal computerized tomography and magnetic resonance imaging allowed us to identify and localize the tumor. The patient underwent a robotic distal pancreatectomy with partial omentectomy and splenectomy. Insulin-producing tumors may go undetected for a long period due to nonspecific clinical symptoms, and may cause episodes of loss of consciousness with potentially lethal consequences. Robot-assisted procedures can be performed with the same techniques of the traditional surgery, reducing surgical trauma, intraoperative blood loss, and hospital stays. PMID:25816027

  3. [In-hospital mortality due to stroke].

    Science.gov (United States)

    Rodríguez Lucci, Federico; Pujol Lereis, Virginia; Ameriso, Sebastián; Povedano, Guillermo; Díaz, María F; Hlavnicka, Alejandro; Wainsztein, Néstor A; Ameriso, Sebastián F

    2013-01-01

    Overall mortality due to stroke has decreased in the last three decades probable due to a better control of vascular risk factors. In-hospital mortality of stroke patients has been estimated to be between 6 and 14% in most of the series reported. However, data from recent clinical trials suggest that these figures may be substantially lower. Data from FLENI Stroke Data Bank and institutional mortality records between 2000 and 2010 were reviewed. Ischemic stroke subtypes were classified according to TOAST criteria and hemorrhagic stroke subtypes were classified as intraparenchymal hematoma, aneurismatic subarachnoid hemorrhage, arterio-venous malformation, and other intraparenchymal hematomas. A total of 1514 patients were studied. Of these, 1079 (71%) were ischemic strokes,39% large vessels, 27% cardioembolic, 9% lacunar, 14% unknown etiology, and 11% others etiologies. There were 435 (29%) hemorrhagic strokes, 27% intraparenchymal hematomas, 30% aneurismatic subarachnoid hemorrhage, 25% arterio-venous malformation, and 18% other intraparenchymal hematomas. Moreover, 38 in-hospital deaths were recorded (17 ischemic strokes and 21 hemorrhagic strokes), accounting for 2.5% overall mortality (1.7% in ischemic strokes and 4.8% in hemorrhagic strokes). No deaths occurred associated with the use of intravenous fibrinolytics occurred. In our Centre in-hospital mortality in patients with stroke was low. Management of these patients in a Centre dedicated to neurological diseases along with a multidisciplinary approach from medical and non-medical staff trained in the care of cerebrovascular diseases could, at least in part, account for these results.

  4. Cardioplasty and Roux-en-Y partial gastrectomy (Serra-Dória procedure for reoperation of achalasia Cardioplastia e gastrectomia parcial em Y-de-Roux (operação de Serra-Dória para reoperações no megaesôfago

    Directory of Open Access Journals (Sweden)

    Helio Ponciano

    2004-09-01

    Full Text Available BACKGROUND: After cardiomyotomy for the treatment of megaesophagus, recurrence of symptoms occur in up to 15% of the patients, but only some require a reoperation. AIM: To evaluate the results of reoperation - cardioplasty with Roux-en-Y partial gastrectomy, a technique proposed by Serra-Dória. CASUISTIC AND METHODS: Twenty patients with achalasia previously treated by cardiomyotomy, were retrospectively studied. The etiology of symptoms recurrence was reflux esophagitis in nine (45.0% patients, healing of the myotomy in five (25.0%, end staging megaesophagus in five (25.0% and incomplete myotomy in one (5%. Intra and postoperative complications were analyzed. The patients were studied by clinical (dysphagia, regurgitation, heartburn and weight gain, radiological and endoscopic evaluation, in the pre- and postoperative period. RESULTS: Five (25.0% patients had complications in the immediate postoperative period. No deaths were observed. Dysphagia improved in all the patients. Regurgitation and heartburn almost disappeared in the whole group. Weight was maintained or increased in 64.7% of the patients. Radiological studies showed a decrease in the caliber of the esophagus in 53.0%, while the remaining patients maintained the pre-operative diameter. Endoscopy, performed during the late postoperative period in 17 patients, showed that 6 among the 9 with reflux esophagitis improved; 2 among the 8 with a normal esophagus during the preoperative period, developed esophagitis. CONCLUSIONS: The Serra-Dória procedure for the treatment of megaesophagus in patients who had already undergone cardiomyotomy and whose symptoms recurred, presented a low morbidity and no mortality. It offered a significant relief of symptoms with a decrease of the caliber of the esophagus in several patients. The patients also improved with regards to reflux esophagitis. In some cases reflux was still present after surgery. Others with normal esophagus in the preoperative

  5. Radiation doses due to the natural radioactivity in Pakistan marble

    International Nuclear Information System (INIS)

    Tufail, M.; Iqbal, M.; Mirza, S.M.

    2000-01-01

    In view of its high potential for containing large amounts of radioactive materials and due to its wide-spread use as construction and facing material worldwide, radiation doses received from the marble used in dwellings have been determined. As a first step, specific activity measurements were made using a NaI(TI) gamma ray spectrometer using the spectrum stripping technique. For the samples studied, the average values of specific activities for 226 Ra, 232 Th and 40 K have been found to be 27, 26 and 58 Bg kg -1 respectively. The mesh-adaptive, volume-integral method based code INGRE (Mirza et al. 1991) gave calculated values of the dose equivalent rates inside the standard room (Tufail et al.,1994) due to 226 Ra, 232 Th and 40 K; these were found to lie between 5-77,12-52 and 1-11 nGy h -1 respectively. The values of whole body dose equivalent rates have been found to lie in the 27-108 nGy h -1 range. As these values are below internationally accepted maximum permissible values, therefore marble available in Pakistan can safely be used in dwellings as a construction material. (author)

  6. CO2: EDF's competitiveness is due to nuclear power

    International Nuclear Information System (INIS)

    Anon.

    2003-01-01

    The CO 2 emissions of EDF group (EDF-France + EDF-energy (UK) + Hidrocantabrico (Spain) + EnBW (Germany)) soared by 53% in 2002 which is due to the purchase of british and spanish electricity sub-companies using fossil energies. Despite this sharp increase EDF remains one of the most competitive electricity companies in Europe concerning greenhouse gas emissions. EDF group is the first electricity company in Europe, it generates 22% of the electricity produced in E.U and contributes to CO 2 emissions with a rate of 101 Kg CO 2 /MWh which 3 times less than the average rate of 20 other European companies (358 Kg CO 2 /MWh). This result is due to the large part of nuclear power in the French energy mix. The best electricity companies as far as CO 2 emissions are concerned are Statkraft (Norway) with 0 Kg CO 2 /MWh (100% hydrology) and British-energy (U.K) with 75 Kg CO 2 /MWh (75% nuclear power). At the other end we have the DEI company (Greece) with 863 Kg CO 2 /MWh (100% lignite). (A.C.)

  7. Earth system commitments due to delayed mitigation

    International Nuclear Information System (INIS)

    Pfister, Patrik L; Stocker, Thomas F

    2016-01-01

    As long as global CO 2 emissions continue to increase annually, long-term committed Earth system changes grow much faster than current observations. A novel metric linking this future growth to policy decisions today is the mitigation delay sensitivity (MDS), but MDS estimates for Earth system variables other than peak temperature (ΔT max ) are missing. Using an Earth System Model of Intermediate Complexity, we show that the current emission increase rate causes a ΔT max increase roughly 3–7.5 times as fast as observed warming, and a millenial steric sea level rise (SSLR) 7–25 times as fast as observed SSLR, depending on the achievable rate of emission reductions after the peak of emissions. These ranges are only slightly affected by the uncertainty range in equilibrium climate sensitivity, which is included in the above values. The extent of ocean acidification at the end of the century is also strongly dependent on the starting time and rate of emission reductions. The preservable surface ocean area with sufficient aragonite supersaturation for coral reef growth is diminished globally at an MDS of roughly 25%–80% per decade. A near-complete loss of this area becomes unavoidable if mitigation is delayed for a few years to decades. Also with respect to aragonite, 12%–18% of the Southern Ocean surface become undersaturated per decade, if emission reductions are delayed beyond 2015–2040. We conclude that the consequences of delaying global emission reductions are much better captured if the MDS of relevant Earth system variables is communicated in addition to current trends and total projected future changes. (letter)

  8. The rating reliability calculator

    Directory of Open Access Journals (Sweden)

    Solomon David J

    2004-04-01

    Full Text Available Abstract Background Rating scales form an important means of gathering evaluation data. Since important decisions are often based on these evaluations, determining the reliability of rating data can be critical. Most commonly used methods of estimating reliability require a complete set of ratings i.e. every subject being rated must be rated by each judge. Over fifty years ago Ebel described an algorithm for estimating the reliability of ratings based on incomplete data. While his article has been widely cited over the years, software based on the algorithm is not readily available. This paper describes an easy-to-use Web-based utility for estimating the reliability of ratings based on incomplete data using Ebel's algorithm. Methods The program is available public use on our server and the source code is freely available under GNU General Public License. The utility is written in PHP, a common open source imbedded scripting language. The rating data can be entered in a convenient format on the user's personal computer that the program will upload to the server for calculating the reliability and other statistics describing the ratings. Results When the program is run it displays the reliability, number of subject rated, harmonic mean number of judges rating each subject, the mean and standard deviation of the averaged ratings per subject. The program also displays the mean, standard deviation and number of ratings for each subject rated. Additionally the program will estimate the reliability of an average of a number of ratings for each subject via the Spearman-Brown prophecy formula. Conclusion This simple web-based program provides a convenient means of estimating the reliability of rating data without the need to conduct special studies in order to provide complete rating data. I would welcome other researchers revising and enhancing the program.

  9. Ratchet due to broken friction symmetry

    DEFF Research Database (Denmark)

    Norden, Bengt; Zolotaryuk, Yaroslav; Christiansen, Peter Leth

    2002-01-01

    A ratchet mechanism that occurs due to asymmetric dependence of the friction of a moving system on its velocity or a driving force is reported. For this kind of ratchet, instead of a particle moving in a periodic potential, the dynamics of which have broken space-time symmetry, the system must...... be provided with sonic internal structure realizing such a velocity- or force-friction dependence. For demonstration of a ratchet mechanism of this type, an experimental setup (gadget) that converts longitudinal oscillating or fluctuating motion into a unidirectional rotation has been built and experiments...... with it have been carried out. In this device, an asymmetry of friction dependence on an applied force appears, resulting in rectification of rotary motion, In experiments, our setup is observed to rotate only in one direction, which is in accordance with given theoretical arguments, Despite the setup being...

  10. Fuel bundle movement due to reverse flow

    Energy Technology Data Exchange (ETDEWEB)

    Wahba, N N; Akalin, O [Ontario Hydro, Toronto, ON (Canada)

    1996-12-31

    When a break occurs in the inlet feeder or inlet header, the rapid depressurization will cause the channel flow to reverse forcing the string of bundles to accelerate and impact with upstream shield plug. A model has been developed to predict the bundle motion due to the channel flow reversal. The model accounts for various forces acting on the bundle. A series of five reverse flow, bundle acceleration experiments have been conducted simulating a break in the inlet feeder of a CANDU fuel channel. The model has been validated against the experiments. The predicted impact velocities are in good agreement with the measured values. It is demonstrated that the model may be successfully used in predicting bundle relocation timing following a large LOCA (loss of coolant). (author). 7 refs., 3 tabs., 11 figs.

  11. Dysphagia due to Diffuse Idiopathic Skeletal Hyperostosis

    Directory of Open Access Journals (Sweden)

    Masafumi Ohki

    2012-01-01

    Full Text Available Diffuse idiopathic skeletal hyperostosis (DISH is usually asymptomatic. However, rarely, it causes dysphagia, hoarseness, dyspnea, snoring, stridor, and laryngeal edema. Herein, we present a patient with DISH causing dysphagia. A 70-year-old man presented with a 4-month history of sore throat, dysphagia, and foreign body sensation. Flexible laryngoscopy revealed a leftward-protruding posterior wall in the hypopharynx. Computed tomography and magnetic resonance imaging revealed a bony mass pushing, anteriorly, on the posterior hypopharyngeal wall. Ossification included an osseous bridge involving 5 contiguous vertebral bodies. Dysphagia due to DISH was diagnosed. His symptoms were relieved by conservative therapy using anti-inflammatory drugs. However, if conservative therapy fails and symptoms are severe, surgical treatments must be considered.

  12. Acute Paraplegia due to Thoracic Hematomyelia

    Directory of Open Access Journals (Sweden)

    Aykut Akpınar

    2016-01-01

    Full Text Available Spontaneous intraspinal intramedullary hemorrhage is a rare entity with the acute onset of neurologic symptoms. The etiology of idiopathic spontaneous hematomyelia (ISH is unknown, and there are few published case reports. Hematomyelia is mostly associated with trauma, but the other nontraumatic etiologies are vascular malformations, tumors, bleeding disorders, syphilis, syrinx, and myelitis. MRI is a good choice for early diagnosis. Hematomyelia usually causes acute spinal cord syndrome due to the compression and destruction of the spinal cord. A high-dose steroid treatment and surgical decompression and evacuation of hematoma are the urgent solution methods. We present idiopathic spontaneous hematomyelia of a previously healthy 80-year-old male with a sudden onset of back pain and paraplegia.

  13. Fractures due to insufficient pelvic girdle

    International Nuclear Information System (INIS)

    Garcia Aguayo, F.J.; Martinez Almagro, A.

    1995-01-01

    Eleven cases are presented of postmenopausal women with a total of 37 fractures due to insufficient pelvic girdle: 15 located in sacrum, ten in the pubic rami, four in ilium proximal to the sacroiliac joint, three in iliac fossa, two in iliac tuberosity and three in the public body. Eight of the patients were diagnosed over a period of six years when seeking medical attention for bone pain. The other three were diagnosed retrospectively among a group of 33 cancer patients (the majority having having breast cancer) who presented positive pelvic radionuclide bone scan. CT was superior to conventional radiology in detecting fractures of this type, especially those of sacrum and ilium. Radionuclide bone scan was highly sensitive but its specificity was low, requiring back-up radiology and above all CT to establish the differential diagnosis with respect to other types of lesions, especially metastases. (Author) 14 refs

  14. Small Bowel Obstruction due to Intestinal Xanthomatosis

    Directory of Open Access Journals (Sweden)

    L. E. Barrera-Herrera

    2015-01-01

    Full Text Available Vast majority of bowel obstruction is due to postoperative adhesions, malignancy, intestinal inflammatory disease, and hernias; however, knowledge of other uncommon causes is critical to establish a prompt treatment and decrease mortality. Xanthomatosis is produced by accumulation of cholesterol-rich foamy macrophages. Intestinal xanthomatosis is an uncommon nonneoplastic lesion that may cause small bowel obstruction and several cases have been reported in the English literature as obstruction in the jejunum. We report a case of small intestinal xanthomatosis occurring in a 51-year-old female who presented with one day of copious vomiting and intermittent abdominal pain. Radiologic images revealed jejunal loop thickening and inflammatory changes suggestive of foreign body obstruction, diagnostic laparoscopy found two strictures at the jejunum, and a pathologic examination confirmed a segmental small bowel xanthomatosis. This case illustrates that obstruction even without predisposing factors such as hyperlipidemia or lymphoproliferative disorders.

  15. Occupational fatalities due to electrocutions in the construction industry.

    Science.gov (United States)

    Janicak, Christopher A

    2008-01-01

    Occupational fatalities due to contact with electricity account for approximately 9% of all deaths in the construction industry and is the fourth leading cause of death in this industry. Differences in the proportions of electrocutions in the construction industry are significantly different from other industries based upon the age of the worker and the source of the electricity. This study found that, in the construction industry, the proportion of occupational fatalities due to contact with electric current is significantly higher for workers in the 16 to 19 years old age group. Contact with overhead power lines occurred more frequently with younger workers, while contact with electric wiring, transformers, and related equipment was found to occur more frequently with older workers. The proportion of fatalities due to this event was also found to account for a significantly greater proportion of fatalities in the construction industry overall. The proportions of electrocution fatalities in the construction industry were found to be significantly higher for younger workers when compared to all other industries. Focusing prevention measures toward younger workers who work near overhead power lines could have a significant impact upon death rates. For older workers, the focus should be on those who work on or near transformers, electrical wiring, and components. Across the construction industry, implementation of effective lockout-tagout programs, and verification of energy isolation, can prevent approximately 125 fatalities per year in the construction industry.

  16. Rate Adaptive OFDMA Communication Systems

    International Nuclear Information System (INIS)

    Abdelhakim, M.M.M.

    2009-01-01

    Due to the varying nature of the wireless channels, adapting the transmission parameters, such as code rate, modulation order and power, in response to the channel variations provides a significant improvement in the system performance. In the OFDM systems, Per-Frame adaptation (PFA) can be employed where the transmission variables are fixed over a given frame and may change from one frame to the other. Subband (tile) loading offers more degrees of adaptation such that each group of carriers (subband) uses the same transmission parameters and different subbands may use different parameters. Changing the code rate for each tile in the same frame, results in transmitting multiple codewords (MCWs) for a single frame. In this thesis a scheme is proposed for adaptively changing the code rate of coded OFDMA systems via changing the puncturing rate within a single codeword (SCW). In the proposed structure, the data is encoded with the lowest available code rate then it is divided among the different tiles where it is punctured adaptively based on some measure of the channel quality for each tile. The proposed scheme is compared against using multiple codewords (MCWs) where the different code rates for the tiles are obtained using separate encoding processes. For bit interleaved coded modulation architecture two novel interleaving methods are proposed, namely the puncturing dependant interleaver (PDI) and interleaved puncturing (IntP), which provide larger interleaving depth. In the PDI method the coded bits with the same rate over different tiles are grouped for interleaving. In IntP structure the interleaving is performed prior to puncturing. The performance of the adaptive puncturing technique is investigated under constant bit rate constraint and variable bit rate. Two different adaptive modulation and coding (AMC) selection methods are examined for variable bit rate adaptive system. The first is a recursive scheme that operates directly on the SNR whereas the second

  17. Labor Force Participation Rate

    Data.gov (United States)

    City and County of Durham, North Carolina — This thematic map presents the labor force participation rate of working-age people in the United States in 2010. The 2010 Labor Force Participation Rate shows the...

  18. Rate Review Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — As of September 1, 2011, the Affordable Care Act and rate review regulation require review of rate increases of 10 percent or more. A non-grandfathered health plan...

  19. An outbreak of gastroenteritis due to Escherichia coli 0142 H6 in a neonatal department

    NARCIS (Netherlands)

    Gerards, L. J.; Hennekam, R. C.; von Dijk, W. C.; Roord, J. J.; Fleer, A.

    1984-01-01

    An outbreak of gastroenteritis due to Escherichia coli 0142 H6 in a neonatal ward is described. The epidemic affected 16 of 24 infants (infection-rate 66 per cent), of whom one died due to necrotizing enterocolitis. Administration of antibiotics was of limited value in treatment or in eradicating E.

  20. Interest Rates and Inflation

    OpenAIRE

    Coopersmith, Michael; Gambardella, Pascal J.

    2016-01-01

    This article is an extension of the work of one of us (Coopersmith, 2011) in deriving the relationship between certain interest rates and the inflation rate of a two component economic system. We use the well-known Fisher relation between the difference of the nominal interest rate and its inflation adjusted value to eliminate the inflation rate and obtain a delay differential equation. We provide computer simulated solutions for this equation over regimes of interest. This paper could be of ...

  1. Interest Rate Swaps

    OpenAIRE

    Marina Pepic

    2014-01-01

    Interest rates changes have a huge impact on the business performance. Therefore, it is of great importance for the market participants to identify and adequately manage this risk. Financial derivatives are a relatively simple way of protection from adverse changes in interest rates. Interest rate swaps are particularly popular because they reduce interest rate risk to a minimum with a relatively low initial cost and without great risk, but also because of the fact that there are many modific...

  2. Understanding Interest Rate Volatility

    OpenAIRE

    Volker, Desi

    2016-01-01

    This thesis is the result of my Ph.D. studies at the Department of Finance of the Copenhagen Business School. It consists of three essays covering topics related to the term structure of interest rates, monetary policy and interest rate volatility. The rst essay, \\Monetary Policy Uncertainty and Interest Rates", examines the role of monetary policy uncertainty on the term structure of interest rates. The second essay, \\A Regime-Switching A ne Term Structure Model with Stochast...

  3. Airline Quality Rating 2003

    OpenAIRE

    Bowen, Brent D.; Headley, Dean E.

    2003-01-01

    The Airline Quality Rating (AQR) was developed and first announced in early 1991 as an objective method of comparing airline quality on combined multiple performance criteria. This current report, the Airline Quality Rating 2003, reflects monthly Airline Quality Rating scores for 2002. AQR scores for the calendar year 2002 are based on 15 elements that focus on airline performance areas important to air travel consumers. The Airline Quality Rating 2003 is a summary of month-by-month qualit...

  4. Airline Quality Rating 2001

    OpenAIRE

    Bowen, Brent D.; Headley, Dean E.

    2001-01-01

    The Airline Quality Rating (AQR) was developed and first announced in early 1991 as an objective method of comparing airline quality on combined multiple performance criteria. This current report, Airline Quality Rating 2001, reflects monthly Airline Quality Rating scores for 2000. AQR scores for the calendar year 2000 are based on 15 elements that focus on airline performance areas important to air travel consumers. The Airline Quality Rating 2001 is a summary of month-by-month quality ra...

  5. Thermonuclear reaction rates. III

    International Nuclear Information System (INIS)

    Harris, M.J.; Fowler, W.A.; Caughlan, G.R.; Zimmerman, B.A.

    1983-01-01

    Stellar thermonuclear reaction rates are revised and updated, adding a number of new important reaction rates. Several reactions with large negative Q-values are included, and examples of them are discussed. The importance of the decay rates for Mg-26(p,n) exp 26 Al and Al-26(n,p) exp 26 Mg for stellar studies is emphasized. 19 references

  6. Resonant thermonuclear reaction rate

    International Nuclear Information System (INIS)

    Haubold, H.J.; Mathai, A.M.

    1986-01-01

    Basic physical principles for the resonant and nonresonant thermonuclear reaction rates are applied to find their standard representations for nuclear astrophysics. Closed-form representations for the resonant reaction rate are derived in terms of Meijer's G-function. Analytic representations of the resonant and nonresonant nuclear reaction rates are compared and the appearance of Meijer's G-function is discussed in physical terms

  7. Tearing mode instability due to anomalous resistivity

    International Nuclear Information System (INIS)

    Furuya, Atsushi; Itoh, Sanae I.; Yagi, Masatoshi

    2000-01-01

    Tearing mode instability in the presence of microscopic truculence is investigates. The effects of microscopic turbulence on tearing mode are taken as drags which are calculated by one-point renormalization method and mean-field approximation. These effects are reduced to effective diffusivities in reduced MHD equations. Using these equations, the stability analyses of the tearing mode are performed. It is shown that a finite amplitude of fluctuation enhances the growth rate of tearing mode. For very high values of turbulent diffusivities, marginally stable state exists. The effects of each turbulent diffusivity on mode stability are examined near marginal stability boundary. Parameter dependence of the resistive ballooning mode turbulence on tearing mode is analyzed as an example. (author)

  8. QT Prolongation due to Graves’ Disease

    Directory of Open Access Journals (Sweden)

    Zain Kulairi

    2017-01-01

    Full Text Available Hyperthyroidism is a highly prevalent disease affecting over 4 million people in the US. The disease is associated with many cardiac complications including atrial fibrillation and also less commonly with ventricular tachycardia and fibrillation. Many cardiac pathologies have been extensively studied; however, the relationship between hyperthyroidism and rate of ventricular repolarization manifesting as a prolonged QTc interval is not well known. Prolonged QTc interval regardless of thyroid status is a risk factor for cardiovascular mortality and life-threatening ventricular arrhythmia. The mechanism regarding the prolongation of the QT interval in a hyperthyroid patient has not been extensively investigated although its clinical implications are relevant. Herein, we describe a case of prolonged QTc in a patient who presented with signs of hyperthyroidism that was corrected with return to euthyroid status.

  9. Credit Rating and Competition

    OpenAIRE

    Nelson Camanho; Pragyan Deb; Zijun Liu

    2010-01-01

    In principle, credit rating agencies are supposed to be impartial observers that bridge the gap between private information of issuers and the information available to the wider pool of investors. However, since the 1970s, rating agencies have relied on an issuer-pay model, creating a conflict of interest the largest source of income for the rating agencies are the fees paid by the issuers the rating agencies are supposed to impartially rate. In this paper, we explore the trade-off between re...

  10. Risks and radiation doses due to residential radon in Germany

    International Nuclear Information System (INIS)

    Beck, T.R.

    2017-01-01

    The population-averaged risk rate and the annual average effective dose due to residential radon in Germany were calculated. The calculations were based on an epidemiological approach taking into account the age- and gender-specific lung cancer incidence rates for the German population and the excess relative risk of 0.16 per 100 Bq.m"-"3 for residential radon. In addition, the risk estimates adjusted for the smoking habits were determined. The population-averaged risk rate for the whole population was estimated with 4.1.10"-"5 y"-"1 (95% confidence interval (CI) 1.4.10"-"5 - 7.6.10"-"5 y"-"1). Residential radon causes a detriment per year of 3.3.10"-"5 y"-"1 (95% CI 1.1.10"-"5 - 6.0.10"-"5 y"-"1), which corresponds to an annual average effective dose of 0.6 mSv (95% CI 0.2-1.1 mSv). Annually, ∼3400 lung cancer incidences are attributed to residential radon. The results from the epidemiological approach exercised in this study are considerably lower than the effective dose, which would be obtained from the dose conversion coefficient calculated using biokinetic and dosimetric models. (author)

  11. Understanding Interest Rate Volatility

    DEFF Research Database (Denmark)

    Volker, Desi

    This thesis is the result of my Ph.D. studies at the Department of Finance of the Copenhagen Business School. It consists of three essays covering topics related to the term structure of interest rates, monetary policy and interest rate volatility. The rst essay, \\Monetary Policy Uncertainty...... and Interest Rates", examines the role of monetary policy uncertainty on the term structure of interest rates. The second essay, \\A Regime-Switching A ne Term Structure Model with Stochastic Volatility" (co-authored with Sebastian Fux), investigates the ability of the class of regime switching models...... with and without stochastic volatility to capture the main stylized features of U.S. interest rates. The third essay, \\Variance Risk Premia in the Interest Rate Swap Market", investigates the time-series and cross-sectional properties of the compensation demanded for holding interest rate variance risk. The essays...

  12. Pediatric ischemic stroke due to dengue vasculitis.

    Science.gov (United States)

    Nanda, Subrat Kumar; Jayalakshmi, Sita; Mohandas, Surath

    2014-10-01

    Dengue infection is an important arboviral infection in southeast Asia, especially in India. Neurological manifestations of dengue are increasingly recognized. We report an ischemic stroke due to dengue vasculitis in an 8-year-old child. We present a girl with a short febrile illness followed by episodic severe headache, with gradually progressive hemiparesis and visual impairment. Her brain magnetic resonance imaging revealed multiple infarctions in the anterior and posterior circulation. The magnetic resonance angiogram revealed irregular narrowing of bilateral middle cerebral arteries, right anterior cerebral artery, left posterior cerebral, and bilateral vertebral arteries suggestive of vasculitis. Her dengue serology was strongly positive for immunoglobulin M with 68.9 panbio units. The rest of the evaluation for pediatric stroke was unremarkable. She was treated with intravenous followed by oral corticosteroids and recovered totally with resolution of vasculitis on magnetic resonance angiogram over the next 3 months. This child illustrates possible immune-mediated vasculitis caused by dengue infection which is rather a rare presentation in a child who subsequently recovered well. One should consider dengue in childhood strokes in endemic regions. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Network overload due to massive attacks

    Science.gov (United States)

    Kornbluth, Yosef; Barach, Gilad; Tuchman, Yaakov; Kadish, Benjamin; Cwilich, Gabriel; Buldyrev, Sergey V.

    2018-05-01

    We study the cascading failure of networks due to overload, using the betweenness centrality of a node as the measure of its load following the Motter and Lai model. We study the fraction of survived nodes at the end of the cascade pf as a function of the strength of the initial attack, measured by the fraction of nodes p that survive the initial attack for different values of tolerance α in random regular and Erdös-Renyi graphs. We find the existence of a first-order phase-transition line pt(α ) on a p -α plane, such that if p pt , pf is large and the giant component of the network is still present. Exactly at pt, the function pf(p ) undergoes a first-order discontinuity. We find that the line pt(α ) ends at a critical point (pc,αc) , in which the cascading failures are replaced by a second-order percolation transition. We find analytically the average betweenness of nodes with different degrees before and after the initial attack, we investigate their roles in the cascading failures, and we find a lower bound for pt(α ) . We also study the difference between localized and random attacks.

  14. Homocystinuria due to cystathionine beta synthase deficiency

    Directory of Open Access Journals (Sweden)

    Rao T

    2008-01-01

    Full Text Available A two year-old male child presented with cutis marmorata congenita universalis, brittle hair, mild mental retardation, and finger spasms. Biochemical findings include increased levels of homocysteine in the blood-106.62 µmol/L (normal levels: 5.90-16µmol/L. Biochemical tests such as the silver nitroprusside and nitroprusside tests were positive suggesting homocystinuria. The patient was treated with oral pyridoxine therapy for three months. The child responded well to this therapy and the muscle spasms as well as skin manifestations such as cutis marmorata subsided. The treatment is being continued; the case is reported here because of its rarity. Homocysteinuria arising due to cystathionine beta-synthase (CBS deficiency is an autosomal recessive disorder of methionine metabolism that produces increased levels of urinary homocysteine and methionine It manifests itself in vascular, central nervous system, cutaneous, and connective tissue disturbances and phenotypically resembles Marfan′s syndrome. Skin manifestations include malar flush, thin hair, and cutis reticulata / marmorata.

  15. Epileptic seizures due to multiple cerebral cavernomatosis

    Directory of Open Access Journals (Sweden)

    Spasić Mirjana

    2007-01-01

    Full Text Available Background. Cavernous angiomas are angiographically occult vascular malformations that are present in 0.4−0.9 % of people, and represent around 5% of all cerebrovascular malformations. They can be single or multiple, and sporadic or familial. The presence of multiple lesions is more frequent in familial cavernomatosis. Ten to 30 % are associated with familial clustering. Case report. We presented the case of a 43-year-old man, admitted to the Emergency Department due to unprovoked seizure during the wide awake and everyday activities. Neurological examination was with no focal signs. A 32-channel standard digital EEG was without any significant changes of normal baseline activity. After sleep deprivation EEG showed multifocal, bilateral and asymmetric polyspikes and sharpwaves activity. Hyperventilation induced generalized epileptiform discharges. MRI scan demonstrated multiple small cavernous angiomas. Neuropsychological testing demonstrated a delayed memory impairment. Neurosurgery treatment was not recommended, and the therapy with valproate 1 250 mg/day had an excellent efficacy with no singnificant adverse effects. Conclusion. This patient considered as a rare case with multiple cavernomatosis highlights the importance of neuroradiological examination in adult patients with the first epileptic seizure but with no focal neurological signs. .

  16. Jejunal Diverticular Perforation due to Enterolith

    Directory of Open Access Journals (Sweden)

    Ronaldo Nonose

    2011-08-01

    Full Text Available Jejunal diverticulosis is a rare entity with variable clinical and anatomical presentations. Although there is no consensus on the management of asymptomatic jejunal diverticular disease, some complications are potentially life-threatening and require early surgical treatment. Small bowel perforation secondary to jejunal diverticulitis by enteroliths is rare. The aim of this study was to report a case of small intestinal perforation caused by a large jejunal enterolith. An 86-year-old woman was admitted with signs of diffuse peritonitis. After initial fluid recovery the patient underwent emergency laparotomy. The surgery showed that she had small bowel diverticular disease, mainly localized in the proximal jejunum. The peritonitis was due to intestinal perforation caused by an enterolith 12 cm in length, localized inside one of these diverticula. The intestinal segment containing the perforated diverticulum with the enterolith was removed and an end-to-end anastomosis was done to reconstruct the intestinal transit. The patient recovered well and was discharged from hospital on the 5th postoperative day. There were no signs of abdominal pain 1 year after the surgical procedure. Although jejunal diverticular disease with its complications, such as formation of enteroliths, is difficult to suspect in patients with peritonitis, it should be considered as a possible source of abdominal infection in the elderly patient when more common diagnoses have been excluded.

  17. Dermatoses due to indian cultural practices

    Directory of Open Access Journals (Sweden)

    Divya Gupta

    2015-01-01

    Full Text Available A wide prevalence of socio-religious and cultural practices in the Asian subcontinent often leads to multitude of skin diseases which may be missed by the dermatologists because of a lack of awareness. ′Henna′ use causes IgE-mediated hypersensitivity reactions and contact dermatitis. ′Kumkum′ application can result in pigmented contact dermatitis and lichen planus pigmentosus. Sticker ′bindis′ and ′alta′ induce contact leukoderma. Irritant and allergic contact dermatitis occurs after playing with ′Holi′ colors. Threading and drawstring dermatitis lead to koebnerization of pre-existing dermatoses, infections and even squamous cell carcinoma of skin. Mild irritant reactions and contact sensitization occur secondary to balm and hair oil use. ′Mudichood′ represents the comedogenic effect of hair oils combined with occlusion and humidity. Aromatherapy oils can cause contact dermatitis and photosensitive reactions. Heavy metal and steroid toxicity along with severe cutaneous adverse effects like erythroderma can occur as a consequent to the use of alternative medicines. Squamous cell carcinoma due to chronic heat exposure from the heating device "kangri" is seen in Kashmiris. Prayer nodules in Muslims and traction alopecia in Sikhs illustrate how religious practices can negatively affect the skin. With increasing globalization and migration, the practice of indigenous customs and traditions is no longer limited to regional territories, making it imperative for the dermatologists to be acquainted with the cutaneous side effects they can cause.

  18. Dermatoses due to Indian cultural practices.

    Science.gov (United States)

    Gupta, Divya; Thappa, Devinder Mohan

    2015-01-01

    A wide prevalence of socio-religious and cultural practices in the Asian subcontinent often leads to multitude of skin diseases which may be missed by the dermatologists because of a lack of awareness. 'Henna' use causes IgE-mediated hypersensitivity reactions and contact dermatitis. 'Kumkum' application can result in pigmented contact dermatitis and lichen planus pigmentosus. Sticker 'bindis' and 'alta' induce contact leukoderma. Irritant and allergic contact dermatitis occurs after playing with 'Holi' colors. Threading and drawstring dermatitis lead to koebnerization of pre-existing dermatoses, infections and even squamous cell carcinoma of skin. Mild irritant reactions and contact sensitization occur secondary to balm and hair oil use. 'Mudichood' represents the comedogenic effect of hair oils combined with occlusion and humidity. Aromatherapy oils can cause contact dermatitis and photosensitive reactions. Heavy metal and steroid toxicity along with severe cutaneous adverse effects like erythroderma can occur as a consequent to the use of alternative medicines. Squamous cell carcinoma due to chronic heat exposure from the heating device "kangri" is seen in Kashmiris. Prayer nodules in Muslims and traction alopecia in Sikhs illustrate how religious practices can negatively affect the skin. With increasing globalization and migration, the practice of indigenous customs and traditions is no longer limited to regional territories, making it imperative for the dermatologists to be acquainted with the cutaneous side effects they can cause.

  19. Hospitalisations due to falls in older persons.

    LENUS (Irish Health Repository)

    Carey, D

    2005-06-01

    This paper describes hospitalisations due to falls among people aged 65 years and over resident in the Eastern Region of Ireland. Of the 2,029 hospitalisations recorded for 2002, 78% were female and 68% were aged 75 years and over. Fractures accounted for 1,697 or 84% of cases with nearly half of them (841) sustained to the hip. Females were more likely to have a limb fracture whereas males were more likely to have a head injury. The total inpatient costs of the 2,029 hospitalisations were estimated at 10.6 million euros. Hip fractures were the costliest injuries as they accounted for 7.4 million euros (70%) of inpatient costs. There are also substantial additional costs implications for hip fractures as they constituted the majority (56%) of cases transferred to nursing\\/convalescent homes or long-stay health facilities. In keeping with an ageing population, the problem of injuries in older people is likely to increase over time and as falls are the dominant cause of those injuries, all acute and long-stay health facilities need to develop and implement fall prevention strategies for older people.

  20. Catatonia due to systemic lupus erythematosus

    Directory of Open Access Journals (Sweden)

    Francisco de Assis Pinto Cabral Júnior Rabello

    2014-07-01

    Full Text Available Objectives Discuss neuropsychiatric aspects and differential diagnosis of catatonic syndrome secondary to systemic lupus erythematosus (SLE in a pediatric patient. Methods Single case report. Result A 13-year-old male, after two months diagnosed with SLE, started to present psychotic symptoms (behavioral changes, hallucinations and delusions that evolved into intense catatonia. During hospitalization, neuroimaging, biochemical and serological tests for differential diagnosis with metabolic encephalopathy, neurological tumors and neuroinfections, among other tests, were performed. The possibility of neuroleptic malignant syndrome, steroid-induced psychosis and catatonia was also evaluated. A complete reversal of catatonia was achieved after using benzodiazepines in high doses, associated with immunosuppressive therapy for lupus, which speaks in favor of catatonia secondary to autoimmune encephalitis due to lupus. Conclusion Although catatonia rarely is the initial clinical presentation of SLE, the delay in recognizing the syndrome can be risky, having a negative impact on prognosis. Benzodiazepines have an important role in the catatonia resolution, especially when associated with parallel specific organic base cause treatment. The use of neuroleptics should be avoided for the duration of the catatonic syndrome as it may cause clinical deterioration.

  1. Electrical injuries due to theft of copper.

    Science.gov (United States)

    Curinga, Giuseppe; Pietramaggiori, Giorgio; Scherer, Sandra Saja; Masellis, Alessandro; Gherardini, Giulio; Brancato, Renato; Conte, Francesco; Bistoni, Giovanni

    2010-01-01

    This study shows that the theft of copper, mainly from electrical wires, is becoming a more frequent crime as the value of this metal rises. We have collected all the data from the Burn Centre of the Hospital of Palermo, Italy, from 1992 to 2007. Over the last two decades, we assisted to a dramatic increase of patients admitted to our hospital, reporting burn injuries while attempting to steal it in dangerous conditions. The circumstances of the injury, the clinical management of the case, and the long-term consequences are presented and discussed. We found that the electrical burn related to the theft of copper is often a life-threatening event because of the high-voltage electrical current passing through the patients. Patients, due to the type of activity, often requiring physical effort, were generally young and healthy. From a review of the literature on the subject, we have noticed that theft of copper is not reported as an important risk factor for electrical burns. Our report clearly shows that theft of copper-related electrical injury is becoming more frequent in the community and should be added as a "new" risk factor. The already high incidence reported here may actually be lower than the actual incidence because many patients tend not to come to the hospital because of the risk of being prosecuted by the police.

  2. Decreased pain sensitivity due to trimethylbenzene exposure ...

    Science.gov (United States)

    Traditionally, human health risk assessments have relied on qualitative approaches for hazard identification, often using the Hill criteria and weight of evidence determinations to integrate data from multiple studies. Recently, the National Research Council has recommended the development of quantitative approaches for evidence integration, including the application of meta-analyses. The following hazard identification case study applies qualitative as well as meta-analytic approaches to trimethylbenzene (TMB) isomers exposure and the potential neurotoxic effects on pain sensitivity. In the meta-analytic approach, a pooled effect size is calculated, after consideration of multiple confounding factors, in order to determine whether the entire database under consideration indicates that TMBs are likely to be a neurotoxic hazard. The pain sensitivity studies included in the present analyses initially seem discordant in their results: effects on pain sensitivity are seen immediately after termination of exposure, appear to resolve 24 hours after exposure, and then reappear 50 days later following foot-shock. Qualitative consideration of toxicological and toxicokinetic characteristics of the TMB isomers suggests that the observed differences between studies are due to testing time and can be explained through a complete consideration of the underlying biology of the effect and the nervous system as a whole. Meta-analyses and –regressions support this conclus

  3. Radiation risk due to occupational exposure

    International Nuclear Information System (INIS)

    Kargbo, A.A

    2012-04-01

    Exposure to ionizing radiation occurs in many occupations. Workers can be exposed to both natural and artificial sources of radiation. Any exposure to ionizing radiation incurs some risk, either to the individual or to the individual's progeny. This dissertation investigated the radiation risk due to occupational exposure in industrial radiography. Analysis of the reported risk estimates to occupational exposure contained in the UNSCEAR report of 2008 in industrial radiography practice was done. The causes of accidents in industrial radiography include: Lack of or inadequate regulatory control, inadequate training, failure to follow operational procedures, human error, equipment malfunction or defect, inadequate maintenance and wilful violation have been identified as primary causes of accidents. To minimise radiation risks in industrial radiography exposure devices and facilities should be designed such that there is intrinsic safety and operational safety ensured by establishing a quality assurance programme, safety culture fostered and maintained among all workers, industrial radiography is performed in compliance with approved local rules, workers engaged have appropriate qualifications and training, available safe operational procedures are followed, a means is provided for detecting incidents and accidents and an analysis of the causes and lessons learned. (author)

  4. Sepsis due to clostridium septicum: case report

    International Nuclear Information System (INIS)

    Foga, M.M.; McGinn, G.J.; Kroeker, M.A.; Guzman, R.

    2000-01-01

    Clostridium septicum is an unusual anaerobic, gram-positive, gas-producing bacillus, which has been identified as a cause of fulminant rapidly fatal infection in humans. Infection with C. septicum usually occurs in patients with cancer, patients receiving immunosuppressive chemotherapy, or patients with a nonmalignant hematological disorder such as hemolytic uremic syndrome. C. septicum infection most commonly involves the abdomen, and a recent review article has identified 164 cases in the medical literature describing the abdominal findings in this disease. Intracranial manifestation of C. septicum infection are less common and include meningitis, cerebritis, abscess formation and pneumocephalus. There have been only 12 documented cases in the English literature describing central nervous system lesions associated with C. septicum. We present a case report of a 56-year-old man in whom septicemia due to C. septicum developed as a complication of Crohn's disease. To our knowledge, there has never been a previous report of C. septicum sepsis related to underlying Crohn's disease. Our case is also remarkable in that an intracerebral gas collection developed at the site of a mycotic infarct related to C. septicum bacteremia, Intracranial, intraparenchymal gas formation related to anaerobic infection is extremely rare; to our knowledge, this radiological finding related to C. septicum sepsis has been described in only 1 previous case report in the medical literature. We also describe the intra-abdominal manifestations of C. septicum sepsis that occurred in this patient as well as the associated radiographic and pathologic findings. (author)

  5. Recurrent Pneumonia due to Double Aortic Arch

    Directory of Open Access Journals (Sweden)

    I. Sedighi

    2012-04-01

    Full Text Available Introduction: Pneumonia is one of the most common infections during childhood. In children with recurrent bacterial pneumonia complete evaluation for underlying factors is necessary. The most common underlying diseases include: antibody deficiencies , cystic fibrosis , tracheoesophageal fistula and increased pulmonary blood flow. Vascular ring and its pressure effect is a less common cause of stridor and recurrent pneumonia. Congenital abnormalities in aortic arch and main branches which form vascular ring around esophagus and trachea with variable pressure effect cause respiratory symptoms such as stridor , wheezing and recurrent pneumoniaCase Report: A 2 year old boy was admitted in our hospital with respiratory distress and cough . Chest x-Ray demonstrated right lobar pneumonia. He had history of stridor and wheezing from neonatal period and hospitalization due to pneumonia for four times. The patient received appropriate antibiotics. Despite fever and respiratory distress improvement, wheezing continued. Review of his medical documents showed fixed pressure effect on posterior aspect of esophagus in barium swallow. In CT angiography we confirmed double aortic arch.Conclusion: Double aortic arch is one of the causes of persistant respiratory symptom and recurrent pneumonia in children for which fluoroscopic barium swallow is the first non-invasive diagnostic method.(Sci J Hamadan Univ Med Sci 2012;19(1:70-74

  6. Pulmonary hypertension due to left heart disease.

    Science.gov (United States)

    Berthelot, Emmanuelle; Bailly, Minh Tam; Hatimi, Safwane El; Robard, Ingrid; Rezgui, Hatem; Bouchachi, Amir; Montani, David; Sitbon, Olivier; Chemla, Denis; Assayag, Patrick

    Pulmonary hypertension due to left heart disease, also known as group 2 pulmonary hypertension according to the European Society of Cardiology/European Respiratory Society classification, is the most common cause of pulmonary hypertension. In patients with left heart disease, the development of pulmonary hypertension favours right heart dysfunction, which has a major impact on disease severity and outcome. Over the past few years, this condition has been considered more frequently. However, epidemiological studies of group 2 pulmonary hypertension are less exhaustive than studies of other causes of pulmonary hypertension. In group 2 patients, pulmonary hypertension may be caused by an isolated increase in left-sided filling pressures or by a combination of this condition with increased pulmonary vascular resistance, with an abnormally high pressure gradient between arteries and pulmonary veins. A better understanding of the conditions underlying pulmonary hypertension is of key importance to establish a comprehensive diagnosis, leading to an adapted treatment to reduce heart failure morbidity and mortality. In this review, epidemiology, mechanisms and diagnostic approaches are reviewed; then, treatment options and future approaches are considered. Copyright © 2017. Published by Elsevier Masson SAS.

  7. Urinary retention due to herpes virus infections.

    Science.gov (United States)

    Yamanishi, T; Yasuda, K; Sakakibara, R; Hattori, T; Uchiyama, T; Minamide, M; Ito, H

    1998-01-01

    Urinary retention is uncommon in patients with herpes zoster and anogenital herpes simplex. Seven patients (four men, three women) with a mean age of 68.1 years (range, 35-84) with urinary retention due to herpes zoster (n = 6) or anogenital herpes simplex (n = 1) were studied. Six patients had unilateral skin eruption in the saddle area (S2-4 dermatome) and one patient with herpes zoster had a skin lesion in the L4-5 dermatome. All patients had detrusor areflexia without bladder sensation, and two of them had inactive external sphincter on electromyography at presentation. Clean intermittent catheterization was performed, and voiding function was recovered in 4-6 weeks (average, 5.4) in all patients. Urodynamic study was repeated after recovery of micturition in three patients, and they returned to normal on cystometrography and external sphincter electromyography. Acute urinary retention associated with anogenital herpes infection has been thought to occur when the meninges or sacral spinal ganglia were involved, and, in conclusion, this condition may be considered to be reversible.

  8. Exchange rate policy

    Directory of Open Access Journals (Sweden)

    Plačkov Slađana

    2013-01-01

    Full Text Available Small oscillations of exchange rate certainly affect the loss of confidence in the currency (Serbian dinar, CSD and because of the shallow market even the smallest change in the supply and demand leads to a shift in exchange rate and brings uncertainty. Some economists suggest that the course should be linked to inflation and thus ensure predictable and stable exchange rates. Real exchange rate or slightly depressed exchange rate will encourage the competitiveness of exporters and perhaps ensure the development of new production lines which, in terms of overvalued exchange rate, had no economic justification. Fixed exchange rate will bring lower interest rates, lower risk and lower business uncertainty (uncertainty avoidance, but Serbia will also reduce foreign exchange reserves by following this trend. On the other hand, a completely free exchange rate, would lead to a (real fall of Serbian currency, which in a certain period would lead to a significant increase in exports, but the consequences for businessmen and citizens with loans pegged to the euro exchange rate, would be disastrous. We will pay special attention to the depreciation of the exchange rate, as it is generally favorable to the export competitiveness of Serbia and, on the other hand, it leads to an increase in debt servicing costs of the government as well as of the private sector. Oscillations of the dinar exchange rate, appreciation and depreciation, sometimes have disastrous consequences on the economy, investors, imports and exports. In subsequent work, we will observe the movement of the dinar exchange rate in Serbia, in the time interval 2009-2012, in order to strike a balance and maintain economic equilibrium. A movement of foreign currencies against the local currency is controlled in the foreign exchange market, so in case economic interests require, The National Bank of Serbia (NBS, on the basis of arbitrary criteria, can intervene in the market.

  9. Years of life lost due to infectious diseases in Poland

    Science.gov (United States)

    Bryla, Marek; Dziankowska-Zaborszczyk, Elzbieta; Bryla, Pawel; Pikala, Malgorzata

    2017-01-01

    Purpose An evaluation of mortality due to infectious diseases in Poland in 1999–2012 and an analysis of standard expected years of life lost due to the above diseases. Methods The study material included a database created on the basis of 5,219,205 death certificates of Polish inhabitants, gathered between 1999 and 2012 and provided by the Central Statistical Office. Crude Death Rates (CDR), Standardized Death Rates (SDR) and Standard Expected Years of Life Lost (SEYLL) due to infectious and parasitic diseases were also evaluated in the study period as well as Standard Expected Years of Life Lost per living person (SEYLLp) and Standard Expected Years of Life Lost per dead person (SEYLLd). Time trends were evaluated with the application of joinpoint models and an annual percentage change in their values. Results Death certificates report that 38,261 people died due to infectious diseases in Poland in the period 1999–2012, which made up 0.73% of the total number of deaths. SDR caused by these diseases decreased, particularly in the male group: Annual Percentage Change (APC = -1.05; 95% CI:-2.0 to -0.2; p<0.05). The most positive trends were observed in mortality caused by tuberculosis (A15-A19) (APC = -5.40; 95% CI:-6.3 to -4.5; p<0.05) and also meningitis, encephalitis, myelitis and encephalomyelitis (G03-G04) (APC = -3.42; 95% CI:-4.7 to -2.1; p<0.05). The most negative mortality trends were observed for intestinal infectious diseases (A00-A09) Annual Average Percentage Change (AAPC = 7.3; 95% CI:3.1 to 11.7; p<0.05). SDR substantially decreased in the first half of the study period, but then significantly increased in the second half. Infectious and parasitic diseases contributed to a loss of around 37,000 standard expected years of life in 1999 and more than 28,000 in 2012. During the study period, the SEYLLp index decreased from 9.59 to 7.39 per 10,000 population and the SEYLLd index decreased from 14.26 to 10.34 years (AAPC = 2.3; 95% CI:-2,9 to -1.7; p<0

  10. Ocular Injury due to Potassium Permanganate Granules

    Directory of Open Access Journals (Sweden)

    Chareenun Chirapapaisan

    2018-02-01

    Full Text Available Purpose: We report a rare case of ocular injury due to potassium permanganate (KMnO4 granules in a child. Methods: This is a retrospective case report. Results: A 2-year-old boy was transferred to our emergency room with severe pain in his right eye, inflamed eyelids, and brownish stains on his fingers. Chemical injury was suspected. Copious eye irrigation was immediately performed. Diffuse brownish splotches were then observed at the inferior bulbar conjunctiva. Otherwise, systemic organs were intact. Complete eye exam under general anesthesia revealed a 5-mm epithelial defect at the central cornea, along with generalized conjunctival injection and limbal ischemia, inferiorly. Multiple semi-dissolved granules of KMnO4 trapped in the inferior fornix were identified. The chemical particles were gradually washed out and removed; however, the brownish stains remained. The patient received preservative-free steroid, antibiotic eye drops, and lubricants as regular management for mild to moderate degree of ocular burn. Pseudomembrane developed early and transformed into symblepharon within a few days after the injury. Membrane adhesion was lysed, and more aggressive medications were then substituted. Commercial amniotic membrane (PROKERA® was also applied to promote wound healing and to prevent recurrence of symblepharon. The ocular surface was eventually restored, and corneal transparency was preserved. Conclusion: Ocular injury with the granular form of KMnO4 is rare. Its toxicity is comparable to concentrated KMnO4 solution. However, the dissolved particles that had been absorbed in the stained conjunctiva were continuously released and damaged the ocular surface more than we primarily anticipated. Awareness of this condition and prompt management yield a good treatment outcome.

  11. Subjeans Condensations due to a Thermal Instability

    Science.gov (United States)

    Opher, R.; Valio, A.

    1990-11-01

    RESUMEN. Las observaciones recientes muestran que las nubes moleculares no son homogeneas, sino que tienen condensaciones. Se observa que estas condensaciones estan libres gravitacionalmente. C6mo se forman estas condensaciones? Sugerimos explicar estas conden sac jones como debidas a que la inestabilidad termica ayuda a la gravedad. Se estudi6 una funci5n de enfriamiento por gramo de la forma general A p T , en donde p y T son la densidad y la temperatura. Estamos interesados en el valor maximo de para la cual el colapso ocurre. Se estudiaron varios mode- los. Nuestros resultados indican que los valores de comparables con aquellos sugeridos por la literatura (1 son suficientes para provocar el colapso de masas inferiores a la masa de Jeans por medio de inestabilidad termica, ayudada por gravedad y asi se forman las condensaciones libres gravitacionalmente. ABSTRACT: Recent observations show that molecular clouds are not homogeneous, but clumpy. Some clumps are observed to be gravitationally unbound. How did these clumps then form? We suggest explaining these condensation as due to thermal instability aiding gravit y The cooling function per gram studied is of the general form A p T,where pand T are the density and temperature, respectively. We are interested in the maximum value of for which collapse still occurs. Various models are studied. Our results indicate that values comparable to those suggested in the literature (1 < %< 2) are sufficient to trigger the collapse of subjeans masses by thermal instability, when aided by gravity, and form the observed gravitationally unbound clumps. Keq o : HYDRODYNAMICS - INTERSTELLAR CLOUDS

  12. Acute pancreatitis due to scrub typhus

    Directory of Open Access Journals (Sweden)

    Atif Shaikh Iqbal Ahmed

    2014-01-01

    Full Text Available Scrub typhus is endemic in large parts of India and can cause multi-organ failure and death. Acute pancreatitis as a complication is very rare and is potentially fatal. This case series describes seven adult patients who presented with an acute febrile illness and were diagnosed to have scrub typhus with acute pancreatitis. The mean age of the seven patients with acute pancreatitis was 49.4 years, and mean duration of fever prior to presentation was 7.7 days. All seven patients had abdominal pain, and three had a pathognomonic eschar. The mean serum lipase level was 1,509 U/L (normal value: <190 U/L and the mean serum amylase level was 434 U/L (normal value: <200 U/L. Six patients had evidence of multi-organ dysfunction. Hematological and respiratory system dysfunction was seen in five patients, hepatic and renal dysfunction in four, and central nervous system dysfunction in three patients. Three patients who had ≥4 organs involved, died (mortality rate: 42.8%. Our case series shows that pancreatitis in scrub typhus is an extremely rare complication and when present, is associated with increased mortality (42.8%. Physicians may be familiar with the various complications of scrub typhus but less so with acute pancreatitis and hence may be underdiagnosed.

  13. Electric rate operations

    International Nuclear Information System (INIS)

    Maillard, D.

    1993-01-01

    The share of nuclear power in EDF production implies multiple rate structures. How are these rates determined. What are the new applications of electricity, and in particular those that make use of the especially low summer prices for electricity. These are topics of interest to the man in the street (witness EDF's recent 'red-white-blue' rates). This prompted the 'Nuclear Power in the Financial, Energy and Economic situation' department of France's nuclear power company to organize a conference bringing together an expert on rates - M.P. Bernard, head of the rate fixing service at the EDF's headquarters - and representatives from suppliers of equipment taking advantage of the various EDF rate options

  14. Observed Barium Emission Rates

    Science.gov (United States)

    Stenbaek-Nielsen, H. C.; Wescott, E. M.; Hallinan, T. J.

    1993-01-01

    The barium releases from the CRRES satellite have provided an opportunity for verifying theoretically calculated barium ion and neutral emission rates. Spectra of the five Caribbean releases in the summer of 1991 were taken with a spectrograph on board a U.S. Air Force jet aircraft. Because the line of sight release densities are not known, only relative rates could be obtained. The observed relative rates agree well with the theoretically calculated rates and, together with other observations, confirm the earlier detailed theoretical emission rates. The calculated emission rates can thus with good accuracy be used with photometric observations. It has been postulated that charge exchange between neutral barium and oxygen ions represents a significant source for ionization. If so. it should be associated with emissions at 4957.15 A and 5013.00 A, but these emissions were not detected.

  15. Understanding Rig Rates

    OpenAIRE

    Petter Osmundsen; Knut Einar Rosendahl; Terje Skjerpen

    2013-01-01

    We examine the largest cost component in offshore development projects, drilling rates, which have been high over the last years. To our knowledge, rig rates have not been analysed empirically before in the economic literature. By econometric analysis we examine the effects on Gulf of Mexico rig rates of gas and oil prices, rig capacity utilization, contract length and lead time, and rig specific characteristics. Having access to a unique data set containing contract information, we are able ...

  16. Airline Quality Rating 2013

    OpenAIRE

    Bowen, Brent D.; Headley, Dean E.

    2013-01-01

    The Airline Quality Rating (AQR) was developed and first announced in early 1991 as an objective method for assessing airline quality on combined multiple performance criteria. This current report, the Airline Quality Rating 2013, reflects monthly Airline Quality Rating scores for calendar year 2012. AQR scores for 2013 are based on 15 elements in four major areas that focus on airline performance aspects important to air travel consumers over the calendar year of 2012. The Airline Quality...

  17. Assessment of complications due to intratympanic injections

    Directory of Open Access Journals (Sweden)

    Yu-Chuan Liu

    2016-03-01

    Full Text Available Objective: The purpose of the study is to report and to analyze the complications following intratympanic injections (ITI of steroids. The occurrence rate of complications at different ITI sites, four quadrants of eardrum, was also compared. Methods: A retrospective clinical review in a medical center. Each patient received ITI twice in a week for 2–3 consecutive weeks as a salvage therapy for sudden sensorineural hearing loss. Post-injection complications, especially transient dizziness and vertigo, were recorded. Patients with acute or chronic vertigo episodes in 1 month were excluded. Results: A total of 59 patients with sudden sensorineural hearing loss and a total of 278 times of ITI were performed in 1 year. The post-injection complications included pain, tongue numbness, transient dizziness, vertigo, tinnitus, and a small persistent perforation. There was no significant difference in the occurrence of these complications between the injections sites on the 4 quadrants of the tympanic membrane. However, there was statistical significance in the post-injection vertiginous episode after IT injections to posterior-inferior quadrant (Q3 and posterior-superior quadrant (Q4 compared to anterior-superior quadrant (Q1 and anterior-inferior quadrant (Q2 (P = 0.0113. Conclusion: IT injection is recommended to be applied to the Q2 since the Q1 and Q4 injections are more likely to induce the adverse effect of tongue numbness, while the Q3 and Q4 areas are more likely to induce post-injection vertigo. Keywords: Intratympanic injection, Sudden deafness, Complications, Vertigo

  18. Diabetes due to recurrent pancreatitis secondary to hypercalcemia due to primary hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Sumit Kumar Chakrabarti

    2013-01-01

    Full Text Available Acute pancreatitis due to hypercalcemia associated with hyperparathyroidism (HPT is not very common. We herein report a case of a 21-year-old woman, who presented with acute pancreatitis. She had a past history of recurrent nephrolithiasis. Subsequent evaluation revealed hypercalcemia (serum calcium: 12.6 mg/dL; low phosphate (2.9 mg/dL with elevated parathyroid hormone (PTH, 156.7 pg/mL and HbA1c (6.9%. Diagnosis of primary HPT (PHPT was made. Recurrent pancreatitis due to hypercalcemia may have resulted in diabetes mellitus.

  19. Long Maturity Forward Rates

    DEFF Research Database (Denmark)

    Christiansen, Charlotte

    2001-01-01

    The paper aims to improve the knowledge of the empirical properties of the long maturity region of the forward rate curve. Firstly, the theoretical negative correlation between the slope at the long end of the forward rate curve and the term structure variance is recovered empirically and found...... to be statistically significant. Secondly, the expectations hypothesis is analyzed for the long maturity region of the forward rate curve using "forward rate" regressions. The expectations hypothesis is numerically close to being accepted but is statistically rejected. The findings provide mixed support...... for the affine term structure model....

  20. Interest Rate Swaps

    Directory of Open Access Journals (Sweden)

    Marina Pepić

    2014-12-01

    Full Text Available Interest rates changes have a huge impact on the business performance. Therefore, it is of great importance for the market participants to identify and adequately manage this risk. Financial derivatives are a relatively simple way of protection from adverse changes in interest rates. Interest rate swaps are particularly popular because they reduce interest rate risk to a minimum with a relatively low initial cost and without great risk, but also because of the fact that there are manymodifications of the standard swap created to better satisfy the different needs of market players.

  1. Exploring aggregate economic damage functions due to climate change

    Energy Technology Data Exchange (ETDEWEB)

    Dowlatabadi, H.; Kandlikar, M.; Patwardhan, A. [and others

    1994-12-31

    A number of issues need to be considered when developing aggregated economic damage functions due to climate change. These include: (i) identification of production processes vulnerable to climate change, (ii) an understanding of the mechanism of vulnerability, (iii) the rate of technological advance and diffusion (iv) the issue of detection of damages and availability of response options. In this paper we will explore the implications of these considerations with the aid of an illustrative model. The findings suggest that there is a significant upward bias in damage functions calculated without consideration of these issues. Furthermore, this systematic bias is larger as climate change increases. We believe the approach explored here is a more suitable model for adoption in future integrated assessments of climate change.

  2. Predator and prey perception in copepods due to hydromechanical signals

    DEFF Research Database (Denmark)

    Kiørboe, Thomas; Visser, Andre

    1999-01-01

    of the different components of the fluid disturbance. We use this model to argue that prey perception depends on the absolute magnitude of the fluid velocity generated by the moving prey, while predator perception depends on the magnitude of one or several of the components of the fluid velocity gradients...... (deformation rate, vorticity, acceleration) generated by the predator. On the assumption that hydrodynamic disturbances are perceived through the mechanical bending of sensory setae, we estimate the magnitude of the signal strength due to each of the fluid disturbance components. We then derive equations...... for reaction distances as a function of threshold signal strength and the size and velocity of the prey or predator. We provide a conceptual framework for quantifying threshold signal strengths and, hence, perception distances. The model is illustrated by several examples, and we demonstrate, for example, (1...

  3. Adrenergic crisis due to pheochromocytoma - practical aspects. A short review.

    Science.gov (United States)

    Juszczak, Kajetan; Drewa, Tomasz

    2014-01-01

    The definitive therapy in case of pheochromocytoma is complete surgical resection. Improper preoperative assessment and medical management generally places the patient at risk for complications, resulting from an adrenergic crisis. Therefore, it is crucial to adequately optimize these patients before surgery. Optimal preoperative medical management significantly decreases morbidity and mortality during the tumor resection. This review addresses current knowledge in pre- and intraoperative assessment of a patient with pheochromocytoma. Before surgery the patient is conventionally prepared with α-adrenergic blockade (over 10-14 days) and subsequently, additional β-adrenergic blockade is required to treat any associated tachyarrhythmias. In preoperative assessment, it is obligatory to monitor arterial blood pressure, heart rate, and arrhythmias and to restore the blood volume to normal. In conclusion, due to the pathophysiological complexity of a pheochromocytoma, the strict cooperation between the cardiologist, endocrinologist, surgeon and the anaesthesiologist for an uneventful outcome should be achieved in patients qualified for the surgical removal of such a tumor.

  4. Radiation dose distributions due to sudden ejection of cobalt device.

    Science.gov (United States)

    Abdelhady, Amr

    2016-09-01

    The evaluation of the radiation dose during accident in a nuclear reactor is of great concern from the viewpoint of safety. One of important accident must be analyzed and may be occurred in open pool type reactor is the rejection of cobalt device. The study is evaluating the dose rate levels resulting from upset withdrawal of co device especially the radiation dose received by the operator in the control room. Study of indirect radiation exposure to the environment due to skyshine effect is also taken into consideration in order to evaluate the radiation dose levels around the reactor during the ejection trip. Microshield, SHLDUTIL, and MCSky codes were used in this study to calculate the radiation dose profiles during cobalt device ejection trip inside and outside the reactor building. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Unexpected guest: Atrial fibrillation due to electrical shock

    Directory of Open Access Journals (Sweden)

    Mehmet Zihni Bilik

    2016-03-01

    Full Text Available Cardiac arrhythmias due to electrical injuries are rare among emergency service admittances. A 35 year-old female patient was admitted to emergency service with palpitation after electrical injury as a result of contact with a domestic low-voltage source. Electrocardiography (ECG showed atrial fibrillation with rapid ventricular response. Transthoracic echocardiography findings were normal. Atrial fibrillation spontaneously converted to normal sinus rhythm after rate limiting treatment with beta-blocker. The patient was discharged without any complication on the third day of hospitalization. Although cardiac arrhythmias rarely occur after electrical injury, cardiac monitoring is recommended for all patients with documented rhythm disorder, loss of consciousness, or abnormal ECG at admission.

  6. Concrete cover cracking due to uniform reinforcement corrosion

    DEFF Research Database (Denmark)

    Solgaard, Anders Ole Stubbe; Michel, Alexander; Geiker, Mette Rica

    2013-01-01

    and reinforcement de-passivation is a frequently used limit state. The present paper investigates an alternative limit state: corrosion-induced cover cracking. Results from numerical simulations of concrete cover cracking due to reinforcement corrosion are presented. The potential additional service life...... is calculated using literature data on corrosion rate and Faraday’s law. The parameters varied comprise reinforcement diameter, concrete cover thickness and concrete material properties, viz. concrete tensile strength and ductility (plain concrete and fibre reinforced concrete). Results obtained from......Service life design (SLD) is an important tool for civil engineers to ensure that the structural integrity and functionality of the structure is not compromised within a given time frame, i.e. the service life. In SLD of reinforced concrete structures, reinforcement corrosion is of major concern...

  7. Irradiation deformation due to SIPA induced dislocation anisotropy

    International Nuclear Information System (INIS)

    Woo, CH.

    1980-02-01

    A contribution to irradiation deformation resulting from the stress-induced preferred adsorption (SIPA) effect is considered. SIPA causes a variation of the growth rates of irradiation-generated dislocation loops, according to the alignment of their Burgers vectors with respect to the applied stress. A prolinged period under an applied stress then creates an anisotropic dislocation structure in which the majority of dislocations have their Burgers vectors in alignment with the stress. In the presence of 'neutral' sinks, the resulting anisotropic dislocation structure causes plastic deformation similar to the way in which irradiation growth occurs in zirconium. This mechanism is called SIPA-induced growth (SIG). We have shown that SIG is very significant in comparison to SIPA, except when little or no loop growth has occurred during the period the stress is applied. This report contains the detailed formulation and derivation of the formulae for the evaluation of the contribution due to SIG. (auth)

  8. Exploring aggregate economic damage functions due to climate change

    International Nuclear Information System (INIS)

    Dowlatabadi, H.; Kandlikar, M.; Patwardhan, A.

    1994-01-01

    A number of issues need to be considered when developing aggregated economic damage functions due to climate change. These include: (1) identification of production processes vulnerable to climate change, (2) an understanding of the mechanism of vulnerability, (3) the rate of technological advance and diffusion, (4) the issue of detection of damages and availability of response options. In this paper the authors will explore the implications of these considerations with the aid of an illustrative model. The findings suggest that there is a significant upward bias in damage functions calculated without consideration of these issues. Furthermore, this systematic bias is larger as climate change increases. The authors believe the approach explored here is a more suitable model for adoption in future integrated assessments of climate change

  9. A Framework for Operational Due Diligence in Mergers and Acquisitions

    DEFF Research Database (Denmark)

    Porsgaard, Chris Berg; Haubjerg, Mathias; Herbert-Hansen, Zaza Nadja Lee

    The number of mergers and acquisitions (M&As) has over the last five years increased greatly (Institute of Mergers, Acquisitions and Alliances, 2016). Furthermore, private equity professionals point to operational performance gains to drive an acquisition decision and attribute cost reductions...... as the most important lever for value creation, after a private equity firm acquires a company (PwC, 2016). However, the overall success rate of M&A activity remains low and the approach to understand an acquisition target’s operating model remains non-exhaustive and unstandardized. This paper investigates...... the pivotal eterminants for assessing operational performance and identifying improvement potentials in an acquisition target. The research question is: “What are the fundamental operational determinants influencing the acquisition decision for private equity firms in the due diligence phase?” This paper...

  10. Linear theory of beam depolarization due to vertical betatron motion

    International Nuclear Information System (INIS)

    Chao, A.W.; Schwitters, R.F.

    1976-06-01

    It is well known that vertical betatron motion in the presence of quantum fluctuations leads to some degree of depolarization of a transversely polarized beam in electron-positron storage rings even for energies away from spin resonances. Analytic formulations of this problem, which require the use of simplifying assumptions, generally have shown that there exist operating energies where typical storage rings should exhibit significant beam polarization. Due to the importance of beam polarization in many experiments, we present here a complete calculation of the depolarization rate to lowest order in the perturbing fields, which are taken to be linear functions of the betatron motion about the equilibrium orbit. The results are applicable to most high energy storage rings. Explicit calculations are given for SPEAR and PEP. 7 refs., 8 figs

  11. Does basal metabolic rate drive eating rate?

    Science.gov (United States)

    Henry, Christiani Jeyakumar; Ponnalagu, Shalini; Bi, Xinyan; Forde, Ciaran

    2018-05-15

    There have been recent advances in our understanding of the drivers of energy intake (EI). However, the biological drivers of differences in eating rate (ER) remain less clear. Studies have reported that the fat-free mass (FFM) and basal metabolic rate (BMR) are both major components that contribute to daily energy expenditure (EE) and drive EI. More recently, a number of observations report that higher ER can lead to greater EI. The current study proposed that adults with a higher BMR and higher energy requirements would also exhibit higher ERs. Data on BMR, FFM, and ER were collected from 272 Chinese adults (91 males and 181 females) in a cross-sectional study. Analysis showed significant positive associations between BMR and ER (r s  = 0.405, p BMR explained about 15% of the variation in ER which was taken to be metabolically significant. This association provides metabolic explanation that the differences in an individual's BMR (hence energy requirements) may be correlated with ERs. This merits further research. Copyright © 2018 Elsevier Inc. All rights reserved.

  12. Reduction of thermal quenching of biotite mineral due to annealing

    International Nuclear Information System (INIS)

    Kalita, J.M.; Wary, G.

    2014-01-01

    Graphical abstract: - Highlights: • Thermoluminescence of X-ray irradiate biotite was studied at various heating rates. • Thermal quenching was found to decrease with increase in annealing temperature. • Due to annealing one trap level was vanished and a new shallow trap level generated. • The new trap level contributes low thermally quenched thermoluminescence signal. - Abstract: Thermoluminescence (TL) of X-ray irradiated natural biotite annealed at 473, 573, 673 and 773 K were studied within 290–480 K at various linear heating rates (2, 4, 6, 8 and 10 K/s). A Computerized Glow Curve Deconvolution technique was used to study various TL parameters. Thermal quenching was found to be very high for un-annealed sample, however it decreased significantly with increase in annealing temperature. For un-annealed sample thermal quenching activation energy (W) and pre-exponential frequency factor (C) were found to be W = (2.71 ± 0.05) eV and C = (2.38 ± 0.05) × 10 12 s −1 respectively. However for 773 K annealed sample, these parameters were found to be W = (0.63 ± 0.03) eV, C = (1.75 ± 0.27) × 10 14 s −1 . Due to annealing, the initially present trap level at depth 1.04 eV was vanished and a new shallow trap state was generated at depth of 0.78 eV which contributes very low thermally quenched TL signal

  13. Rate of force development

    DEFF Research Database (Denmark)

    Maffiuletti, Nicola A; Aagaard, Per; Blazevich, Anthony J

    2016-01-01

    The evaluation of rate of force development during rapid contractions has recently become quite popular for characterising explosive strength of athletes, elderly individuals and patients. The main aims of this narrative review are to describe the neuromuscular determinants of rate of force devel...

  14. Extended rate equations

    International Nuclear Information System (INIS)

    Shore, B.W.

    1981-01-01

    The equations of motion are discussed which describe time dependent population flows in an N-level system, reviewing the relationship between incoherent (rate) equations, coherent (Schrodinger) equations, and more general partially coherent (Bloch) equations. Approximations are discussed which replace the elaborate Bloch equations by simpler rate equations whose coefficients incorporate long-time consequences of coherence

  15. Applications of Reaction Rate

    Science.gov (United States)

    Cunningham, Kevin

    2007-01-01

    This article presents an assignment in which students are to research and report on a chemical reaction whose increased or decreased rate is of practical importance. Specifically, students are asked to represent the reaction they have chosen with an acceptable chemical equation, identify a factor that influences its rate and explain how and why it…

  16. Neutron spectra due 13N production in a PET cyclotron

    International Nuclear Information System (INIS)

    Benavente, J.A.; Vega-Carrillo, H.R.; Lacerda, M.A.S.; Fonseca, T.C.F.; Faria, F.P.; Silva, T.A. da

    2015-01-01

    Monte Carlo and experimental methods have been used to characterize the neutron radiation field around PET (Positron Emission Tomography) cyclotrons. In this work, the Monte Carlo code MCNPX was used to estimate the neutron spectra, the neutron fluence rates and the ambient dose equivalent (H*(10)) in seven locations around a PET cyclotron during 13 N production. In order to validate these calculations, H*(10) was measured in three sites and were compared with the calculated doses. All the spectra have two peaks, one above 0.1 MeV due to the evaporation neutrons and another in the thermal region due to the room-return effects. Despite the relatively large difference between the measured and calculated H*(10) for one point, the agreement was considered good, compared with that obtained for 18 F production in a previous work. - Highlights: • MCNPX code was used to estimate the neutron spectra in a PET cyclotron. • Neutrons were estimated when 13 N is produced. • Neutron spectra show evaporation and room-return neutrons. • Calculated H*(10) were compared with measured H*(10)

  17. DNA fork displacement rates in human cells

    International Nuclear Information System (INIS)

    Kapp, L.N.; Painter, R.B.

    1981-01-01

    DNA fork displacement rates were measured in 20 human cell lines by a bromodeoxyuridine-313 nm photolysis technique. Cell lines included representatives of normal diploid, Fanconi's anemia, ataxia telangiectasia, xeroderma pigmentosum, trisomy-21 and several transformed lines. The average value for all the cell lines was 0.53 +- 0.08 μm/min. The average value for individual cell lines, however, displayed a 30% variation. Less than 10% of variation in the fork displacement rate appears to be due to the experimental technique; the remainder is probably due to true variation among the cell types and to culture conditions. (Auth.)

  18. DNA fork displacement rates in human cells

    Energy Technology Data Exchange (ETDEWEB)

    Kapp, L.N.; Painter, R.B. (California Univ., San Francisco (USA). Lab. of Radiobiology)

    1981-11-27

    DNA fork displacement rates were measured in 20 human cell lines by a bromodeoxyuridine-313 nm photolysis technique. Cell lines included representatives of normal diploid, Fanconi's anemia, ataxia telangiectasia, xeroderma pigmentosum, trisomy-21 and several transformed lines. The average value for all the cell lines was 0.53 +- 0.08 ..mu..m/min. The average value for individual cell lines, however, displayed a 30% variation. Less than 10% of variation in the fork displacement rate appears to be due to the experimental technique; the remainder is probably due to true variation among the cell types and to culture conditions.

  19. Falsely Elevated Plasma Creatinine Due to an Immunoglobulin M Paraprotein.

    Science.gov (United States)

    McGill, Mitchell R; Vijayan, Anitha; Trulock, Elbert P; Witt, Chad A; Kohler, Giselle D; Scott, Mitchell G

    2016-11-01

    The most common method for measuring plasma creatinine is based on its reaction with picric acid. However, enzymatic methods are becoming more popular due to improved specificity. We present a case of falsely elevated plasma creatinine values obtained by an enzymatic method that turned out to be due to a monoclonal immunoglobulin M (IgM) paraprotein. A 63-year-old woman evaluated for lung transplantation had falsely increased plasma creatinine levels (1.54-1.71mg/dL; corresponding to estimated glomerular filtration rates of 32-36 mL/min/1.73m 2 ) as measured by the Roche Creatinine plus enzymatic assay when compared with the picric acid-based procedure and several other enzymatic methods, which gave plasma creatinine values of 0.7 to 0.8mg/dL. Serum protein electrophoresis revealed an IgM κ light chain paraprotein. Removal of high-molecular-weight (>30kDa) proteins by ultrafiltration reduced the patient's plasma creatinine level by the Roche enzymatic method to 0.7mg/dL. Addition of the patient's immunoglobulin fraction to plasma from other patients with normal plasma creatinine levels resulted in values that were increased by 0.58 to 0.62mg/dL. Furthermore, removal of non-IgM immunoglobulins with protein G-coupled beads did not eliminate the interference from the patient's plasma. Taken together, these studies demonstrate that falsely elevated plasma creatinine values by the Roche enzymatic method can be due to an IgM paraprotein. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  20. Rating mutual funds

    DEFF Research Database (Denmark)

    Bechmann, Ken L.; Rangvid, Jesper

    2007-01-01

    We develop a new rating of mutual funds: the atpRating. The atpRating assigns crowns to each individual mutual fund based upon the costs an investor pays when investing in the fund in relation to what it would cost to invest in the fund's peers. Within each investment category, the rating assigns...... the return of a fund in a certain year generally contains only little information about the future return that the fund will generate. Finally, we have information on the investments in different mutual funds made by a small subgroup of investors known to have been exposed to both the atp...... five crowns to funds with the lowest costs and one crown to funds with the highest costs. We investigate the ability of the atpRating to predict the future performance of a fund. We find that an investor who has invested in the funds with the lowest costs within an investment category would have...

  1. Rating Mutual Funds

    DEFF Research Database (Denmark)

    Bechmann, Ken L.; Rangvid, Jesper

    We develop a new rating of mutual funds: the atpRating. The atpRating assigns crowns to each individual mutual fund based upon the costs an investor pays when investing in the fund in relation to what it would cost to invest in the fund’s peers. Within each investment category, the rating assigns......, whereas the return of a fund in a certain year generally contains only little information about the future return that the fund will generate. Finally, we have information on the investments in different mutual funds made by a small subgroup of investors known to have been exposed to both the atp...... five crowns to funds with the lowest costs and one crown to funds with the highest costs. We investigate the ability of the atpRating to predict the future performance of a fund. We find that an investor who has invested in the funds with the lowest costs within an investment category would have...

  2. Interest rates mapping

    Science.gov (United States)

    Kanevski, M.; Maignan, M.; Pozdnoukhov, A.; Timonin, V.

    2008-06-01

    The present study deals with the analysis and mapping of Swiss franc interest rates. Interest rates depend on time and maturity, defining term structure of the interest rate curves (IRC). In the present study IRC are considered in a two-dimensional feature space-time and maturity. Exploratory data analysis includes a variety of tools widely used in econophysics and geostatistics. Geostatistical models and machine learning algorithms (multilayer perceptron and Support Vector Machines) were applied to produce interest rate maps. IR maps can be used for the visualisation and pattern perception purposes, to develop and to explore economical hypotheses, to produce dynamic asset-liability simulations and for financial risk assessments. The feasibility of an application of interest rates mapping approach for the IRC forecasting is considered as well.

  3. Antipredator defenses predict diversification rates

    Science.gov (United States)

    Arbuckle, Kevin; Speed, Michael P.

    2015-01-01

    The “escape-and-radiate” hypothesis predicts that antipredator defenses facilitate adaptive radiations by enabling escape from constraints of predation, diversified habitat use, and subsequently speciation. Animals have evolved diverse strategies to reduce the direct costs of predation, including cryptic coloration and behavior, chemical defenses, mimicry, and advertisement of unprofitability (conspicuous warning coloration). Whereas the survival consequences of these alternative defenses for individuals are well-studied, little attention has been given to the macroevolutionary consequences of alternative forms of defense. Here we show, using amphibians as the first, to our knowledge, large-scale empirical test in animals, that there are important macroevolutionary consequences of alternative defenses. However, the escape-and-radiate hypothesis does not adequately describe them, due to its exclusive focus on speciation. We examined how rates of speciation and extinction vary across defensive traits throughout amphibians. Lineages that use chemical defenses show higher rates of speciation as predicted by escape-and-radiate but also show higher rates of extinction compared with those without chemical defense. The effect of chemical defense is a net reduction in diversification compared with lineages without chemical defense. In contrast, acquisition of conspicuous coloration (often used as warning signals or in mimicry) is associated with heightened speciation rates but unchanged extinction rates. We conclude that predictions based on the escape-and-radiate hypothesis must incorporate the effect of traits on both speciation and extinction, which is rarely considered in such studies. Our results also suggest that knowledge of defensive traits could have a bearing on the predictability of extinction, perhaps especially important in globally threatened taxa such as amphibians. PMID:26483488

  4. Years of potential life lost due to motorcycle accidents

    Directory of Open Access Journals (Sweden)

    Flávia Emília Cavalcante Valença Fernandes

    2017-05-01

    Full Text Available Introduction: Traffic accidents represent a serious public health problem, because they kill approximately 1.24 million persons annually, and leave another 20 to 50 million with non-fatal lesions and traumatisms worldwide. In Brazil, in the year 2011, motorcyclists alone were responsible for one third of these deaths. Therefore, the aim of this study was to estimate the years of potential life lost due to motorcycle accidents, according to sex and age group, and analyze the trend of the indicator for the state of Pernambuco in the period from 2005 to 2014. Methods and Results an ecological study based on data from the System of Information about Mortality was used. The indicator and rate were calculated by using the age limit of 70 years. The linear regression model and Kruskal-Wallis and Mann-Whitney tests were used, at the level of significance of 5% and confidence of 95%. The most affected sex and age-range were men between 20-29 years of age. The rates followed a trend of growth in both sexes, in the young population with the exception of those from 10 to 19 years of age. Conclusions: This context points out the magnitude and precociousness of motorcycle accidents in both sexes and the young population.

  5. Refractory Dysphonia Due to Isolated Cricothyroid Muscle Dystonia.

    Science.gov (United States)

    Kraft, Shannon; Childes, Jana; Hillel, Allen; Schindler, Joshua

    2016-07-01

    To demonstrate the utility of electromyography (EMG) in the evaluation and management of treatment-resistant dysphonia. We report a case of refractory dysphonia in which EMG was used to identify and treat isolated cricothyroid (CT) dystonia. The patient, a healthy 43-year-old woman, presented with 9 months of progressive hoarseness. Her symptoms were present across vocal tasks but were particularly bothersome while dictating. On presentation, her voice was rated grade 3, roughness 3, breathiness 1, asthenia 0, and strain 3 (G3R3B1A0S3). Videostroboscopy was remarkable for hyperfunction. Voice therapy was not beneficial despite appropriate effort. Microdirect laryngoscopy revealed no evidence of structural pathology. The patient was referred for EMG because of her normal examination and failure to improve with therapy. The CT muscle demonstrated an increased latency of 750 ms in all vocal tasks. One month after CT injection with 3 units of botulinum toxin (BTX), her voice was improved. Perceptual voice evaluation was rated G1R1B0A0S1. Voice Handicap Index improved from 87 to 35. In the absence of structural pathology, EMG can be a useful adjunct in the diagnosis of dysphonia that persists despite adequate trials of voice therapy. To our knowledge, this is the only report of laryngeal dystonia due to isolated CT dysfunction successfully treated with BTX. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  6. Decreased abundance of crustose coralline algae due to ocean acidification

    Science.gov (United States)

    Kuffner, Ilsa B.; Andersson, Andreas J; Jokiel, Paul L.; Rodgers, Ku'ulei S.; Mackenzie, Fred T.

    2008-01-01

    Owing to anthropogenic emissions, atmospheric concentrations of carbon dioxide could almost double between 2006 and 2100 according to business-as-usual carbon dioxide emission scenarios1. Because the ocean absorbs carbon dioxide from the atmosphere2, 3, 4, increasing atmospheric carbon dioxide concentrations will lead to increasing dissolved inorganic carbon and carbon dioxide in surface ocean waters, and hence acidification and lower carbonate saturation states2, 5. As a consequence, it has been suggested that marine calcifying organisms, for example corals, coralline algae, molluscs and foraminifera, will have difficulties producing their skeletons and shells at current rates6, 7, with potentially severe implications for marine ecosystems, including coral reefs6, 8, 9, 10, 11. Here we report a seven-week experiment exploring the effects of ocean acidification on crustose coralline algae, a cosmopolitan group of calcifying algae that is ecologically important in most shallow-water habitats12, 13, 14. Six outdoor mesocosms were continuously supplied with sea water from the adjacent reef and manipulated to simulate conditions of either ambient or elevated seawater carbon dioxide concentrations. The recruitment rate and growth of crustose coralline algae were severely inhibited in the elevated carbon dioxide mesocosms. Our findings suggest that ocean acidification due to human activities could cause significant change to benthic community structure in shallow-warm-water carbonate ecosystems.

  7. Shoulder Injury Incidence Rates in NASA Astronauts

    Science.gov (United States)

    Laughlin, Mitzi S.; Murray, Jocelyn D.; Foy, Millennia; Wear, Mary L.; Van Baalen, Mary

    2014-01-01

    Evaluation of the astronaut shoulder injury rates began with an operational concern at the Neutral Buoyancy Laboratory (NBL) during Extravehicular Activity (EVA) training. An astronaut suffered a shoulder injury during an NBL training run and commented that it was possibly due to a hardware issue. During the subsequent investigation, questions arose regarding the rate of shoulder injuries in recent years and over the entire history of the astronaut corps.

  8. River rating complexity

    Science.gov (United States)

    Holmes, Robert R.

    2016-01-01

    Accuracy of streamflow data depends on the veracity of the rating model used to derive a continuous time series of discharge from the surrogate variables that can readily be collected autonomously at a streamgage. Ratings are typically represented as a simple monotonic increasing function (simple rating), meaning the discharge is a function of stage alone, however this is never truly the case unless the flow is completely uniform at all stages and in transitions from one stage to the next. For example, at some streamflow-monitoring sites the discharge on the rising limb of the hydrograph is discernably larger than the discharge at the same stage on the falling limb of the hydrograph. This is the so-called “loop rating curve” (loop rating). In many cases, these loops are quite small and variation between rising- and falling-limb discharge measurements made at the same stage are well within the accuracy of the measurements. However, certain hydraulic conditions can produce a loop that is large enough to preclude use of a monotonic rating. A detailed data campaign for the Mississippi River at St. Louis, Missouri during a multi-peaked flood over a 56-day period in 2015 demonstrates the rating complexity at this location. The shifting-control method used to deal with complexity at this site matched all measurements within 8%.

  9. Assessing radiologic risk for population due to human activities

    International Nuclear Information System (INIS)

    Toma, Al.; Dulama, C.; Dobrin, R.; Hirica, O.

    2002-01-01

    The most important factor in assessing radiologic risk is ensuring scientific means for evaluation of the radioactive release impact upon humans and organisms. To evaluate quantitatively this impact not only knowledge of radioactivity distribution in these dynamical systems is necessary but also understanding the transfer mechanisms between ecosystem components is needed. Thus a complete radioecologic study appear to be very complex and needs defining the source term, dynamic description of radionuclides behavior in the ecosystem, estimation of radiation doses in the major components of the ecosystem and finally the effects of radiation doses upon different parts of the systems. A diagram of the steps implied in evaluation of the effects due to radioactive effluent release in the environment is presented and discussed. The following steps are described: - identification of radioactive sources, as well as their input rate. Presence of noxious materials such as heavy metals or some organic compounds should be taken into account to assess the synergetic or antagonistic interactions; - determination of space-time distribution of release radionuclides; - estimation of dose rates and radiation exposure of population; - estimation of radiation dose effects upon individuals, population and ecosystems. This fourth step implies: experimental field or laboratory studies to determine the somatic/genetic response to radiation as a function of the exposure dose; following-up and interpretation of the organism response to dose or dose rates in terms of radiation-induce changes in the population life cycles; forecasting the irradiation effects upon population or communities within environment. Finally, this evaluation is completed by the decision making process implying a society acceptance of the forecast and/or observed effects

  10. Throughput rate study

    International Nuclear Information System (INIS)

    Ford, L.; Bailey, W.; Gottlieb, P.; Emami, F.; Fleming, M.; Robertson, D.

    1993-01-01

    The Civilian Radioactive Waste Management System (CRWMS) Management and Operating (M ampersand O) Contractor, has completed a study to analyze system wide impacts of operating the CRWMS at varying throughput rates, including the 3000 MTU/year rate which has been assumed in the past. Impacts of throughput rate on all phases of the CRWMS operations (acceptance, transportation, storage and disposal) were evaluated. The results of the study indicate that a range from 3000 to 5000 MTU/year is preferred, based on system cost per MTU of SNF emplaced and logistics constraints

  11. Scoliosis associated with airflow obstruction due to endothoracic vertebral hump.

    Science.gov (United States)

    Ito, Kenyu; Kawakami, Noriaki; Miyasaka, Kazuyoshi; Tsuji, Taichi; Ohara, Tetsuya; Nohara, Ayato

    2012-12-01

    A retrospective clinical study of scoliosis-associated airflow obstruction due to endothoracic vertebral hump. The purpose of this study was to evaluate and present anatomical features of patients with scoliosis who showed airflow obstruction caused by endothoracic vertebral hump. It is well known that severe scoliosis causes airflow restriction due to thoracic cage deformity. There have been few reports of clinical data and anatomical features on scoliosis associated with airflow obstruction due to endothoracic vertebral hump. The subjects were 6 patients. The diagnoses were idiopathic scoliosis in 3 patients, symptomatic scoliosis in 2 patients, and thoracogenic scoliosis in 1 patient. The radiological outcome, comorbidities, pre- and postoperative respiratory function, and surgical complication were analyzed. Four patients had preoperative atelectasis on the convex side of the lower lobe and improved after the operations. All patients showed main thoracic curves and their apex was located at T7-T9. All patients had lordoscoliosis except 1, who demonstrated kyphosing scoliosis. The correction rate was 78% (62.8%-83.5%). Preoperative thoracic lordosis within the range of -5° to -47° was postoperatively corrected to a substantially normal kyphosis within the range of 9° to 24°. The average vital capacity, percent VC improved from 0.72 L (0.33-1.17 L) to 1.21 L (0.82-1.71 L) and 45.5% (37.3%- 50.8%) to 63.7% (41.0%-88.6%) relatively. Spine Penetration Index improved from 23% (18%-35%) to 16% (13%-19%). Endothoracic hump ratio improved from 1.34 (0.98-1.93) to 1.12 (0.86-1.28). Each patient with symptomatic scoliosis and thoracogenic scoliosis required relatively long periods of respiration management. Patients having lordoscoliosis with an apex located between T7 and T9 may develop airflow obstruction due to an endothoracic vertebral hump. Correction of lordoscoliosis through anterior and posterior approaches successfully improved endothoracic hump ratio and

  12. Chest Traumas due to Bicycle accident in Childhood

    Directory of Open Access Journals (Sweden)

    Ufuk Cobanoglu

    2011-09-01

    Full Text Available Aim:Childhood injuries are the leading cause of death in children and result in significant healthcare utilization. Trauma is the second most common cause of mortality in children aged 1-4 years and leading cause of death in children older than 4 years. Thoracic injury is the second most leading cause of death in traumatized children. Multisystemic injury is found in more than 50% of children with thoracic injuries most of which are secondary to blunt traumas. We planned this study to evaluate thorax trauma cases secondary to bicycle driving in childhood and to draw attention to the importance of the regulation of traffic rules, the education of bicycle drivers.Material and Methods:  A retrospective evaluation was performed in 17 pediatric patients admitted to the Department of Thoracic Surgery during 2006-2010 with a diagnosis of chest trauma due to bicycle driving. For every patient, a pediatric trauma score (PTS was calculated. Descriptive statistics were performed for PTS. Results; Eleven (64.70% cases were injured due to the tricycle accidents and six cases 6 (35.29% were injured due to the two-wheeled bicycle accidents. The most frequent thoracic pathologies included pulmonary contusion (41.2% and chest wall contusion (29.41%. Extrathoracic injuries were seen in 35.29%, the extremities (17.64% and abdomino pelvic (11.76% being the most commonly involved. Treatment consisted of symptomatic treatment in 12 patients (70.58%, tube thoracostomy in 2 patients (11.76%, and thoracotomy in 1 patient (5.9%. The morbidity was seen in 3 patients (17.64%. The mortality rate was 5.9% (n:1. The mean PTS of the cases who had additional system injuries were significantly worse than the cases who had isolated chest traumas Conclusions: The pediatric thorax has a greater cartilage content and incomplete ossification of the ribs. Due to the pliability of the pediatric rib cage and mediastinal mobility, significant intrathoracic injury may exist in the

  13. 76 FR 77581 - Interest Rates

    Science.gov (United States)

    2011-12-13

    ... SMALL BUSINESS ADMINISTRATION Interest Rates The Small Business Administration publishes an interest rate called the optional ``peg'' rate (13 CFR 120.214) on a quarterly basis. This rate is a.... This rate may be used as a base rate for guaranteed fluctuating interest rate SBA loans. This rate will...

  14. 77 FR 76586 - Interest Rates

    Science.gov (United States)

    2012-12-28

    ... SMALL BUSINESS ADMINISTRATION Interest Rates The Small Business Administration publishes an interest rate called the optional ``peg'' rate (13 CFR 120.214) on a quarterly basis. This rate is a.... This rate may be used as a base rate for guaranteed fluctuating interest rate SBA loans. This rate will...

  15. 76 FR 18821 - Interest Rates

    Science.gov (United States)

    2011-04-05

    ... SMALL BUSINESS ADMINISTRATION Interest Rates The Small Business Administration publishes an interest rate called the optional ``peg'' rate (13 CFR 120.214) on a quarterly basis. This rate is a.... This rate may be used as a base rate for guaranteed fluctuating interest rate SBA loans. This rate will...

  16. 78 FR 18664 - Interest Rates

    Science.gov (United States)

    2013-03-27

    ... SMALL BUSINESS ADMINISTRATION Interest Rates The Small Business Administration publishes an interest rate called the optional ``peg'' rate (13 CFR 120.214) on a quarterly basis. This rate is a.... This rate may be used as a base rate for guaranteed fluctuating interest rate SBA loans. This rate will...

  17. 75 FR 81326 - Interest Rates

    Science.gov (United States)

    2010-12-27

    ... SMALL BUSINESS ADMINISTRATION Interest Rates The Small Business Administration publishes an interest rate called the optional ``peg'' rate (13 CFR 120.214) on a quarterly basis. This rate is a.... This rate may be used as a base rate for guaranteed fluctuating interest rate SBA loans. This rate will...

  18. 77 FR 39560 - Interest Rates

    Science.gov (United States)

    2012-07-03

    ... SMALL BUSINESS ADMINISTRATION Interest Rates The Small Business Administration publishes an interest rate called the optional ``peg'' rate (13 CFR 120.214) on a quarterly basis. This rate is a.... This rate may be used as a base rate for guaranteed fluctuating interest rate SBA loans. This rate will...

  19. 75 FR 37872 - Interest Rates

    Science.gov (United States)

    2010-06-30

    ... SMALL BUSINESS ADMINISTRATION Interest Rates The Small Business Administration publishes an interest rate called the optional ``peg'' rate (13 CFR 120.214) on a quarterly basis. This rate is a.... This rate may be used as a base rate for guaranteed fluctuating interest rate SBA loans. This rate will...

  20. 77 FR 20476 - Interest Rates

    Science.gov (United States)

    2012-04-04

    ... SMALL BUSINESS ADMINISTRATION Interest Rates The Small Business Administration publishes an interest rate called the optional ``peg'' rate (13 CFR 120.214) on a quarterly basis. This rate is a.... This rate may be used as a base rate for guaranteed fluctuating interest rate SBA loans. This rate will...