WorldWideScience

Sample records for replacement requirements experience

  1. Replacing reserve requirements

    OpenAIRE

    Edward J. Stevens

    1993-01-01

    An examination of the fading significance of the Federal Reserve System's reserve requirements and the recent flowering of required clearing balances, a rapidly growing feature of Reserve Bank operations.

  2. Replacing reserve requirements

    OpenAIRE

    Edward J. Stevens

    1993-01-01

    An examination of the fading significance of the Federal Reserve System's reserve requirements and the recent flowering of required clearing balances, a rapidly growing feature of Reserve Bank operations.

  3. Fluid replacement requirements in soccer.

    Science.gov (United States)

    Maughan, R J; Leiper, J B

    1994-01-01

    Soccer is an endurance sport that consists of moderate activity levels interspersed with intermittent high-intensity bursts, leading to high rates of metabolic heat production. Even when the weather is cold, significant sweat loss will occur, leading to a degree of dehydration which impairs exercise performance. Fluid intake before and during the game will provide water to reduce the degree of dehydration and can also supply carbohydrate to supplement the body's limited carbohydrate stores. Dilute carbohydrate-electrolyte drinks are most effective for rehydration. The optimum formulation will vary between individuals and will also depend on climatic conditions. Players should be encouraged to experiment with fluid intake during training to identify the type of drink and the amount and frequency of drinks that best meet their needs.

  4. [Animal experiment, can we replace?

    Science.gov (United States)

    Combrisson, H

    2017-09-01

    Animal experiment is a subject of controversies. Some people, defenders of animals, think that it is not acceptable to use for scientific purposes at the risk of making them suffer or assert that the results obtained with animals are not transposable in the human beings. Others, in particular researchers in biology or medicine, think that the animal models are essential for the biomedical search. This confrontation of the opinions bases largely on an evolution of the place of animals in our society. The regulations authorize the use of animals for scientific purposes but oblige to make it under restrictive conditions. The application of 3Rs - replacement, reduction, and refinement - expressed in 1959 by Russel and Burch is an ethical guide to improve the welfare of animals in research. The alternative methods do not allow, in the present state of the knowledge, to answer all the scientific questions in biology and medicine research. They are, most of the time, complementary methods of the in vivo methods. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  5. The Scandinavian Total Ankle Replacement and the ideal biomechanical requirements of ankle replacements.

    Science.gov (United States)

    Robati, Shibby; Salih, Alan; Ghosh, Koushik; Vinayakam, Parthiban

    2016-03-01

    The complex anatomy of the articular bone surfaces, ligaments, tendon attachments and muscles makes the ankle joint difficult to replicate in prosthetic replacements. Ever since the early 1970s, which saw the dawn of the first total ankle replacements, there have been numerous other attempts at replicating the joint, often with poor clinical outcomes. The anatomy of the ankle is discussed, followed by evidence of the normal ankle biomechanics and the ideal requirements of an ankle replacement. We focus on the Scandinavian Total Ankle Replacement and evaluate whether these requirements have been met.

  6. Total ankle replacement. Early experiences with STAR prosthesis.

    Science.gov (United States)

    Murnaghan, J. M.; Warnock, D. S.; Henderson, S. A.

    2005-01-01

    Early designs of Total Ankle Replacement (TAR) had a high failure rate. More recent experience with the 3-piece, meniscal bearing, total ankle replacement has been more promising. We report a review of the early results of our first 22 prostheses in 20 patients undergoing Scandinavian Total Ankle Replacement (STAR) in Northern Ireland. There was a mean follow-up time of 26 months. Seventeen patients are pain-free at the ankle joint during normal daily activities. Two of the early cases have required revision surgery due to technical errors. Other complications have included malleolar fractures, poor wound healing and postoperative stiffness. These early results show high levels of patient satisfaction, and we are encouraged to continue with total ankle arthroplasty. There is a steep initial learning curve and use of TAR should be restricted to foot and ankle surgeons. Images Fig 1 Figs 2a and b Figs 2 c and d PMID:16022128

  7. Valve replacement in pediatric patients:a single center experience

    Institute of Scientific and Technical Information of China (English)

    YU Jian-hua; GUO Hong-wei; ZHANG Gong; WU Shu-ming; SONG Guang-min; SUN Wen-yu

    2011-01-01

    Background Reconstructive surgery is the primary goal in pediatric patients with valve disease.However,in cases with irreparable valve lesions,valve replacement is the only option.This study aimed to retrospectively analyze the clinical experience of heart valve prosthesis replacement in children.Methods Between January 1990 and July 2009,35 pediatric patients (16 boys,19 girls) underwent mechanical valve replacement in Shandong University Qilu Hospital.The ages ranged from 2.5 to 14 years (mean,(8.8±3.8) years) and body weight varied from 11 to 37 kg (mean,(22.1±5.2) kg).Mechanical valve replacement was performed because of congenital heart disease in 23 patients,rheumatic disease in ten patients and infective endocarditis in two patients.St.Jude bileaflet mechanical valves were implanted in all the 35 patients including mitral valve replacement (MVR) in 18,aortic valve replacement (AVR) in 12,tricuspid valve replacement (TVR) in two,AVR and MVR in two and MVR and TVR in one.The size of the prostheses ranged between 19 and 27 mm.All patients received long-term anticoagulation treatment with sodium warfarin,aiming to maintain an international normalized ratio between 1.5 to 2.0.Follow-up was performed in all the patients with a total follow-up of 119.4 patient-years.Results The operative mortality was 8.57% (3/35).One patient,who underwent cardiac debridement and AVR,died 2 hours after being admitted to the intensive care unit because of severe low cardiac output syndrome and ventricular fibrillation.Two patients died of cardiogenic shock and renal failure during initial hospitalization after the operation.One patient who received replacement of a tricuspid valve developed complete heart block requiring temporary pacing and recovered sinus rhythm 4 days later.Thirty-two patients survived and their cardiac function was in New York Heart Association (NYHA) class Ⅰ to class Ⅱ when discharged.Late events included hemorrhage and endocarditis.Two patients required

  8. Our Experience with Patello femoral joint replacement

    Science.gov (United States)

    Ramos, Pablo; Arteaga, Gonzalo; Vargas, Medardo; Naranjo, Juan

    2017-01-01

    Background: Ten to fifteen percent of knee arthritis is reported to be isolated patellofemoral arthritis. Total knee arthroplasty is not recommended for isolated patella femoral arthritis particularly in young patients. We present the retrospective review our series in 7 years. Objectives: The aim of this presentation is to describe our experience in the management of patellofemoral osteoarthritis with the use of the partial patellofemoral arthroplasty, as well as to delineate the pitfalls and causes of revision in our initial series of 153 cases. Methods: between 2009 and 2016, our group performed 157 patellofemoral arthroplasties (PFA) 74% being in women, and 26% in men, the mean age for women was 58 yrs. And 38 yrs. for men, our initial 13 cases were managed with the Avon prosthesis (Stryker Corporation Kalamazoo, Michigan), and then we switched to the Vanguard PF (Zimmer-Biomet Warsaw In), both systems are an On-Lay design that is more flexible for addressing dysplastic trochleas that are more common in our population. Results: We performed a Knee Osteoarthritis Outcome Score (KOOS) for the assessment of the success of the procedure and obtained 87% of patients with excellent results (95 to 100), 10% with fair results (70 to 90) and 3% with poor outcomes (50), we performed a total of 3 revisions due to pain or progress to global arthritis. Conclusion: The PFA is a successful, safe and reproducible surgery that can be used in the group of patients that have isolated patellofemoral osteoarthritis. It requires a thorough knowledge of the patello femoral joint biomechanics, and physiopathology.

  9. Effects and patients' experiences of interactive video-based physiotherapy at home after shoulder joint replacement

    OpenAIRE

    Eriksson, Lisbeth

    2009-01-01

    Physiotherapy is essential to optimize the results of shoulder joint replacement, but requires a close monitoring and co-operation between patient and physiotherapist. The development of telerehabilitation brings opportunities for distance-spanning and home-based physiotherapy interventions. The aim of this thesis is to explore effects and to describe experiences among patients participating in interactive video-based physiotherapy at home after shoulder joint replacement. A series of 22 pati...

  10. Relapsing hypocupraemic myelopathy requiring high‐dose oral copper replacement

    OpenAIRE

    Prodan, C.I.; Bottomley, S S; Holland, N R; Lind, S. E.

    2006-01-01

    Adult‐onset copper deficiency with neurological manifestations is a newly recognised syndrome. Long‐term oral copper replacement therapy has been the mainstay of treatment in the literature. A case of relapsing hypocupraemic myelopathy responsive to increased doses of copper replacement is reported. Standard doses of copper may not be sufficient for all patients.

  11. Our Experience with Short Stem Hip Replacement Surgery

    Directory of Open Access Journals (Sweden)

    Sumeet Rastogi

    2016-07-01

    Full Text Available Context- A short anatomical metaphyseal femoral stem is a desirable hip implant for bone and soft tissue preserving hip replacing surgery in young arthritic patients. Physiological loading of the proximal femur prevents stress shielding and preserves bone stock of the femur in the long run. Thus it is an ideal hip implant suited for conservative hip surgeries in active young adults with arthritic hips. Materials and methods- 50 Proxima hip replacements were performed on 41 patients with a mean age of 45 over a 3-year period (between July 2006 and September 2009. Diagnosis of hip pathologies varied from osteoarthritis secondary to avascular necrosis, rheumatoid arthritis, post-tubercular arthritis to dysplastic hips. 9 of these patients had symptomatic bilateral hip involvement and underwent bilateral hip replacement in a single sitting. All patient had a Proxima metaphyseal stem implantation( DePuy, Warsaw with either a large diameter metal on metal or pinnacle articulation. Clinical and radiological evaluation was done at 3 months, 6 months, 1 year and then yearly thereafter. Statiscal analysis used- VAS and Harris hip score formed the basis of evaluation Results- These patients were followed up for a mean period of 49 months (Range 36-72 months. The average incision size was 14.38 cm (10-18 cm and blood loss was 269 ml (175-450 ml. There was no peri-operative mortality or serious morbidity in any patients. One patient had an intraoperative lateral cortex crack that required only delayed rehabilitation. Five of the 41 patients (12.1 % had complications with three recovering completely and one requiring revision of femoral stem for aseptic loosening. One patient was lost in follow-up. Harris hip score improved from 52 to 89.3 at last follow-up. Overall 95.1% (39/41 patients had an excellent outcome at last follow-up. Conclusion- We conclude that Proxima metaphyseal stem provided clinically and radiologically stable fixation through snug fit

  12. Replacement

    Directory of Open Access Journals (Sweden)

    S. Radhakrishnan

    2014-03-01

    Full Text Available The fishmeal replaced with Spirulina platensis, Chlorella vulgaris and Azolla pinnata and the formulated diet fed to Macrobrachium rosenbergii postlarvae to assess the enhancement ability of non-enzymatic antioxidants (vitamin C and E, enzymatic antioxidants (superoxide dismutase (SOD and catalase (CAT and lipid peroxidation (LPx were analysed. In the present study, the S. platensis, C. vulgaris and A. pinnata inclusion diet fed groups had significant (P < 0.05 improvement in the levels of vitamins C and E in the hepatopancreas and muscle tissue. Among all the diets, the replacement materials in 50% incorporated feed fed groups showed better performance when compared with the control group in non-enzymatic antioxidant activity. The 50% fishmeal replacement (best performance diet fed groups taken for enzymatic antioxidant study, in SOD, CAT and LPx showed no significant increases when compared with the control group. Hence, the present results revealed that the formulated feed enhanced the vitamins C and E, the result of decreased level of enzymatic antioxidants (SOD, CAT and LPx revealed that these feeds are non-toxic and do not produce any stress to postlarvae. These ingredients can be used as an alternative protein source for sustainable Macrobrachium culture.

  13. Preliminary Experience with a New Total Distal Radioulnar Joint Replacement

    Science.gov (United States)

    Ewald, Timothy J.; Skeete, Kshamata; Moran, Steven L.

    2012-01-01

    This study reports the intermediate-term results of four patients from a series eight patients who have had an insertion of a new complete distal radioulnar joint (DRUJ) prosthesis. A retrospective review was performed for all patients who underwent DRUJ joint replacement with the STABILITY Sigmoid Notch Total DRUJ System between the years of 2003 and 2008. To be included in this report, all patients had to have more than 24 months of follow-up and hand examination by the senior author. From the eight patients with this procedure, four patients met the inclusion criteria. These included one patient with painful posttraumatic arthritis, two patients with failed hemiarthroplasty, and one patient with a failed Sauvé–Kapandji procedure. Mean age at the time of surgery was 42.5 years (range: 35 to 51 years) and mean follow-up was 46 months (range: 36 to 66 months). Preoperative and postoperative assessment included range of motion, grip strength, visual analog pain scale, patient satisfaction, and radiographic evaluation. There was a successful replacement of the DRUJ in all four patients. Final range of motion showed mean pronation of 80 degrees (range: 60 to 90 degrees) and mean supination of 64 degrees (range: 45 to 90 degrees). Final grip strength on the operated extremity was 25.5 kg and averaged 73% of contralateral side. This was an improvement from preoperative grip strength of 14.5 kg visual analog pain scale decreased from 8 to 2.5 following surgery (scale: 1 to 10). Patient satisfaction was 100%. One patient returned to manual labor, one patient returned to office work, and two patients remained off work. Postoperative radiographs depict appropriate alignment of the DRUJ, and there have been no cases of subluxation or dislocation. Implant survival has been 100%. Total DRUJ joint replacement with sigmoid notch resurfacing and distal ulna replacement is an alternative to ulnar head resection in cases of DRUJ arthritis. Total DRUJ arthroplasty with this

  14. Patients' experiences of telerehabilitation at home after shoulder joint replacement.

    Science.gov (United States)

    Eriksson, Lisbeth; Lindström, Britta; Ekenberg, Lilly

    2011-01-01

    We investigated the experience of ten patients who received video-based physiotherapy at home for two months after a shoulder joint replacement. Videoconferencing took place via the patient's home broadband connection at a bandwidth of 256-768 kbit/s. Qualitative interviews were carried out, transcribed and analysed. Through qualitative content analysis six categories were identified: (1) a different reinforced communication; (2) pain-free exercising as an effective routine; (3) from a dependent patient to a strengthened person at home; (4) closeness at a distance; (5) facilitated daily living; and (6) continuous physiotherapy chain. The access to bodily knowledge, continuity, collaboration and being at home were all aspects that contributed to the patients' recovery. The patients described experiences of safety, and strengthening during their daily exercise routine at home. The frequent interplay with the patient during telerehabilitation made it possible for the physiotherapist to make an individual judgement about each patient; this could be one reason for the positive findings. Home video-based physiotherapy may be useful in other kinds of physiotherapy.

  15. Experiments with Replacement of Inverter Fed Drives in a Danish Power Station

    DEFF Research Database (Denmark)

    Lunow, Morten Erlandsson; Rønne-Hansen, Peter; Holbøll, Joachim;

    2006-01-01

    Maintaining low voltage inverter fed drives in operation can often require complete replacement of both the frequency converter and the induction motor. This paper presents a case with refurbishment of 13 years old drives, where the owner wanted to keep the old motors and only replace the frequen...

  16. 14 CFR 63.55 - Experience requirements.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Experience requirements. 63.55 Section 63.55 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRMEN CERTIFICATION: FLIGHT CREWMEMBERS OTHER THAN PILOTS Flight Navigators § 63.55 Experience...

  17. Renal Replacement Therapy in Congestive Heart Failure Requiring Left Ventricular Assist Device Augmentation

    OpenAIRE

    Thomas, Bernadette A.; Logar, Christine M.; Anderson, Arthur E.

    2012-01-01

    “Cardiorenal syndrome” is a term used to describe a dys-regulation of the heart affecting the kidneys, or vice versa, in an acute or chronic manner (1,2). Renal impairment can range from reversible ischemic damage to renal failure requiring short- or long-term renal replacement therapy (2). Patients who require mechanical circulatory support, such as a left ventricular assist device (LVAD), as definitive treatment for congestive heart failure or as a bridge to cardiac transplantation pose a u...

  18. Patient experiences of recovery after heart valve replacement: suffering weakness, struggling to resume normality

    DEFF Research Database (Denmark)

    Berg, Selina Kikkenborg; Zwisler, Ann-Dorthe; Pedersen, Birthe D.;

    2013-01-01

    Heart valve disease is becoming a public health problem due to increasing life expectancy and new treatment methods. Patients are at risk of developing depression, anxiety or post-traumatic stress disorder after heart valve surgery. To better plan proper care, describing and understanding patients......' perception of recovery after heart valve replacement is essential. The objective was to describe the experience of recovery at home after heart valve replacement....

  19. A new model to predict acute kidney injury requiring renal replacement therapy after cardiac surgery

    Science.gov (United States)

    Pannu, Neesh; Graham, Michelle; Klarenbach, Scott; Meyer, Steven; Kieser, Teresa; Hemmelgarn, Brenda; Ye, Feng; James, Matthew

    2016-01-01

    Background: Acute kidney injury after cardiac surgery is associated with adverse in-hospital and long-term outcomes. Novel risk factors for acute kidney injury have been identified, but it is unknown whether their incorporation into risk models substantially improves prediction of postoperative acute kidney injury requiring renal replacement therapy. Methods: We developed and validated a risk prediction model for acute kidney injury requiring renal replacement therapy within 14 days after cardiac surgery. We used demographic, and preoperative clinical and laboratory data from 2 independent cohorts of adults who underwent cardiac surgery (excluding transplantation) between Jan. 1, 2004, and Mar. 31, 2009. We developed the risk prediction model using multivariable logistic regression and compared it with existing models based on the C statistic, Hosmer–Lemeshow goodness-of-fit test and Net Reclassification Improvement index. Results: We identified 8 independent predictors of acute kidney injury requiring renal replacement therapy in the derivation model (adjusted odds ratio, 95% confidence interval [CI]): congestive heart failure (3.03, 2.00–4.58), Canadian Cardiovascular Society angina class III or higher (1.66, 1.15–2.40), diabetes mellitus (1.61, 1.12–2.31), baseline estimated glomerular filtration rate (0.96, 0.95–0.97), increasing hemoglobin concentration (0.85, 0.77–0.93), proteinuria (1.65, 1.07–2.54), coronary artery bypass graft (CABG) plus valve surgery (v. CABG only, 1.25, 0.64–2.43), other cardiac procedure (v. CABG only, 3.11, 2.12–4.58) and emergent status for surgery booking (4.63, 2.61–8.21). The 8-variable risk prediction model had excellent performance characteristics in the validation cohort (C statistic 0.83, 95% CI 0.79–0.86). The net reclassification improvement with the prediction model was 13.9% (p < 0.001) compared with the best existing risk prediction model (Cleveland Clinic Score). Interpretation: We have developed

  20. IEC 61850 interoperability : user requirements and implementation experiences

    Energy Technology Data Exchange (ETDEWEB)

    Dawidczak, H.; Englert, H. [Siemens AG, Nurnberg (Germany)

    2009-07-01

    IEC 61850 edition 1 was published in 2004 as the global standard for communication networks and systems for power utility automation. As of 2010, there were over 100,000 Siemens intelligent electronic devices (IEDs) with IED 61850 interface in operation. This presentation discussed the IEC 61850 situation in Germany. Specific topics that were addressed included German transmission system operators (TSOs) and the high standardization of layouts and processes; the introduction of IEC 61850 as more than just a replacement; a working group of the German National Committee set up to design an object data model of an example substation with the substation configuration language IEC 61850; and German experiences and resulting requirements. The presentation provided a definition of interoperability as being the ability of two or more IEDs from the same vendor, or different vendors, to exchange information and use that information for correct co-operation. Interchangeability was defined as the ability to replace a device supplied by one manufacturer with a device supplied by another manufacturer, without making changes to the other elements in the system. The presentation concluded with a discussion of resulting engineering and testing by replacement of IED with a different object addressing scheme. figs.

  1. Aortic valve replacement with cryopreserved aortic allograft: ten-year experience.

    Science.gov (United States)

    Doty, J R; Salazar, J D; Liddicoat, J R; Flores, J H; Doty, D B

    1998-02-01

    Cryopreserved aortic allograft can be used for aortic valve replacement in congenital, rheumatic, degenerative, and infected native valve conditions, as well as failed prosthetic valves. This study was conducted to determine the long-term results of aortic valve replacement with cryopreserved aortic allografts. Aortic valve replacement with cryopreserved aortic allografts was performed in 117 patients from July 1985 until August 1996. All patients requiring aortic valve replacement regardless of valve disease were considered for allograft replacement; the valve was preferentially used in patients under age 55 years and in the setting of bacterial endocarditis. Four operative techniques involving cryopreserved aortic allografts were used: freehand aortic valve replacement with 120-degree rotation, freehand aortic valve replacement with intact noncoronary sinus, aortic root enlargement with intact noncoronary sinus, and total aortic root replacement. Valve function was assessed by echocardiography during the operation in 78 patients (66%) and after the operation in 77 patients (65%). One-hundred eighteen aortic valve replacements with cryopreserved aortic allografts were performed on 117 patients; mean age was 45.6 years (range 15 to 83 years) and mean follow-up was 4.6 years (range up to 11 years). Intraoperative echocardiography disclosed no significant aortic valve incompetence. There were four operative deaths (3%) and seven late deaths; freedom from valve-related mortality at 10 years was 9:3% +/- 4.55%. New York Heart Association functional status at latest follow-up was normal in 98 (94%) patients. On postoperative echocardiography, 90% had no or trivial aortic valve incompetence. Freedom from thromboembolism at 10 years was 100% and from endocarditis, 98% +/- 2.47%. Seven (6%) patients required valve explantation, four for structural deterioration. At 10 years, freedom from reoperation for allograft-related causes was 92% +/- 3.47%. Aortic valve replacement

  2. Early postpartum mitral valve thrombosis requiring extra corporeal membrane oxygenation before successful valve replacement.

    Science.gov (United States)

    Halldorsdottir, H; Nordström, J; Brattström, O; Sennström, M M; Sartipy, U; Mattsson, E

    2016-05-01

    Pregnancy is associated with an increased risk of thrombosis in women with mechanical prosthetic heart valves. We present the case of a 29-year-old woman who developed early postpartum mitral valve thrombus after an elective cesarean delivery. The patient had a mechanical mitral valve and was treated with warfarin in the second trimester, which was replaced with high-dose dalteparin during late pregnancy. Elective cesarean delivery was performed under general anesthesia at 37weeks of gestation. The patient was admitted to the intensive care unit for postoperative care and within 30min she developed dyspnea and hypoxia requiring mechanical ventilation. She deteriorated rapidly and developed pulmonary edema, worsening hypoxia and severe acidosis. Urgent extra corporeal membrane oxygenation was initiated. Transesophageal echocardiography revealed a mitral valve thrombus. The patient underwent a successful mitral valve replacement after three days on extra corporeal membrane oxygenation. This case highlights the importance of multidisciplinary care and frequent monitoring of anticoagulation during care of pregnant women with prosthetic heart valves.

  3. [Disseminated intravascular coagulation and acute kidney injury requiring renal replacement therapy after diagnostic amniocentesis].

    Science.gov (United States)

    Ratković, Marina; Bašić-Jukić, Nikolina; Gledović, Branka; Radunović, Danilo

    2014-04-01

    Disseminated intravascular coagulation (DIC) is a very rare complication of amniocentesis. We present a case of a 33-year-old patient who developed DIC with acute respiratory distress syndrome and acute kidney injury after diagnostic amniocentesis. The patient required replacement of renal function for 59 days with continuous venovenous hemodiafiltration and later with hemodialysis. She was treated with heparin, fresh frozen plasma, platelets and cryoprecipitate. Her condition was further complicated with the development of intracranial hematoma. After 67 days of hospitalization, she was discharged from the hospital with serum creatinine 337 μmol/L. Three years later, her serum creatinine was 102 μmol/L, and she is currently in the 7th month of pregnancy.

  4. Belle-II Experiment Network Requirements

    Energy Technology Data Exchange (ETDEWEB)

    Asner, David [Pacific Northwest National Laboratory (PNNL), Richland, WA (United States); Bell, Greg [ESnet; Carlson, Tim [Pacific Northwest National Laboratory (PNNL), Richland, WA (United States); Cowley, David [Pacific Northwest National Laboratory (PNNL), Richland, WA (United States); Dart, Eli [ESnet; Erwin, Brock [Pacific Northwest National Laboratory (PNNL), Richland, WA (United States); Godang, Romulus [Univ. of South Alabama, Mobile, AL (United States); Hara, Takanori [High Energy Accelerator Research Organization (KEK), Tsukuba (Japan); Johnson, Jerry [Pacific Northwest National Laboratory (PNNL), Richland, WA (United States); Johnson, Ron [Univ. of Washington, Seattle, WA (United States); Johnston, Bill [ESnet; Dam, Kerstin Kleese-van [Pacific Northwest National Laboratory (PNNL), Richland, WA (United States); Kaneko, Toshiaki [High Energy Accelerator Research Organization (KEK), Tsukuba (Japan); Kubota, Yoshihiro [NII; Kuhr, Thomas [Karlsruhe Inst. of Technology (KIT) (Germany); McCoy, John [Pacific Northwest National Laboratory (PNNL), Richland, WA (United States); Miyake, Hideki [High Energy Accelerator Research Organization (KEK), Tsukuba (Japan); Monga, Inder [ESnet; Nakamura, Motonori [NII; Piilonen, Leo [Virginia Polytechnic Inst. and State Univ. (Virginia Tech), Blacksburg, VA (United States); Pordes, Ruth [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States); Ray, Douglas [Pacific Northwest National Laboratory (PNNL), Richland, WA (United States); Russell, Richard [Pacific Northwest National Laboratory (PNNL), Richland, WA (United States); Schram, Malachi [Pacific Northwest National Laboratory (PNNL), Richland, WA (United States); Schroeder, Jim [Pacific Northwest National Laboratory (PNNL), Richland, WA (United States); Sevior, Martin [Univ. of Melbourne (Australia); Singh, Surya [Pacific Northwest National Laboratory (PNNL), Richland, WA (United States); Suzuki, Soh [High Energy Accelerator Research Organization (KEK), Tsukuba (Japan); Sasaki, Takashi [High Energy Accelerator Research Organization (KEK), Tsukuba (Japan); Williams, Jim [Indiana Univ., Bloomington, IN (United States)

    2013-05-28

    The Belle experiment, part of a broad-based search for new physics, is a collaboration of ~400 physicists from 55 institutions across four continents. The Belle detector is located at the KEKB accelerator in Tsukuba, Japan. The Belle detector was operated at the asymmetric electron-positron collider KEKB from 1999-2010. The detector accumulated more than 1 ab-1 of integrated luminosity, corresponding to more than 2 PB of data near 10 GeV center-of-mass energy. Recently, KEK has initiated a $400 million accelerator upgrade to be called SuperKEKB, designed to produce instantaneous and integrated luminosity two orders of magnitude greater than KEKB. The new international collaboration at SuperKEKB is called Belle II. The first data from Belle II/SuperKEKB is expected in 2015. In October 2012, senior members of the Belle-II collaboration gathered at PNNL to discuss the computing and neworking requirements of the Belle-II experiment with ESnet staff and other computing and networking experts. The day-and-a-half-long workshop characterized the instruments and facilities used in the experiment, the process of science for Belle-II, and the computing and networking equipment and configuration requirements to realize the full scientific potential of the collaboration's work.

  5. replacement of the heart of the CMS experiment - the pixel #detector. Part2

    CERN Multimedia

    Brice, Maximilien

    2017-01-01

    This week, one of the Large Hadron Collider’s experiments gets a “heart transplant”. --- Physicists and engineers are replacing the heart of the CMS experiment - the pixel #detector. This will improve CMS’s ability to make precise measurements on aspects of the Standard Model, including the properties of the #HiggsBoson. The #LHC and its experiments are currently preparing to wake up this spring, when the accelerator will begin to collide particles once more at close to the speed of light. --- Today at 12:15 CET, join us live on #Facebook and ask us anything: https://www.facebook.com/cern/

  6. replacement of the heart of the CMS experiment - the pixel #detector.

    CERN Multimedia

    AUTHOR|(CDS)2070299

    2017-01-01

    This week, one of the Large Hadron Collider’s experiments gets a “heart transplant”. --- Physicists and engineers are replacing the heart of the CMS experiment - the pixel #detector. This will improve CMS’s ability to make precise measurements on aspects of the Standard Model, including the properties of the #HiggsBoson. The #LHC and its experiments are currently preparing to wake up this spring, when the accelerator will begin to collide particles once more at close to the speed of light. --- Today at 12:15 CET, join us live on #Facebook and ask us anything: https://www.facebook.com/cern/

  7. Enhancing team-based active learning through hands-on experience with nicotine replacement therapy.

    Science.gov (United States)

    Franks, Andrea S

    2013-08-12

    To enhance tobacco cessation active-learning in an ambulatory care elective course by adding hands-on experience with nicotine replacement therapy to a team-based learning (TBL) session. A hands-on experience that included students chewing a piece of nicotine gum was added to a TBL class session. Student pairs used a skills checklist to evaluate and give peer feedback on appropriate counseling and gum use. Students' scores on a tobacco cessation examination were higher than those of students enrolled in the previous course in which TBL alone had been used. Based on pre- and post-experience survey responses, students' perceptions regarding their abilities to provide tobacco cessation counseling improved. Subjective student comments regarding the experience were positive. Participating in a TBL session that incorporated hands-on experience with nicotine gum in an ambulatory care elective course increased students' confidence in their ability to provide tobacco cessation counseling and provided a unique perspective on the product's characteristics.

  8. The CREAM-CE First experiences, results and requirements of the four LHC experiments

    CERN Document Server

    Mendez Lorenzo, P; Sciaba, A; Thackray, N; Shiers, J; Renshall, H; Sgaravatto, M; Padhi, S

    2010-01-01

    In terms of the gLite middleware, the current LCG-CE used by the four LHC experiments is about to be deprecated. The new CREAM-CE service (Computing Resource Execution And Management) has been approved to replace the previous service. CREAM-CE is a lightweight service created to handle job management operations at the CE level. It is able to accept requests both via the gLite WMS service and also via direct submission for transmission to the local batch system. This flexible duality provides the experiments with a large level of freedom to adapt the service to their own computing models, but at the same time it requires a careful follow up of the requirements and tests of the experiments to ensure that their needs are fulfilled before real data taking. In this paper we present the current testing results of the four LHC experiments concerning this new service. The operations procedures, which have been elaborated together with the experiment support teams will be discussed. Finally, the experiments requiremen...

  9. The patient's experience of temporary paralysis from spinal anaesthesia, a part of total knee replacement.

    Science.gov (United States)

    Bager, Louise; Konradsen, Hanne; Dreyer, Pia Sander

    2015-12-01

    The aim of this study was to describe the meaning of being temporary paralysed from spinal anaesthesia when undergoing total knee replacement. Total knee arthroplasty is a common procedure, and regional anaesthesia is used as a method for anaesthetising the patient. The experience is highly individual in substance and duration, and it can extend far beyond care settings as intraoperative care and the postanaesthesia care unit that have been investigated so far. A qualitative phenomenological hermeneutic design was chosen to gain a deeper understanding of the experience of spinal anaesthesia, as a part of having a total knee replacement. Twelve patients were interviewed in March 2014 after undergoing an elective total knee arthroplasty under spinal anaesthesia. The interviews were analysed with a Ricoeur-inspired interpretation method. Three themes were derived from the interviews: 'anaesthesia--an unavoidable necessity', 'an unrecognisable and incomprehensible body' and 'the body returns--joy and agony'. The results reveal that trust in the health care personnel and knowledge of the course of events play a key role in the experience. The trust can be breached by unforeseen events, or if the patient's experiences were not taken into account. The ability of the health care personnel to be in contact, share relevant knowledge with- and compensate for the patient is crucial in the prevention of negative experiences. The results of this study contribute to insights and deeper knowledge that can enhance staff's ability to provide care for patients undergoing total knee arthroplasty in spinal anaesthesia. The results provide perspectives that argue for care in accordance to individual needs. © 2015 John Wiley & Sons Ltd.

  10. The articular surface replacement implant recall: a United Kingdom district hospital experience.

    Science.gov (United States)

    Whitwell, George S; Shine, Ashokan; Young, Steve K

    2012-01-01

    We present our experience of the articular surface replacement (ASR) hip and the implant recall process. One hundred and twenty-one ASR components were implanted (21 resurfacing hip arthroplasty (RHA) and 100 ASR/XL modular total hip replacements). At the time of the implant recall in August 2010 there were 111 surviving hips (92%) with a mean follow-up of 44 months. Nine hips had been revised and one had been listed for revision surgery. Ninety-two percent of surviving implants were reviewed in the recall clinics, and blood metal ion levels or ultrasound scans were indicated in 38 hips (34%). Immediately after the recall process seven hips (6 ASR/XL and 1 RHA) were listed for revision and a further 9 were kept under close surveillance. One year after completion of the recall process 23 hips (19 ASR/XL and 4 RHA's) had been revised. A diagnosis of adverse reaction to metal debris (ARMD) was made at surgery in all but two hips. Our current revision rate for ASR RHA is 19% (mean follow-up 62 months, range 29-80) and for the ASR/XL is 19% (mean follow-up 53 months, range 10-80). The 5-year cumulative survival rates with revision for any reason for the ASR/XL, was 80.8% (95% confidence interval 72.0 - 89.5). Given experience elsewhere we expect this rate may increase significantly with time.

  11. Laboratory prediction of the requirement for renal replacement in acute falciparum malaria

    NARCIS (Netherlands)

    Hanson, J.; Hasan, M.M.U.; Royakkers, A.A.; Alam, S.; Charunwatthana, P.; Maude, R.J.; Douthwaite, S.T.; Yunus, E.B.; Mantha, M.L.; Schultz, M.J.; Faiz, M.A.; White, N.J.; Day, N.P.; Dondorp, A.M.

    2011-01-01

    Acute renal failure is a common complication of severe malaria in adults, and without renal replacement therapy (RRT), it carries a poor prognosis. Even when RRT is available, delaying its initiation may increase mortality. Earlier identification of patients who will need RRT may improve outcomes. P

  12. The short stem GHEs in total hip replacementexperience after 380 implantations

    Directory of Open Access Journals (Sweden)

    Ghanem, Mohamed

    2013-11-01

    Full Text Available Introduction: Standard straight stems have been recognized as a gold standard implant in the field of hip replacement surgery. However, lately uncemented bone-preserving short stems started to gain more and more popularity. This was reflected in the increasing variety of available models. Up till now, short and mid-term results are available.Patients and methods: In 2002, the cementless short stemmed GHEs was introduced. 380 patients were included in our study between 2002 and 2008. Only GHEs short stems were implanted. The clinical and radiological evaluations were performed in the Orthopaedic Department, Leipzig University Hospitals, on the average of 24 months (3 to 60 months postoperatively.Results: 365 primary implantations and 15 revision implantations were carried out. Average age 60 years. Favourable clinical and radiological outcome was seen in 361/380 patients (95%. Postoperative complications were seen in 19/380 patients (5%: 8 fissures/fractures (2.1%, 5 infections (1.3%, 4 aseptic loosenings (1.1%, 2 dislocations (0.5%.Conclusions: Short stem implants, including our own experience with GHEs model, are satisfying and promising. They represent a valuable supplementation of the treatment modalities in hip replacement surgery. However, long term results are still awaited.

  13. Health status, renal function, and quality of life after multiorgan failure and acute kidney injury requiring renal replacement therapy

    Directory of Open Access Journals (Sweden)

    Faulhaber-Walter R

    2016-05-01

    Full Text Available Robert Faulhaber-Walter,1,2 Sebastian Scholz,1,3 Herrmann Haller,1 Jan T Kielstein,1,* Carsten Hafer1,4,* 1Department of Renal and Hypertensive Disease, Medical School Hannover, Hannover, Germany; 2Facharztzentrum Aarberg, Waldshut-Tiengen, Germany; 3Sanitaetsversorgungszentrum Wunstorf, Wunstorf, Germany; 4HELIOS Klinikum Erfurt, Erfurt, Germany *These authors contributed equally to this work Background: Critically ill patients with acute kidney injury (AKI in need of renal replacement therapy (RRT may have a protracted and often incomplete rehabilitation. Their long-term outcome has rarely been investigated. Study design: Survivors of the HANnover Dialysis OUTcome (HANDOUT study were evaluated after 5 years for survival, health status, renal function, and quality of life (QoL. The HANDOUT study had examinded mortality and renal recovery of patients with AKI receiving either standard extendend or intensified dialysis after multi organ failure. Results: One hundred fifty-six former HANDOUT participants were analyzed. In-hospital mortality was 56.4%. Five-year survival after AKI/RRT was 40.1% (86.5% if discharged from hospital. Main causes of death were cardiovascular complications and sepsis. A total of 19 survivors presented to the outpatient department of our clinic and had good renal recovery (mean estimated glomerular filtration rate 72.5±30 mL/min/1.73 m2; mean proteinuria 89±84 mg/d. One person required maintenance dialysis. Seventy-nine percent of the patients had a pathological kidney sonomorphology. The Charlson comorbidity score was 2.2±1.4 and adjusted for age 3.3±2.1 years. Numbers of comorbid conditions averaged 2.38±1.72 per patient (heart failure [52%] > chronic kidney disease/myocardial infarction [each 29%]. Median 36-item short form health survey (SF-36™ index was 0.657 (0.69 physical health/0.66 mental health. Quality-adjusted life-years after 5 years were 3.365. Conclusion: Mortality after severe AKI is higher than

  14. 41 CFR 102-74.570 - Are State and local governments required to fund the cost of installing, repairing, and replacing...

    Science.gov (United States)

    2010-07-01

    ... Replacing Sidewalks § 102-74.570 Are State and local governments required to fund the cost of installing... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Are State and local governments required to fund the cost of installing, repairing, and replacing sidewalks? 102-74.570...

  15. The structure-specific endonuclease Ercc1–Xpf is required for targeted gene replacement in embryonic stem cells

    Science.gov (United States)

    Niedernhofer, Laura J.; Essers, Jeroen; Weeda, Geert; Beverloo, Berna; de Wit, Jan; Muijtjens, Manja; Odijk, Hanny; Hoeijmakers, Jan H.J.; Kanaar, Roland

    2001-01-01

    The Ercc1–Xpf heterodimer, a highly conserved structure-specific endonuclease, functions in multiple DNA repair pathways that are pivotal for maintaining genome stability, including nucleotide excision repair, interstrand crosslink repair and homologous recombination. Ercc1–Xpf incises double-stranded DNA at double-strand/single-strand junctions, making it an ideal enzyme for processing DNA structures that contain partially unwound strands. Here we demonstrate that although Ercc1 is dispensable for recombination between sister chromatids, it is essential for targeted gene replacement in mouse embryonic stem cells. Surprisingly, the role of Ercc1–Xpf in gene targeting is distinct from its previously identified role in removing nonhomologous termini from recombination intermediates because it was required irrespective of whether the ends of the DNA targeting constructs were heterologous or homologous to the genomic locus. Our observations have implications for the mechanism of gene targeting in mammalian cells and define a new role for Ercc1–Xpf in mammalian homologous recombination. We propose a model for the mechanism of targeted gene replacement that invokes a role for Ercc1–Xpf in making the recipient genomic locus receptive for gene replacement. PMID:11707424

  16. Digital Resolution Requirements for Replacing Text-Based Material: Methods for Benchmarking Image Quality. Tutorial.

    Science.gov (United States)

    Kenney, Anne R.; Chapman, Stephen

    This tutorial provides a means to estimate resolution requirements for the use of digital imaging technology in converting text-based material. It is suggested that benchmarks for resolution can be calculated by evaluating the physical attributes of source documents and by applying Quality Index formulas that have been derived from those…

  17. Repair, Replace or Throw Away: Linking Sustainment Strategies to Data Requirements

    Science.gov (United States)

    2015-02-01

    Automobile A complete description of OSA requirements and implications is beyond this article’s scope. However, a familiar scenario— the choice of...a failing alternator—component 1.2.2.1.6 in Figure 1. In principle, a car owner who notices such indicators can either buy a brand new car or...on the day the car was purchased. For an automobile , access to essential information—and permission to use it—will depend not only on the

  18. Ophthalmic experience over 10 years in an observational nationwide Danish cohort of Fabry patients with access to enzyme replacement

    DEFF Research Database (Denmark)

    Fledelius, Hans C.; Sandfeld, Lisbeth; Rasmussen, Åse Krogh

    2015-01-01

    PURPOSE: Enzyme replacement therapy (ERT) was offered from year 2001 to patients with Fabry disease. The ophthalmic experience was analysed, as part of a general 10-year status. METHODS: A retrospective observational series comprising 39 patients (25 females, 14 males) closely followed by the end...

  19. Synthesis of Hollow Gold-Silver Alloyed Nanoparticles: A "Galvanic Replacement" Experiment for Chemistry and Engineering Students

    Science.gov (United States)

    Jenkins, Samir V.; Gohman, Taylor D.; Miller, Emily K.; Chen, Jingyi

    2015-01-01

    The rapid academic and industrial development of nanotechnology has led to its implementation in laboratory teaching for undergraduate-level chemistry and engineering students. This laboratory experiment introduces the galvanic replacement reaction for synthesis of hollow metal nanoparticles and investigates the optical properties of these…

  20. Synthesis of Hollow Gold-Silver Alloyed Nanoparticles: A "Galvanic Replacement" Experiment for Chemistry and Engineering Students

    Science.gov (United States)

    Jenkins, Samir V.; Gohman, Taylor D.; Miller, Emily K.; Chen, Jingyi

    2015-01-01

    The rapid academic and industrial development of nanotechnology has led to its implementation in laboratory teaching for undergraduate-level chemistry and engineering students. This laboratory experiment introduces the galvanic replacement reaction for synthesis of hollow metal nanoparticles and investigates the optical properties of these…

  1. Life without methyl bromide: the Italian experience in replacing the fumigant.

    Science.gov (United States)

    Gullino, M L; Clini, C; Garibaldi, A

    2005-01-01

    Methyl bromide (MB) has been the most widely used chemical for the fumigation of soil, commodities, buildings and furniture for over seventy years. Since January 1st 2005, it has been phased-out in industrialized countries, where only critical uses are allowed, because of international regulatory measures designed to reduce substances that potentially deplete the stratospheric ozone layer. Italy ranked second in the world, after USA, in MB consumption, due to the importance of horticultural crop production. In order to replace the use of MB, research in Italy was aimed at: a) reducing the use of MB and its emission (short-term goal); b) developing alternative pest control methods, based on available technologies (mid-term goal); c) developing new MB alternatives (mid- and long-term goal). Italian growers switched to other fumigants, applied at reduced dosages, lowering their environmental impact and risk of worker exposure. Moreover, the adoption of non-chemical alternatives slowly but steadily increased as a result of the many activities (demonstration trials, seminars, etc.) carried out in the country. The gradual shift to MB alternatives over a 10 year period, as well as the use of half rates of MB under virtually impermeable plastic films (VIFs), has generally prevented the feared loss of competitiveness of Italian horticulture. Extension in cooperation with the fumigation companies was able to provide growers with a range of methods for soil disinfestation. The experience gained in Italy and how it can help developing countries to define strategies and training programmes needed to comply with the Montreal Protocol is discussed.

  2. Acute Renal Replacement Therapy in Children with Diarrhea-Associated Hemolytic Uremic Syndrome: A Single Center 16 Years of Experience

    Directory of Open Access Journals (Sweden)

    Silviu Grisaru

    2011-01-01

    Full Text Available Acute kidney injury (AKI is becoming more prevalent among hospitalized children, its etiologies are shifting, and new treatment modalities are evolving; however, diarrhea-associated hemolytic uremic syndrome (D+HUS remains the most common primary disease causing AKI in young children. Little has been published about acute renal replacement therapy (ARRT and its challenges in this population. We describe our single center's experience managing 134 pediatric patients with D+HUS out of whom 58 (43% required ARRT over the past 16 years. In our cohort, all but one patient were started on peritoneal dialysis (PD. Most patients, 47 (81%, received acute PD on a pediatric inpatient ward. The most common recorded complications in our cohort were peritoneal fluid leaks 13 (22%, peritonitis 11 (20%, and catheter malfunction 5 (9%. Nine patients (16% needed surgical revision of their PD catheters. There were no bleeding events related to PD despite a mean platelets count of 40.9 (±23.5 × 103/mm3 and rare use of platelets infusions. Despite its methodological limitations, this paper adds to the limited body of evidence supporting the use of acute PD as the primary ARRT modality in children with D+HUS.

  3. "Not a replacement": emotional experiences and practical consequences of Israeli second couplehood stepfamilies constructed in old age.

    Science.gov (United States)

    Koren, Chaya; Lipman-Schiby, Sharon

    2014-12-01

    The increase in life expectancy enhances phenomena such as second couplehood in old age following widowhood or divorce as an alternative way of coping with changes that occur with aging. Research on the phenomenon has focused mainly on individual and dyadic perspectives of the repartnered. The aim of this article was to explore repartnering from the stepfamily's perspective, which has scarcely been studied. Nineteen Israeli stepfamilies (38 multigenerational families) were recruited using criterion sampling, of men who repartnered at age 65+ and women at 60+, with children and grandchildren from a lifelong marriage that ended in widowhood or divorce. We audio-recorded and transcribed verbatim 107 semi-structured, qualitative interviews with older partners, their adult children, and grandchildren. Analysis was based on grounded theory and dyadic analysis principles adapted to families. It showed how repartnering in old age changed the family structure, constructing complex stepfamilies, which require further study. Emotional experiences refer to repartnering being a replacement for couplehood but not for parenthood/grandparenthood. Practical consequences refer to "knowing their place" within the stepfamily and included the following subthemes: showing affection; participating in memorials for the deceased spouse; sharing, listening, and assisting. Findings are discussed regarding life course and family life cycle perspectives.

  4. Influence of changes in the pulmonary artery pressure on ventilation requirements in patients undergoing mitral valve replacement.

    Directory of Open Access Journals (Sweden)

    Muralidhar K

    2004-01-01

    Full Text Available The study was designed to evaluate the influence of changes in pulmonary artery pressure on the ventilation requirements in patients undergoing mitral valve surgery. Thirty patients with mitral valve disease with significant pulmonary arterial hypertension undergoing mitral valve replacement under cardiopulmonary bypass were included in this prospective study. All patients had a pulmonary artery catheter placed after the anaesthetic induction. The minute ventilation was adjusted to achieve an arterial carbon dioxide tension (PaCO2 of 35-40 mm Hg. After a stabilisation period of 15 minutes, the pulmonary artery pressure and the minute volume needed for maintaining a PaCO2 of 35-40 mm Hg in the precardiopulmonary bypass, post-cardiopulmonary bypass and six hours postoperatively were measured after ensuring stable haemodynamics and normothermia. There was a significant decrease in the mean pulmonary artery pressure from pre-cardiopulmonary bypass value of 41.3+/-15 mm Hg to 29.3+/-8 mm Hg in the postcardiopulmonary bypass period and subsequently to 25.5+/-7 mm Hg in the intensive care unit. There was a corresponding increase in the minute volume requirements from a pre-cardiopulmonary bypass value of 6.8+/-1 L/min to 8.0+/-1 L/min in the post cardiopulmonary bypass period and then to 9.4+/-1.2 L/min in the postoperative period. We conclude that there is a significant decrease in the pulmonary blood volume and a subsequent decrease in the pulmonary artery pressure after a successful mitral valve replacement in patients with pulmonary arterial hypertension. This is associated with a significant increase in the requirement of minute ventilation to maintain normocarbia.

  5. Characteristics and Outcomes of Granulomatosis With Polyangiitis (Wegener) and Microscopic Polyangiitis Requiring Renal Replacement Therapy: Results From the European Renal Association-European Dialysis and Transplant Association Registry

    NARCIS (Netherlands)

    Hruskova, Z.; Stel, V.S.; Jayne, D.; Aasarod, K.; Meester, J. de; Ekstrand, A.; Eller, K.; Heaf, J.G.; Hoitsma, A.J.; Jimenez, C. Martos; Ravani, P.; Wanner, C.; Tesar, V.; Jager, K.J.

    2015-01-01

    BACKGROUND: This study describes the incidence and outcomes of European patients requiring renal replacement therapy (RRT) for kidney failure due to antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). STUDY DESIGN: Cohort study. SETTING & PARTICIPANTS: 12 renal registries providi

  6. "Permanent" records: experience with data migration in radiology information system and picture archiving and communication system replacement.

    Science.gov (United States)

    Behlen, F M; Sayre, R E; Weldy, J B; Michael, J S

    2000-05-01

    In the replacement of both a radiology information system (RIS) and a picture archiving and communication system (PACS) archive, data were migrated from the prior system to the new system. We report on the process, the time and resources required, and the fidelity of data transfer. We find that for two PACS archives, both organized according to the Digital Imaging and Communications in Medicine (DICOM) information model, data may be transferred with full fidelity, but the time required for transfer is significant. Transfer from off-line backup media was found to be faster than transfer from our robotic tape library. In contrast, the RIS replacement required extensive labor to translate prior data between dissimilar information models, and some data were inevitably lost in the translation. Standards for RIS information models are needed to promote the migration of data without loss of content.

  7. Pulmonary Valve Replacement : Twenty-Six Years of Experience With Mechanical Valvar Prostheses

    NARCIS (Netherlands)

    Freling, Hendrik G.; van Slooten, Ymkje J.; van Melle, Joost P.; Ebels, Tjark; Hoendermis, Elke S.; Berger, Rolf M. F.; Hillege, Hans L.; Waterbolk, Tjalling W.; van Veldhuisen, Dirk J.; Willems, Tineke P.; Pieper, Petronella G.

    2015-01-01

    BACKGROUND: Although the thromboembolic risk after pulmonary valve replacement (PVR) with mechanical valves is presumed to be high, recent studies suggest promising short-term and mid-term results. However, large studies reporting long-term mortality and valve-related complications are missing. METH

  8. The patient's experience of temporary paralysis from spinal anaesthesia, a part of total knee replacement

    DEFF Research Database (Denmark)

    Bager, Louise; Konradsen, Hanne; Dreyer, Pia Sander

    2015-01-01

    AIMS AND OBJECTIVES: The aim of this study was to describe the meaning of being temporary paralysed from spinal anaesthesia when undergoing total knee replacement. BACKGROUND: Total knee arthroplasty is a common procedure, and regional anaesthesia is used as a method for anaesthetising the patien...

  9. Acute Renal Replacement Therapy in Children with Diarrhea-Associated Hemolytic Uremic Syndrome: A Single Center 16 Years of Experience

    OpenAIRE

    Silviu Grisaru; Morgunov, Melissa A.; Samuel, Susan M.; Julian P Midgley; Wade, Andrew W; Tee, James B.; Hamiwka, Lorraine A.

    2011-01-01

    Acute kidney injury (AKI) is becoming more prevalent among hospitalized children, its etiologies are shifting, and new treatment modalities are evolving; however, diarrhea-associated hemolytic uremic syndrome (D+HUS) remains the most common primary disease causing AKI in young children. Little has been published about acute renal replacement therapy (ARRT) and its challenges in this population. We describe our single center's experience managing 134 pediatric patients with D+HUS out of whom 5...

  10. Cardiac-surgery associated acute kidney injury requiring renal replacement therapy. A Spanish retrospective case-cohort study

    Directory of Open Access Journals (Sweden)

    Garcia-Fernandez Nuria

    2009-09-01

    Full Text Available Abstract Background Acute kidney injury is among the most serious complications after cardiac surgery and is associated with an impaired outcome. Multiple factors may concur in the development of this disease. Moreover, severe renal failure requiring renal replacement therapy (RRT presents a high mortality rate. Consequently, we studied a Spanish cohort of patients to assess the risk factors for RRT in cardiac surgery-associated acute kidney injury (CSA-AKI. Methods A retrospective case-cohort study in 24 Spanish hospitals. All cases of RRT after cardiac surgery in 2007 were matched in a crude ratio of 1:4 consecutive patients based on age, sex, treated in the same year, at the same hospital and by the same group of surgeons. Results We analyzed the data from 864 patients enrolled in 2007. In multivariate analysis, severe acute kidney injury requiring postoperative RRT was significantly associated with the following variables: lower glomerular filtration rates, less basal haemoglobin, lower left ventricular ejection fraction, diabetes, prior diuretic treatment, urgent surgery, longer aortic cross clamp times, intraoperative administration of aprotinin, and increased number of packed red blood cells (PRBC transfused. When we conducted a propensity analysis using best-matched of 137 available pairs of patients, prior diuretic treatment, longer aortic cross clamp times and number of PRBC transfused were significantly associated with CSA-AKI. Patients requiring RRT needed longer hospital stays, and suffered higher mortality rates. Conclusion Cardiac-surgery associated acute kidney injury requiring RRT is associated with worse outcomes. For this reason, modifiable risk factors should be optimised and higher risk patients for acute kidney injury should be identified before undertaking cardiac surgery.

  11. The iDuo Bi-compartmental Knee Replacement: Our Early Experience.

    Directory of Open Access Journals (Sweden)

    Peter Jemmett

    2016-12-01

    Our early results suggest that the iDuo knee is a good option for those with isolated bi-compartmental disease and outcome scores are comparable with those reported for the BKA. This bi-compartmental design may bridge the gap between the uni-compartmental and total knee replacement. The choice between monolithic or modular designs remains in debate. We will continue to use this prosthesis for a carefully selected group of patients.

  12. Replacing penalties

    Directory of Open Access Journals (Sweden)

    Vitaly Stepashin

    2017-01-01

    Full Text Available УДК 343.24The subject. The article deals with the problem of the use of "substitute" penalties.The purpose of the article is to identify criminal and legal criteria for: selecting the replacement punishment; proportionality replacement leave punishment to others (the formalization of replacement; actually increasing the punishment (worsening of legal situation of the convicted.Methodology.The author uses the method of analysis and synthesis, formal legal method.Results. Replacing the punishment more severe as a result of malicious evasion from serving accused designated penalty requires the optimization of the following areas: 1 the selection of a substitute punishment; 2 replacement of proportionality is serving a sentence other (formalization of replacement; 3 ensuring the actual toughening penalties (deterioration of the legal status of the convict. It is important that the first two requirements pro-vide savings of repression in the implementation of the replacement of one form of punishment to others.Replacement of punishment on their own do not have any specifics. However, it is necessary to compare them with the contents of the punishment, which the convict from serving maliciously evaded. First, substitute the punishment should assume a more significant range of restrictions and deprivation of certain rights of the convict. Second, the perfor-mance characteristics of order substitute the punishment should assume guarantee imple-mentation of the new measures.With regard to replacing all forms of punishment are set significant limitations in the application that, in some cases, eliminates the possibility of replacement of the sentence, from serving where there has been willful evasion, a stricter measure of state coercion. It is important in the context of the topic and the possibility of a sentence of imprisonment as a substitute punishment in cases where the original purpose of the strict measures excluded. It is noteworthy that the

  13. Epidemiologic trends in chronic renal replacement therapy over forty years: A Swiss dialysis experience

    Directory of Open Access Journals (Sweden)

    Lehmann Petra

    2012-07-01

    Full Text Available Abstract Background Long term longitudinal data are scarce on epidemiological characteristics and patient outcomes in patients on maintenance dialysis, especially in Switzerland. We examined changes in epidemiology of patients undergoing renal replacement therapy by either hemodialysis or peritoneal dialysis over four decades. Methods Single center retrospective study including all patients which initiated dialysis treatment for ESRD between 1970 and 2008. Analyses were performed for subgroups according to dialysis vintage, based on stratification into quartiles of date of first treatment. A multivariate model predicting death and survival time, using time-dependent Cox regression, was developed. Results 964 patients were investigated. Incident mean age progressively increased from 48 ± 14 to 64 ± 15 years from 1st to 4th quartile (p  Discussion We document an increase of a predominantly elderly incident and prevalent dialysis population, with progressively shortened survival after initiation of renal replacement over four decades, and, nevertheless, a prolonged lifespan. Analysis of the data is limited by lack of information on comorbidity in the study population. Conclusions Survival in patients on renal replacement therapy seems to be affected not only by medical and technical advances in dialysis therapy, but may mostly reflect progressively lower mortality of individuals with cardiovascular and metabolic complications, as well as a policy of accepting older and polymorbid patients for dialysis in more recent times. This is relevant to make demographic predictions in face of the ESRD epidemic nephrologists and policy makers are facing in industrialized countries.

  14. Lactate clearance is associated with mortality in septic patients with acute kidney injury requiring continuous renal replacement therapy

    Science.gov (United States)

    Passos, Rogério da Hora; Ramos, Joao Gabriel Rosa; Gobatto, André; Mendonça, Evandro José Bulhões; Miranda, Eva Alves; Dutra, Fábio Ricardo Dantas; Coelho, Maria Fernanda R; Pedroza, Andrea C; Batista, Paulo Benigno Pena; Dutra, Margarida Maria Dantas

    2016-01-01

    Abstract The aim of the study was to assess the clinical utility of lactate measured at different time points to predict mortality at 48 hours and 28 days in septic patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). Consecutive critically ill patients with septic AKI requiring CRRT were prospectively studied. Variables were collected at initiation of CRRT and 24 hours later. In total, 186 patients were analyzed. Overall mortality at 48 hours was 28% and at 28 days was 69%. Initial lactate, lactate at 24 hours and the proportion of patients with a lactate clearance superior to 10% were different between survivors at 28 days [2.0 mmol/L, 1.95 mmol/L and 18/45 (40%)] and nonsurvivors [3.46 mmol, 4.66 mmol, and 18/94 (19%)]. Multivariate analysis demonstrated that lactate at 24 hours and lactate clearance, but not initial lactate, were independently associated to mortality. Area under the ROC curves for 28-day mortality was 0.635 for initial lactate; 0.828 for lactate at 24 hours and 0.701 for lactate clearance. Lactate clearance and lactate after 24 hours of CRRT, but not initial lactate, were independently associated with mortality in septic AKI patients undergoing CRRT. Serial lactate measurements may be useful prognostic markers than initial lactate in these patients. PMID:27749594

  15. Motion analysis of total cervical disc replacements using computed tomography: Preliminary experience with nine patients and a model

    Energy Technology Data Exchange (ETDEWEB)

    Svedmark, Per (Div. of Orthopedics, Dept. of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm (Sweden); Stockholm Spine Center, Lowenstromska Hospital, Stockholm (Sweden)), email: per.svedmark@spinecenter.se; Lundh, Fredrik; Olivecrona, Henrik (Div. of Orthopedics, Dept. of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm (Sweden)); Nemeth, Gunnar (Capio group, Stockholm (Sweden)); Noz, Marilyn E. (Dept. of Radiology, New York Univ. School of Medicine, New York (United States)); Maguire Jr, Gerald Q. (School of Information and Communication Technology, Royal Inst. of Technology, Kista (Sweden)); Zeleznik, Michael P. (Saya Systems Inc., Salt Lake City (United States))

    2011-12-15

    Background. Cervical total disc replacement (CTDR) is an alternative to anterior fusion. Therefore, it is desirable to have an accurate in vivo measurement of prosthetic kinematics and assessment of implant stability relative to the adjacent vertebrae. Purpose. To devise an in vivo CT-based method to analyze the kinematics of cervical total disc replacements (CTDR), specifically of two prosthetic components between two CT scans obtained under different conditions. Material and Methods. Nine patients with CTDR were scanned in flexion and extension of the cervical spine using a clinical CT scanner with a routine low-dose protocol. The flexion and extension CT volume data were spatially registered, and the prosthetic kinematics of two prosthetic components, an upper and a lower, was calculated and expressed in Euler angles and orthogonal linear translations relative to the upper component. For accuracy analysis, a cervical spine model incorporating the same disc replacement as used in the patients was also scanned and processed in the same manner. Results. Analysis of both the model and patients showed good repeatability, i.e. within 2 standard deviations of the mean using the 95% limits of agreement with no overlapping confidence intervals. The accuracy analysis showed that the median error was close to zero. Conclusion. The mobility of the cervical spine after total disc replacement can be effectively measured in vivo using CT. This method requires an appropriate patient positioning and scan parameters to achieve suitable image quality

  16. 5. Mitral valve replacement for mitral stenosis: 15 years single center experience

    Directory of Open Access Journals (Sweden)

    A. Arifi

    2016-07-01

    Full Text Available Mitral valve replacement (MVR with either a bioprosthetic or a mechanical valve is the treatment of choice for severe mitral stenosis. This study aimed to evaluate and compare the early and late outcome of mitral valve replacement (mechanical versus bioprosthetic for severe mitral stenosis. A retrospective cohort study was performed on prospectively collected data involving mitral stenosis patients who have undergone MVR with either bioprosthetic (BMV (n = 50 or mechanical (MMV (n = 145 valves in our institute from 1999 to 2012. Data were analyzed for early and late mortality, NYHA functional classes, stroke, early and late valve-related complications, and survival. Chi Square test, logistic regression, Kaplan Meier curve, and dependent proportions tests were performed. A total of 195 patients were included in the study with a follow-up of 190 patients (97.5%. One patient died early post-operatively; twelve patients died late in the post-operative period, BMV group (6 and the MMV (6. The Late mortality had significantly associated with post-op stroke (p < 0.001 and post-op NYHA classes III and IV (p = 0.002. Post-op NYHA class was significantly associated with age (p = 0.003, pulmonary disease (p = 0.02, mitral valve implant type (p = 0.01, and post-op stroke (p = 0.02; 14 patients had strokes in the MMV (9 and in the BMV (5 groups. NYHA classes were significantly better after the replacement surgeries (p < 0.001. Bioprosthetic valves were significantly associated with worse survival (p = 0.03, worse NYHA post-op (p = 0.01, and more re-operations (p = 0.006. Survival was significantly better with mechanical valves (p = 0.03. When the two groups were matched for age and mitral regurgitation, the analysis revealed that bioprosthetic valves were significantly associated with re-operations (p = 0.02 but not significantly associated with worse survival (p = 0.4 or worse NYHA (p = 0.4. Mechanical mitral valve

  17. Prediction of Long-term Post-operative Testosterone Replacement Requirement Based on the Pre-operative Tumor Volume and Testosterone Level in Pituitary Macroadenoma

    OpenAIRE

    Cheng-Chi Lee; Chung-Ming Chen; Shih-Tseng Lee; Kuo-Chen Wei; Ping-Ching Pai; Cheng-Hong Toh; Chi-Cheng Chuang

    2015-01-01

    Non-functioning pituitary macroadenomas (NFPAs) are the most prevalent pituitary macroadenomas. One common symptom of NFPA is hypogonadism, which may require long-term hormone replacement. This study was designed to clarify the association between the pre-operative tumor volume, pre-operative testosterone level, intraoperative resection status and the need of long-term post-operative testosterone replacement. Between 2004 and 2012, 45 male patients with NFPAs were enrolled in this prospective...

  18. 14 CFR 65.83 - Recent experience requirements.

    Science.gov (United States)

    2010-01-01

    ... (CONTINUED) AIRMEN CERTIFICATION: AIRMEN OTHER THAN FLIGHT CREWMEMBERS Mechanics § 65.83 Recent experience requirements. A certificated mechanic may not exercise the privileges of his certificate and rating unless...) He has, for at least 6 months— (1) Served as a mechanic under his certificate and rating;...

  19. Population dynamics of the species Plantago major L. and Poa annua L. in a replacement series experiment

    Directory of Open Access Journals (Sweden)

    Mijović A.

    2009-01-01

    Full Text Available Population dynamics of the species Plantago major L. and Poa annua L., typical representatives of ruderal vegetation, was analyzed in a replacement series experiment. The analyzed species were sown in an area with meadow vegetation, where the vegetation present had been previously removed by a total herbicide and additionally by hoeing. The objective of the experiment was to monitor growth dynamics and the effect of intra- and inter-specific interaction of the species Plantago major and Poa annua in conditions of different sowing densities and proportions. The effects of intra- and inter-specific interference and the density-dependent responses were assessed on the basis of several parameters (natality, mortality, age structure, and measures of ontogenetic changes. Based on the study results, it can be concluded that the responses of the species in the experiment were different, which is explained by different adaptive mechanisms, i.e., strategies, in the specific environmental conditions. An effect of the density dependent response was present in both species in the replacement series experiment. The response was amplified by water deficit caused by intensive evapora­tion of the bare soil. No effect of inter-specific interference was observed at the given densities of the study species on the sample plots. An effect of intra-specific interference of the species Plantago major and Poa annua was observed in the guise of a density-negative response of the rate of ontogenetic changes and fecundity.

  20. Comparison between transcatheter and surgical aortic valve replacement: a single-center experience.

    Science.gov (United States)

    Silberman, Shuli; Abu Akr, Firas; Bitran, Daniel; Almagor, Yaron; Balkin, Jonathan; Tauber, Rachel; Merin, Ofer

    2013-07-01

    A comparison was made of the outcomes after transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (AVR) in high-risk patients. All patients aged > 75 years that underwent a procedure for severe aortic stenosis with or without coronary revascularization at the authors' institution were included in the study; thus, 64 patients underwent TAVI and 188 underwent AVR. Patients in the TAVI group were older (mean age 84 +/- 5 versus 80 +/- 4 years; p < 0.0001) and had a higher logistic EuroSCORE (p = 0.004). Six patients (9%) died during the procedure in the TAVI group, and 23 (12%) died in the AVR group (p = 0.5). Predictors for mortality were: age (p < 0.0001), female gender (p = 0.02), and surgical valve replacement (p = 0.01). Gradients across the implanted valves at one to three months postoperatively were lower in the TAVI group (p < 0.0001). Actuarial survival at one, two and three years was 78%, 64% and 64%, respectively, for TAVI, and 83%, 78% and 75%, respectively, for AVR (p = 0.4). Age was the only predictor for late mortality (p < 0.0001). TAVI patients were older and posed a higher predicted surgical risk. Procedural mortality was lower in the TAVI group, but mid-term survival was similar to that in patients undergoing surgical AVR. Age was the only predictor for late survival. These data support the referral of high-risk patients for TAVI.

  1. Therapeutic efficiency of continuous renal replacement therapy--experience of a single Romanian center.

    Science.gov (United States)

    Voiculescu, M; Ionescu, Camelia; Ismail, G; Roşu, Mihaela; Szigeti, A; Iliescu, Olguţa

    2004-01-01

    We have studied 24 patients with acute renal failure (ARF) or acutization of chronic renal failure (CRF) caused by a variety of different disorders. A rapid decline in renal excretory function, fluid, electrolyte, and divalent ion disturbances determined us to initiate continuous renal replacement: continuous venovenous hemofiltration (CVVHF)--28 procedures in 15 patients and continuous venovenous hemodiafiltration (CVVHDF)--11 procedures in 11 patients. Mean duration of CVVHF was 21.6+/-6.9 h, with a mean blood flow rate of 116.9+/-16.4 ml/min and an ultrafiltration rate of 6.4+/-4.6 ml/min. Serum creatinine level decreased from 12.6 to 8.3 mg% and the concentration of urea from 237 to 166 mg%. Mean duration of hemodiafiltration was 24+/-8.5 h, with mean blood flow rate of 134+/-15.2 ml/min, mean dialysate flow of 35+/-7 ml/min and mean ultrafiltration rate of 5.6+/-2.1 ml/min. Serum creatinine level decreased from 11.6 to 6.36 mg% and the concentration of urea from 236 to 137 mg%. Survival rate was 79.2% (19/24 patients). Complete recover of renal function was achieved in 5 patients, partial recover in 5 patients and 9 patients were included in chronic dialysis. In 8/24 (30%) patients we encountered complications, such as hypotension in 2 cases, bleeding disorders in 5 cases or diselectrolithemias in 2 cases. As a consequence, continuous renal replacement therapy is efficient, having an acceptable rate of adverse effects in patients with ARF or acutization of CRF.

  2. Engineering development of a digital replacement protection system at an operating US PWR nuclear power plant: Installation and operational experiences

    Energy Technology Data Exchange (ETDEWEB)

    Miller, M.H. [Duke Power Co., Seneca, SC (United States)

    1995-04-01

    The existing Reactor Protection Systems (RPSs) at most US PWRs are systems which reflect 25 to 30 year-old designs, components and manufacturing techniques. Technological improvements, especially in relation to modern digital systems, offer improvements in functionality, performance, and reliability, as well as reductions in maintenance and operational burden. The Nuclear power industry and the US nuclear regulators are poised to move forward with the issues that have slowed the transition to modern digital replacements for nuclear power plant safety systems. The electric utility industry is now more than ever being driven by cost versus benefit decisions. Properly designed, engineered, and installed digital systems can provide adequate cost-benefit and allow continued nuclear generated electricity. This paper describes various issues and areas related to an ongoing RPS replacement demonstration project which are pertinant for a typical US nuclear plant to consider cost-effective replacement of an aging analog RPS with a modern digital RPS. The following subject areas relative to the Oconee Nuclear Station ISAT{trademark} Demonstrator project are discussed: Operator Interface Development; Equipment Qualification; Validation and Verification of Software; Factory Testing; Field Changes and Verification Testing; Utility Operational, Engineering and Maintenance; Experiences with Demonstration System; and Ability to operate in parallel with the existing Analog RPS.

  3. The Impact of Macro-and Micronutrients on Predicting Outcomes of Critically Ill Patients Requiring Continuous Renal Replacement Therapy.

    Directory of Open Access Journals (Sweden)

    Kittrawee Kritmetapak

    Full Text Available Critically ill patients with acute kidney injury (AKI who receive renal replacement therapy (RRT have very high mortality rate. During RRT, there are markedly loss of macro- and micronutrients which may cause malnutrition and result in impaired renal recovery and patient survival. We aimed to examine the predictive role of macro- and micronutrients on survival and renal outcomes in critically ill patients undergoing continuous RRT (CRRT. This prospective observational study enrolled critically ill patients requiring CRRT at Intensive Care Unit of King Chulalongkorn Memorial Hospital from November 2012 until November 2013. The serum, urine, and effluent fluid were serially collected on the first three days to calculate protein metabolism including dietary protein intake (DPI, nitrogen balance, and normalized protein catabolic rate (nPCR. Serum zinc, selenium, and copper were measured for micronutrients analysis on the first three days of CRRT. Survivor was defined as being alive on day 28 after initiation of CRRT.Dialysis status on day 28 was also determined. Of the 70 critically ill patients requiring CRRT, 27 patients (37.5% survived on day 28. The DPI and serum albumin of survivors were significantly higher than non-survivors (0.8± 0.2 vs 0.5 ±0.3g/kg/day, p = 0.001, and 3.2±0.5 vs 2.9±0.5 g/dL, p = 0.03, respectively while other markers were comparable. The DPI alone predicted patient survival with area under the curve (AUC of 0.69. A combined clinical model predicted survival with AUC of 0.78. When adjusted for differences in albumin level, clinical severity score (APACHEII and SOFA score, and serum creatinine at initiation of CRRT, DPI still independently predicted survival (odds ratio 4.62, p = 0.009. The serum levels of micronutrients in both groups were comparable and unaltered following CRRT. Regarding renal outcome, patients in the dialysis independent group had higher serum albumin levels than the dialysis dependent group, p = 0

  4. Earth Sciences Requirements for the Information Sciences Experiment System

    Science.gov (United States)

    Bowker, David E. (Editor); Katzberg, Steve J. (Editor); Wilson, R. Gale (Editor)

    1990-01-01

    The purpose of the workshop was to further explore and define the earth sciences requirements for the Information Sciences Experiment System (ISES), a proposed onboard data processor with real-time communications capability intended to support the Earth Observing System (Eos). A review of representative Eos instrument types is given and a preliminary set of real-time data needs has been established. An executive summary is included.

  5. Assessment of left ventricular function after mitral valvular replacement using multidetector row computed tomography: initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dong Hun [Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of); Byun, Joo Nam [Chosun University, College of Medicine, Kwangju (Korea, Republic of); Ryu, Sang Wan [Miraero21 Hospital, Kwangju (Korea, Republic of); Choi, Sang Il [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2008-04-15

    To assess the usefulness of cardiac MDCT for the evaluation of cardiac function and morphology of mitral valve replacement (MVR) with or without subvalvular preservation. Sixteen patients with (n = 10) or without (n = 6) subvalvular sparing and control subjects (n = 6) were evaluated using 16-slice MDCT (Sensation 16, Siemens, Erlangen, Germany). Images of MDCT were reconstructed for the evaluation of cardiac morphology and ventricular function. Patients were compared with respect to variables such as ejection fraction (EF), end-diastolic volume (EDV), and-systolic volume (ESV), and the diastolic-systolic left ventricular area ratio on a short-axis view at apical, mid-ventricular, and basal levels. The average values for cardiac function variables for control subjects and after MVR (with subvalvular preservation versus without subvalvular preservation) were, respectively, 54 {+-} 8%, 54 {+-} 7% and 44 {+-} 6%, for EF; 91 {+-} 28 ml, 108 {+-} 35 ml and 99 {+-} 33 ml for EDV; 43 {+-} 19 ml, 52 {+-} 24 ml and, 56 {+-} 21 ml for ESV. The area ratio was 2.56, 2.75, 2.09 at the apex; 2.20, 2.17, 1.56 at the mid-ventricular level; 1.90, 1.87, 1.76 at the basal level, respectively. Mid ventricular contraction for patients following subvalvular resection was significantly decreased ({rho} < 0.05). MDCT is a useful diagnostic modality for functional and morphologic evaluation of MVR.

  6. Modified surgical techniques for total alloplastic temporomandibular joint replacement: One institution's experience.

    Science.gov (United States)

    ShanYong, Zhang; Liu, Huan; Yang, Chi; Zhang, XiaoHu; Abdelrehem, Ahmed; Zheng, JiSi; Jiao, ZiXian; Chen, MinJie; Qiu, YaTing

    2015-07-01

    To present three modified techniques of total alloplastic temporomandibular joint replacement (TMJ TJR) and to evaluate the outcomes regarding prosthesis stability and heterotopic bone formation. A total of 15 patients (19 joints), treated with the Biomet stock prosthesis from May 2006 to May 2013, were retrospectively analyzed. Surgical procedures were performed with the following three modifications: bone grafting of the glenoid fossa; salvage of TMJ discs; and harvesting of retro-mandibular subcutaneous fats. The glenoid fossa depth was measured preoperatively by Surgicase 5.0 software. All patients were evaluated by radiographic examination and surgical observation. The fossa was grafted with an autogenous bone in 15 joints (78.9%). In 4 joints (21.1%), only bone repair was performed. Radiographic evaluation revealed a good integration between the autogenous and host bones. All patients showed postoperative occlusal stability. In 5 joints (26.3%), the discs were salvaged. Both bleeding and operation time were reduced. Fat grafts were harvested in 17 joints (89.5%), in which there were no abnormalities in the periprosthetic bone structure. In 2 joints (10.5%), with no fat grafting, heterotopic bone formation was found. The modified techniques of TJR help to improve prostheses stability, reducing heterotopic bone formation and avoiding additional scars. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  7. Anticoccidial efficacy testing: In vitro Eimeria tenella assays as replacement for animal experiments.

    Science.gov (United States)

    Thabet, Ahmed; Zhang, Runhui; Alnassan, Alaa-Aldin; Daugschies, Arwid; Bangoura, Berit

    2017-01-15

    Availability of an accurate in vitro assay is a crucial demand to determine sensitivity of Eimeria spp. field strains toward anticoccidials routinely. In this study we tested in vitro models of Eimeria tenella using various polyether ionophores (monensin, salinomycin, maduramicin, and lasalocid) and toltrazuril. Minimum inhibitory concentrations (MIC95, MIC50/95) for the tested anticoccidials were defined based on a susceptible reference (Houghton strain), Ref-1. In vitro sporozoite invasion inhibition assay (SIA) and reproduction inhibition assay (RIA) were applied on sensitive laboratory (Ref-1 and Ref-2) and field (FS-1, FS-2, and FS-3) strains to calculate percent of inhibition under exposure of these strains to the various anticoccidials (%ISIA and%IRIA, respectively). The in vitro data were related to oocyst excretion, lesion scores, performance, and global resistance indices (GI) assessed in experimentally infected chickens. Polyether ionophores applied in the RIA were highly effective at MIC95 against Ref-1 and Ref-2 (%IRIA≥95%). In contrast, all tested field strains displayed reduced to low efficacy (%IRIAanimal model (p89%) against all strains used in this study. However, adjusted GI (GIadj) for toltrazuril-treated groups exhibited differences between reference and field strains which might indicate varying sensitivity. RIA is a suitable in vitro tool to detect sensitivity of E. tenella towards polyether ionophores, and may thus help to reduce, replace, or refine use of animal experimentation for in vivo sensitivity assays. Copyright © 2016 Elsevier B.V. All rights reserved.

  8. First experience with enzyme replacement therapy during pregnancy and lactation in Pompe disease.

    Science.gov (United States)

    de Vries, Juna M; Brugma, Jan-Dietert C; Ozkan, Lale; Steegers, Eric A P; Reuser, Arnold J J; van Doorn, Pieter A; van der Ploeg, Ans T

    2011-12-01

    Enzyme replacement therapy (ERT) with alglucosidase alfa was registered as a treatment for Pompe disease in 2006. It is as yet unknown whether ERT can be safely applied during pregnancy and lactation. A primiparous 40-year-old woman diagnosed with Pompe disease continued receiving ERT during pregnancy and lactation. Before pregnancy, she had moderate limb-girdle weakness and used nocturnal ventilation. During pregnancy, her clinical condition remained fairly stable until the 25th gestational week. Thereafter she experienced more problems with mobility and respiration. Fetal growth was normal as monitored by regular ultrasound investigations. A healthy boy was born at a gestational age of 37 weeks and 5 days by elective Cesarean section. There were no maternal complications and the child developed normally. One year after delivery the mother's physical condition was similar as prior to her pregnancy. Pharmacokinetic studies following enzyme infusion showed that alglucosidase alfa was secreted into the breast milk. Activity levels in the milk (245 nmol/ml.h) peaked at 2.5h after the end of the infusion; which was 2h later than in the plasma (80 μmol/ml.h). Twenty-four hours after start of the infusion, the enzyme activity in the breast milk was back to the pre-infusion level. In this case report, the continuation of treatment with alglucosidase alfa during pregnancy and lactation has been safe for the mother and the child.

  9. Experience with daptomycin daily dosing in ICU patients undergoing continuous renal replacement therapy.

    Science.gov (United States)

    Preiswerk, B; Rudiger, A; Fehr, J; Corti, N

    2013-04-01

    For critically ill patients undergoing continuous renal replacement therapy (CRRT), daptomycin dosing recommendations are scarce. We, therefore, retrospectively assessed routinely measured daptomycin plasma concentrations, daptomycin dose administered and microbiological data in 11 critically ill patients with Gram-positive infections that had received daptomycin once daily. The retrospective analysis included critically ill patients treated at the intensive care unit (ICU) who had daptomycin plasma concentrations measured. Daptomycin dose ranged from 3 to 8 mg/kg/q24 h in patients undergoing CRRT (n = 7) and 6 to 10 mg/kg/q24 h in patients without CRRT (n = 4). Peak and trough concentrations showed a high intra- and inter-patient variability in both groups, independent of the dosage per kg body weight. No drug accumulation was detected in CRRT patients with once-daily daptomycin dosing. Causative pathogens were Enterococcus faecium (n = 6), coagulase-negative Staphylococcus (n = 2), Staphylococcus aureus (n = 2) and unknown in one patient. Microbiological eradication was successful in 8 of 11 patients. Two of three patients with unsuccessful microbiological eradication and fatal outcome had an Enterococcus faecium infection. In critically ill patients undergoing CRRT, daptomycin exposure with once-daily dosing was similar to ICU patients with normal renal function, but lower compared to healthy volunteers. Our data suggest that daptomycin once-daily dosing is appropriate in patients undergoing CRRT.

  10. Enzymatic replacement therapy for Hunter disease: Up to 9 years experience with 17 patients

    Directory of Open Access Journals (Sweden)

    Rossella Parini

    2015-06-01

    Full Text Available Hunter disease is an X-linked lysosomal storage disorder characterized by progressive storage of glycosaminoglycans (GAGs and multi-organ impairment. The central nervous system (CNS is involved in at least 50% of cases. Since 2006, the enzymatic replacement therapy (ERT is available but with no effect on the cognitive impairment, as the present formulation does not cross the blood–brain barrier. Here we report the outcome of 17 Hunter patients treated in a single center. Most of them (11 started ERT in 2006, 3 had started it earlier in 2004, enrolled in the phase III trial, and 3 after 2006, as soon as the diagnosis was made. The liver and spleen sizes and urinary GAGs significantly decreased and normalized throughout the treatment. Heart parameters improved, in particular the left ventricular mass index/m2 decreased significantly. Amelioration of hearing was seen in many patients. Joint range of motion improved in all patients. However, no improvement on respiratory function, eye, skeletal and CNS disease was found. The developmental quotient of patients with a CNS involvement showed a fast decline. These patients were no more testable after 6 years of age and, albeit the benefits drawn from ERT, their quality of life worsened throughout the years. The whole group of patients showed a consistent residual disease burden mainly represented by persistent skeletal disease and frequent need of surgery. This study suggests that early diagnosis and treatment and other different therapies which are able to cross the blood–brain barrier, might in the future improve the MPS II outcome.

  11. Why Clinical Experience and Mentoring Are Replacing Student Teaching on the Best Campuses. A White Paper

    Science.gov (United States)

    Fraser, James W.; Watson, Audra M.

    2014-01-01

    Woodrow Wilson Senior Fellow James W. Fraser and Audra Watson, the Foundation's Director of Mentoring and Induction Strategy, take a look at emerging trends in clinical preparation for new teachers. This new white paper is based on experience with the Woodrow Wilson Teaching Fellowships, and includes observations from some of the colleges and…

  12. SCAI/AATS/ACC/STS operator and institutional requirements for transcatheter valve repair and replacement, Part III: Pulmonic valve.

    Science.gov (United States)

    Hijazi, Ziyad M; Ruiz, Carlos E; Zahn, Evan; Ringel, Richard; Aldea, Gabriel S; Bacha, Emile A; Bavaria, Joseph; Bolman, R Morton; Cameron, Duke E; Dean, Larry S; Feldman, Ted; Fullerton, David; Horlick, Eric; Mack, Michael J; Miller, D Craig; Moon, Marc R; Mukherjee, Debabrata; Trento, Alfredo; Tommaso, Carl L

    2015-07-01

    With the evolution of transcatheter valve replacement, an important opportunity has arisen for cardiologists and surgeons to collaborate in identifying the criteria for performing these procedures. Therefore, The Society for Cardiovascular Angiography and Interventions (SCAI), American Association for Thoracic Surgery (AATS), American College of Cardiology (ACC), and The Society of Thoracic Surgeons (STS) have partnered to provide recommendations for institutions to assess their potential for instituting and/or maintaining a transcatheter valve program. This article concerns transcatheter pulmonic valve replacement (tPVR). tPVR procedures are in their infancy with few reports available on which to base an expert consensus statement. Therefore, many of these recommendations are based on expert consensus and the few reports available. As the procedures evolve, technology advances, experience grows, and more data accumulate, there will certainly be a need to update this consensus statement. The writing committee and participating societies believe that the recommendations in this report serve as appropriate requisites. In some ways, these recommendations apply to institutions more than to individuals. There is a strong consensus that these new valve therapies are best performed using a Heart Team approach; thus, these credentialing criteria should be applied at the institutional level. Partnering societies used the ACC's policy on relationships with industry (RWI) and other entities to author this document (http://www.acc.org/guidelines/about-guidelines-and-clinical-documents). To avoid actual, potential, or perceived conflicts of interest due to industry relationships or personal interests, all members of the writing committee, as well as peer reviewers of the document, were asked to disclose all current healthcare-related relationships including those existing 12 months before the initiation of the writing effort. A committee of interventional cardiologists and

  13. MIRAGE: the minimum information required for a glycomics experiment.

    Science.gov (United States)

    York, William S; Agravat, Sanjay; Aoki-Kinoshita, Kiyoko F; McBride, Ryan; Campbell, Matthew P; Costello, Catherine E; Dell, Anne; Feizi, Ten; Haslam, Stuart M; Karlsson, Niclas; Khoo, Kay-Hooi; Kolarich, Daniel; Liu, Yan; Novotny, Milos; Packer, Nicolle H; Paulson, James C; Rapp, Erdmann; Ranzinger, Rene; Rudd, Pauline M; Smith, David F; Struwe, Weston B; Tiemeyer, Michael; Wells, Lance; Zaia, Joseph; Kettner, Carsten

    2014-05-01

    The MIRAGE (minimum information required for a glycomics experiment) initiative was founded in Seattle, WA, in November 2011 in order to develop guidelines for reporting the qualitative and quantitative results obtained by diverse types of glycomics analyses, including the conditions and techniques that were applied to prepare the glycans for analysis and generate the primary data along with the tools and parameters that were used to process and annotate this data. These guidelines must address a broad range of issues, as glycomics data are inherently complex and are generated using diverse methods, including mass spectrometry (MS), chromatography, glycan array-binding assays, nuclear magnetic resonance (NMR) and other rapidly developing technologies. The acceptance of these guidelines by scientists conducting research on biological systems in which glycans have a significant role will facilitate the evaluation and reproduction of glycomics experiments and data that is reported in scientific journals and uploaded to glycomics databases. As a first step, MIRAGE guidelines for glycan analysis by MS have been recently published (Kolarich D, Rapp E, Struwe WB, Haslam SM, Zaia J., et al. 2013. The minimum information required for a glycomics experiment (MIRAGE) project - Improving the standards for reporting mass spectrometry-based glycoanalytic data. Mol. Cell Proteomics. 12:991-995), allowing them to be implemented and evaluated in the context of real-world glycobiology research. In this paper, we set out the historical context, organization structure and overarching objectives of the MIRAGE initiative.

  14. STREAM2016: Streaming Requirements, Experience, Applications and Middleware Workshop

    Energy Technology Data Exchange (ETDEWEB)

    Fox, Geoffrey [Indiana Univ., Bloomington, IN (United States); Jha, Shantenu [Rutgers Univ., New Brunswick, NJ (United States); Ramakrishnan, Lavanya [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2016-10-01

    The Department of Energy (DOE) Office of Science (SC) facilities including accelerators, light sources and neutron sources and sensors that study, the environment, and the atmosphere, are producing streaming data that needs to be analyzed for next-generation scientific discoveries. There has been an explosion of new research and technologies for stream analytics arising from the academic and private sectors. However, there has been no corresponding effort in either documenting the critical research opportunities or building a community that can create and foster productive collaborations. The two-part workshop series, STREAM: Streaming Requirements, Experience, Applications and Middleware Workshop (STREAM2015 and STREAM2016), were conducted to bring the community together and identify gaps and future efforts needed by both NSF and DOE. This report describes the discussions, outcomes and conclusions from STREAM2016: Streaming Requirements, Experience, Applications and Middleware Workshop, the second of these workshops held on March 22-23, 2016 in Tysons, VA. STREAM2016 focused on the Department of Energy (DOE) applications, computational and experimental facilities, as well software systems. Thus, the role of “streaming and steering” as a critical mode of connecting the experimental and computing facilities was pervasive through the workshop. Given the overlap in interests and challenges with industry, the workshop had significant presence from several innovative companies and major contributors. The requirements that drive the proposed research directions, identified in this report, show an important opportunity for building competitive research and development program around streaming data. These findings and recommendations are consistent with vision outlined in NRC Frontiers of Data and National Strategic Computing Initiative (NCSI) [1, 2]. The discussions from the workshop are captured as topic areas covered in this report's sections. The report

  15. EFFECT OF TRANEXAMIC ACID IN CONTROL OF PERIOPERATIVE BLOOD LOSS ASSOCIATE WITH TOTAL KNEE REPLACEMENT OUR EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Bhaskar

    2015-05-01

    Full Text Available BACKGROUND : Costs of allogenic blood transfusions and the associated risks mandate strategies to reduce blood loss in surgery. The objective of this study was to asse ss the efficacy of antifibrinolytic treatment in reducing perioperative blood loss during total knee replacement. MATERIALS AND METHOD S: A prospective study was carried out on 148patients undergoing total knee replacement. 88pts received tranexamic acid 10 mg kg −1 i.v. just before the cementation, 3hours post op and 6 hrs later.60 patients did not receive tranexamic acid. External perioperative blood loss was measured by post op amount of drain, and Hb levels and Hematocrit. The number of patients transfuse d and number of packed red cell (PRC units transfused was recorded and possible postoperative thrombo embolic complications were studied clinically. RESULTS : Amongst 78 pts who were given Cyclokapron, only 10(12.8% were given blood transfusions and the a verage transfusions were 3.9 units and Amongst 70 pts who were not given Cyclokapron, 20(28.5% were given blood transfusions and the average transfusions were 8.7 units. The average blood loss in the group of patients who were given cyclokapron was 1004ml while in the groups which were not given the average blood loss was 1507ml. Clinical assessment did not reveal any thromboembolic complications. CONCLUSIONS : Antifibrinolytic agents produce a significant decrease in blood loss in patients undergoing total knee replacement, reflected in a reduction in the number of blood transfusions required. Based on this study we can conclude that three doses of IV tranexamic acid of 10mg/kg, can be used in TKR procedures with proven effectiveness and efficiency to decre ase postoperative blood loss in patients undergoing TKR.

  16. Replacement of Cobalt base alloys hardfacing by NOREM alloy; EDF experience and development, some metallurgical considerations. Valves application (CLAMA, RAMA)

    Energy Technology Data Exchange (ETDEWEB)

    Carnus, M. [EDF DPN UTO Direction Expertise Technique, Noisy le Grand (France); Confort, X. [VELAN SAS, Lyon (France)

    2011-07-01

    Cobalt base alloys, such as Stellite 6 and 21, are used extensively in applications where superior resistance to wear and corrosion are required. However the use of Cobalt alloys hardfacing materials, especially on valves, is a major contributor to the level of radioactive contamination of nuclear facilities. NOREM alloys, an iron base and cobalt free materials, have been developed through an Electric Power Research Institute (EPRI) long running program during the eighties as an alternative of Stellite. This alloy has relatively good weldability properties, it was developed initially for repairing Stellite hardfacing (deposit over existing hardfacing alloys). This alloy has good corrosion resistance properties associated with elevated hardness (HRC 36-42). Technological properties (such as galling resistance, wear resistance) have been evaluated through different testing programs led by EPRI, AECL(Atomic Energy of Canada Limited), Valves manufacturers, EDF and others during the nineties. More recently EDF (for replacement of globe valves) has carried out testing program focused on weld deposit chemistry and mechanical properties. NOREM is a candidate for replacement of stellite hardfacing on valves. However this alloy is not so versatile as stellite alloys regarding technological properties (such as wear resistance) at elevated temperature and under high contact pressure. As a consequence some limits have to be considered for application on valves operating at elevated temperature and under high contact pressure (> 20 Mpa). Examples of application on valves, from VELAN manufacturer, for EDF PWR equipment are given. The industrial feedback from installed equipment (CLAMA, RAMA) since 2006 on EDF PWR has been good

  17. Prediction of Long-term Post-operative Testosterone Replacement Requirement Based on the Pre-operative Tumor Volume and Testosterone Level in Pituitary Macroadenoma.

    Science.gov (United States)

    Lee, Cheng-Chi; Chen, Chung-Ming; Lee, Shih-Tseng; Wei, Kuo-Chen; Pai, Ping-Ching; Toh, Cheng-Hong; Chuang, Chi-Cheng

    2015-11-05

    Non-functioning pituitary macroadenomas (NFPAs) are the most prevalent pituitary macroadenomas. One common symptom of NFPA is hypogonadism, which may require long-term hormone replacement. This study was designed to clarify the association between the pre-operative tumor volume, pre-operative testosterone level, intraoperative resection status and the need of long-term post-operative testosterone replacement. Between 2004 and 2012, 45 male patients with NFPAs were enrolled in this prospective study. All patients underwent transsphenoidal surgery. Hypogonadism was defined as total serum testosterone levels of testosterone to patients with defined hypogonadism or clinical symptoms of hypogonadism. Hormone replacement for longer than 1 year was considered as long-term therapy. The need for long-term post-operative testosterone replacement was significantly associated with larger pre-operative tumor volume (p = 0.0067), and lower pre-operative testosterone level (p = 0.0101). There was no significant difference between the gross total tumor resection and subtotal resection groups (p = 0.1059). The pre-operative tumor volume and testosterone level impact post-operative hypogonadism. By measuring the tumor volume and the testosterone level and by performing adequate tumor resection, surgeons will be able to predict post-operative hypogonadism and the need for long-term hormone replacement.

  18. [Surfactant replacement therapy with a minimally invasive technique: Experience in a tertiary hospital].

    Science.gov (United States)

    Canals Candela, F J; Vizcaíno Díaz, C; Ferrández Berenguer, M J; Serrano Robles, M I; Vázquez Gomis, C; Quiles Durá, J L

    2016-02-01

    Surfactant delivered using a minimally invasive technique, known as MIST (Minimally Invasive Surfactant Therapy) is a method which allows surfactant to be administered to a patient connected to non-invasive respiratory support. This is an increasingly used therapy in Neonatal Units that reduces the intubation rate and the pathology associated with intubation and allows the surfactant to be administered to the patients who clinically need it. In years 2013 and 2014 in the Hospital General Universitario de Elche surfactant was delivered using this method to 19 patients, five of whom were 28 or less weeks of gestation age at birth. A comparison is made with a historical cohort consisting of 28 patients with Respiratory Distress Syndrome treated initially with non-invasive respiratory support. No incidents were recorded that caused the interruption of the administration. A reduction in the fraction of inspired oxygen was observed in all cases after surfactant administration. Fewer intubations in the first 72 hours of life were found in the treatment group compared to the control group (42% vs. 54%). The experience recorded in the Hospital General Universitario de Elche shows that the administration of surfactant using a MIST technique is a reproducible method of treatment, which allows the surfactant distribution during spontaneous breathing with non invasive respiratory support. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  19. Low-flow CO2 removal integrated into a renal-replacement circuit can reduce acidosis and decrease vasopressor requirements

    Science.gov (United States)

    2013-01-01

    Introduction Lung-protective ventilation in patients with ARDS and multiorgan failure, including renal failure, is often paralleled with a combined respiratory and metabolic acidosis. We assessed the effectiveness of a hollow-fiber gas exchanger integrated into a conventional renal-replacement circuit on CO2 removal, acidosis, and hemodynamics. Methods In ten ventilated critically ill patients with ARDS and AKI undergoing renal- and respiratory-replacement therapy, effects of low-flow CO2 removal on respiratory acidosis compensation were tested by using a hollow-fiber gas exchanger added to the renal-replacement circuit. This was an observational study on safety, CO2-removal capacity, effects on pH, ventilator settings, and hemodynamics. Results CO2 elimination in the low-flow circuit was safe and was well tolerated by all patients. After 4 hours of treatment, a mean reduction of 17.3 mm Hg (−28.1%) pCO2 was observed, in line with an increase in pH. In hemodynamically instable patients, low-flow CO2 elimination was paralleled by hemodynamic improvement, with an average reduction of vasopressors of 65% in five of six catecholamine-dependent patients during the first 24 hours. Conclusions Because no further catheters are needed, besides those for renal replacement, the implementation of a hollow-fiber gas exchanger in a renal circuit could be an attractive therapeutic tool with only a little additional trauma for patients with mild to moderate ARDS undergoing invasive ventilation with concomitant respiratory acidosis, as long as no severe oxygenation defects indicate ECMO therapy. PMID:23883472

  20. Requirements for a Next Generation Framework: ATLAS Experience

    CERN Document Server

    Kama, Sami; The ATLAS collaboration

    2015-01-01

    The challenge faced by HEP experiments from the current and expected architectural evolution of CPUs and co-processors is how to successfully exploit concurrency and keep memory consumption within reasonable limits. This is a major change from frameworks which were designed for serial event processing on single core processors in the 2000s. ATLAS has recently considered this problem in some detail through its Future Frameworks Requirements group. Here we report on the major considerations of the group, which was charged with considering the best strategies to exploit current and anticipated CPU technologies. The group has re-examined the basic architecture of event processing and considered how the building blocks of a framework (algorithms, services, tools and incidents) should evolve. The group has also had to take special care to ensure that the use cases of the ATLAS high level trigger are encompassed, which differ in important ways from offline event processing (for example, 99% of events are rejected, w...

  1. Organisational reviews - requirements, methods and experience. Progress report 2006

    Energy Technology Data Exchange (ETDEWEB)

    Reiman, T.; Oedewald, P.; Wahlstroem, B. [VTT, Technical Research Centre of Finland (Finland); Rollenhagen, C.; Kahlbom, U. [Maelardalen University (FI)

    2007-04-15

    Organisational reviews are important instruments in the continuous quest for improved performance. In the nuclear field there has been an increasing regulatory interest in organisational performance, because incidents and accidents often point to organisational deficiencies as one of the major precursors. Many methods for organisational reviews have been proposed, but they are mostly based on ad hoc approaches to specific problems. The absence of well-established techniques for organisational reviews has already shown to cause discussions and controversies on different levels. The aim of the OrRe project is to collect the experiences from organisational reviews carried out so far and to reflect them in a theoretical model of organisational performance. Furthermore, the project aims to reflect on the criteria for the definition of the scope and content of organisational reviews. Finally, recommendations will be made for guidance for people participating in organisational reviews. This progress report describes regulatory practices in Finland and Sweden together with some case examples of organizational reviews and assessment in both countries. Some issues of concern are raised and an outline for the next year's work is proposed. Issues of concern include the sufficient depth of the assessment, the required competence in assessments, data and criteria problems, definition of the boundaries of the system to be assessed, and the necessary internal support and organisational maturity required for successful assessments. Finally, plans for next year's work are outlined. (au)

  2. Computationally driven, quantitative experiments discover genes required for mitochondrial biogenesis.

    Directory of Open Access Journals (Sweden)

    David C Hess

    2009-03-01

    Full Text Available Mitochondria are central to many cellular processes including respiration, ion homeostasis, and apoptosis. Using computational predictions combined with traditional quantitative experiments, we have identified 100 proteins whose deficiency alters mitochondrial biogenesis and inheritance in Saccharomyces cerevisiae. In addition, we used computational predictions to perform targeted double-mutant analysis detecting another nine genes with synthetic defects in mitochondrial biogenesis. This represents an increase of about 25% over previously known participants. Nearly half of these newly characterized proteins are conserved in mammals, including several orthologs known to be involved in human disease. Mutations in many of these genes demonstrate statistically significant mitochondrial transmission phenotypes more subtle than could be detected by traditional genetic screens or high-throughput techniques, and 47 have not been previously localized to mitochondria. We further characterized a subset of these genes using growth profiling and dual immunofluorescence, which identified genes specifically required for aerobic respiration and an uncharacterized cytoplasmic protein required for normal mitochondrial motility. Our results demonstrate that by leveraging computational analysis to direct quantitative experimental assays, we have characterized mutants with subtle mitochondrial defects whose phenotypes were undetected by high-throughput methods.

  3. Transfusion requirements and clinical outcome in intensive care patients receiving continuous renal replacement therapy: comparison of prostacyclin vs. heparin prefilter administration

    DEFF Research Database (Denmark)

    Windeløv, Nis Agerlin; Ostrowski, Sisse R; Perner, Anders;

    2010-01-01

    Prostacyclin (PGI(2)) analogous are potent antithrombotics recommended as prefilter infusion during renal replacement therapy (RRT) when heparin is contraindicated. It is debated whether PGI(2) administration during RRT affects transfusion requirements and outcome. Retrospective cohort study of a...... intravascular coagulation (DIC) (P=0.006), severe thrombocytopenia (P=0.03), higher maximum Sequential Organ Failure Assessment score (P......: before, during and after CRRT. For each time period, laboratory values were analysed as changes/day and blood transfusion requirements as absolute values. Organ failures during the ICU stay and 1 year all-cause mortality were registered. During CRRT the PGI(2) group had a higher incidence of disseminated...

  4. New calorimeters for space experiments: physics requirements and technological challenges

    Science.gov (United States)

    Marrocchesi, Pier Simone

    2015-07-01

    Direct measurements of charged cosmic radiation with instruments in Low Earth Orbit (LEO), or flying on balloons above the atmosphere, require the identification of the incident particle, the measurement of its energy and possibly the determination of its sign-of-charge. The latter information can be provided by a magnetic spectrometer together with a measurement of momentum. However, magnetic deflection in space experiments is at present limited to values of the Maximum Detectable Rigidity (MDR) hardly exceeding a few TV. Advanced calorimetric techniques are, at present, the only way to measure charged and neutral radiation at higher energies in the multi-TeV range. Despite their mass limitation, calorimeters may achieve a large geometric factor and provide an adequate proton background rejection factor, taking advantage of a fine granularity and imaging capabilities. In this lecture, after a brief introduction on electromagnetic and hadronic calorimetry, an innovative approach to the design of a space-borne, large acceptance, homogeneous calorimeter for the detection of high energy cosmic rays will be described.

  5. Amino Acid requirements in critically ill patients with acute kidney injury treated with continuous renal replacement therapy.

    Science.gov (United States)

    Btaiche, Imad F; Mohammad, Rima A; Alaniz, Cesar; Mueller, Bruce A

    2008-05-01

    Acute kidney injury in critically ill patients is often a complication of an underlying condition such as organ failure, sepsis, or drug therapy. In these patients, stress-induced hypercatabolism results in loss of body cell mass. Unless nutrition support is provided, malnutrition and negative nitrogen balance may ensue. Because of metabolic, fluid, and electrolyte abnormalities, optimization of nutrition to patients with acute kidney injury presents a challenge to the clinician. In patients treated with conventional intermittent hemodialysis, achieving adequate amino acid intake can be limited by azotemia and fluid restriction. With the use of continuous renal replacement therapy (CRRT), however, better control of azotemia and liberalization of fluid intake allow amino acid intake to be maximized to support the patient's metabolic needs. High amino acid doses up to 2.5 g/kg/day in patients treated with CRRT improved nitrogen balance. However, to our knowledge, no studies have correlated increased amino acid intake with improved outcomes in critically ill patients with acute kidney injury. Data from large, prospective, randomized, controlled trials are needed to optimize the dosing of amino acids in critically ill patients with acute kidney injury who are treated with CRRT and to study the safety of high doses and their effects on patient morbidity and survival.

  6. Transfusion requirements and clinical outcome in intensive care patients receiving continuous renal replacement therapy: comparison of prostacyclin vs. heparin prefilter administration

    DEFF Research Database (Denmark)

    Windeløv, Nis Agerlin; Ostrowski, Sisse R; Perner, Anders;

    2010-01-01

    Prostacyclin (PGI(2)) analogous are potent antithrombotics recommended as prefilter infusion during renal replacement therapy (RRT) when heparin is contraindicated. It is debated whether PGI(2) administration during RRT affects transfusion requirements and outcome. Retrospective cohort study of all...... patients at a general intensive care unit (ICU) receiving continuous RRT (CRRT) in a 14-month period. Patients were stratified according to the used anticoagulant, that is prefilter PGI(2) group (n=24) and prefilter heparin group (n=70). The ICU stay of the patients was divided into three time periods...

  7. Ankle replacement

    Science.gov (United States)

    Ankle arthroplasty - total; Total ankle arthroplasty; Endoprosthetic ankle replacement; Ankle surgery ... You may not be able to have a total ankle replacement if you have had ankle joint infections in ...

  8. Knee Replacement

    Science.gov (United States)

    Knee replacement is surgery for people with severe knee damage. Knee replacement can relieve pain and allow you to ... Your doctor may recommend it if you have knee pain and medicine and other treatments are not ...

  9. System Requirements Document for the Molten Salt Reactor Experiment

    Energy Technology Data Exchange (ETDEWEB)

    Aigner, R.D.

    2000-04-01

    The purpose of the conversion process is to convert the {sup 233}U fluoride compounds that are being extracted from the Molten Salt Reactor Experiment (MSRE) equipment to a stable oxide for long-term storage at Bldg. 3019.

  10. Deep-sea impact experiments and their future requirements

    Digital Repository Service at National Institute of Oceanography (India)

    Sharma, R.

    In recent years, several experiments to assess the potential impacts due to deep-sea mining in the Pacific as well as the Indian Oceans have indicated the immediate changes and restoration patterns of environmental conditions in the marine ecosystem...

  11. NifU and NifS are required for the maturation of nitrogenase and cannot replace the function of isc-gene products in Azotobacter vinelandii.

    Science.gov (United States)

    Johnson, D C; Dos Santos, P C; Dean, D R

    2005-02-01

    In recent years, it has become evident that [Fe-S] proteins, such as hydrogenase, nitrogenase and aconitase, require a complex machinery to assemble and insert their associated [Fe-S] clusters. So far, three different types of [Fe-S] cluster biosynthetic systems have been identified and these have been designated nif, isc and suf. In the present work, we show that the nif-specific [Fe-S] cluster biosynthetic system from Azotobacter vinelandii, which is required for nitrogenase maturation, cannot functionally replace the isc [Fe-S] cluster system used for the maturation of other [Fe-S] proteins, such as aconitase. The results indicate that, in certain cases, [Fe-S] cluster biosynthetic machineries have evolved to perform only specialized functions.

  12. Catheter dysfunction and dialysis performance according to vascular access among 736 critically ill adults requiring renal replacement therapy: a randomized controlled study.

    Science.gov (United States)

    Parienti, Jean-Jacques; Mégarbane, Bruno; Fischer, Marc-Olivier; Lautrette, Alexandre; Gazui, Nicole; Marin, Nathalie; Hanouz, Jean-Luc; Ramakers, Michel; Daubin, Cédric; Mira, Jean-Paul; Charbonneau, Pierre; du Cheyron, Damien

    2010-04-01

    To compare dialysis catheter function according to catheter site. Multicenter, open, randomized controlled trial. Nine university-affiliated hospitals and three general hospitals in France. Seven hundred thirty-six patients in intensive care units who required a first venous catheterization to perform either intermittent hemodialysis (470 patients with 1275 sessions) or continuous renal replacement therapy (266 patients with 1003 days). Patients randomly received either femoral (n = 370) or jugular (n = 366) catheterization. For the jugular site, right-side position (n = 252) was recommended. Time to catheter ablation for dysfunction, urea reduction ratio (intermittent hemodialysis), and downtime (continuous renal replacement therapy) were assessed for all participants and evaluated by randomly assigned catheterization site (femoral or jugular). Baseline demography and dialysis prescriptions were similar between the site arms. In modified intent-to-treat, catheter dysfunction occurred in 36 of 348 (10.3%) and 38 of 342 (11.1%) patients in the femoral and jugular groups, respectively. The risk of catheter dysfunction did not significantly differ between randomized groups (hazard ratio, 1.06; 95% confidence interval, 0.67-1.68; p = .80). Compared to the femoral site, the observed risk of dysfunction decreased in the right jugular position (15 of 226; 6.6%; adjusted hazard ratio, 0.58; 95% confidence interval, 0.31-1.07; p = .09) and significantly increased in the left jugular position (23 of 118; 19.5%; adjusted hazard ratio, 1.89; 95% confidence interval, 1.12-3.21; p hemodialysis mean urea reduction ratio per session was 50.8% (standard deviation, 16.1) for femoral vs. 52.8% (standard deviation, 15.8) for jugular (p = .30) sites, and the median continuous renal replacement therapy downtime per patient-day was 1.17 hrs (interquartile range, 0.75-1.50) for both sites (p = .98). In terms of catheter dysfunction and dialysis performance among critically ill adults

  13. A Bacterial Glucanotransferase Can Replace the Complex Maltose Metabolism Required for Starch to Sucrose Conversion in Leaves at Night

    DEFF Research Database (Denmark)

    Ruzanski, Christian; Smirnova, Julia; Rejzek, Martin

    2013-01-01

    Controlled conversion of leaf starch to sucrose at night is essential for the normal growth of Arabidopsis. The conversion involves the cytosolic metabolism of maltose to hexose phosphates via an unusual, multidomain protein with 4-glucanotransferase activity, DPE2, believed to transfer glucosyl...... moieties to a complex heteroglycan prior to their conversion to hexose phosphate via a cytosolic phosphorylase. The significance of this complex pathway is unclear; conversion of maltose to hexose phosphate in bacteria proceeds via a more typical 4-glucanotransferase that does not require a heteroglycan...... approaches suggested that it can potentially generate a glucosyl buffer between maltose and hexose phosphate because, unlike DPE2, it can generate polydisperse malto-oligosaccharides from maltose. Consistent with this suggestion, MalQ is capable of restoring an essentially wild-type phenotype when expressed...

  14. Experience in implementing regulatory requirements to protect against industrial sabotage

    Energy Technology Data Exchange (ETDEWEB)

    Knuth, D.F.

    1978-01-01

    Some of the problems and concerns in implementing the current regulatory requirements in physical protection of nuclear power plants are discussed. Until 1973, the Nuclear Regulatory Commission (NRC) was of the opinion that a determined group of professional saboteurs was beyond the scope of protection required. Since then regulatory changes have altered that concept; each successive regulatory change envisions a higher level of threat, and, hence, requires more provisions to protect the facilities. The author contends that, in some areas, NRC's decisions were hastily conceived with unrealistic implementation schedules. These decisions and regulations, if fully implemented, could be counterproductive to maintaining good security in a nuclear power plant, and are counterproductive to safety and operability of the plants.

  15. Is routine replacement of i.v. administration sets required after each change of intermittently administrated antibiotic infusions?

    Directory of Open Access Journals (Sweden)

    von Au, Felix

    2013-04-01

    Full Text Available [english] Aim: Manufacturers’ instructions recommend changing the infusion line together with the infusion bottle after each administration. We investigated if the complete infusion line may be microbiologically contaminated after short-time antibiotic and rinse-solution application.Method: Immediately after the change of an infusion administration set after 72 hours the remaining antibiotic solution was inactivated with yolk and cultured on blood agar for 48 hours at 36°C to detect possible contaminants.Results: Among 87 investigated samples no microbial growth was detected. One sample which hadn’t any contact to antibiotics yielded forming unit (cfu of coagulase-negative staphylococci.These results suggest that in case of consecutive antibiotic-short- and rinse-infusions the infusion line may be in place up to 72 hours without contamination. This, however, may be only the case for infusion sets, which are in contact with antibiotics. If no antibiotic is administered, the infusion bottle and the infusion line must be renewed together for every change. To clarify this question into more detail, a larger consecutive study is required. Conclusion: I.v. administration sets without any contact to antibiotics must be changed together with their infusion bottle after administration. In case of consecutive antibiotic-short- and rinse-infusions our pilot study suggests using the i.v. administration sets for up to 72 hours without renewing it at every infusion-set exchange.

  16. Artificial Lighting Protection of Mauna Kea Observatories: An Experiment to Replace LPS Street Lighting With LEDs in Waikoloa Village, HI

    Science.gov (United States)

    Craine, Eric R.; Craine, Brian L.

    2016-06-01

    Segments of the astronomical community have long lobbied in support of the use of Low Pressure Sodium (LPS) street lights as a method of minimizing impacts of sky glow on neighboring observatories. There has been vociferous objection to the replacement of LPS by Light Emitting Diode (LED) street lights. Such replacement is being precipitated by advances in lighting technologies, high economic efficiencies of LEDs, and plummeting interest in manufacturing LPS fixtures. Waikoloa Village, HI, located on the western slopes of Mauna Kea, home to major northern hemisphere observatories, has for many years been almost exclusively illuminated by LPS lighting. During the winter of 2015-2016 the County of Hawai’i Department of Public Works, Traffic Division replaced the approximately 550 LPS street lights in the community with Filtered LED (FLED) fixtures on a one-for-one basis. About 100 other LPS lights on private properties in the community were similarly replaced by the lighting manufacturer. This retrofit offered an excellent opportunity to make measurements of lighting parameters in the community before and after the retrofit process. Measurements were made using satellite, airborne, and ground based observations, and included photometric, photographic, and spectroscopic measurements. Data analyzed included integrated brightness of the community, zenith angle function brightness distributions, and spectral energy distributions. We present the results of these observations and discuss their implications for future protection of astronomical observatory sites.

  17. Directed Replacement

    CERN Document Server

    Karttunen, L

    1996-01-01

    This paper introduces to the finite-state calculus a family of directed replace operators. In contrast to the simple replace expression, UPPER -> LOWER, defined in Karttunen (ACL-95), the new directed version, UPPER @-> LOWER, yields an unambiguous transducer if the lower language consists of a single string. It transduces the input string from left to right, making only the longest possible replacement at each point. A new type of replacement expression, UPPER @-> PREFIX ... SUFFIX, yields a transducer that inserts text around strings that are instances of UPPER. The symbol ... denotes the matching part of the input which itself remains unchanged. PREFIX and SUFFIX are regular expressions describing the insertions. Expressions of the type UPPER @-> PREFIX ... SUFFIX may be used to compose a deterministic parser for a ``local grammar'' in the sense of Gross (1989). Other useful applications of directed replacement include tokenization and filtering of text streams.

  18. Exceptional running skill in dogs requires extensive experience.

    Science.gov (United States)

    Helton, William S

    2009-07-01

    Performances across a wide variety of animal species share a similar pattern of development. Performance starts out low, over time increases to a peak, and then declines with old age. The increase of performance in early life is due to growth, adaptation, and learning. The author examined changes in running performance in 14 elite greyhound (Canis lupus familiaris) runners. The time to peak performance from initiation of a professional career took up 9.1% of a typical dog's lifespan. This amount of time devoted to skill development relative to species lifespan is similar to that of elite human track runners. Even with controll for changes in size (weight in kilograms), dogs' skill development showed marked improvement with increasing race experience. The author discusses the benefit of future research on motor-skill acquisition in nonhuman athletes.

  19. Double Valve Replacement (Mitral and Aortic for Rheumatic Heart Disease: A 20-year experience with 300 patients.

    Directory of Open Access Journals (Sweden)

    Prashant Mishra

    2016-09-01

    Full Text Available Introduction: Rheumatic heart disease still remains one of the leading causes of congestive heart failure and death owing to valvular pathologies, in developing countries. Valve replacement still remains the treatment of choice in such patients.The aim of this study wasto analyze the postoperative outcome of  double valve replacement (Mitral and Aortic in patients of rheumatic heart disease. Materials and Methods: Between 1988 and 2008, 300 patients of rheumatic heart disease underwent double (Mitral and Aortic valve replacement with Starr Edwards valve or St Jude mechanical valve prosthesis were implanted. These patients were studied retrospectively for preoperative data and postoperative outcome including causes of early and late deaths and the data was analyzed statistically. Results: The 30-day hospital death rate was 11.3% andlate death occurred in 11.6%. Anticoagulant regimen was followed to maintain the target pro-thrombin time at 1.5 times the control value. The actuarial survival (exclusive of hospital mortality was 92.4%, 84.6%, and 84.4%, per year at 5, 10, and 20 years, respectively Conclusions: In view of the acknowledged advantageof superior durability, increased thromboresistance in our patient population, and its cost effectiveness the Starr-Edwards ball valve or St. Jude valve is the mechanical prosthesis of choice for advanced combined valvular disease. The low-intensity anticoagulant regimen has offered suffcient protection against thromboembolism as well as hemorrhage.

  20. Large area crop inventory experiment crop assessment subsystem software requirements document

    Science.gov (United States)

    1975-01-01

    The functional data processing requirements are described for the Crop Assessment Subsystem of the Large Area Crop Inventory Experiment. These requirements are used as a guide for software development and implementation.

  1. Incidence of Complications During Initial Experience with Revision of the Agility and Agility LP Total Ankle Replacement Systems: A Single Surgeon's Learning Curve Experience.

    Science.gov (United States)

    Roukis, Thomas S; Simonson, Devin C

    2015-10-01

    As the frequency in which foot and ankle surgeons are performing primary total ankle replacement (TAR) continues to build, revision TAR will likely become more commonplace, creating a need for an established benchmark by which to evaluate the safety of revision TAR as determined by the incidence of complications. Currently, no published data exist on the incidence of intraoperative and early postoperative complications during revision of the Agility or Agility LP Total Ankle Replacement Systems during the surgeon learning curve period; therefore, the authors sought to determine this incidence during the senior author's learning curve period.

  2. Experiences with Continuous Venovenous Hemofiltration using 18mmol/L predilution Citrate anticoagulation and a Phosphate Containing Replacement Solution

    Science.gov (United States)

    Jeffrey, Yuen Henry; Hoi-Ping, Shum; Kit Hung, Anne Leung; Chung-Ling, Lam; Wing-Wa, Yan; King-Yiu, Lai

    2017-01-01

    Context: Regional citrate anticoagulation for continuous renal replacement therapy is associated with a longer filter-life, less bleeding events and improved mortality. Problems associated with using Prismocitrate 10/2 solution in continuous renal replacement therapy, include hypomagnesemia, hypophosphatemia and the need for additional bicarbonate infusion. Aims: This study uses the new Prismocitrate 18/0 solution for improved buffer balance and Phoxilium solution for a more favourable electrolyte profile. Settings and Design: A retrospective analysis of patients who underwent continuous venovenous hemofiltration (CVVH) using Prismocitrate 18/0 and Phoxilium in our 21-bed ICU was conducted from March to July 2014. Methods and Material: Continuous venovenous hemofiltration (CVVH) was performed at fixed rate by using Prismocitrate 18/0 predilution at 1250 ml/hour, a blood flow rate of 110 ml/min and post-replacement with Phoxilium at 1250 ml/hr. CVVH was run for 72 h or until filter clotting, transportation, or achievement of the clinical target. Statistical Analysis Used: The results were displayed as the median with the interquartile range (IQR). The trend in pH, electrolytes, and base excess are shown using a standard box plot. All analyses were performed by the Statistical Package for Social Science for Windows, version 17 (SPSS, Chicago, IL, USA). Results: Forty-five CVVH episodes were analysed. The median circuit lifetime was 44 h (interquartile range, IQR 29-55). Metabolic alkalosis, hypophosphatemia and hypomagnesemia occurred in 8.3%, 3.5% and 40.2% of the blood samples, respectively. No patient developed hypokalemia or citrate toxicity. Conclusions: This new CVVH regime is safe and easy to administer for critically ill patients. PMID:28197045

  3. Experiences with continuous venovenous hemofiltration using 18mmol/l predilution citrate anticoagulation and a phosphate containing replacement solution

    Directory of Open Access Journals (Sweden)

    Yuen Henry Jeffrey

    2017-01-01

    Full Text Available Context: Regional citrate anticoagulation for continuous renal replacement therapy is associated with a longer filter-life, less bleeding events and improved mortality. Problems associated with using Prismocitrate 10/2 solution in continuous renal replacement therapy, include hypomagnesemia, hypophosphatemia and the need for additional bicarbonate infusion. Aims: This study uses the new Prismocitrate 18/0 solution for improved buffer balance and Phoxilium solution for a more favourable electrolyte profile. Settings and Design: A retrospective analysis of patients who underwent continuous venovenous hemofiltration (CVVH using Prismocitrate 18/0 and Phoxilium in our 21-bed ICU was conducted from March to July 2014. Methods and Material: Continuous venovenous hemofiltration (CVVH was performed at fixed rate by using Prismocitrate 18/0 predilution at 1250 ml/hour, a blood flow rate of 110 ml/min and post-replacement with Phoxilium at 1250 ml/hr. CVVH was run for 72 h or until filter clotting, transportation, or achievement of the clinical target. Statistical Analysis Used: The results were displayed as the median with the interquartile range (IQR. The trend in pH, electrolytes, and base excess are shown using a standard box plot. All analyses were performed by the Statistical Package for Social Science for Windows, version 17 (SPSS, Chicago, IL, USA. Results: Forty-five CVVH episodes were analysed. The median circuit lifetime was 44 h (interquartile range, IQR 29-55. Metabolic alkalosis, hypophosphatemia and hypomagnesemia occurred in 8.3%, 3.5% and 40.2% of the blood samples, respectively. No patient developed hypokalemia or citrate toxicity. Conclusions: This new CVVH regime is safe and easy to administer for critically ill patients.

  4. Knee Replacement

    Science.gov (United States)

    ... need knee replacement surgery usually have problems walking, climbing stairs, and getting in and out of chairs. Some ... a total living space on one floor since climbing stairs can be difficult. Install safety bars or a ...

  5. Experience of valve replacement under mild hypothermia on pump-beating heart:an analysis of 800 cases

    Institute of Scientific and Technical Information of China (English)

    陈柏成; 肖颖彬; 陈林; 钟前进; 王学锋; 周骐; 易广兵

    2004-01-01

    Objective: To assess the outcome of valve replacement under mild hypothermia on pump-beating heart and to discuss the risk factors of cardiac valve surgery. Methods: In the period from November 1997 to May 2003, a total of 800cases of valve replacement were carried out in our institute. The clinical data were reviewed and the technique of mild hypothermia and pump-beating heart to replace cardiac valve was described in detail. Results: 800 patients, 308 male and 492female, with age range from 8 to 66 years, weighing 19 to 88 kg, underwent operation. The average cardiopulmonary bypass time was (109.38 ± 40.64) min, the average clamping time of the vena cava was (77.87 ± 27.99) min and the average mechanical ventilation time was (17.78 ± 12.21) h. There were 17 patients died in the early postoperative stage with an early mortality rate of 2.13%. The causes of death were failure in the weaning of extracorporeal circulation in 2 cases, severe low output syndrome in 3 cases, ventricular fibrillation in 3 cases, obstruction of coronary ostium of mechanical prosthetic valve in 1 case, hepatic failure in 2 cases, pulmonary failure in 1 case, multiorgan failure in 4 cases, and prosthetic valve dysfunction in 1 case. Severe postopertive complications occurred in 51 cases (6.375%), which included reexploration because of excessive bleeding in 16 cases (2.0%), lavage of poststemal infection in 2 cases (0.25%), postoperative strike in 7 cases (0.875%), pulmonary failure in 5 cases (0.625%), hepatic failure in 4 cases (0.5%), multiorgan failure in 11 cases (1.375 % ), ventricular arrhythmia in 5 cases (0.625%) and peripheral circulation failure in 1 case(0. 125 % ). Conclusion: Mild hypothermia and pump-beating heart result in satisfying clinical outcome in patients undergoing valve replacement. The integrated sequenced deairing procedure ensures the avoidance of air embolism during operation.Pump-beating heart technique offers a safe and practical option especially in

  6. Transaortic aortic valve replacement using the Edwards Sapien-XT Valve and the Medtronic CoreValve: initial experience.

    Science.gov (United States)

    Spargias, Konstantinos; Bouboulis, Nikolaos; Halapas, Antonios; Chrissoheris, Michael; Skardoutsos, Spyridon; Nikolaou, Joulia; Tsolakis, Apostolos; Mourmouris, Christos; Pattakos, Stratis

    2014-01-01

    Transcatheter aortic valve replacement (TAVR) is now an established treatment for certain patients with severe aortic valve stenosis (AS). However, as the number of patients screened for TAVR increases, many are found to have absolutely no option for peripheral artery access. Transaortic valve replacement (TAoVR) has been proposed as a new alternative route in patients deemed unsuitable for conventional approaches. We present our first series of TAoVR cases using the Edwards Sapien-XT and the Medtronic CoreValve prostheses. Twenty-five (25) symptomatic patients (mean age 78 ± 8 years, mean logistic EuroSCORE I 25 ± 11%) with severe AS underwent TAoVR using the Sapien-XT valve (10 patients) or the CoreValve (15 patients). The mean fluoroscopy time was 15.6 ± 4.2 minutes, the mean time in the intensive care unit was 1.9 ± 1.0 days, and the mean hospital stay was 6.4 ± 1.6 days. The mean effective aortic valve area increased (from 0.68 ± 0.15 cm(2) to 1.82 ± 0.34 cm(2), pMedtronic CoreValve prosthesis demonstrated that it could be performed safely, resulting in substantial acute echocardiographic and early clinical improvement.

  7. [Experience of Mitral Valve Replacement Using a Pulmonary Autograft (Ross II Operation) in an Infant;Report of a Case].

    Science.gov (United States)

    Kawahito, Tomohisa; Egawa, Yoshiyasu; Yoshida, Homare; Shimoe, Yasushi; Onishi, Tatsuya; Miyagi, Yuhichi; Terada, Kazuya; Ohta, Akira

    2015-07-01

    A 24-day-old boy suddenly developed progressive heart failure and was transported to our hospital. Echocardiography showed massive mitral regurgitation due to chordal rupture. Mitral valve repair was performed at 28 days of life, but postoperative valvular function was not satisfactory. A mechanical valve was implanted in the supra-annular position at 37 days of life. Two months after valve replacement, the mechanical valve was suddenly stuck. Emergent redo valve replacement was performed, but the prosthetic valve became stuck again 2 months after the 3rd operation, despite sufficient anti-coagulation therapy. At the 4th operation (6 months after birth), we implanted a pulmonary autograft in the mitral position instead of another mechanical valve in an emergent operation. The right ventricular outflow tract was reconstructed with a valved conduit. A postoperative catheter examination, which was performed 1 year after the Ross II operation, showed mild mitral stenosis with no regurgitation. Previous reports of Ross II operations in infants are rare and long-term results are unknown. However, we advocate that this procedure should be a rescue operation for mitral valve dysfunction in the early period of infants.

  8. Esophageal replacement.

    Science.gov (United States)

    Kunisaki, Shaun M; Coran, Arnold G

    2017-04-01

    This article focuses on esophageal replacement as a surgical option for pediatric patients with end-stage esophageal disease. While it is obvious that the patient׳s own esophagus is the best esophagus, persisting with attempts to retain a native esophagus with no function and at all costs are futile and usually detrimental to the overall well-being of the child. In such cases, the esophagus should be abandoned, and the appropriate esophageal replacement is chosen for definitive reconstruction. We review the various types of conduits used for esophageal replacement and discuss the unique advantages and disadvantages that are relevant for clinical decision-making. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. 42 CFR 482.80 - Condition of participation: Data submission, clinical experience, and outcome requirements for...

    Science.gov (United States)

    2010-10-01

    ... center. (3) A pancreas transplant center is not required to comply with the clinical experience... pancreas transplants performed at the center. (4) A center that is requesting initial Medicare approval...

  10. DSN radio science system description and requirements. [for satellite radio astronomy experiments

    Science.gov (United States)

    Mulhall, B. D. L.

    1977-01-01

    The data system created to collect the functions performed by the Deep Space Network in support of spacecraft radio science experiments is described. Some of the major functional requirements presently being considered for the system are delineated.

  11. DSN radio science system description and requirements. [for satellite radio astronomy experiments

    Science.gov (United States)

    Mulhall, B. D. L.

    1977-01-01

    The data system created to collect the functions performed by the Deep Space Network in support of spacecraft radio science experiments is described. Some of the major functional requirements presently being considered for the system are delineated.

  12. 14 CFR 65.119 - Master parachute rigger certificate: Experience, knowledge, and skill requirements.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Master parachute rigger certificate: Experience, knowledge, and skill requirements. 65.119 Section 65.119 Aeronautics and Space FEDERAL AVIATION... CREWMEMBERS Parachute Riggers § 65.119 Master parachute rigger certificate: Experience, knowledge, and...

  13. 14 CFR 65.115 - Senior parachute rigger certificate: Experience, knowledge, and skill requirements.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Senior parachute rigger certificate: Experience, knowledge, and skill requirements. 65.115 Section 65.115 Aeronautics and Space FEDERAL AVIATION... CREWMEMBERS Parachute Riggers § 65.115 Senior parachute rigger certificate: Experience, knowledge, and...

  14. Large-scale Experiment of Water Quality Change for Xijiang River Water Source Replacement%西江水源置换水质变化规律的生产性试验研究

    Institute of Scientific and Technical Information of China (English)

    陈诚; 李振林; 朱争亮; 潘铁军; 苏兆斌; 董玉莲; 匡科

    2012-01-01

    为了保障西江水源置换后管网水质安全,根据西江水源置换后广州市西北部水厂和以北江为水源的南洲水厂出厂水水质相似的特点,在西村水厂供水范围内选择试验区域,通过阀门调整改为南洲水厂供水,实施水源置换生产性试验,开展水质变化规律研究.试验结果表明,由于阀门调整,管网水力条件发生改变,浊度瞬时升高,待水力条件稳定后浊度逐步下降.置换后试验区域内浊度保持稳定,余氯浓度和pH值提高,耗氧量下降,菌落总数先升高,2d后下降并能满足水质标准的要求,管道沉积物稳定,生物膜附着稳固,试验区域水质稳定性和水质明显提升.%In order to safeguard distribution system water quality after Xijiang River source replacement , large-scale experiment of water source replacement was carried out to research the change of water quality. Based on the similar characteristic of drinking water from the northwest plants after the replacement and Nanzhou Water Treatment Plant which source is Beijiang River, some area was chosen to conduct large-scale experiment, but the water supply source was converted from Xicun Water Treatment Plant to Nanzhou Water Treatment Plant by valve adjustment. The results showed that turbidity increased suddenly with the change of hydraulic condition due to valve adjustment and went down gradually after stabilization of hydraulic condition. Turbidity of test area could keep steady, residual chlorine and pH increased , and chemical oxygen demand decreased. Total bacteria count increased at first, decreased gradually and can meet the requirement of the water quality standard after 2 days. Pipe sediment and biofilm kept steady. The stability and water quality were significantly improved after replacement.

  15. Replacing magnets at the LHC

    CERN Multimedia

    LHC, LSI2, Point 4

    2013-01-01

    CERN engineers have been working through the night this week to move the final replacement dipole magnets into position on the Large Hadron Collider (LHC). Though there are several still to go, the teams expect to have completed the task by the end of this month. Dipole magnets bend the paths of particles as they travel around the circular accelerator. Of the LHC's 1232 dipoles – each 15 metres long and weighing 35 tonnes – 15 are being replaced as part of the long shutdown of CERN's accelerator complex. These 15 magnets suffered wear and tear during the LHC's first 4-year run. Three quadrupole-magnet assemblies – which help to focus particles into a tight beam – have also been replaced. Moving such heavy magnets requires specially adapted cranes and trailers both above and below ground. There are several access points on the LHC. Some, such as the 100-metre vertical access shaft down to the ALICE experiment, are equipped with lifts to allow technical personnel and visitors down to the caverns. Other ...

  16. Practical experience with R32 mixtures as replacement substances for R22 and R502; Praxiserfahrungen mit R32-Gemischen als Austauschstoffe fuer R22 und R502

    Energy Technology Data Exchange (ETDEWEB)

    Schwennesen, K. [Deutsche ICI GmbH, Frankfurt am Main (Germany)

    1995-12-31

    Like R11 and R12, the refrigerant R502 will soon belong to the past and the steps for the prohibition of use of R22 have already been taken. Due to both its thermo-physical properties and its relatively low greenhouse gas potential, R32 is an important part of replacement refrigerants compatible with the ozone layer for both R22 and R502. There is a report on practical experience with R407A and R407C here. (orig.) [Deutsch] Das Kaeltemittel R 502 wird, wie R 11 und R 12, in naechster Zukunft der Vergangenheit angehoeren und auch fuer R 22 sind die Schritte zu Verwendungsverboten bereits festgelegt. R 32 ist sowohl aufgrund seiner thermophysikalischen Eigenschaften als auch wegen seines relative niedrigen Treibhauspotentials eine bedeutende Komponente in ozonvertraeglichen Austauschkaeltemitteln sowohl fuer R 22 als uach fuer R 502. Ueber Praxiserfahrungen mit R 407A und R 407C wird hier berichtet. (orig.)

  17. Effect of tranexamic acid on blood loss and transfusion requirement in total knee replacement in the Indian population: A case series

    Science.gov (United States)

    Gautam, Parshotam Lal; Katyal, Sunil; Yamin, Mohammad; Singh, Amandip

    2011-01-01

    Context: Total knee replacement (TKR) is often carried out using a tourniquet to minimize intraoperative blood loss. However, its application enhances local fibrinolysis, resulting in excessive blood loss during the post-operative period. Fibrinolytic profile varies in different regions and races. Tranexamic acid has been shown to reduce post-operative blood loss and the need for transfusion in TKR. However, there is paucity of literature from the Indian population and the efficacy of the agent has not been tested in Indian patients undergoing TKR. Aims: Effect of tranexamic acid on blood loss in TKR surgery in the Indian population. Setting and Design: In this double-blinded study, 40 patients undergoing unilateral TKR were randomly divided into two groups. Methods: All patients were conducted under spinal anaesthesia using injection bupivacaine 0.5% heavy 12-15 mg. The treatment group received 10 mg/kg tranexamic acid, intravenous (IV), half an hour before deflation of the tourniquet, with a second dose of 2 mg/kg administered 3 hours after the first dose. The exact protocol was followed for the placebo group, except that normal saline was used instead of tranexamic acid. Blood loss, blood transfusion details and change in haemoglobin levels were noted. Statistical Analysis: Student's paired ‘t’ test was used in statistical analysis. Results: The mean post-operative blood loss in the tranexamic acid group was 272.5±122.5 ml (mean±SD), and 685±118.2 ml in the placebo group (P<0.001). The total blood loss was lower in the tranexamic acid group than in the placebo group (427.6 ml vs. 911.6 ml; P<0.001). The absolute number of blood transfusions and the number of patients who required transfusions were lower in the tranexamic acid group than in the placebo group. None of the patients had any side or adverse effect. Conclusions: Tranexamic acid significantly decreases post-operative blood loss and reduces the need for blood transfusion in patients undergoing

  18. Effect of tranexamic acid on blood loss and transfusion requirement in total knee replacement in the Indian population: A case series

    Directory of Open Access Journals (Sweden)

    Parshotam Lal Gautam

    2011-01-01

    Full Text Available Context: Total knee replacement (TKR is often carried out using a tourniquet to minimize intraoperative blood loss. However, its application enhances local fibrinolysis, resulting in excessive blood loss during the post-operative period. Fibrinolytic profile varies in different regions and races. Tranexamic acid has been shown to reduce post-operative blood loss and the need for transfusion in TKR. However, there is paucity of literature from the Indian population and the efficacy of the agent has not been tested in Indian patients undergoing TKR. Aims: Effect of tranexamic acid on blood loss in TKR surgery in the Indian population. Setting and Design: In this double-blinded study, 40 patients undergoing unilateral TKR were randomly divided into two groups. Methods: All patients were conducted under spinal anaesthesia using injection bupivacaine 0.5% heavy 12-15 mg. The treatment group received 10 mg/kg tranexamic acid, intravenous (IV, half an hour before deflation of the tourniquet, with a second dose of 2 mg/kg administered 3 hours after the first dose. The exact protocol was followed for the placebo group, except that normal saline was used instead of tranexamic acid. Blood loss, blood transfusion details and change in haemoglobin levels were noted. Statistical Analysis: Student′s paired ′t′ test was used in statistical analysis. Results: The mean post-operative blood loss in the tranexamic acid group was 272.5±122.5 ml (mean±SD, and 685±118.2 ml in the placebo group (P<0.001. The total blood loss was lower in the tranexamic acid group than in the placebo group (427.6 ml vs. 911.6 ml; P<0.001. The absolute number of blood transfusions and the number of patients who required transfusions were lower in the tranexamic acid group than in the placebo group. None of the patients had any side or adverse effect. Conclusions: Tranexamic acid significantly decreases post-operative blood loss and reduces the need for blood transfusion in

  19. Meropenem population pharmacokinetics in critically ill patients with septic shock and continuous renal replacement therapy: influence of residual diuresis on dose requirements.

    Science.gov (United States)

    Ulldemolins, Marta; Soy, Dolors; Llaurado-Serra, Mireia; Vaquer, Sergi; Castro, Pedro; Rodríguez, Alejandro H; Pontes, Caridad; Calvo, Gonzalo; Torres, Antoni; Martín-Loeches, Ignacio

    2015-09-01

    Meropenem dosing in critically ill patients with septic shock and continuous renal replacement therapy (CRRT) is complex, with the recommended maintenance doses being 500 mg to 1,000 mg every 8 h (q8h) to every 12 h. This multicenter study aimed to describe the pharmacokinetics (PKs) of meropenem in this population to identify the sources of PK variability and to evaluate different dosing regimens to develop recommendations based on clinical parameters. Thirty patients with septic shock and CRRT receiving meropenem were enrolled (153 plasma samples were tested). A population PK model was developed with data from 24 patients and subsequently validated with data from 6 patients using NONMEM software (v.7.3). The final model was characterized by CL = 3.68 + 0.22 · (residual diuresis/100) and V = 33.00 · (weight/73)(2.07), where CL is total body clearance (in liters per hour), residual diuresis is the volume of residual diuresis (in milliliters per 24 h), and V is the apparent volume of distribution (in liters). CRRT intensity was not identified to be a CL modifier. Monte Carlo simulations showed that to maintain concentrations of the unbound fraction (fu ) of drug above the MIC of the bacteria for 40% of dosing interval T (referred to as 40% of the ƒ uT >MIC), a meropenem dose of 500 mg q8h as a bolus over 30 min would be sufficient regardless of the residual diuresis. If 100% of the ƒ uT >MIC was chosen as the target, oligoanuric patients would require 500 mg q8h as a bolus over 30 min for the treatment of susceptible bacteria (MIC dose given as an infusion over 3 h. If bacteria with MICs close to the resistance breakpoint (2 to 4 mg/liter) were to be treated with meropenem, a dose of 500 mg every 6 h would be necessary: a bolus over 30 min for oligoanuric patients and an infusion over 3 h for patients with preserved diuresis. Our results suggest that residual diuresis may be an easy and inexpensive tool to help with titration of the meropenem dose and infusion

  20. Depth Requirements for a Tonne-scale 76Ge Neutrinoless Double-beta Decay Experiment

    CERN Document Server

    Aguayo, E; Back, H O; Barabash, A S; Bergevin, M; Bertrand, F E; Boswell, M; Brudanin, V; Busch, M; Chan, Y-D; Christofferson, C D; Collar, J I; Combs, D C; Cooper, R J; Detwiler, J A; Doe, P J; Efremenko, Yu; Egorov, V; Ejiri, H; Elliott, S R; Esterline, J; Fast, J E; Fields, N; Finnerty, P; Fraenkle, F M; Gehman, V M; Giovanetti, G K; Green, M P; Guiseppe, V E; Gusey, K; Hallin, A L; Hazama, R; Henning, R; Hime, A; Hoppe, E W; Horton, M; Howard, S; Howe, M A; Johnson, R A; Keeter, K J; Keillor, M E; Keller, C; Kephart, J D; Kidd, M F; Knecht, A; Kochetov, O; Konovalov, S I; Kouzes, R T; LaFerriere, B D; LaRoque, B H; Leon, J; Leviner, L E; Loach, J C; MacMullin, S; Marino, M G; Martin, R D; Mei, D -M; Merriman, J H; Miller, M L; Mizouni, L; Nomachi, M; Orrell, J L; Overman, N R; Phillips, D G; Poon, A W P; Perumpilly, G; Prior, G; Radford, D C; Rielage, K; Robertson, R G H; Ronquest, M C; Schubert, A G; Shima, T; Shirchenko, M; Snavely, K J; Sobolev, V; Steele, D; Strain, J; Thomas, K; Timkin, V; Tornow, W; Vanyushin, I; Varner, R L; Vetter, K; Vorren, K; Wilkerson, J F; Wolfe, B A; Yakushev, E; Young, A R; Yu, C -H; Yumatov, V; Zhang, C

    2011-01-01

    Neutrinoless double-beta decay experiments can potentially determine the Majorana or Dirac nature of the neutrino, and aid in understanding the neutrino absolute mass scale and hierarchy. Future 76Ge-based searches target a half-life sensitivity of >10^27 y to explore the inverted neutrino mass hierarchy. Reaching this sensitivity will require a background rate of ~5200 meters water equivalent is required for a tonne-scale experiment with a compact shield similar to the planned 40-kg MAJORANA DEMONSTRATOR. The required overburden is highly dependent on the chosen shielding configuration and could be relaxed significantly if, for example, a liquid cryogen and water shield, or an active neutron shield were employed. Operation of the MAJORANA DEMONSTRATOR and GERDA detectors will serve to reduce the uncertainties on cosmic-ray background rates and will impact the choice of shielding style and location for a future tonne-scale experiment.

  1. 48 CFR 752.7005 - Submission requirements for development experience documents.

    Science.gov (United States)

    2010-10-01

    ..., technologies, management, research, results and experience as outlined in the Agency's ADS Chapter 540, section... paragraph (b)(1)(i) of this clause. (2) Format. (i) Descriptive information is required for all Contractor... descriptive information: (A) Name and version of the application software used to create the file, e.g.,...

  2. [Estrogen replacement].

    Science.gov (United States)

    Søgaard, A J; Berntsen, G K; Magnus, J H; Tollan, A

    1998-02-10

    Recent research on long-term postmenopausal hormone replacement therapy (HRT) indicates a positive effect on both total mortality and morbidity. This has raised the question of widespread preventive long-term use of HRT. Possible side-effects and ideological issues related to preventive HRT have led to debate and uncertainty among health professionals, in the media, and in the population at large. In order to evaluate the level of knowledge about and attitudes towards HRT, a randomly selected group of 737 Norwegian women aged 16-79 was interviewed by the Central Bureau of Statistics. One in three women had received information about HRT in the last two years, mainly through weekly magazines and physicians. The proportion who answered the questions on knowledge correctly varied from 36% to 47%. Those who had been given information by a physician possessed accurate knowledge, had more positive attitudes towards HRT and were more willing to use HRT than women who had reviewed information through other channels. Women with a higher level of education were better informed and more knowledgeable than others, but were nevertheless more reluctant to use HRT than those who were less educated. The limited number of women who actually receive information on HRT, the low level of knowledge and the ambivalent attitudes toward HRT are a major challenge to the public health service.

  3. JET-ISX-B beryllium limiter experiment safety analysis report and operational safety requirements

    Energy Technology Data Exchange (ETDEWEB)

    Edmonds, P.H.

    1985-09-01

    An experiment to evaluate the suitability of beryllium as a limiter material has been completed on the ISX-B tokamak. The experiment consisted of two phases: (1) the initial operation and characterization in the ISX experiment, and a period of continued operation to the specified surface fluence (10/sup 22/ atoms/cm/sup 2/) of hydrogen ions; and (2) the disassembly, decontamination, or disposal of the ISX facility. During these two phases of the project, the possibility existed for beryllium and/or beryllium oxide powder to be produced inside the vacuum vessel. Beryllium dust is a highly toxic material, and extensive precautions are required to prevent the release of the beryllium into the experimental work area and to prevent the contamination of personnel working on the device. Details of the health hazards associated with beryllium and the appropriate precautions are presented. Also described in appendixes to this report are the various operational safety requirements for the project.

  4. Site-directed in vitro replacement of nucleosides in the anticodon loop of tRNA: application to the study of structural requirements for queuine insertase activity.

    Science.gov (United States)

    Carbon, P; Haumont, E; Fournier, M; de Henau, S; Grosjean, H

    1983-01-01

    We have investigated the specificity of the enzymes Q-insertase and mannosyl-Q transferase that replace the guanosine at position 34 (wobble base) in the anticodon of several tRNAs by Q or mannosyl-Q derivatives. We have restructured in vitro the normal anticodon of yeast tRNA-Asp-GUC, yeast tRNAArgICG and yeast tRNALeuUAG. With yeast tRNA-Asp-GUC, we have replaced one or several nucleotides in the vicinity of G34 by one of the four canonical nucleotides or by pseudouridylic acid; we have also constructed a tRNAAsp with eight bases instead of seven in the anticodon loop. With yeast tRNAArgICG and yeast tRNALeuUAG, we have replaced their anticodon by the trinucleotide GUC, coding for aspartic acid. The chimerical tRNAs were microinjected into the cytoplasm of Xenopus laevis oocytes and after 72 h the amount of Q34 and mannosyl-Q34 incorporated was measured. Our results show that the U33G34U35 sequence, within an anticodon loop of seven bases in chimerical yeast tRNA-Asp-GUC, tRNAArgGUC or tRNALeuGUC, is the main determinant for Q-insertase activity at position 34; the rest of the tRNA sequence has only a slight influence. For mannosyl-Q transferase, however, a much broader structural feature of the tRNA than just the U33G34U35 sequence is important for the efficiency of Q34 transformation into mannosyl-Q34.

  5. 颈椎前路融合与置换体外生物力学实验的新观点%Advances in research on anterior cervical fusion and replacement in vitro biomechanical experiment

    Institute of Scientific and Technical Information of China (English)

    吕聪伟; 蒲婷; 廖振华; 刘伟强

    2013-01-01

    , CNKI database and Wanfang database were retrieved with the key words of“cervical spine, fusion, replacement, hybrid, biomechanics, in vitro, adjacent-level degeneration, review”in English and Chinese. The articles in the past 3 years on the in vitro biomechanical experiments of anterior cervical fusion and replacement from January 2007 to March 2013 were included. The old and repetitive articles were excluded. Final y, a total of 40 articles were included for review. RESULTS AND CONCLUSION:This article reviewed the in vitro cervical specimen fusion and replacement experiments, and introduced major progress in multi-level, motion control condition differences, cervical coupled motion test and newly designed implant device. The effects of fusion and replacement on adjacent-level range of motion, intra-articular pressure, pressure inside nucleus pulposus and intervertebral foramen morphology were compared to discuss the problems after fusion and replacement, and thus prospecting the development and application of in vitro cervical specimen experiments based on the clinical requirements.

  6. Transcatheter Mitral Valve Replacement: Long-Term Outcomes of First-In-Man Experience with an Apically Tethered Device - A Case Series from a Single Centre.

    Science.gov (United States)

    Duncan, Alison; Daqa, Anan; Yeh, James; Davies, Simon; Uebing, Anselm; Quarto, Cesare; Moat, Neil

    2017-08-13

    Transcatheter mitral valve replacement (TMVR) is a novel technique for treating mitral regurgitation. We report 18-month/2-year outcomes of the 5 first-in-man patients undergoing chronic TMVR with the Tendyne device. Five patients (STS score 14%-23%) underwent TMVR using a Tendyne system under compassionate use at a single centre. 1 patient (who was noncompliant with anti-coagulation) died 9 months after TMVR following a cerebrovascular accident. Whilst some of the remaining patients experienced recognised post-TMVR complications (left ventricular outflow tract obstruction, paravalvular leak, stent thrombosis), all patients alive at 18-months/2-years after TMVR reported significant reduction in NYHA Class and increase in exercise capacity compared to baseline. Transthoracic echocardiography demonstrated valve stability, absent transvalvular mitral regurgitation, and significant reductions in tricuspid regurgitation severity and systolic pulmonary arterial pressure. Eighteen months/2 years after compassionate use of Tendyne TMVR in a highrisk surgical group, the majority of patients were alive, patient symptoms improved, and the device was stable with good haemodynamic function and no late migration. Continued follow-up of patients treated with Tendyne TMVR are required to further describe its safety and efficacy.

  7. Estimation of the lead thickness required to shield scattered radiation from synchrotron radiation experiments

    Science.gov (United States)

    Wroblewski, Thomas

    2015-03-01

    In the enclosure of synchrotron radiation experiments using a monochromatic beam, secondary radiation arises from two effects, namely fluorescence and scattering. While fluorescence can be regarded as isotropic, the angular dependence of Compton scattering has to be taken into account if the shielding shall not become unreasonably thick. The scope of this paper is to clarify how the different factors starting from the spectral properties of the source and the attenuation coefficient of the shielding, over the spectral and angular distribution of the scattered radiation and the geometry of the experiment influence the thickness of lead required to keep the dose rate outside the enclosure below the desired threshold.

  8. Computing requirements for high energy physics experiments at the LHC collider

    CERN Document Server

    Witek, Mariusz

    2002-01-01

    In this article the requirements for the future experiments of elementary particle physics are discussed. The nature of physics phenomena expected at the LHC collider at CERN leads to an unprecedented scale of the computing infrastructure for the data storage and analysis. The possible solution is based on the distributed computing model, and is presented within the context of the global unification of the computer resources as proposed by the GRID projects. (7 refs).

  9. Integration of photovoltaic units into electric utility grids: experiment information requirements and selected issues

    Energy Technology Data Exchange (ETDEWEB)

    1980-09-01

    A number of investigations have led to the recognition of technical, economic, and institutional issues relating to the interface between solar electric technologies and electric utility systems. These issues derive from three attributes of solar electric power concepts, including (1) the variability and unpredictability of the solar resources, (2) the dispersed nature of those resources which suggest the deployment of small dispersed power units, and (3) a high initial capital cost coupled with relatively low operating costs. An important part of the DOE programs to develop new source technologies, in particular photovoltaic systems, is the experimental testing of complete or nearby complete power units. These experiments provide an opportunity to examine operational and integration issues which must be understood before widespread commercial deployment of these technologies can be achieved. Experiments may also be required to explicitly examine integration, operational, and control aspects of single and multiple new source technology power units within a utility system. An identification of utility information requirements, a review of planned experiments, and a preliminary determination of additional experimental needs and opportunities are presented. Other issues discussed include: (1) the impacts of on-site photovoltaic units on load duration curves and optimal generation mixes are considered; (2) the impacts of on-site photovoltaic units on utility production costs, with and without dedicated storage and with and without sellback, are analyzed; and (3) current utility rate structure experiments, rationales, policies, practices, and plans are reviewed.

  10. Ulnar head replacement.

    Science.gov (United States)

    Herbert, Timothy J; van Schoonhoven, Joerg

    2007-03-01

    Recent years have seen an increasing awareness of the anatomical and biomechanical significance of the distal radioulnar joint (DRUJ). With this has come a more critical approach to surgical management of DRUJ disorders and a realization that all forms of "excision arthroplasty" can only restore forearm rotation at the expense of forearm stability. This, in turn, has led to renewed interest in prosthetic replacement of the ulnar head, a procedure that had previously fallen into disrepute because of material failures with early implants, in particular, the Swanson silicone ulnar head replacement. In response to these early failures, a new prosthesis was developed in the early 1990s, using materials designed to withstand the loads across the DRUJ associated with normal functional use of the upper limb. Released onto the market in 1995 (Herbert ulnar head prosthesis), clinical experience during the last 10 years has shown that this prosthesis is able to restore forearm function after ulnar head excision and that the materials (ceramic head and noncemented titanium stem), even with normal use of the limb, are showing no signs of failure in the medium to long term. As experience with the use of an ulnar head prosthesis grows, so does its acceptance as a viable and attractive alternative to more traditional operations, such as the Darrach and Sauve-Kapandji procedures. This article discusses the current indications and contraindications for ulnar head replacement and details the surgical procedure, rehabilitation, and likely outcomes.

  11. Verification and Validation of Requirements on the CEV Parachute Assembly System Using Design of Experiments

    Science.gov (United States)

    Schulte, Peter Z.; Moore, James W.

    2011-01-01

    The Crew Exploration Vehicle Parachute Assembly System (CPAS) project conducts computer simulations to verify that flight performance requirements on parachute loads and terminal rate of descent are met. Design of Experiments (DoE) provides a systematic method for variation of simulation input parameters. When implemented and interpreted correctly, a DoE study of parachute simulation tools indicates values and combinations of parameters that may cause requirement limits to be violated. This paper describes one implementation of DoE that is currently being developed by CPAS, explains how DoE results can be interpreted, and presents the results of several preliminary studies. The potential uses of DoE to validate parachute simulation models and verify requirements are also explored.

  12. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients

    DEFF Research Database (Denmark)

    Husted, Henrik; Holm, Gitte; Jacobsen, Steffen

    2008-01-01

    after total hip and knee replacement surgery. PATIENTS AND METHODS: Between September 2003 and December 2005, 712 consecutive, unselected patients (440 women) with a mean age of 69 (31-91) years were admitted for hip and knee replacement surgery at our specialized fast-track joint replacement unit......BACKGROUND AND PURPOSE: Very few studies have focused on patient characteristics that influence length of stay (LOS) in fast-track total hip (THR) and knee arthroplasty (TKR). The aim of this prospective study was to identify patient characteristics associated with LOS and patient satisfaction...... characteristics that influence postoperative outcome, LOS, and patient satisfaction in our series of consecutive fast-track joint replacement patients, enabling further attention to be paid to certain aspects of surgery and rehabilitation....

  13. Patient participation in postoperative care activities in patients undergoing total knee replacement surgery: Multimedia Intervention for Managing patient Experience (MIME). Study protocol for a cluster randomised crossover trial.

    Science.gov (United States)

    McDonall, Jo; de Steiger, Richard; Reynolds, John; Redley, Bernice; Livingston, Patricia; Botti, Mari

    2016-07-18

    Patient participation is an important indicator of quality care. Currently, there is little evidence to support the belief that participation in care is possible for patients during the acute postoperative period. Previous work indicates that there is very little opportunity for patients to participate in care in the acute context. Patients require both capability, in terms of having the required knowledge and understanding of how they can be involved in their care, and the opportunity, facilitated by clinicians, to engage in their acute postoperative care. This cluster randomised crossover trial aims to test whether a multimedia intervention improves patient participation in the acute postoperative context, as determined by pain intensity and recovery outcomes. A total of 240 patients admitted for primary total knee replacement surgery will be invited to participate in a cluster randomised, crossover trial and concurrent process evaluation in at least two wards at a major non-profit private hospital in Melbourne, Australia. Patients admitted to the intervention ward will receive the multimedia intervention daily from Day 1 to Day 5 (or day of discharge, if prior). The intervention will be delivered by nurses via an iPad™, comprising information on the goals of care for each day following surgery. Patients admitted to the control ward will receive usual care as determined by care pathways currently in use across the organization. The primary endpoint is the "worst pain experienced in the past 24 h" on Day 3 following TKR surgery. Pain intensity will be measured using the numerical rating scale. Secondary outcomes are interference of pain on activities of daily living, length of stay in hospital, function and pain following TKR surgery, overall satisfaction with hospitalisation, postoperative complications and hospital readmission. The results of this study will contribute to our understanding of the effectiveness of interventions that provide knowledge and

  14. App Inventor for Android Build Your Own Apps - No Experience Required!

    CERN Document Server

    Tyler, Jason

    2011-01-01

    Create Android mobile apps, no programming required! Even with limited programming experience, you can easily learn to create apps for the Android platform with this complete guide to App Inventor for Android. App Inventor for Android is a visual language that relies on simple programming blocks that users can drag and drop to create apps. This handy book gives you a series of fully worked-out apps, complete with their programming blocks, which you can customize for your own use or use as a starting point for creating the next killer app. And it's all without writing a single line of code. Don

  15. Establishment and Implementation of a Required Medication Therapy Management Advanced Pharmacy Practice Experience

    Science.gov (United States)

    Gilliam, Eric; Thompson, Megan; Griend, Joseph Vande

    2017-01-01

    Objective. To develop a community pharmacy-based medication therapy management (MTM) advanced pharmacy practice experience (APPE) that provides students with skills and knowledge to deliver entry-level pharmacy MTM services. Design. The University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences (SSPPS) partnered with three community pharmacy chains to establish this three-week, required MTM APPE. Students completed the American Pharmacists Association MTM Certificate Course prior to entering the APPE. Students were expected to spend 90% or more of their time at this experience working on MTM interventions, using store MTM platforms. Assessment. All 151 students successfully completed this MTM APPE, and each received a passing evaluation from their preceptor. Preceptor evaluations of students averaged above four (entry-level practice) on a five-point Likert scale. The majority of students reported engagement in MTM services for more than 80% of the time on site. Students’ self-reporting of their ability to perform MTM interventions improved after participation in the APPE. Conclusion. The SSPPS successfully implemented a required MTM APPE, preparing students for entry-level delivery of MTM services. PMID:28381896

  16. Astronaut operations requirements document for the White Light Coronagraph experiment s-052 for the Apollo Telescope Mount

    Science.gov (United States)

    Ross, C. L.

    1973-01-01

    Information necessary for successful performance of the observer's function in the White Light Coronagraph portion of the Apollo Telescope Mount experiments is presented. The pre-flight, in-flight, and post-flight operations required to perform the S-052 experiment are described. A discussion of the scientific objectives of the experiment and a description of the hardware are provided.

  17. Instrumentation concepts and requirements for a space vacuum research facility. [molecular shield for spaceborne experiments

    Science.gov (United States)

    Norton, H. N.

    1979-01-01

    An earth-orbiting molecular shield that offers a unique opportunity for conducting physics, chemistry, and material processing experiments under a combination of environmental conditions that are not available in terrestrial laboratories is equipped with apparatus for forming a molecular beam from the freestream. Experiments are carried out using a moderate energy, high flux density, high purity atomic oxygen beam in the very low density environment within the molecular shield. As a minimum, the following instruments are required for the molecular shield: (1) a mass spectrometer; (2) a multifunction material analysis instrumentation system; and (3) optical spectrometry equipment. The design is given of a furlable molecular shield that allows deployment and retrieval of the system (including instrumentation and experiments) to be performed without contamination. Interfaces between the molecular shield system and the associated spacecraft are given. An in-flight deployment sequence is discussed that minimizes the spacecraft-induced contamination in the vicinity of the shield. Design approaches toward a precursor molecular shield system are shown.

  18. Health services management development: what formal knowledge should support the skills and experience required?

    Science.gov (United States)

    Ritchie, David J; Yen, Margaret L

    2013-05-01

    This study reports on an analysis of 17 postgraduate programs in health services management. Public information was collected from websites in February 2010. Data analysed included core subject abstracts, admission requirements and length and aims of each course. Findings indicate that only three out of 16 subjects identified as core are common to more than 50% of the programs, with the eight most common individual subjects appearing in only a third of programs. This suggests diversity in what is deemed core foundational knowledge in managing health services and the approach taken to management development. We believe there should be greater consensus on core subjects in a specialist health services management qualification. WHAT IS KNOWN ABOUT THE TOPIC? With changes in the organisational structure of health organisations in Australia over the past two decades, managerial positions and roles have also changed. The educational preparation for those managerial roles would also be expected to have changed but core foundational knowledge should remain similar between the various academic institutions.WHAT DOES THIS PAPER ADD? This paper indicates greater diversity in core knowledge areas in health services management education than expected despite a similar target audience.WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? There are differences in what are deemed to be core foundational areas of knowledge required in specialist management development between academic programs. Management development requires a balance between knowledge, skills and experience and intending st

  19. Determining staffing requirements for blood donor clinics: the Canadian Blood Services experience.

    Science.gov (United States)

    Blake, John T; Shimla, Susan

    2014-03-01

    Canadian Blood Services runs approximately 16,000 donor clinics annually. While there were more than 220 different clinic configurations used in 2011 and 2012, 67% of all clinic configurations followed one of 51 standard models. As part of operational planning for current and future configurations it was necessary for Canadian Blood Services to calculate staffing requirements for standard clinic models. In this article we present a method that incorporates both cost control and impact on donor experience. We calculate staffing requirements to minimize costs, but adjust using queuing theory to ensure donor wait time metrics are met. The method can be applied in a wide variety of situations. Although developed for a particular study, the methods described in this article can be applied in a wide variety of situations. A case study in which the model is used to review existing staffing arrangements at Canadian Blood Services is presented. The staffing model can be used to balance the requirements of minimizing staffing costs with that of ensuring that donors do not suffer unnecessary delays. Moreover, in an example application, savings of 3.4% were identified through the modeling process. © 2013 American Association of Blood Banks.

  20. A Hybrid Integrated Laboratory and Inquiry-Based Research Experience: Replacing Traditional Laboratory Instruction with a Sustainable Student-Led Research Project

    Science.gov (United States)

    Hartings, Matthew R.; Fox, Douglas M.; Miller, Abigail E.; Muratore, Kathryn E.

    2015-01-01

    The Department of Chemistry at American University has replaced its junior- and senior-level laboratory curriculum with two, two-semester long, student-led research projects as part of the department's American Chemical Society-accredited program. In the first semester of each sequence, a faculty instructor leads the students through a set of…

  1. Experiment requirements and implementation plan (Erip) for semiconductor materials growth in low-G environment

    Science.gov (United States)

    Crouch, R. K.; Fripp, A. L.; Debnam, W. J.; Clark, I. O.

    1983-01-01

    The MEA-2 A facility was used to test the effect of the low gravity environment on suppressing convective mixing in the growth of Pb(1-x)Sn(x)Te crystals. The need to eliminate convection, the furnace characteristics and operation that will be required for successful experimental implementation, and to the level that is presently known, the measured physical properties of the Pb(1-x)Sn(x)Te system were discussed. In addition, a brief background of the present and potential utilization of Pb(1-x)Sn(x)Te is given. Additional experiments are anticipated in future MEA-A, improved MEA and other dedicated materials processing in space flight apparatus.

  2. Impact of elective versus required medical school research experiences on career outcomes.

    Science.gov (United States)

    Weaver, Alice N; McCaw, Tyler R; Fifolt, Matthew; Hites, Lisle; Lorenz, Robin G

    2017-06-01

    Many US medical schools have added a scholarly or research requirement as a potential intervention to increase the number of medical students choosing to become academic physicians and physician scientists. We designed a retrospective qualitative survey study to evaluate the impact of medical school research at the University of Alabama at Birmingham (UAB) on career choices. A survey tool was developed consisting of 74 possible questions with built-in skip patterns to customize the survey to each participant. The survey was administered using the web-based program Qualtrics to UAB School of Medicine alumni graduating between 2000 and 2014. Alumni were contacted 3 times at 2-week intervals during the year 2015, resulting in 168 completed surveys (11.5% response rate). MD/PhD graduates were excluded from the study. Most respondents completed elective research, typically for reasons relating to career advancement. 24 per cent said medical school research increased their desire for research involvement in the future, a response that positively correlated with mentorship level and publication success. Although completion of medical school research was positively correlated with current research involvement, the strongest predictor for a physician scientist career was pre-existing passion for research (p=0.008). In contrast, students motivated primarily by curricular requirement were less likely to pursue additional research opportunities. Positive medical school research experiences were associated with increased postgraduate research in our study. However, we also identified a strong relationship between current research activity and passion for research, which may predate medical school. Copyright © 2017 American Federation for Medical Research.

  3. Shoulder Joint Replacement

    Science.gov (United States)

    ... Shoulder Replacement Options Shoulder replacement surgery is highly technical. It should be performed by a surgical team ... area and will meet a doctor from the anesthesia department. You, your anesthesiologist, and your surgeon will ...

  4. Partial knee replacement - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100225.htm Partial knee replacement - series—Normal anatomy To use the sharing ... A.M. Editorial team. Related MedlinePlus Health Topics Knee Replacement A.D.A.M., Inc. is accredited ...

  5. [Analysis of key vision position technologies in robot assisted surgical system for total knee replacement].

    Science.gov (United States)

    Zhao, Zijian; Liu, Yuncai; Wu, Xiaojuan; Liu, Hongjian

    2008-02-01

    Robot assisted surgery is becoming a widely popular technology and is now entering the total knee replacement. The development of total knee replacement and the operation system structure are introduced in this paper. The vision position technology and the related calibration technology, which are very important, are also analyzed. The experiments of error analysis in our WATO system demonstrate that the position and related calibration technologies have a high precision and can satisfy surgical requirement.

  6. TOTAL JOINT REPLACEMENT OF THE LOWER EXTREMITY IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

    OpenAIRE

    Стюарт Б. Гудмэн

    2014-01-01

    Joint replacement of the lower extremity in Juvenile Idiopathic Arthritis (JIA) is becoming more commonly performed worldwide. These young adults experience severe pain and disability from end-stage arthritis, and require joint replacement of the hip or knee to alleviate pain, and restore ambulation and function. These procedures are very challenging from the anesthesia and surgical point of view, due to small overall proportions, numerous bony and other deformities and soft tissue contractur...

  7. 风湿性心脏病手术3个瓣膜同时置换的临床经验%Experience of triple-valve replacement in rheumatic heart valve disease

    Institute of Scientific and Technical Information of China (English)

    张国报; 乔刚; 赵小娟; 权晓强; 赵健; 程兆云

    2012-01-01

    Objective:To explore the triple-valve replacement experience in rheumatic heart valve disease. Methods: We reviewed our experience in A patients who underwent combined mitral and aortic valve replacement with tricuspid valve replacement between 2007 and 2011. Results:We found tricuspid annular dilatation and leaflet thickening resulting in tricuspid regurgitation in four patients, tricuspid commissural fusion leading to tricuspid stenosis in two patients. One patient received bioprosthetic valves replacement procedures in aortic and mitral position with tricuspid position. The other three patients received mechanical valves replacement procedures in aortic and mitral position, and bioprosthetic valve in tricuspid position. One patient died after operation due to low cardiac output syndrome. The mean follow-up was 30 months (range, 12 to 49 months). Post-operative heart function NYHA classifi-cation:two cases in class I, one case in class Ⅱ. Conclusion;We recommend the use of a bioprosthetic valve in tricuspid position if tricuspid valve should be replaced. Even if mechanical valves are implanted in the left side of the heart, a bioprosthetic valve may be a better choice at the tricuspid position.%目的:探讨风湿性心脏病手术中3个瓣膜同时置换的经验.方法:对4例同时置换二尖瓣、主动脉瓣和三尖瓣的病人资料进行分析.结果:术中发现4例病人均有三尖瓣环扩大和瓣叶增厚导致关闭不全,2例病人伴有交界融合导致瓣膜狭窄.1例病人接受了二尖瓣位、主动脉瓣位以及三尖瓣位生物瓣置换.另3例病人接受了二尖瓣位和主动脉瓣位机械瓣置换,以及三尖瓣位生物瓣置换.1例病人死于术后低心排.其他病人平均随访30个月(12~49个月),术后心功能I级2例,Ⅱ级1例.结论:如果三尖瓣需要置换时应使用生物瓣.尽管左侧心脏瓣膜应用机械瓣,三尖瓣位应用生物瓣仍是较好的选择.

  8. Implosion and core heating requirements in subignition experiments FIREX-I

    Science.gov (United States)

    Johzaki, Tomoyuki; Nakao, Yasuyuki; Mima, Kunioki

    2008-06-01

    In the fast ignition realization experiment project phase-I (FIREX-I) [H. Azechi and the FIREX Project, Plasma Phys. Control. Fusion 48, B267 (2006)], core heating up to an ion temperature of 5keV is expected for subignition-class carbon-deuterium (CD) and deuterium-tritium (DT) fuels. The dependence of the achieved ion temperature on heating pulse parameters, and core density is investigated using two-dimensional simulations. Since the core size in FIREX-I is insufficient for self-ignition, and the confinement time is comparable to the heating duration (˜10ps), the temperature relaxation between the bulk electrons and ions is important for efficient ion heating. High compression (a core density of ρ >200g/cm3) is required for pure DT fuel to shorten the relaxation time. In this case, a heating energy of Eh>2kJ and a duration of τh2kJ and τh˜10ps.

  9. Using multidetector-row CT in neonates with complex congenital heart disease to replace diagnostic cardiac catheterization for anatomical investigation: initial experiences in technical and clinical feasibility

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Tain; Tsai, I.C.; Chen, Min-Chi [Taichung Veterans General Hospital, 407 Department of Radiology, Taichung (Taiwan); Medical College of Chung Shan Medical University, Faculty of Medicine, Taichung (Taiwan); National Yang Ming University School of Medicine, Department of Medicine, Taipei (Taiwan); Fu, Yun-Ching; Jan, Sheng-Lin [Taichung Veterans General Hospital, Department of Paediatrics, Taichung (Taiwan); National Yang-Ming University, Institute of Clinical Medicine, Taipei (Taiwan); Wang, Chung-Chi; Chang, Yen [Taichung Veterans General Hospital, Section of Cardiovascular Surgery, Department of Surgery, Taichung (Taiwan)

    2006-12-15

    Echocardiography is the first-line modality for the investigation of neonatal congenital heart disease. Diagnostic cardiac catheterization, which has a small but recognized risk, is usually performed if echocardiography fails to provide a confident evaluation of the lesions. To verify the technical and clinical feasibilities of replacing diagnostic cardiac catheterization with multidetector-row CT (MDCT) in neonatal complex congenital heart disease. Over a 1-year period we prospectively enrolled all neonates with complex congenital heart disease referred for diagnostic cardiac catheterization after initial assessment by echocardiography. MDCT was performed using a 40-detector-row CT scanner with dual syringe injection. A multidisciplinary congenital heart disease team evaluated the MDCT images and decided if further diagnostic cardiac catheterization was necessary. The accuracy of MDCT in detecting separate cardiovascular anomalies and bolus geometry of contrast enhancement were calculated. A total of 14 neonates were included in the study. No further diagnostic cardiac catheterization was needed in any neonate. The accuracy of MDCT in diagnosing separate cardiovascular anomalies was 98% (53/54) with only one atrial septal defect missed in a patient with coarctation syndrome. The average cardiovascular enhancement in evaluated chambers was 471 HU. No obvious beam-hardening artefact was observed. The technical and clinical feasibility of MDCT in complex congenital heart disease in neonates is confirmed. After initial assessment with echocardiography, MDCT could probably replace diagnostic cardiac catheterization for further anatomical clarification in neonates. (orig.)

  10. 风电场风电机组更新改建经验浅谈%Discussion on the Experience of Replacement and Reconstruction of Wind Turbines

    Institute of Scientific and Technical Information of China (English)

    2013-01-01

      文章介绍了某风电场对已经运行23年的风电机组及其故障频发、存在设计缺陷的机组进行替换改建的项目,涉及项目实施中遇到的问题及处理措施。该项目作为国内风电场改建的先例,从风电场运行经济性及机组更新改建过程等方面提出合理化建议。%is paper introducedthe project of a windfarm on the replacement and reconstruction of wind turbines which has been operating for 23 years and wind turbines with design defects which o en break down, involving the problems and processing measures during the implementation of the project. As a domestic precedent for reconstruction of wind farms, this project proposedreasonable suggestions on the aspects of operating economy of wind power plant and process of replacement and reconstruction of wind turbines.

  11. Prioritization methodology for chemical replacement

    Science.gov (United States)

    Goldberg, Ben; Cruit, Wendy; Schutzenhofer, Scott

    1995-01-01

    This methodology serves to define a system for effective prioritization of efforts required to develop replacement technologies mandated by imposed and forecast legislation. The methodology used is a semi quantitative approach derived from quality function deployment techniques (QFD Matrix). QFD is a conceptual map that provides a method of transforming customer wants and needs into quantitative engineering terms. This methodology aims to weight the full environmental, cost, safety, reliability, and programmatic implications of replacement technology development to allow appropriate identification of viable candidates and programmatic alternatives.

  12. Experiences in Using Practitioner’s Checklists to Evaluate the Relevance of Experiments Reported in Requirements Engineering

    NARCIS (Netherlands)

    Daneva, Maia; Sikkel, Nicolaas; Condori-Fernandez, Nelly; Herrmann, Andrea

    2011-01-01

    Background: Requirements Engineering (RE) researchers recognize that for RE methods to be adopted in industry, practitioners should be able to evaluate the relevance of a study to their practice. Kitchenham et al proposed a set of perspective-based checklists, which demonstrated to be a useful instr

  13. Utilization of biomass in the U.S. for the production of ethanol fuel as a gasoline replacement. I - Terrestrial resource potential. II - Energy requirements, with emphasis on lignocellulosic conversion

    Science.gov (United States)

    Ferchak, J. D.; Pye, E. K.

    The paper assesses the biomass resource represented by starch derived from feed corn, surplus and distressed grain, and high-yield sugar crops planted on set-aside land in the U.S. It is determined that the quantity of ethanol produced may be sufficient to replace between 5 to 27% of present gasoline requirements. Utilization of novel cellulose conversion technology may in addition provide fermentable sugars from municipal, agricultural and forest wastes, and ultimately from highly productive silvicultural operations. The potential additional yield of ethanol from lignocellulosic biomass appears to be well in excess of liquid fuel requirements of an enhanced-efficiency transport sector at present mileage demands. No conflict with food production would be entailed. A net-energy assessment is made for lignocellulosic biomass feedstocks' conversion to ethanol and an almost 10:1 energy yield/energy cost ratio determined. It is also found that novel cellulose pretreatment and enzymatic conversion methods still under development may significantly improve even that figure, and that both chemical-feedstocks and energy-yielding byproducts such as carbon dioxide, biogas and lignin make ethanol production potentially energy self-sufficient. A final high-efficiency production approach incorporates site-optimized, nonpolluting energy sources such as solar and geothermal.

  14. Integration of the sensory experience and post-ingestive measures for understanding food satisfaction. A case study on sucrose replacement by Stevia rebaudiana and addition of beta glucan in fruit drinks

    DEFF Research Database (Denmark)

    Andersen, Barbara Vad; Mielby, Line H.; Viemose, Ida

    2017-01-01

    The present study provides a more holistic view on consumers’ hedonic food experience compared to what is traditionally seen in sensory research, by integrating the hedonic sensory experience and post-ingestive sensations in one study to understand food satisfaction. The study was performed using....... Satisfaction with sensory attributes was found to be the main driver of food satisfaction, while post-ingestive sensations drove satisfaction as well. While replacing sucrose with Stevia rebaudiana did not affect the hedonic and post-ingestive sensations, addition of beta glucan resulted in both positive...... apple-cherry fruit drinks with different levels of beta-glucans and different sweeteners, sucrose or Stevia rebaudiana. The aims were: 1) to study the hedonic sensory experience, 2) to study time and product effects on post-ingestive sensations and satisfaction, and 3) to study main drivers...

  15. Orchestrating care through the fast-track perspective: Orthopaedic nurses’ perceptions and experiences of providing individualised nursing care in older patients’ standardised fast-track programmes after total hip or knee replacement

    DEFF Research Database (Denmark)

    Bøttcher Berthelsen, Connie; Frederiksen, Kirsten

    2017-01-01

    The lack of individualised care in orthopaedic regimes is often explained by the extended use of patient pathways and clinical guidelines. The aim of this study was to illuminate orthopaedic nurses' perceptions and experiences of providing individual nursing care for older patients in standardised...... fast-track programmes after total hip or knee replacement. Ten semi-structured interviews were conducted with orthopaedic nurses in orthopaedic wards at three Danish hospitals between April and June of 2015. Data were analysed using manifest and latent content analysis according to Graneheim...

  16. Nursing experience of minimally invasive mitral valve replacement via right minithoracotomy%经右胸微创小切口二尖瓣置换术后的护理体会

    Institute of Scientific and Technical Information of China (English)

    张代英; 李远

    2013-01-01

    Abstrct Objective: To explore the best nursing cooperation for improving the successful rate of surgery by analyzing the nursing experience in minimally invasive mitral valve replacement via right minithoracotomy. Methods: The nursing observation and experience with 41 patients after minimally invasive mitral valve replacement via right minithoracotomy from December 2010 to October 2012 were analyzed retrospectively. Results: Among the 41 patients, I case with postoperative bleeding,2 cases with postoperative venal dysfunction, all the 3 cases were ultimately recovered and discharged after active treatment and enhanced nursing. Conclusion: The positive postoperative nursing observation and cooperation can effectively promote the development of minimally invasive valve replacement.%  目的:通过分析经右胸小切口二尖瓣膜置换术后的护理体会,探讨经右胸小切口二尖瓣膜置换术后最佳护理配合,提高手术成功率。方法:总结分析自2010年12月至2012年10月完成的41例经右胸小切口二尖瓣置换手术后的护理观察和体会。结果:41例病人中1例发生术后大出血,2例发生术后肾功能不全,经积极治疗和加强护理后最终均康复出院。结论:经右胸小切口二尖瓣膜置换术术后积极的护理配合、观察能有效促进微创瓣膜置换手术的开展。

  17. Aeronautical Information System Replacement -

    Data.gov (United States)

    Department of Transportation — Aeronautical Information System Replacement is a web-enabled, automation means for the collection and distribution of Service B messages, weather information, flight...

  18. Software architects’ experiences of quality requirements : what we know and what we do not know?

    NARCIS (Netherlands)

    Daneva, Maia; Buglione, Luigi; Herrmann, Andrea; Doerr, J.; Opdahl, A.

    2013-01-01

    [Context/motivation] Quality requirements (QRs) are a concern of both requirement engineering (RE) specialists and software architects (SAs). However, the majority of empirical studies on QRs take the RE analysts’/clients’ perspectives, and only recently very few included the SAs’ perspective. As a

  19. Efecto de la terapia hormonal de reemplazo sobre la mamografía: nuestra experiencia Effect of replacement hormone therapy on mammography: our experience in this field

    Directory of Open Access Journals (Sweden)

    Daysi Navarro Despaigne

    2005-12-01

    Full Text Available Se realizó un estudio retrospectivo, cuyo objetivo fue describir el efecto de la terapia hormonal de reemplazo (THR sobre las mamografías de mujeres de edad mediana que asistieron a la Clínica de Climaterio y Osteoporosis (ClimOs entre enero de 1998 y diciembre de 2003. A cada mujer se le realizó mamografía (Mx inicial y durante el uso de la THR, las cuales fueron informadas como: 1 mamografías sin alteraciones, 2 con cambios menores [densidad irregular y microcalcificaciones] y 3 con cambios mayores [nódulos, quistes u otra alteración]. Como tratamiento recibieron estrógenos solos (E, estrógenos y progestagenos combinados continuos (EP y terapia no estrogénica (fitoestrógenos, tibolona. La muestra estuvo constituida por 112 mujeres, con edades entre 34 y 59 años. La Mx inicial mostró: no alteraciones en el 85,5 %, cambios menores en el 9,1 y cambios mayores en el 5,4. En la posTHR (tiempo promedio entre ambos estudios: 2,5 años, el 66 % continuó con mamografías normales, en el 29,0 hubo cambios menores (pA retrospective study was conducted, with the objective of describing the effect of hormone replacement therapy (HRT on mammography performed on middle-aged females, who had been seen at climacterics and osteoporosis clinics from January 1998 to December 2003. Mammography had been performed on each woman at the beginning and during the use of the HRT, being the results as follows: 1 mammography showing no changes; 2 mammography with slight changes irregular density and microcalcification and 3 mammography with major changes nodules, cysts or any other change . As a treatment, they received estrogen (E, continuos combined estrogen and progestagen (EP and nonestrogen therapy (phytoestrogen, tibolone. The sample was composed of 112 women aged 34 to 59 years. The initial Mx showed no changes in 85,5 %, slight changes in 9,1 and major changes in 5,4 of females. After the application of HRT (average time between both mammographic

  20. Required and Elective Experiences During the 4th Year: An Analysis of ACGME Accredited Psychiatry Residency Program Websites.

    Science.gov (United States)

    Vestal, Heather S; Belitsky, Richard; Bernstein, Carol A; Chaukos, Deanna; Cohen, Mitchell B; Dickstein, Leah J; Hilty, Donald M; Hutner, Lucy; Sakman, Ferda; Scheiber, Stephen C; Wrzosek, Marika I; Silberman, Edward K

    2016-10-01

    The objective of this study was to assess and describe required and elective components of the 4th post-graduate year (PGY4) in psychiatry residency programs. We reviewed the websites of all 193 2014-2015 ACGME accredited psychiatry residency programs for content describing the specific components of the PGY4 year. Nearly all residency programs (99 %) had some form of required experiences during the PGY4 year. Ninety-four percent had clinical requirements for PGY4 residents, with longitudinal outpatient clinic being the most common (77 %). All programs offered some elective time during PGY4, but the amount of time ranged from 2 months to 100 %. Virtually all residency programs include some requirements in the 4th year (most commonly didactics and outpatient clinic) in addition to a broad array of elective experiences. Although 3 years may suffice for residents to complete ACGME requirements, a variety of factors may motivate programs to include required 4th year curricula. Future studies should explore the rationales for and possible benefits of programmatic requirements throughout 4 versus only 3 years of psychiatric training.

  1. Development of flight experiment task requirements. Volume 2: Technical Report. Part 2: Appendix H: Tasks-skills data series

    Science.gov (United States)

    Hatterick, G. R.

    1972-01-01

    The data sheets presented contain the results of the task analysis portion of the study to identify skill requirements of space shuttle crew personnel. A comprehensive data base is provided of crew functions, operating environments, task dependencies, and task-skills applicable to a representative cross section of earth orbital research experiments.

  2. Developing a Policy for an International Experience Requirement in a Graduate Teacher Education Program: A Cautionary Tale

    Science.gov (United States)

    Buczynski, Sandy; Lattimer, Heather; Inoue, Noriyuki; Alexandrowicz, Viviana

    2010-01-01

    This case study describes the process education faculty went through to craft a response to a school-wide international experience initiative. Analysis revealed three competing frames that shaped individual faculty members' expectations. This made developing an internationalization requirement in graduate teacher education multifaceted, often…

  3. Comparison of heparin to citrate as a catheter locking solution for non-tunneled central venous hemodialysis catheters in patients requiring renal replacement therapy for acute renal failure (VERROU-REA study): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Bruyère, Rémi; Soudry-Faure, Agnès; Capellier, Gilles; Binquet, Christine; Nadji, Abdelouaid; Torner, Stephane; Blasco, Gilles; Yannaraki, Maria; Barbar, Saber Davide; Quenot, Jean-Pierre

    2014-11-19

    The incidence of acute kidney injury (AKI) is estimated at 10 to 20% in patients admitted to intensive care units (ICU) and often requires renal replacement therapy (RRT). ICU mortality in AKI patients can exceed 50%. Venous catheters are the preferred vascular access method for AKI patients requiring RRT, but carry a risk of catheter thrombosis or infection. Catheter lock solutions are commonly used to prevent such complications. Heparin and citrate locks are both widely used for tunneled, long-term catheters, but few studies have compared citrate versus heparin for patients with short-term, non-tunneled catheters. We aim to compare citrate 4% catheter lock solution versus heparin in terms of event-free survival of the first non-tunneled hemodialysis catheter inserted in ICU patients with AKI requiring RRT. Secondary objectives are the rate of fibrinolysis, incidence of catheter thrombosis and catheter-related infection per 1,000 catheter days, length of stay in ICU and in-hospital and 28-day mortality. The VERROU-REA study is a randomized, prospective, multicenter, double-blind, parallel-group, controlled superiority study carried out in the medical, surgical and nephrological ICUs of two large university hospitals in eastern France. A catheter lock solution composed of trisodium citrate at 4% will be compared to unfractionated heparin at a concentration of 5,000 IU/mL. All consecutive adult patients with AKI requiring extracorporeal RRT, and in whom a first non-tunneled catheter is to be inserted by the jugular or femoral approach, will be eligible. Catheters inserted by the subclavian approach, patients with acute liver failure, thrombopenia or contraindication to systemic anticoagulation will be excluded. Patients will be followed up daily in accordance with standard practices for RRT until death or discharge. Data is scarce regarding the use of non-tunneled catheters in the ICU setting in patients with AKI. This study will provide an evidence base for

  4. 22 CFR 96.37 - Education and experience requirements for social service personnel.

    Science.gov (United States)

    2010-04-01

    ... practice; (2) Meet the INA requirements for home study preparers in 8 CFR 204.3(b); and (3) Are supervised... doctorate) in a related human service field, including, but not limited to, psychology,...

  5. Requirements for Electronic Delivery Systems in eGovernment - An Austrian Experience

    Science.gov (United States)

    Tauber, Arne

    Electronic mailing systems are the dominant communication systems in private and business matters. Public administrations deliver documents to citizens and businesses - subpoenas, legal verdicts, notifications, administrative penalties etc. However, official activities are more strongly linked to legal regulations than in civil law. Delivery of crucial and strictly personal documents raises the demand for qualified identification and non-repudiation services as featured by registered mail in the paper world. Legal requirements for electronic delivery carried-out by public administrations (eDelivery) cannot be fulfilled by standard certified mailing systems. Although the requirements for eDelivery systems may differ due to national legal regulations, this paper discusses common requirements and challenges on an abstract level. Moreover, we show how these requirements have been addressed by introducing the Austrian eDelivery system for eGovernment applications.

  6. Radiation Source Replacement Workshop

    Energy Technology Data Exchange (ETDEWEB)

    Griffin, Jeffrey W.; Moran, Traci L.; Bond, Leonard J.

    2010-12-01

    This report summarizes a Radiation Source Replacement Workshop in Houston Texas on October 27-28, 2010, which provided a forum for industry and researchers to exchange information and to discuss the issues relating to replacement of AmBe, and potentially other isotope sources used in well logging.

  7. Comparison of Resource Requirements for a Wind Tunnel Test Designed with Conventional vs. Modern Design of Experiments Methods

    Science.gov (United States)

    DeLoach, Richard; Micol, John R.

    2011-01-01

    The factors that determine data volume requirements in a typical wind tunnel test are identified. It is suggested that productivity in wind tunnel testing can be enhanced by managing the inference error risk associated with evaluating residuals in a response surface modeling experiment. The relationship between minimum data volume requirements and the factors upon which they depend is described and certain simplifications to this relationship are realized when specific model adequacy criteria are adopted. The question of response model residual evaluation is treated and certain practical aspects of response surface modeling are considered, including inference subspace truncation. A wind tunnel test plan developed by using the Modern Design of Experiments illustrates the advantages of an early estimate of data volume requirements. Comparisons are made with a representative One Factor At a Time (OFAT) wind tunnel test matrix developed to evaluate a surface to air missile.

  8. Total joint replacement preadmission programs.

    Science.gov (United States)

    Messer, B

    1998-01-01

    Patients begin to formulate their expectations of the postoperative hospitalization during the preadmission program. The challenge is to better understand the factors patients consider when formulating judgments about the quality of preadmission education. For example, it may be that perceptions of the preadmission program are influenced by what patients believe about their postoperative pain and functional abilities. Specific attention needs to be given both preoperatively and postoperatively to instructing patients on realistic expectations for recovery. One other method of measuring patient outcomes is with the Health Status Profile (SF-36) (Response Healthcare Information Management, 1995). The SF-36 approach emphasizes the outcome of medical care as the patient sees it, in addition to a clinical evaluation of successful health care. This form is currently initiated in the physician's office and returned for scanning at the preadmission class. The patient then completes another SF-36 at 6 months and every year thereafter to compare measurable outcomes. Patients intending to have elective total joint replacements experience anxiety and require much support and education. An effective preadmission program is a major investment in a patient's recovery, as well as a unique marketing tool to customers. Preadmission programs can be viewed as an opportunity to enhance customer satisfaction. Preadmission clinics are an excellent means for nurses to improve the quality of patient care through patient education. the overall goal of preadmission testing programs is to ensure patient preparedness while increasing quality health care and overall customer satisfaction. To enhance program effectiveness, health care providers must lead collaborative efforts to improve the efficiency of systems.

  9. Experiment Requirements and Implementation Plan (ERIP) for semiconductor materials growth in low-G environment experiment no. MPS-77F087

    Science.gov (United States)

    Crouch, R. K.; Fripp, A. L.; Debnam, W. J.; Clark, I. O.

    1981-01-01

    Crystals of the intermetallic compound Pb1-xSnxTe will be grown in furnaces on the Space Shuttle. The reasons for conducting this growth in space, the program of investigation to develop the space experiment and the requirements that are placed on the Space Shuttle furnace are discussed. Also included are relevent thermophysical properties of Pb1-xSnxTe to the degree which they are known.

  10. Experience-driven axon retraction in the pharmacologically inactivated visual cortex does not require synaptic transmission.

    Directory of Open Access Journals (Sweden)

    Kana Watanabe

    Full Text Available BACKGROUND: Experience during early postnatal development plays an important role in the refinement of specific neural connections in the brain. In the mammalian visual system, altered visual experiences induce plastic adaptation of visual cortical responses and guide rearrangements of afferent axons from the lateral geniculate nucleus. Previous studies using visual deprivation demonstrated that the afferents serving an open eye significantly retract when cortical neurons are pharmacologically inhibited by applying a gamma-aminobutyric acid type A receptor agonist, muscimol, whereas those serving a deprived eye are rescued from retraction, suggesting that presynaptic activity can lead to the retraction of geniculocortical axons in the absence of postsynaptic activity. Because muscimol application suppresses the spike activity of cortical neurons leaving transmitter release intact at geniculocortical synapses, local synaptic interaction may underlie the retraction of active axons in the inhibited cortex. METHOD AND FINDINGS: New studies reported here determined whether experience-driven axon retraction can occur in the visual cortex inactivated by blocking synaptic inputs. We inactivated the primary visual cortex of kittens by suppressing synaptic transmission with cortical injections of botulinum neurotoxin type E, which cleaves a synaptic protein, SNAP-25, and blocks transmitter release, and examined the geniculocortical axon morphology in the animals with normal vision and those deprived of vision binocularly. We found that afferent axons in the animals with normal vision showed a significant retraction in the inactivated cortex, as similarly observed in the muscimol-treated cortex, whereas the axons in the binocularly deprived animals were preserved. CONCLUSIONS: Therefore, the experience-driven axon retraction in the inactivated cortex can proceed in the absence of synaptic transmission. These results suggest that presynaptic mechanisms play

  11. E-LEARNING SYSTEM DEVELOPMENT IN ACCORDANCE WITH THE REQUIREMENTS OF EFQUEL: VYATKA STATE UNIVERSITY EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Elena Syrtsova

    2017-06-01

    Full Text Available The article is devoted to the study of various aspects of development and implementation of e-learning at higher education institutions. This system has been created according to the main approaches and criteria used by the European Foundation for quality assurance of e-learning (EFQUEL. The article presents the main results of the experiment on Vyatka State University's e-learning system development. The article reveals the feasibility of the development of e-learning in the region. The authors consider three main strategies of implementation of e-learning system at Vyatka State University. The authors substantiate the choice of the most effective and promising strategy of them based on the analysis and considering the peculiarities of the university and the region. In the article, the fundamental results of the experiment and description of the stages of the implementation of e-learning system are presented.

  12. [New conduction disturbances and pacemaker indications after CoreValve® transcatheter aortic valve replacement. Incidence and follow up in a single center experience].

    Science.gov (United States)

    Aversa, Eliana; Muratore, Claudio A; Nemesio, M Laura; Tentori, Maria Cristina; Payaslian, Miguel

    2015-01-01

    Transcatheter aortic valve implantation (TAVI) is currently reserved for patients with symptomatic aortic stenosis and high surgical risk. One major limiting factor related to TAVI procedural complications is conduction abnormalities and the need for permanent pacemaker implantation. Evaluate the incidence of new conduction disturbances and pacemaker indications in patients with TAVI CoreValve® prosthesis (Medtronic Inc. Minneapolis, Minnesota, United States). We included 28 patients, mean age 80 years. ECG parameters were evaluated previous and after implantation. All patients were monitorized during TAVI. Follow up Holter monitoring was performed at one, 6 and 12 months after the procedure and we also evaluated telemetry of implanted pacemaker. In previous ECG we found 7 patients had right bundle branch block and 7 patients had left bundle brunch block (LBBB). The post implant ECG showed 7 new LBBB: 3 during valvuloplasty and 4 on the end of it. Six patients required pacemaker implantation for permanent or paroxysmal complete AV block (CAVB). At one year follow up, 3 patients with LBBB during valvuloplasty had a normal ECG, one still had LBBB and one an asymptomatic CAVB found in Holter monitoring. Conduction abnormalities are frequent after CoreValve® aortic valve prosthesis implantation. The incidence of new LBBB was 25%. CAVB during or post TAVI require PM implantation. New LBBB may need a closer follow up because in a 3% of the cases it may progress to CAVB. Copyright © 2014 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  13. Army Experience and Requirements for Stability and Cleanliness of Diesel Fuels.

    Science.gov (United States)

    1980-07-01

    X Cladosporium resinae Ft. Lewis, WA AL-6980-X Cladosporium resinae Ft. Lewis, WA AL-6981-X Cladosporium resinae plus unidentified yeast? Ft. Lewis...WA AL-6982-X Cladosporium residae plus unidentified yeast? Ft. Lewis, WA AL-6986-X Cladosporium resinae Ft. Lewis, WA AL-701I-F undergoing...conditions (shak- ing flasks at 30 0 C) are required for Cladosporium resinae to develop any volume of mycelia. In the field, extensive studies would be

  14. A Data Management System Integrating Web-based Training and Randomized Trials: Requirements, Experiences and Recommendations.

    Science.gov (United States)

    Muroff, Jordana; Amodeo, Maryann; Larson, Mary Jo; Carey, Margaret; Loftin, Ralph D

    2011-01-01

    This article describes a data management system (DMS) developed to support a large-scale randomized study of an innovative web-course that was designed to improve substance abuse counselors' knowledge and skills in applying a substance abuse treatment method (i.e., cognitive behavioral therapy; CBT). The randomized trial compared the performance of web-course-trained participants (intervention group) and printed-manual-trained participants (comparison group) to determine the effectiveness of the web-course in teaching CBT skills. A single DMS was needed to support all aspects of the study: web-course delivery and management, as well as randomized trial management. The authors briefly reviewed several other systems that were described as built either to handle randomized trials or to deliver and evaluate web-based training. However it was clear that these systems fell short of meeting our needs for simultaneous, coordinated management of the web-course and the randomized trial. New England Research Institute's (NERI) proprietary Advanced Data Entry and Protocol Tracking (ADEPT) system was coupled with the web-programmed course and customized for our purposes. This article highlights the requirements for a DMS that operates at the intersection of web-based course management systems and randomized clinical trial systems, and the extent to which the coupled, customized ADEPT satisfied those requirements. Recommendations are included for institutions and individuals considering conducting randomized trials and web-based training programs, and seeking a DMS that can meet similar requirements.

  15. Replacing a Missing Tooth

    Science.gov (United States)

    ... vessels in the tooth pulps are rather large. Drilling down these teeth for crowns may expose the ... porcelain replacement tooth is held in place by metal extensions cemented to the backs of the adjacent ...

  16. Hormone Replacement Therapy

    Science.gov (United States)

    ... before and during menopause, the levels of female hormones can go up and down. This can cause ... hot flashes and vaginal dryness. Some women take hormone replacement therapy (HRT), also called menopausal hormone therapy, ...

  17. Knee joint replacement

    Science.gov (United States)

    ... of your kneecap. Your kneecap is called the patella. The replacement part is usually made from a ... long. Then your surgeon will: Move your kneecap (patella) out of the way, then cut the ends ...

  18. Knee joint replacement - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100088.htm Knee joint replacement - series—Normal anatomy To use the ... to slide 4 out of 4 Overview The knee is a complex joint. It contains the distal ...

  19. Product Platform Replacements

    DEFF Research Database (Denmark)

    Sköld, Martin; Karlsson, Christer

    2012-01-01

    Purpose – It is argued in this article that too little is known about product platforms and how to deal with them from a manager's point of view. Specifically, little information exists regarding when old established platforms are replaced by new generations in R&D and production environments...... originality and value is achieved by focusing on product platform replacements believed to represent a growing management challenge....

  20. Operational experience of load shedding and new requirements on frequency relays

    Energy Technology Data Exchange (ETDEWEB)

    Lindahl, S. [ASEA-ATOM AB, Vaesteraas (Sweden); Runvik, G. [Sydkraft AB, Malmoe (Sweden); Stranne, G. [ABB Network Partner AB (Sweden)

    1997-12-31

    This paper summarises experience and analysis of underfrequency load shedding and power generator islanding. Most power systems can withstand the loss of a single generating unit or a single transmission line. Simultaneous loss of several power system components may cause a severe deficit in active and reactive power. The action of overexcitation limiters on the remaining generators may further aggravate the situation. Such infrequent events may cause severe drop in system frequency and voltage magnitude. Frequency relays for load shedding and power generator islanding must operate correctly even if the system frequency decays and the voltage magnitude decays rapidly at the same time. (author)

  1. Experiments on the Acquisition of the Semantics and Grammatical Constructions Required for Communicating Propositional Logic Sentences

    Science.gov (United States)

    Sierra, Josefina; Santibáñez, Josefina

    We describe some experiments which simulate a grounded approach to language acquisition in which a population of autonomous agents without prior linguistic knowledge tries to construct at the same time a conceptualisation of its environment and a shared language. The conceptualisation and language acquisition processes in each individual agent are based on general purpose cognitive capacities, such as categorisation, discrimination, evaluation and induction. The emergence of a shared language in the population results from a process of self-organisation of a particular type of linguistic interaction which takes place among the agents in the population.

  2. Using Slovenian Experience in the Croatian Agricultural Policy Adjustment to EU Requirements

    Directory of Open Access Journals (Sweden)

    Ornella Kumrić

    2005-03-01

    Full Text Available Strict EU requirements in politics, legislation and economics on new and future member states pose a great challenge for Croatia, which strives to become its member. Agriculture, being an important economic sector, needs to be considerably reformed in the process of adjustment to the Common Agricultural Policy (CAP. The Croatia decided to use the Slovenian case for better understanding of the requirements and their fulfilment. The Slovenian agricultural policy reform included change from market price supports towards direct payments, and implementation of different structural, environmental and rural development measures. Slovenia has implemented numerous reforms, plans and laws. Slovenian four-year pre-accession negotiations with the EU in agricultural sector comprised: implementing the acquis communitaire, exceptions from the acquis, and the financial part. To achieve the best negotiation results, Slovenia collected detailed and reliable data and engaged professionals who negotiated the most favourable position for Slovenian agriculture in the European agricultural sector. The Croatian agricultural policy reform is underway, so there is a tendency of decreasing and phasing out the system of guaranteed prices, direct payments are being introduced, Croatia is included in trade integration processes, steps need to be taken for strengthening of competitive capacity of domestic products both in domestic and foreign markets, and rural development and the whole social situation in agricultural sector needs to be improved.

  3. Using Slovenian Experience in the Croatian Agricultural Policy Adjustment to EU Requirements

    Directory of Open Access Journals (Sweden)

    Ornella Kumrić

    2005-03-01

    Full Text Available Strict EU requirements in politics, legislation and economics on new and future member states pose a great challenge for Croatia, which strives to become its member. Agriculture, being an important economic sector, needs to be considerably reformed in the process of adjustment to the Common Agricultural Policy (CAP. The Croatia decided to use the Slovenian case for better understanding of the requirements and their fulfilment. The Slovenian agricultural policy reform included change from market price supports towards direct payments, and implementation of different structural, environmentaland rural development measures. Slovenia has implemented numerous reforms, plans and laws. Slovenian four-year pre-accession negotiations with the EU in agricultural sector comprised: implementing the acquis communitaire, exceptions from the acquis, and the financial part. To achieve the best negotiation results, Slovenia collected detailed and reliable data and engaged professionals who negotiated the most favourable position for Slovenian agriculture in the European agricultural sector. The Croatian agricultural policy reform is underway, so there is a tendency of decreasing and phasing out the system of guaranteed prices, direct payments are being introduced, Croatia is included in trade integration processes, steps need to be taken for strengthening of competitive capacity of domestic products both in domestic and foreign markets, and rural development and the whole social situation in agricultural sector needs to be improved.

  4. 用代乳粉替代全乳饲喂荷斯坦母犊牛的试验%Experiment of Feeding Female Holstein Calf with Milk Replacer Substitute Full Milk

    Institute of Scientific and Technical Information of China (English)

    郑爱华; 汪红琴

    2012-01-01

    Twenty Holstein calves from 5 to 8 d of age,after 5 d foremilk period were randomly divided into two groups according to similar weight,10 calves in each group,experiment and control group.Milk replacer was fed to experiment group and full milk was fed to control group,the formula of the concentrate and roughage feed in the two groups were alike,the animals weaned after 45 lactation period.The results indicated that during the first month,the average weight gain of calves was 513g and 611g,during the second month,the average weight gain of calves was 823g and 812g,respectively.The calves in the experiment group grew normally,during the second month,feed conversion ratio of experiment group improved slightly compared to control group,this indicate that milk replacer can substitute full milk to feed calves.%选择出生日期5~8 d,5 d初乳期后的荷斯坦母犊牛20头,按照体重相近的原则随机分为两组,每组10头,记为试验组和对照组,试验组饲喂代乳粉,对照组饲喂全乳,其精料、粗料两组均相同,哺乳期45 d,断奶。1月龄和2月龄两组牛平均日增重,第一个月分别为513 g、611 g;第二个月分别为823 g、812 g。试验组生长发育正常,第二个月试验组比对照组饲料转化率稍有提高,表明代乳粉可用来代替全乳饲养犊牛。

  5. Integration of photovoltaic units into electric utility grids: experiment information requirements and selected issues

    Energy Technology Data Exchange (ETDEWEB)

    1980-09-01

    A number of investigations, including those conducted by The Aerospace Corporation and other contractors, have led to the recognition of technical, economic, and institutional issues relating to the interface between solar electric technologies and electric utility systems. These issues derive from three attributes of solar electric power concepts, including (1) the variability and unpredictability of the solar resources, (2) the dispersed nature of those resources which suggests the feasible deployment of small dispersed power units, and (3) a high initial capital cost coupled with relatively low operating costs. It is imperative that these integration issues be pursued in parallel with the development of each technology if the nation's electric utility systems are to effectively utilize these technologies in the near to intermediate term. Analyses of three of these issues are presented: utility information requirements, generation mix and production cost impacts, and rate structures in the context of photovoltaic units integrated into the utility system. (WHK)

  6. Evaluating an Online Cognitive Training Platform for Older Adults: User Experience and Implementation Requirements.

    Science.gov (United States)

    Haesner, Marten; Steinert, Anika; O'Sullivan, Julie Lorraine; Weichenberger, Markus

    2015-08-01

    Decline of cognitive function is a part of aging. However, intensive cognitive training can improve important cognitive functions, such as attention and working memory. Because existing systems are not older adult-friendly and are usually not based on scientific evidence, an online platform was developed for cognitive training with information and communication features and evaluated in an 8-week field test. In a randomized clinical trial with 80 older adults, findings from log data analysis and questionnaires revealed a good use of the online platform. Communication or assistive features were not used often. Good usability ratings were given to the cognitive exercises. Subjective improvements of cognitive functions due to the training were reported. The current article presents concrete requirements and recommendations for deploying cognitive training software in older adult residential homes.

  7. Conceptual Design Plan SM-43 Replacement Project

    Energy Technology Data Exchange (ETDEWEB)

    University of California, Los Alamos National Laboratory, SCC Project Office

    2000-11-01

    The Los Alamos National Laboratory Conceptual Design Plan for the SM-43 Replacement Project outlines plans for replacing the SM-43 Administration Building. Topics include the reasons that replacement is considered a necessity; the roles of the various project sponsors; and descriptions of the proposed site and facilities. Also covered in this proposal is preliminary information on the project schedule, cost estimates, acquisition strategy, risk assessment, NEPA strategy, safety strategy, and safeguards and security. Spreadsheets provide further detail on space requirements, project schedules, and cost estimates.

  8. [Requirements for drug approval and additional benefits assessment: Regulatory aspects and experiences].

    Science.gov (United States)

    Broich, K; Löbker, W; Schulte, A; Beinlich, P; Müller, T

    2016-04-01

    The early assessment of benefits of newly approved drugs with novel active substances or new applications, which came into force on 1 January 2011 still represents a challenge to all parties involved. This article highlights the definitions, regulatory requirements and interaction between drug marketing approval and early assessment of benefits in Germany. The constellation of an extensively harmonized European and even international drug authorization process with a predominantly national regulation of drug reimbursement situation inevitably causes friction, which could be markedly reduced through early joint advisory discussions during the planning phase for pivotal clinical trials. During the year 2015 the Federal Institute for Drugs and Medical Devices (BfArM) carried out 300 scientific advice procedures of which 34 were concerned with applications in the field of indications for the central nervous system (CNS). In comparison 98 advisory meetings were held by the Federal Joint Committee (G-BA) of which the BfArM provided advice in 12 instances and in 2 cases on CNS indications. Study design, endpoints and appropriate comparative therapies are the key issues in exchanges and discussions between the BfArM, the G‑BA and applicants. Under these aspects the BfArM and G‑BA promote an early and consistent involvement in early advice procedures regarding the prerequisites for drug approval and assessment of additional benefits.

  9. Balancing innovation and medical device regulation: the case of modern metal-on-metal hip replacements

    Science.gov (United States)

    Howard, Jason J

    2016-01-01

    Due to problems with wear particle generation and subsequent loosening using conventional metal-on-polyethylene total hip replacements, there has been a shift toward alternative bearing systems, including metal-on-metal (MoM), for younger, more active patients with degenerative joint disease. Based on positive results from early short-term clinical studies, MoM hip replacements were readily adopted by orthopedic surgeons with thousands being implanted worldwide over the past decade. Unacceptably high revision rates reported by two national joint registries called into question the rigorousness of the regulatory approval process for these implants, particularly with respect to premarket data requirements to prove safety, effectiveness, and the appropriateness of the regulatory pathway chosen. The purpose of this review was to investigate the balance between facilitating the introduction of new medical technologies and the need to ensure safety and effectiveness through comprehensive regulatory assessment. The case of MoM hip replacement devices was used to frame the investigation and subsequent discussions. The regulatory approval processes and post-market surveillance requirements associated with three common MoM hip replacements (two resurfacings: the Birmingham and articular surface replacement and the articular surface replacement XL total hip replacement) were investigated. With respect to modern MoM hip replacement devices, the balance between facilitating the introduction of these new medical technologies and the need to ensure safety and effectiveness through comprehensive regulatory assessment was not achieved. The lessons learned from these experiences have application beyond joint replacements to the introduction of new medical technologies in general, particularly for those who have a significant potential for harm. In this regard, a series of recommendations have been developed to contribute to the evolution of the medical device regulatory process

  10. Conventional approaches for assessment of caving behaviour and support requirement with regard to strata control experiences in longwall workings

    Institute of Scientific and Technical Information of China (English)

    G.S.P. Singh

    2015-01-01

    Effective control of roof strata is very important for trouble free operation and regular face advance in mechanised longwall workings. It is now technically possible to exploit coal seams in difficult geo-mining conditions with the help of newer innovations in longwall face machineries. A reliable assess-ment of caving behaviour and support capacity requirement helps in selecting supports of adequate capacity and making operational preparedness for timely and confident solution of impending problems. This paper reviews the mechanism of roof caving and the conventional approaches of caving behaviour and support requirement in the context of major strata control experiences gained worldwide. The re-view shows that a number of approaches are being used for advance prediction of caving behaviour and support capacity requirement in a variety of geo-mining conditions. The theoretical explanation of the mechanism of roof caving and the design function of roof supports have been worked out through staged development of approaches, their evaluation followed by their gradual modification and enrichment of synthesized findings. This process is still continuing with consistently improved understanding through growing field experiences in the larger domain of geo-mining conditions and state-of-art strata analysis and monitoring techniques. These attempts have contributed significantly to improving the level of understanding and reducing the gap of uncertainty in planning and design of longwall operation in a given geo-mining condition.

  11. Dez anos de experiência com a substituição da valva aórtica com homoenxertos valvares aórticos implantados pela técnica da substituição total da raiz Ten years experience of aortic valve replacement with aortic homograft root replacement

    Directory of Open Access Journals (Sweden)

    Francisco Costa

    2006-06-01

    áximo variando entre 3 a 47 mmHg (média de 14,5 mmHg, sendo que apenas dois pacientes apresentavam gradiente superior a 40mmHg. Insuficiência valvar moderada foi encontrada em quatro pacientes. CONCLUSÕES: Os resultados imediatos e tardios com a substituição da valva aórtica por homoenxerto valvar criopreservado foram excelentes, com boa capacidade funcional e baixa morbi-mortalidade tardia. O único fator de risco para a degeneração tecidual primária foi a idade do paciente menor que 20 anos. Homoenxertos aórticos representam uma excelente opção para pacientes com idade acima de 40-50 anos, especialmente naqueles com contra-indicação ou que não desejem fazer o uso de anticoagulantes.OBJECTIVE: To evaluate the imediate and late results of 10 years of aortic valve root replacement with aortic homografts and to identify possible risk factors related with homograft primary tissue failure. METHODS: Between May 1995 and January 2006, 282 patients with a mean age of 52.8±16.6 years were submitted to aortic valve root replacement with an aortic homografts. The most prevalent etiologies were calcified bicuspid aortic valves and senile degeneration, corresponding to 49% of the cases. Forty-seven patients were reoperations and acute bacterial endocarditis were present in 26. Associated procedures were necessary in 113 patients. The homograft was implanted as a root replacement in all. Follow-up time varied between 1 and 129 months (mean= 41±25 months. RESULTS: Early overall mortality was 7%, with only 2.6% for cases of aortic valve replacement in isolation. Of the 262 patients discharged from hospital, it was possible to obtain clinical and echocardiographic evaluations in 209. Fifty-one patients (20% were lost in the follow-up. There were 17 late deaths between the 2nd and 81st postoperative months, which resulted in an actuarial survival rate of 90% and 80.1% at 5 and 10 years respectively. There were eight thromboembolic events (four early and four late, for a

  12. Radiation therapists' perceptions of the minimum level of experience required to perform portal image analysis

    Energy Technology Data Exchange (ETDEWEB)

    Rybovic, Michala [Discipline of Medical Radiation Sciences, Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe, NSW 1825 (Australia)], E-mail: mryb6983@mail.usyd.edu.au; Halkett, Georgia K. [Western Australia Centre for Cancer and Palliative Care, Curtin University of Technology, Health Research Campus, GPO Box U1987, Perth, WA 6845 (Australia)], E-mail: g.halkett@curtin.edu.au; Banati, Richard B. [Faculty of Health Sciences, Brain and Mind Research Institute - Ramaciotti Centre for Brain Imaging, University of Sydney, PO Box 170, Lidcombe, NSW 1825 (Australia)], E-mail: r.banati@usyd.edu.au; Cox, Jennifer [Discipline of Medical Radiation Sciences, Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe, NSW 1825 (Australia)], E-mail: jenny.cox@usyd.edu.au

    2008-11-15

    Background and purpose: Our aim was to explore radiation therapists' views on the level of experience necessary to undertake portal image analysis and clinical decision making. Materials and methods: A questionnaire was developed to determine the availability of portal imaging equipment in Australia and New Zealand. We analysed radiation therapists' responses to a specific question regarding their opinion on the minimum level of experience required for health professionals to analyse portal images. We used grounded theory and a constant comparative method of data analysis to derive the main themes. Results: Forty-six radiation oncology facilities were represented in our survey, with 40 questionnaires being returned (87%). Thirty-seven radiation therapists answered our free-text question. Radiation therapists indicated three main themes which they felt were important in determining the minimum level of experience: 'gaining on-the-job experience', 'receiving training' and 'working as a team'. Conclusions: Radiation therapists indicated that competence in portal image review occurs via various learning mechanisms. Further research is warranted to determine perspectives of other health professionals, such as radiation oncologists, on portal image review becoming part of radiation therapists' extended role. Suitable training programs and steps for implementation should be developed to facilitate this endeavour.

  13. Robotic mitral valve replacement.

    Science.gov (United States)

    Senay, Sahin; Gullu, Ahmet Umit; Kocyigit, Muharrem; Degirmencioglu, Aleks; Karabulut, Hasan; Alhan, Cem

    2014-01-01

    Robotic surgical techniques allow surgeons to perform mitral valve surgery. This procedure has gained acceptance, particularly for mitral valve repair in degenerative mitral disease. However, mitral repair may not always be possible, especially in severely calcified mitral valve of rheumatic origin. This study demonstrates the basic concepts and technique of robotic mitral valve replacement for valve pathologies that are not suitable for repair.

  14. Replacing America's Job Bank

    Science.gov (United States)

    Vollman, Jim

    2009-01-01

    The Job Central National Labor Exchange (www.jobcentral.com) has become the effective replacement for America's Job Bank with state workforce agencies and, increasingly, with community colleges throughout the country. The American Association of Community Colleges (AACC) has formed a partnership with Job Central to promote its use throughout the…

  15. Replacing America's Job Bank

    Science.gov (United States)

    Vollman, Jim

    2009-01-01

    The Job Central National Labor Exchange (www.jobcentral.com) has become the effective replacement for America's Job Bank with state workforce agencies and, increasingly, with community colleges throughout the country. The American Association of Community Colleges (AACC) has formed a partnership with Job Central to promote its use throughout the…

  16. Impact of regulatory requirements on medicine registration in African countries - perceptions and experiences of pharmaceutical companies in South Africa.

    Science.gov (United States)

    Narsai, Kirti; Williams, Abeda; Mantel-Teeuwisse, Aukje Kaija

    2012-07-01

    Access to medicines has long been and remains a challenge in African countries. The impact of medicines registration policies in these countries poses a challenge for pharmaceutical companies wanting to register medicines in these countries. The recent AMRHI (African Medicines Registration Harmonisation Initiative) has increased the focus on the need for harmonisation. Medicines registration regulations differ across African countries. Anecdotal evidence, based on the experience of pharmaceutical companies on progress towards harmonisation is somewhat different, i.e. that country specific requirements were a barrier to the registration of medicines. The objective of this study was therefore to determine the nature and extent of regulatory hurdles experienced by pharmaceutical companies who wish to register and supply medicines to African countries. This cross-sectional descriptive pilot study was conducted across pharmaceutical companies, both local and multinational. These companies were based in South Africa and were also members of Pharmaceutical Industry Association of South Africa (PIASA). The pharmaceutical companies supply both the private and public sectors. An online survey was developed using Survey Monkey. Survey questions focused on the following strands: nature and level of current supply of medicines to African countries by companies, general regulatory requirements, region specific questions and country specific questions across four regional economic communities in Africa, namely; Southern African Development Community (SADC), East African Community (EAC), Economic Community of the West African States (ECOWAS) and Economic Community of Central African States (ECCAS). A total of 33 responses were received to the questionnaire of which 26 respondents were from the PIASA Regulatory working group and 7 were from the PIASA Export working group.It was noted that since most of the regulatory authorities in Africa are resource-constrained, harmonisation of

  17. Impact of regulatory requirements on medicine registration in African countries – perceptions and experiences of pharmaceutical companies in South Africa

    Science.gov (United States)

    Narsai, Kirti; Williams, Abeda; Mantel-Teeuwisse, Aukje Kaija

    2012-01-01

    Objective: Access to medicines has long been and remains a challenge in African countries. The impact of medicines registration policies in these countries poses a challenge for pharmaceutical companies wanting to register medicines in these countries. The recent AMRHI (African Medicines Registration Harmonisation Initiative) has increased the focus on the need for harmonisation. Medicines registration regulations differ across African countries. Anecdotal evidence, based on the experience of pharmaceutical companies on progress towards harmonisation is somewhat different, i.e. that country specific requirements were a barrier to the registration of medicines. The objective of this study was therefore to determine the nature and extent of regulatory hurdles experienced by pharmaceutical companies who wish to register and supply medicines to African countries. Methods: This cross-sectional descriptive pilot study was conducted across pharmaceutical companies, both local and multinational. These companies were based in South Africa and were also members of Pharmaceutical Industry Association of South Africa (PIASA). The pharmaceutical companies supply both the private and public sectors. An online survey was developed using Survey Monkey. Survey questions focused on the following strands: nature and level of current supply of medicines to African countries by companies, general regulatory requirements, region specific questions and country specific questions across four regional economic communities in Africa, namely; Southern African Development Community (SADC), East African Community (EAC), Economic Community of the West African States (ECOWAS) and Economic Community of Central African States (ECCAS). Results: A total of 33 responses were received to the questionnaire of which 26 respondents were from the PIASA Regulatory working group and 7 were from the PIASA Export working group.It was noted that since most of the regulatory authorities in Africa are resource

  18. Trials and Tribulations with VH Replacement

    Directory of Open Access Journals (Sweden)

    Wenzhao eMeng

    2014-01-01

    Full Text Available VH replacement is a type of antibody gene rearrangement in which an upstream heavy chain variable gene segment (VH invades a pre-existing rearrangement (VDJ. In this Hypothesis and Theory article, we begin by reviewing the mechanism of VH replacement, its developmental timing and its potential biological consequences. Then we explore the hypothesis that specific sequence motifs called footprints reflect VH replacement vs. other processes. We provide a compilation of footprint sequences from different regions of the antibody heavy chain, include data from the literature and from a high throughput sequencing experiment to evaluate the significance of footprint sequences. We conclude by discussing the difficulties of attributing footprints to VH replacement.

  19. Renal replacement therapy for acute renal failure.

    Science.gov (United States)

    Macedo, E; Bouchard, J; Mehta, R L

    2009-09-01

    Renal replacement therapy became a common clinical tool to treat patients with severe acute kidney injury (AKI) since the 1960s. During this time dialytic options have expanded considerably; biocompatible membranes, bicarbonate dialysate and dialysis machines with volumetric ultrafiltration control have improved the treatment for acute kidney injury. Along with advances in methods of intermittent hemodialysis, continuous renal replacement therapies have gained widespread acceptance in the treatment of dialysis-requiring AKI. However, many of the fundamental aspects of the renal replacement treatment such as indication, timing of dialytic intervention, and choice of dialysis modality are still controversial and may influence AKI patient's outcomes. This review outlines current concepts in the use of dialysis techniques for AKI and suggests an approach for selecting the optimal method of renal replacement therapy.

  20. Effects of additional milk replacer feeding on calf health, growth, and selected blood metabolites in calves.

    Science.gov (United States)

    Quigley, J D; Wolfe, T A; Elsasser, T H

    2006-01-01

    The objective of the experiment was to evaluate effects of increased milk replacer feeding on growth, intake, feed efficiency, and health parameters in stressed calves. Holstein bull calves (n = 120; approximately 3 to 8 d of age) were purchased from sale barns and dairy farms and housed in fiberglass hutches. In addition, wood shavings contaminated with coronavirus were mixed with clean shavings and added to each hutch before the start of the experiment. Calves were fed either a fixed amount (454 g/d) of a 20% crude protein (CP), 20% fat milk replacer to weaning at 28 d or a variable amount (454, 681, 908, and 454 g/d on d 0 to 7, 8 to 14, 15 to 31, and 32 to 41, respectively) of a milk replacer containing 28% CP and 17% fat without or with added dietary supplement containing bovine serum. Calves were also fed commercial calf starter and water ad libitum. Plasma IgG concentration in most calves on arrival at the facility was feed efficiency, morbidity and mortality, and selected plasma metabolites were determined. Body weight at 28 d, 56 d, daily body weight gain, intake of milk replacer, fecal scores, days with diarrhea, and days treated with antibiotics were increased with feeding variable amount of milk replacer over the 56-d study. Starter intake from d 1 to 56 was reduced from 919 to 717 g/d in calves fed fixed and variable amounts of milk replacer, respectively. Morbidity, measured as the number of days that calves had diarrhea, was increased by 53% when a variable amount of milk replacer was fed. Calves fed variable milk replacer were treated with antibiotics for 3.1 d compared with 1.9 d for calves fed 454 g of milk replacer/d. Concentrations of plasma glucose, urea N, and insulin-like growth factor-I were increased when calves were fed variable amount of milk replacer. Dietary supplement containing bovine serum had no effect on any parameter measured. There was no effect of milk replacer feeding on concentrations of nonesterified fatty acids, total

  1. Clinical experience of elderly patients with artificial hip replacement perioperaitv e management%高龄患者人工髋关节置换围手术期处理临床体会

    Institute of Scientific and Technical Information of China (English)

    关凯; 朱伟

    2014-01-01

    Abstarct Objective:To observe and analyze of artificial hip replacement perioperative management in patients with the surgical effect of clinical experience .MethodsI:n our hospital between January 2000 and January2014 so far, 14 years older than 75 -year -old fem-oral neck fracture in 421 cases, the hip arthroplasty.Results:421 cases followed up for1 year 6 months on average, according to the A-merican Harris standard from pain , function, activity and deformity four aspects for clinical effect assessment , optimal 145 cases, 191 ca-ses, 72 cases of benign, 13cases, and the fine rate was 79.81%.Conclu sion:In the treatment of hip arthroplasty, perioperative manage-ment should be the indispensable important constituent , it directly affects the effect of surgery and postoperative recovery .In this paper , the age in 14 years of perioperative management of hip arthroplasty was summarized analysis .Although artificial femoral head replacement was the ideal method of treatment of elderly patients with femoral neck fracture , but the perioperative treatment might be the key to deter-mine the effect of factors .%目的:观察和分析人工髋关节置换围手术期处理对于高龄患者手术效果的临床体会。方法:对我院2000年1月~2014年1月为止14年间75岁以上高龄股骨颈骨折421例,施行了人工髋关节置换术。结果:421例平均随访1年6个月,按照美国Harris标准从疼痛、功能、活动度及畸形4个方面进行临床效果评定,优145例、良191例、中72例、差13例,其中优良率达79.81%。结论:人工髋关节置换术虽然是治疗高龄患者股骨颈骨折的理想方法,但围手术期的处理才是决定手术效果的关键因素,直接影响着手术效果和患者术后恢复。

  2. Qualitative evaluation of general university requirements in a new 4-year university curriculum: findings based on experiences of students.

    Science.gov (United States)

    Shek, Daniel T L; Yu, Lu; Wu, Florence K Y; Ng, Catalina S M; Chai, Wen Yu

    2017-02-01

    Following the North American model, the length of undergraduate program in Hong Kong has been extended from 3 to 4 years since 2012. To maximize the impact of the additional year, The Hong Kong Polytechnic University (PolyU) has implemented a new general education framework entitled "General University Requirements (GUR)" aiming to cultivate students in a holistic manner. This study explored students' impressions of the GUR subjects using a survey collecting primarily qualitative data. Results from 163 students of eight faculties showed that students perceived the GUR subjects favorably. Having opportunities to make new friends from other departments and the teaching and learning methods, particularly experiential learning stimulated students' interest and enriched their learning experiences which were reportedly are unforgettable. Some of the obstacles encountered by students in several subjects were identified. The beneficial effects of the GUR subjects in different domains were voiced by the students.

  3. [Replacement of tracheo-esophageal Provox prosthesis].

    Science.gov (United States)

    Biacabe, B; Laccourreye, O; Ménard, M; Hans, S; Brasnu, D

    2000-02-01

    To compare anesthesic techniques used between 1992 and 1997 at Laënnec Hospital for replacement by tracheo-esophageal Provox prosthesis: local and general anesthesia. Theoretical financial cost for replacement was estimated according to anaesthetic techniques. Provox in situ lifetime was calculated in 58 patients who underwent 115 and 49 replacements under general and local anaesthesia respectively. Age, sex, surgical and radiotherapy backgrounds, complications and anaesthetic techniques were studied as potential factors correlated with Provox in situ lifetime. Theoretical financial cost for replacement was estimated according to anaesthetic techniques. In 1992, 12% of Provox prosthesis were inserted under local anaesthesia and 54% in 1997. Provox in situ lifetime was either not influenced by anaesthetic techniques or other factors under analysis. The theoretical financial cost was estimated at 14, 341 FFrs and 6,048 FFrs for replacement under general and local anaesthesia respectively. Due to increased control of health care costs, we advocated local anaesthesia for Provox prosthesis replacement if control endoscopy is not required.

  4. Are output measurements always necessary after CT tube replacement?

    Directory of Open Access Journals (Sweden)

    Paul J Stauduhar

    2014-03-01

    Full Text Available Purpose: TX regulations and the ACR require that CT radiation output be measured within 30 days of major service. The most common major service is tube replacement. We hypothesized that historical QC data could be used instead to determine if output measurements are necessary, reducing the need for costly output measurements.Methods: We reviewed 66 records of tube replacements to determine with what frequency output falls outside specifications. We also conducted an experiment to verify that clinically significant output changes could be identified by comparing image noise in historical QC data with the same data after tube replacement. We used 30 days of historical QC data to establish a baseline noise level and 95% confidence interval (CI for individual noise measurements. To simulate output changes, we acquired phantom images with our QC protocol while manually changing output (mA. We acquired 10 images using the baseline output and 10 images at each different “output”. We evaluated individual images and subsets of images at each “output” to determine if the system was within the manufacturer’s specifications.Results: None of the 66 tube replacements resulted in an output change that exceeded specifications. Analysis of 30 days of historic QC data for our experimental system indicated a mean noise of 5.4 HU with 95% CI of 5.1 ‒ 5.7 HU. When using the mean noise of 10 images acquired at each of the varying outputs, we were able to identify, with 100% accuracy, images acquired at outputs outside manufacturer’s specifications.Conclusion: The results of our review of historical tube replacement data indicated the likelihood of output falling outside manufacturer’s specifications is low. Considering this, it is likely that by using QC data from programs required by regulation and the ACR physicists can reliably verify radiation output stability remotely instead of making physical measurements.--------------------Cite this article

  5. HDAC1 negatively regulates Bdnf and Pvalb required for parvalbumin interneuron maturation in an experience-dependent manner.

    Science.gov (United States)

    Koh, Dawn X P; Sng, Judy C G

    2016-11-01

    During early postnatal development, neuronal circuits are sculpted by sensory experience provided by the external environment. This experience-dependent regulation of circuitry development consolidates the balance of excitatory-inhibitory (E/I) neurons in the brain. The cortical barrel-column that innervates a single principal whisker is used to provide a clear reference frame for studying the consolidation of E/I circuitry. Sensory deprivation of S1 at birth disrupts the consolidation of excitatory-inhibitory balance by decreasing inhibitory transmission of parvalbumin interneurons. The molecular mechanisms underlying this decrease in inhibition are not completely understood. Our findings show that epigenetic mechanisms, in particular histone deacetylation by histone deacetylases, negatively regulate the expression of brain-derived neurotrophic factor (Bdnf) and parvalbumin (Pvalb) genes during development, which are required for the maturation of parvalbumin interneurons. After whisker deprivation, increased histone deacetylase 1 expression and activity led to increased histone deacetylase 1 binding and decreased histone acetylation at Bdnf promoters I-IV and Pvalb promoter, resulting in the repression of Bdnf and Pvalb gene transcription. The decrease in Bdnf expression further affected parvalbumin interneuron maturation at layer II/III in S1, demonstrated by decreased parvalbumin expression, a marker for parvalbumin interneuron maturation. Knockdown of HDAC1 recovered Bdnf and Pvalb gene transcription and also prevented the decrease of inhibitory synapses accompanying whisker deprivation.

  6. Aortic valve replacement

    DEFF Research Database (Denmark)

    Kapetanakis, Emmanouil I; Athanasiou, Thanos; Mestres, Carlos A

    2008-01-01

    BACKGROUND AND AIMS OF THE STUDY: Prompted by anecdotal evidence and observations by surgeons, an investigation was undertaken into the potential differences in implanted aortic valve prosthesis sizes, during aortic valve replacement (AVR) procedures, between northern and southern European...... countries. METHODS: A multi-institutional, non-randomized, retrospective analysis was conducted among 2,932 patients who underwent AVR surgery at seven tertiary cardiac surgery centers throughout Europe. Demographic and perioperative variables including valve size and type, body surface area (BSA) and early...

  7. Total ankle joint replacement.

    Science.gov (United States)

    2016-02-01

    Ankle arthritis results in a stiff and painful ankle and can be a major cause of disability. For people with end-stage ankle arthritis, arthrodesis (ankle fusion) is effective at reducing pain in the shorter term, but results in a fixed joint, and over time the loss of mobility places stress on other joints in the foot that may lead to arthritis, pain and dysfunction. Another option is to perform a total ankle joint replacement, with the aim of giving the patient a mobile and pain-free ankle. In this article we review the efficacy of this procedure, including how it compares to ankle arthrodesis, and consider the indications and complications.

  8. Controversies in hormone replacement therapy

    Directory of Open Access Journals (Sweden)

    A. Baziad

    2001-09-01

    Full Text Available Deficiency of estrogen hormone will result in either long-term or short-term health problems which may reduce the quality of life. There are numerous methods by which the quality of female life can be achieved. Since the problems occuring are due to the deficiency of estrogen hormone, the appropriate method to tackle the problem is by administration of estrogen hormone. The administration of hormone replacement therapy (HRT with estrogen may eliminate climacteric complaints, prevent osteoporosis, coronary heart disease, dementia, and colon cancer. Although HRT has a great deal of advantage, its use is still low and may result in controversies. These controversies are due to fact that both doctor and patient still hold on to the old, outmoded views which are not supported by numerous studies. Currently, the use of HRT is not only based on experience, or temporary observation, but more on evidence based medicine. (Med J Indones 2001; 10: 182-6Keywords: controversies, HRT

  9. The Optimum Replacement of Weapon

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xiao; ZHANG Jin-chun

    2002-01-01

    The theory of LCC (Life Cycle Cost) is applied in this paper. The relation between the economic life of weapon and the optimum replacement is analyzed. The method to define the optimum replacement time of weapon is discussed.

  10. Property Assessment of Sponge Cake Added with Egg Replacer

    Directory of Open Access Journals (Sweden)

    Yaqiang He

    2015-08-01

    Full Text Available Chicken egg which is always used in sponge cake production is likely to deteriorate during storage or transportation. This weakness prevents the wide use of chicken egg in sponge cake making. In order to solve this problem, egg replacer has been developed. In this study, effect of egg replacer on the property of sponge cake was analyzed. The result indicated egg replacer could improve the yield rate and specific volume of sponge cake. However, high content of egg replacer would negatively impact the internal structure and sensory property of sponge cake. Based on the result of this research, optimum content of egg replacer in sponge cake is 3.6 g. In the industrial production of sponge cake, different types of wheat flour and additives would be used. The optimum content of egg replacer may be different from the result of this research. Therefore, in the industrial production, the optimum content of egg replacer should be determined based on experiment.

  11. Power Plant Replacement Study

    Energy Technology Data Exchange (ETDEWEB)

    Reed, Gary

    2010-09-30

    This report represents the final report for the Eastern Illinois University power plant replacement study. It contains all related documentation from consideration of possible solutions to the final recommended option. Included are the economic justifications associated with the chosen solution along with application for environmental permitting for the selected project for construction. This final report will summarize the results of execution of an EPC (energy performance contract) investment grade audit (IGA) which lead to an energy services agreement (ESA). The project includes scope of work to design and install energy conservation measures which are guaranteed by the contractor to be self‐funding over its twenty year contract duration. The cost recovery is derived from systems performance improvements leading to energy savings. The prime focus of this EPC effort is to provide a replacement solution for Eastern Illinois University’s aging and failing circa 1925 central steam production plant. Twenty‐three ECMs were considered viable whose net impact will provide sufficient savings to successfully support the overall project objectives.

  12. Total disc replacement.

    Science.gov (United States)

    Vital, J-M; Boissière, L

    2014-02-01

    Total disc replacement (TDR) (partial disc replacement will not be described) has been used in the lumbar spine since the 1980s, and more recently in the cervical spine. Although the biomechanical concepts are the same and both are inserted through an anterior approach, lumbar TDR is conventionally indicated for chronic low back pain, whereas cervical TDR is used for soft discal hernia resulting in cervicobrachial neuralgia. The insertion technique must be rigorous, with precise centering in the disc space, taking account of vascular anatomy, which is more complex in the lumbar region, particularly proximally to L5-S1. All of the numerous studies, including prospective randomized comparative trials, have demonstrated non-inferiority to fusion, or even short-term superiority regarding speed of improvement. The main implant-related complication is bridging heterotopic ossification with resulting loss of range of motion and increased rates of adjacent segment degeneration, although with an incidence lower than after arthrodesis. A sufficiently long follow-up, which has not yet been reached, will be necessary to establish definitively an advantage for TDR, particularly in the cervical spine. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  13. REPLACEMENT OF FRENCH CARDS

    CERN Multimedia

    HR/SOC

    2001-01-01

    The French Ministry of Foreign Affairs has informed the Organization that it is shortly to replace all diplomatic cards, special cards and employment permits ('attestations de fonctions') now held by members of the personnel and their families. Between 2 July and 31 December 2001, these cards are to be replaced by secure, computerized equivalents. The old cards may continue to be used until 31 December 2001. For the purposes of the handover, members of the personnel must go personally to the cards office (33/1-015), in order to fill in a 'fiche individuelle' form, taking the following documents for themselves and members of their families already in possession of a French card : A recent identity photograph in 4.5 cm x 3.5 cm format. The French card in their possession. An A4 photocopy of the same French card, certified by the cards office as being a true copy. Those members of the personnel whose cards (and/or cards belonging to members of their families) are shortly due to expire, or have recently done...

  14. REPLACEMENT OF FRENCH CARDS

    CERN Multimedia

    Human Resources Division; Cards.Service@cern.ch

    2001-01-01

    The French Ministry of Foreign Affairs is currently replacing all diplomatic cards, special cards and employment permits («attestations de fonctions») held by members of the personnel and their families. These cards are replaced by secure, computerized equivalents. The old cards may no longer be used after 31 December 2001. For the purposes of the handover, members of the personnel must go personally to the cards office (33/1-015) between 8h30 and 12h30, in order to fill in a «fiche individuelle» form, taking the following documents for themselves and members of their families already in possession of a French card : A recent identity photograph in 4.5 cm x 3.5 cm format, the French card in their possession, an A4 photocopy of the same French card, certified by the cards office as being a true copy. Those members of the personnel whose cards (and/or cards belonging to members of their families) are shortly due to expire, or have recently done so, are also requested...

  15. REPLACEMENT OF FRENCH CARDS

    CERN Multimedia

    Human Resources Division

    2001-01-01

    The French Ministry of Foreign Affairs has informed the Organization that it is shortly to replace all diplomatic cards, special cards and employment permits ('attestations de fonctions') now held by members of the personnel and their families. Between 2 July and 31 December 2001, these cards are to be replaced by secure, computerized equivalents. The old cards may continue to be used until 31 December 2001. For the purposes of the handover, members of the personnel are asked to go to the cards office (33/1-015), taking the following documents for themselves and members of their families already in possession of a French card : A recent identity photograph in 4.5 cm x 3.5 cm format, The French card in their possession, an A4 photocopy of the same French card, certified by the cards office as being a true copy. Those members of the personnel whose cards (and/or cards belonging to members of their families) are shortly due to expire, or have recently done so, are also requested to take these items to the c...

  16. REPLACEMENT OF FRENCH CARDS

    CERN Multimedia

    Human Resources Division

    2001-01-01

    The French Ministry of Foreign Affairs has informed the Organization that it is shortly to replace all diplomatic cards, special cards and employment permits ('attestations de fonctions') now held by members of the personnel and their families. Between 2 July and 31 December 2001, these cards are to be replaced by secure, computerized equivalents. A 'personnel office' stamped photocopy of the old cards may continue to be used until 31 December 2001. For the purposes of the handover, members of the personnel must go personally to the cards office (33/1-015), between 8:30 and 12:30, in order to fill a 'fiche individuelle' form (in black ink only), which has to be personally signed by themselves and another separately signed by members of their family, taking the following documents for themselves and members of their families already in possession of a French card : A recent identity photograph in 4.5 cm x 3.5 cm format (signed on the back) The French card in their possession an A4 photocopy of the same Fre...

  17. Power Plant Replacement Study

    Energy Technology Data Exchange (ETDEWEB)

    Reed, Gary

    2010-09-30

    This report represents the final report for the Eastern Illinois University power plant replacement study. It contains all related documentation from consideration of possible solutions to the final recommended option. Included are the economic justifications associated with the chosen solution along with application for environmental permitting for the selected project for construction. This final report will summarize the results of execution of an EPC (energy performance contract) investment grade audit (IGA) which lead to an energy services agreement (ESA). The project includes scope of work to design and install energy conservation measures which are guaranteed by the contractor to be self-funding over its twenty year contract duration. The cost recovery is derived from systems performance improvements leading to energy savings. The prime focus of this EPC effort is to provide a replacement solution for Eastern Illinois University's aging and failing circa 1925 central steam production plant. Twenty-three ECMs were considered viable whose net impact will provide sufficient savings to successfully support the overall project objectives.

  18. Faster Replacement Paths

    CERN Document Server

    Williams, Virginia Vassilevska

    2010-01-01

    The replacement paths problem for directed graphs is to find for given nodes s and t and every edge e on the shortest path between them, the shortest path between s and t which avoids e. For unweighted directed graphs on n vertices, the best known algorithm runtime was \\tilde{O}(n^{2.5}) by Roditty and Zwick. For graphs with integer weights in {-M,...,M}, Weimann and Yuster recently showed that one can use fast matrix multiplication and solve the problem in O(Mn^{2.584}) time, a runtime which would be O(Mn^{2.33}) if the exponent \\omega of matrix multiplication is 2. We improve both of these algorithms. Our new algorithm also relies on fast matrix multiplication and runs in O(M n^{\\omega} polylog(n)) time if \\omega>2 and O(n^{2+\\eps}) for any \\eps>0 if \\omega=2. Our result shows that, at least for small integer weights, the replacement paths problem in directed graphs may be easier than the related all pairs shortest paths problem in directed graphs, as the current best runtime for the latter is \\Omega(n^{2.5...

  19. Power Plant Replacement Study

    Energy Technology Data Exchange (ETDEWEB)

    Reed, Gary

    2010-09-30

    This report represents the final report for the Eastern Illinois University power plant replacement study. It contains all related documentation from consideration of possible solutions to the final recommended option. Included are the economic justifications associated with the chosen solution along with application for environmental permitting for the selected project for construction. This final report will summarize the results of execution of an EPC (energy performance contract) investment grade audit (IGA) which lead to an energy services agreement (ESA). The project includes scope of work to design and install energy conservation measures which are guaranteed by the contractor to be self-funding over its twenty year contract duration. The cost recovery is derived from systems performance improvements leading to energy savings. The prime focus of this EPC effort is to provide a replacement solution for Eastern Illinois University’s aging and failing circa 1925 central steam production plant. Twenty-three ECMs were considered viable whose net impact will provide sufficient savings to successfully support the overall project objectives.

  20. Unusual redo mitral valve replacement for bleeding in Glanzmann thrombasthenia.

    Science.gov (United States)

    Garcia-Villarreal, Ovidio A; Fernández-Ceseña, Ernesto; Solano-Ricardi, Mercedes; Aguilar-García, Alma L; Vega-Hernández, Raquel; Del Angel-Soto, Gustavo

    2016-01-01

    We report the case of 23-year-old man with mitral valve regurgitation and Glanzmann thrombasthenia, who underwent mechanical mitral valve replacement. Warfarin therapy was devastating, causing bilateral hemothorax, pericardial effusion, gastrointestinal bleeding, and hematuria. Redo mitral valve replacement with a biological prosthesis was required to resolve this critical situation. To our knowledge, this is the first report of mitral valve replacement in Glanzmann thrombasthenia, highlighting the danger of oral anticoagulation in this pathology.

  1. Toleration, Synthesis or Replacement?

    DEFF Research Database (Denmark)

    Holtermann, Jakob v. H.; Madsen, Mikael Rask

    2016-01-01

    to have considerable problems keeping a clear focus on the key question: What are the implications of this empirical turn in terms of philosophy of legal science, of the social understanding of IL, and, not least, of the place of doctrinal scholarship after the alleged Wende? What is needed, we argue......, in order to answer is not yet another partisan suggestion, but rather an attempt at making intelligible both the oppositions and the possibilities of synthesis between normative and empirical approaches to law. Based on our assessment and rational reconstruction of current arguments and positions, we...... therefore outline a taxonomy consisting of the following three basic, ideal-types in terms of the epistemological understanding of the interface of law and empirical studies: toleration, synthesis and replacement. This tripartite model proves useful with a view to teasing out and better articulating...

  2. Double Valve Replacement for Lupus Valvulitis

    Science.gov (United States)

    Ferraris, Victor A.; Hawksley, Vaughn C.; Rabinowitz, Max; Coyne, Carolyn M.; Sullivan, Thomas J.; Sprague, Merle S.

    1990-01-01

    Hemodynamically significant lupus valvulitis, requiring valve replacement, is rare: 21 cases have been reported so far in the literature, and only 2 of these have involved double valve replacement. We describe an additional case of double valve replacement in a patient with systemic lupus erythematosus. The histopathologic and clinical features of this case suggest that valvular involvement resulted from both acute and chronic disease processes. Medical success in the treatment of systemic lupus erythematosus, especially that achieved through prolonged or high-dose steroid therapy, may cause chronic valvular disease to become a more common surgical problem. A review of the literature supports this contention. (Texas Heart Institute Journal 1990;17:56-60) Images PMID:15227191

  3. OPTIMAL MAINTENANCE AND REPLACEMENT OF EXTRACTION MACHINERY

    Institute of Scientific and Technical Information of China (English)

    Suresh P.SETHI; Hong-Mo YEH; Rong ZHANG; Andrew K.S.JARDINE

    2008-01-01

    This paper considers a problem of optimal preventive maintenance and replacement schedule ofequipment devoted to extracting resources from known deposits. Typical examples are oil drills, mine shovels, etc. At most one replacement of the existing machinery by a new one is allowed. The problem is formulated as an optimal control problem subject to the state constraint that the remaining deposit at any given time is nonnegative. We show that the optimal preventive maintenance, production rates, and the replacement and salvage times of the existing machinery and the new one, if required, can be obtained by solving sequentially a series of free-end-point optimal control problems. Moreover, an algorithm based on this result is developed and used to solve two illustrative examples.

  4. Balancing innovation and medical device regulation: the case of modern metal-on-metal hip replacements

    Directory of Open Access Journals (Sweden)

    Howard JJ

    2016-08-01

    Full Text Available Jason J Howard1,2 1Division of Orthopedic Surgery, Department of Surgery, Sidra Medical and Research Center, 2Department of Orthopedic Surgery, Weill Cornell Medical College, Doha, Qatar Abstract: Due to problems with wear particle generation and subsequent loosening using conventional metal-on-polyethylene total hip replacements, there has been a shift toward alternative bearing systems, including metal-on-metal (MoM, for younger, more active patients with degenerative joint disease. Based on positive results from early short-term clinical studies, MoM hip replacements were readily adopted by orthopedic surgeons with thousands being implanted worldwide over the past decade. Unacceptably high revision rates reported by two national joint registries called into question the rigorousness of the regulatory approval process for these implants, particularly with respect to premarket data requirements to prove safety, effectiveness, and the appropriateness of the regulatory pathway chosen. The purpose of this review was to investigate the balance between facilitating the introduction of new medical technologies and the need to ensure safety and effectiveness through comprehensive regulatory assessment. The case of MoM hip replacement devices was used to frame the investigation and subsequent discussions. The regulatory approval processes and post-market surveillance requirements associated with three common MoM hip replacements (two resurfacings: the Birmingham and articular surface replacement and the articular surface replacement XL total hip replacement were investigated. With respect to modern MoM hip replacement devices, the balance between facilitating the introduction of these new medical technologies and the need to ensure safety and effectiveness through comprehensive regulatory assessment was not achieved. The lessons learned from these experiences have application beyond joint replacements to the introduction of new medical technologies in

  5. 老年患者髋关节置换术后认知功能障碍的护理体会%Nursing experience of postoperative cognitive dysfunction in elderly patients with hip joint replacement

    Institute of Scientific and Technical Information of China (English)

    李敏

    2015-01-01

    ObjectiveTo explore the nursing experience of postoperative cognitive dysfunction in elderly patients with total hip replacement.Methods 7 elderly patients with postoperative cognitive dysfunction after total hip arthroplasty were selected. All the patients were combined with spinal epidural anesthesia, and the patients were used the method of analgesia pump controlled analgesia.Resultsin 7 patients, 3 to 5 days after surgery, and gradually relieved, discharged when cured.Conclusions patients with postoperative cognitive dysfunction, surgical treatment of elderly patients should be carefully observed and carefully, pay attention to preoperative patients with psychological care, preoperative patients with preoperative psychological care, preoperative patients with various pathological conditions, adequate oxygen supply, to prevent hypoxia; postoperative strict observation of disease and mood changes, timely diagnosis, active intervention, early treatment, strengthen rehabilitation training, improve the quality of life of elderly patients.%目的:探讨老年患者髋关节置换术后认知功能障碍的护理体会。方法选取对髋关节置换术后出现认知功能障碍的7例老年患者,术中全部采用腰硬联合麻醉,术后均应用镇痛泵自控镇痛的方法,主要依据症状持续时间、临床表现和神经内科会诊意见作出诊断。结果7例患者在术后3至5天逐渐缓解,出院时痊愈。结论对术后认知功能障的患者,手术期对老年患者应该仔细观察和精心治疗,重视术前患者的心理护理,纠正老年病人术前各种病理状态;术中充分供氧,防止低氧血症;术后严密观察病情及情绪变化,及时诊断,积极干预,及早治疗,加强康复训练,提高老年患者的生活质量。

  6. Valve Repair or Replacement

    Science.gov (United States)

    ... valve surgery can be done using a robot. Robotic surgery does not require a large incision in the ... The Texas Heart Institute has a robot. With robotic surgery, the surgeon has a control console, a side ...

  7. Total hip and total knee replacement: preoperative nursing management.

    Science.gov (United States)

    Lucas, Brian

    Total hip replacement (THR) and total knee replacement (TKR) surgery are carried out for the relief of hip or knee pain, usually caused by osteoarthritis. This is the first of two articles on THR and TKR. It will outline the different types of replacement used in lower limb joint replacement surgery. Preparation of patients for surgery requires attention to physical, psychological and social factors and these are explored in detail. The organization of services along the patient pathway to ensure comprehensive preparation is considered and the nursing role highlighted. The second article, to be published in the next issue, will discuss recovery and rehabilitation from THR and TKR surgery.

  8. Iron replacement therapy

    DEFF Research Database (Denmark)

    Nielsen, Ole Haagen; Coskun, Mehmet; Weiss, Günter

    2016-01-01

    PURPOSE OF REVIEW: Approximately, one-third of the world's population suffers from anemia, and at least half of these cases are because of iron deficiency. With the introduction of new intravenous iron preparations over the last decade, uncertainty has arisen when these compounds should be admini...... treatment, when to follow-up for relapse, which dosage and type of therapy should be recommended or not recommended, and if some patients should not be treated....... be administered and under which circumstances oral therapy is still an appropriate and effective treatment. RECENT FINDINGS: Numerous guidelines are available, but none go into detail about therapeutic start and end points or how iron-deficiency anemia should be best treated depending on the underlying cause...... of iron deficiency or in regard to concomitant underlying or additional diseases. SUMMARY: The study points to major issues to be considered in revisions of future guidelines for the true optimal iron replacement therapy, including how to assess the need for treatment, when to start and when to stop...

  9. Nursing Experience of Perioperative Nursing for Patients with Artificial Hip Replacement%人工髋关节置换术患者围手术期的护理体会

    Institute of Scientific and Technical Information of China (English)

    冷观琴

    2015-01-01

    目的探讨人工髋关节置换术患者的围手术期护理。方法回顾性分析40例人工髋关节置换术手术后患者的护理资料。结果39例平稳渡过围手术期安全出院,只有1例患者出现深静脉血栓并发症。结论人工髋关节置换术手术风险较高,加强围手术期护理能有效降低手术风险,提高手术成功率。%Objective To investigate the peri operation period nursing of the patients with artificial hip joint replacement. Methods The nursing data of 40 patients after artificial hip joint replacement were reviewed retrospectively. Results 39 cases which smoothly passed through the operation were safely discharged, only 1 patients with deep venous thrombosis complications. Conclusion Artificial hip joint replacement operation with high risk, Because the artificial hip joint replacement operation risk is higher, to strengthen peri operation period nursing can ef ectively reduce the operation risk, improve the success rate of operation.

  10. Principles of human joint replacement design and clinical application

    CERN Document Server

    Buechel, Frederick F

    2015-01-01

    This book is written for the users and designers of joint replacements. In its second extended edition it conveys to the reader the knowledge accumulated by the authors during their forty year effort on the development of replacement devices for the lower limb for the purpose of aiding the reader in their design and evaluation of joint replacement devices. The early chapters describe the engineering, scientific and medical principles needed for replacement joint evaluation. One must understand the nature and performance of the materials involved and their characteristics in vivo, i.e. the response of the body to implant materials. It is also essential to understand the response of the implants to applied loading and motion, particularly in the hostile physiological environment. A chapter describes the design methodology now required for joint replacement in the USA and EU countries. The remaining chapters provide a history of joint replacement, an evaluation of earlier and current devices and sample case hist...

  11. THE REPLACEMENT-RENEWAL OF INDUSTRIAL EQUIPMENTS. THE MAPI FORMULAS

    Directory of Open Access Journals (Sweden)

    Meo Colombo Carlotta

    2010-07-01

    Full Text Available Since the production has been found to be an economical means for satisfying human wants, this process requires a complex industrial organization together with a large investment in equipments, plants and productive systems. These productive systems are employed to alter the physical environment and create consumer goods. As a result, they are consumed or become obsolete, inadequate, or otherwise candidates for replacement. When replacement is being considered, two assets must be evaluated: the present asset, the defender and its potential replacement, the challenger. Since the success of an industrial organization depends upon profit, replacement should generally occur if an economic advantage will result. Whatever the reason leading to the consideration of replacement, the analysis and decisions must be based upon estimates of what will occur in the future. In this paper we present the Mapi algorithm as a procedure for evaluating investments or for analyzing replacement opportunities.

  12. Using your shoulder after replacement surgery

    Science.gov (United States)

    Joint replacement surgery - using your shoulder; Shoulder replacement surgery - after ... You have had shoulder replacement surgery to replace the bones of your shoulder joint with artificial parts. The parts include a stem made of metal and a ...

  13. Gene replacement in Penicillium roqueforti.

    Science.gov (United States)

    Goarin, Anne; Silar, Philippe; Malagnac, Fabienne

    2015-05-01

    Most cheese-making filamentous fungi lack suitable molecular tools to improve their biotechnology potential. Penicillium roqueforti, a species of high industrial importance, would benefit from functional data yielded by molecular genetic approaches. This work provides the first example of gene replacement by homologous recombination in P. roqueforti, demonstrating that knockout experiments can be performed in this fungus. To do so, we improved the existing transformation method to integrate transgenes into P. roqueforti genome. In the meantime, we cloned the PrNiaD gene, which encodes a NADPH-dependent nitrate reductase that reduces nitrate to nitrite. Then, we performed a deletion of the PrNiaD gene from P. roqueforti strain AGO. The ΔPrNiaD mutant strain is more resistant to chlorate-containing medium than the wild-type strain, but did not grow on nitrate-containing medium. Because genomic data are now available, we believe that generating selective deletions of candidate genes will be a key step to open the way for a comprehensive exploration of gene function in P. roqueforti.

  14. Educating My Replacement

    Science.gov (United States)

    Tarter, Jill

    , in partnership with the dedicated teachers out there, I think I can help promote the critical thinking skills and scientific literacy of the next generation of voters. Hopefully, I can also help train my replacement to be a better scientist, capable of seizing all the opportunities generated by advances in technology and our improved understanding of the universe to craft search strategies with greater probability of success than those I have initiated.

  15. [Ascending aorta replacement late after aortic valve replacement].

    Science.gov (United States)

    Hayashi, Yasunari; Ito, Toshiaki; Maekawa, Atsuo; Sawaki, Sadanari; Fujii, Genyo; Hoshino, Satoshi; Tokoro, Masayoshi; Yanagisawa, Junji

    2013-07-01

    Replacement of the asceding aorta is indicated in patients undergoing aortic valve replacement( AVR), if the diameter of the ascending aorta is greater than 5.0 cm. If the diameter of the asceding aorta is from 4.0 to 5.0 cm, it was arguable whether replacement of the ascending aorta should be performed. Nine patients who underwent reoperative ascending aorta replacement after AVR were reviewed retrospectively. Reoperation on the asending aorta replacement was performed 11.8±7.2 years (range 1y5m~23y3m) after AVR. Mean patient age was 69.9±6.3 (range 60~81). In 2 cases, reoperations were performed early year after AVR. Although ascending aorta was dilated at the 1st operation, replacement wasn't performed for the age and minimally invasive cardiac surgery (MICS). In 3 cases, reoperations were performed more than 10 years later. On these cases, ascending aorta aneurysm and dissection occurred with no pain and were pointed out by computed tomography(CT) or ultrasonic cardiogram(UCG). We think that patients with dilatation of the ascending aorta should undergo AVR and aorta replacement at the 1st operation regardness of age. It is important that patients who underwent AVR should undergo a regular checkup on the ascending aorta.

  16. Iterative Learning of Transcatheter Mitral Valve Replacement in Mitral Valve Annulus Calcification: Management and Prevention of Transcatheter Mitral Valve Replacement Dislocation.

    Science.gov (United States)

    Hulman, Michal; Bena, Martin; Artemiou, Panagiotis; Gasparovic, Ivo; Hudec, Vladan; Rajani, Ronak; Bapat, Vinayak

    2016-10-01

    Transcatheter mitral valve replacement using balloon-expandable valves is an emerging technique for the treatment of patients with significant mitral regurgitation who have been judged to be inoperable owing to significant mitral valve annulus calcification. Although initial reports have been promising, there remains a lack of consensus as to how to plan for transcatheter mitral valve replacement deployment in terms of appropriateness, sizing, and positioning to mitigate the risks of valve displacement and paravalvular regurgitation. We describe two cases of transcatheter mitral valve replacement in patients with significant mitral valve annulus calcification. The first was complicated by valve displacement into the left atrium, which was successfully managed by surgical redeployment and fixation. The second case was thereafter performed successfully using iterative learning and the application of specific preprocedural planning techniques acquired from a root cause analysis of the first case. We describe our experience with both cases and the specific planning principles required to prevent transcatheter mitral valve replacement displacement in patients with mitral valve annulus calcification.

  17. Study of requirements and performances of the electromagnetic calorimeter for the Mu2e experiment at Fermilab

    Energy Technology Data Exchange (ETDEWEB)

    Soleti, S. [Sapienza Univ. of Rome (Italy)

    2015-06-15

    In this thesis we discuss the simulation and tests carried out for the optimization and design of the electromagnetic calorimeter for the Mu2e (Muon to electron conversion) experiment, which is a proposed experiment part of the Muon Campus hosted at Fermi National Accelerator Laboratory (FNAL) in Batavia, United States.

  18. Science requirements for free-flying imaging radar (FIREX) experiment for sea ice, renewable resources, nonrenewable resources and oceanography

    Science.gov (United States)

    Carsey, F.

    1982-01-01

    A future bilateral SAR program was studied. The requirements supporting a SAR mission posed by science and operations in sea-ice-covered waters, oceanography, renewable resources, and nonrenewable resources are addressed. The instrument, mission, and program parameters were discussed. Research investigations supporting a SAR flight and the subsequent overall mission requirements and tradeoffs are summarized.

  19. Nursing experience of mechanical ventilation in patients with replacement of mitral valve%二尖瓣置换术后患者机械通气的护理体会

    Institute of Scientific and Technical Information of China (English)

    谢幼华; 卢红; 黄春叶

    2013-01-01

    Objective To explore the nursing measures for mechanical ventilation in patients with replacement of mitral valve.Methods Clinical materials of 11 patients with replacement of mitral valve were analyzed retrospectively.Results Respiratory support for 11 patients by mechanical ventilation were effective,and all the patients passed the surgical period safely and discharged successfully.Conclusion Mechanical ventilation is the main therapeutic method for patients with replacement of mitral valve.Rigorous observation on the condition of disease,unobstructed respiratory tract,careful preparation for mechanical ventilation and mental nursing are the important points of successful cardiac surgery.%目的 探讨二尖瓣置换术后患者机械通气的护理措施.方法 回顾性分析11例二尖瓣置换术后患者的临床资料.结果 11例患者呼吸支持均有效,安全度过手术期,康复出院.结论 机械通气仍是治疗二尖瓣置换术后患者的主要手段,而严密观察病情、保持气道通畅、做好机械通气及心理护理等护理措施也是决定心脏手术成功与否的关键.

  20. An Examination of U.S. AACSB International Accounting-Accredited Schools to Determine Global Travel Experience Requirements in Accounting Masters Programs

    Science.gov (United States)

    Taylor, Susan Lee; Finley, Jane B.

    2010-01-01

    The authors report on the extent to which U.S. graduate accounting programs accredited by the Association to Advance Collegiate Schools of Business have included some type of global travel experience in their graduate accounting curriculum. The authors contacted 137 member schools offering accounting masters degrees. Only one school required an…

  1. 42 CFR 482.82 - Condition of participation: Data submission, clinical experience, and outcome requirements for re...

    Science.gov (United States)

    2010-10-01

    ... performed at the center. (3) A pancreas transplant center is not required to comply with the clinical... section for pancreas transplants performed at the center. (4) A center that is approved to...

  2. Operational Readiness Review: Savannah River Replacement Tritium Facility

    Energy Technology Data Exchange (ETDEWEB)

    1993-02-01

    The Operational Readiness Review (ORR) is one of several activities to be completed prior to introducing tritium into the Replacement Tritium Facility (RTF) at the Savannah River Site (SRS). The Secretary of Energy will rely in part on the results of this ORR in deciding whether the startup criteria for RTF have been met. The RTF is a new underground facility built to safely service the remaining nuclear weapons stockpile. At RTF, tritium will be unloaded from old components, purified and enriched, and loaded into new or reclaimed reservoirs. The RTF will replace an aging facility at SRS that has processed tritium for more than 35 years. RTF has completed construction and is undergoing facility startup testing. The final stages of this testing will require the introduction of limited amounts of tritium. The US Department of Energy (DOE) ORR was conducted January 19 to February 4, 1993, in accordance with an ORR review plan which was developed considering previous readiness reviews. The plan also considered the Defense Nuclear Facilities Safety Board (DNFSB) Recommendations 90-4 and 92-6, and the judgements of experienced senior experts. The review covered three major areas: (1) Plant and Equipment Readiness, (2) Personnel Readiness, and (3) Management Systems. The ORR Team was comprised of approximately 30 members consisting of a Team Leader, Senior Safety Experts, and Technical Experts. The ORR objectives and criteria were based on DOE Orders, industry standards, Institute of Nuclear Power Operations guidelines, recommendations of external oversight groups, and experience of the team members.

  3. Electrocatalysts Prepared by Galvanic Replacement

    OpenAIRE

    Athanasios Papaderakis; Ioanna Mintsouli; Jenia Georgieva; Sotiris Sotiropoulos

    2017-01-01

    Galvanic replacement is the spontaneous replacement of surface layers of a metal, M, by a more noble metal, Mnoble, when the former is treated with a solution containing the latter in ionic form, according to the general replacement reaction: nM + mMnoblen+ → nMm+ + mMnoble. The reaction is driven by the difference in the equilibrium potential of the two metal/metal ion redox couples and, to avoid parasitic cathodic processes such as oxygen reduction and (in some cases) hydrogen evolution too...

  4. 经股动脉球囊扩张式主动脉瓣置换术的初步经验%Aortic valve replacement via transfemoral balloon dilation: an initial experience

    Institute of Scientific and Technical Information of China (English)

    陆清声; 景在平; 洪毅; 吴宏; 王志农; 李卫萍; 张勇学; 李南; 马宇; 秦永文

    2011-01-01

    Objective To discuss the feasibility of treating patients with severe aortic valve stenosis by aortic valve replacement via transfemoral balloon dilation. Methods Three patients with severe aortic valve stenosis, who could not tolerate traditional open surgery, were chosen to receive aortic valve replacement via transfemoral balloon dilation. Results All the three operations were successfully done by transfemoral approach, including one assisted by transapical puncture. The aortic valve function of patients was improved, and there was no related complication or death. Conclusion Aortic valve replacement via transfemoral balloon dilation can be used for treatment of Chinese patients with severe aortic valve stenosis; but which demands more detailed preoperative preparation, evaluation, and surgical manipulation.%目的 探讨经股动脉球囊扩张式主动脉瓣置换术治疗严重主动脉瓣狭窄患者的可行性.方法 选取3例严重主动脉瓣钙化狭窄的患者,术前评估无法耐受传统开放手术,行经股动脉球扩式主动脉瓣置换术.结果 3例均经股动脉完成,其中1例经心尖穿刺辅助完成.3例手术全部成功,术后患者主动脉瓣功能显著改善,无并发症,无死亡.结论 经股动脉球扩式主动脉瓣置换术可用于国人严重主动脉瓣狭窄患者,但在术前准备与评估、术中操作等方面提出了更高的要求.

  5. Minimally invasive aortic valve replacement

    DEFF Research Database (Denmark)

    Foghsgaard, Signe; Schmidt, Thomas Andersen; Kjaergard, Henrik K

    2009-01-01

    In this descriptive prospective study, we evaluate the outcomes of surgery in 98 patients who were scheduled to undergo minimally invasive aortic valve replacement. These patients were compared with a group of 50 patients who underwent scheduled aortic valve replacement through a full sternotomy....... The 30-day mortality rate for the 98 patients was zero, although 14 of the 98 mini-sternotomies had to be converted to complete sternotomies intraoperatively due to technical problems. Such conversion doubled the operative time over that of the planned full sternotomies. In the group of patients whose...... is an excellent operation in selected patients, but its true advantages over conventional aortic valve replacement (other than a smaller scar) await evaluation by means of randomized clinical trial. The "extended mini-aortic valve replacement" operation, on the other hand, is a risky procedure that should...

  6. The Dedicated Aerosol Retrieval Experiment (DARE): scientific requirements for a dedicated satellite instrument to measure atmospheric aerosols

    NARCIS (Netherlands)

    Decae, R.; Courrèges-Lacoste, G.B.; Leeuw, G. de

    2004-01-01

    DARE (Dedicated Aerosol Retrieval Experiment) is a study to design an instrument for accurate remote sensing of aerosol properties from space. DARE combines useful properties of several existing instruments like TOMS, GOME, ATSR and POLDER. It has a large wavelength range, 330 to 1000 nm, to discrim

  7. The utility of trans-catheter aortic valve replacement after commercialization: does the European experience provide a glimpse into the future use of this technology in the United States?

    Science.gov (United States)

    Linke, Axel; Walther, Thomas; Schuler, Gerhard

    2010-03-01

    Treatment of aortic stenosis remains challenging in older individuals, as their perioperative mortality for open heart surgery is increased due to comorbidities. Transcatheter aortic valve implantation using the CoreValve ReValving System (Medtronic, Minneapolis, USA) and the Edwards SAPIEN transcatheter heart valve (THV; Edwards Lifescience, Irvine, California, USA) represents an alternative to conventional valve replacement in elderly patients that have a high risk for conventional surgery. This article summarizes the evidence-base from recent clinical trials. The early results of these landmark studies suggest that transcatheter aortic valve implantation with either one of the prosthesis is feasible, safe, improves hemodynamics and, therefore, might be an alternative to conventional aortic valve replacement in very high-risk patients. However, all of the available transcatheter heart valves have certain disadvantages, limiting their use in daily clinical practice. The process of decision making, which valve to use and which access route to choose is illustrated in this article through clinical case scenarios. Additionally, the lessons learned thus far from the European perspective and the potential impact on the future use in the US are discussed. Despite of the progress in this field, we are still lacking an optimal transcatheter heart valve. Once it is available, we can take the plunge to compare transcatheter valve implantation with convention surgery in severe aortic stenosis!

  8. Measuring work activities and skill requirements of occupations: experiences from a European pilot study with a web-survey

    NARCIS (Netherlands)

    Tijdens, K.G.; de Ruijter, J.; de Ruijter, E.

    2012-01-01

    Purpose - The purpose of this article is to evaluate a method for measuring work activities and skill requirements of 160 occupations in eight countries, used in EurOccupations, an EU-FP6 project. Additionally, it aims to explore how the internet can be used for measuring work activities and skill r

  9. Trends of fluid requirement in dengue fever and dengue haemorrhagic fever: a single centre experience in Sri Lanka.

    Science.gov (United States)

    Kularatne, Senanayake A M; Weerakoon, Kosala G A D; Munasinghe, Ruwan; Ralapanawa, Udaya K; Pathirage, Manoji

    2015-04-08

    Meticulous fluid management is the mainstay of treatment in dengue fever that is currently governed by consensus guidelines rather than by strong research evidence. To examine this issue we audited the fluid requirement of a cohort of adult patients with dengue fever (DF) and dengue haemorrhagic fever (DHF) in a tertiary care clinical setting. This retrospective cohort study was conducted from July 2012 to January 2013 in Teaching Hospital, Peradeniya, Sri Lanka. Adult patients with confirmed dengue infection managed according to the national and WHO guidelines were included. Their fluid requirement was audited once data collection was over in both DF and DHF groups. Out of 302 patients, 209 (69%) had serological confirmation of dengue infection, comprising 62 (30%) patients gone into critical phase of DHF. Mean age of the DHF group was 30 years (range 12-63 years) and included more males (n = 42, 68%, p fever on admission and total duration of fever were 4 days and 6 days respectively. DHF group had high incidence of vomiting, abdominal pain and flushing, lowest platelet counts and highest haematocrit values compared to DF group. In DHF group, the mean total daily requirements of fluid from 2(nd) to 7(th) day were 2123, 2733, 2846, 2981, 3139 and 3154 milliliters respectively to maintain a safe haematocrit value and the vital parameters. However, in DF group the fluid requirement was lowest on 3(rd) day (2158 milliliters). DHF group had significantly high fluid requirement on 5(th) -7(th) day compared to DF group (p fever and again on 5(th) to 7(th) day of fever. Despite being an audit, these finding could be useful in future updates of guidelines and designing research.

  10. Initial Experience of Laparoendoscopic Single-Site Radical Prostatectomy Requiring Well-Equipped Appliances and a Skilled Technique

    Directory of Open Access Journals (Sweden)

    Joo Yong Lee

    2010-12-01

    Full Text Available We report an initial experience in laparoendoscopic single-site radical prostatectomy (LESSRP using a homemade single-port device for prostate cancer. A 63-year-old man was diagnosed with prostate cancer. The patient underwent LESSRP using an Alexis® wound retractor, which was inserted through an umbilical incision. A homemade single-port device was made by fixing a 61/2 surgical glove to the retractor’s outer ring and securing the glove finger to the end of 4 trocars with a tie. Using the flexible laparoscopic and rigid instruments, LESSRP was performed using a procedure similar to conventional laparoscopic radical prostatectomy (LRP. In the current case, we could not perform complete LESSRP, so we report our initial experience and consider the reason why laparoendoscopic single-site surgery was converted to conventional LRP.

  11. The 10 basic requirements for a scientific paper reporting antioxidant, antimutagenic or anticarcinogenic potential of test substances in in vitro experiments and animal studies in vivo

    DEFF Research Database (Denmark)

    Verhagen, H.; Aruoma, O.I.; van Delft, J.H.M.;

    2003-01-01

    future, it has become essential that studies reported in this journal reflect an adequate level of scientific scrutiny. Therefore a set of essential characteristics of studies has been defined. These basic requirements are default properties rather than non-negotiables: deviations are possible and useful......, provided they can be justified on scientific grounds. The 10 basic requirements for a scientific paper reporting antioxidant, antimutagenic or anticarcinogenic potential of test substances in in vitro experiments and animal studies in vivo concern the following areas: (1) Hypothesis-driven study design; (2...

  12. Nurses', midwives' and key stakeholders' experiences and perceptions on requirements to demonstrate the maintenance of professional competence.

    OpenAIRE

    Casey, Mary; Cooney, Adeline; O'Connell, Rhona; Hegarty, Josephine; Brady, Anne-Marie; O'Reilly, Pauline; Kennedy, Catriona; Heffernan, Elizabeth; Fealy, Gerard; McNamara, Martin; O' Connor, Laserina

    2016-01-01

    Aim: To present the qualitative findings from a study on the development of scheme(s) to give evidence of maintenance of professional competence for nurses and midwives. Background: Key issues in maintenance of professional competence include notions of self- assessment, verification of engagement and practice hours, provision of an evidential record, the role of the employer and articulation of possible consequences for non-adherence with the requirements. Schemes to demonstrate the maintena...

  13. Introducing radiology report checklists among residents: adherence rates when suggesting versus requiring their use and early experience in improving accuracy.

    Science.gov (United States)

    Powell, Daniel K; Lin, Eaton; Silberzweig, James E; Kagetsu, Nolan J

    2014-03-01

    To retrospectively compare resident adherence to checklist-style structured reporting for maxillofacial computed tomography (CT) from the emergency department (when required vs. suggested between two programs). To compare radiology resident reporting accuracy before and after introduction of the structured report and assess its ability to decrease the rate of undetected pathology. We introduced a reporting checklist for maxillofacial CT into our dictation software without specific training, requiring it at one program and suggesting it at another. We quantified usage among residents and compared reporting accuracy, before and after counting and categorizing faculty addenda. There was no significant change in resident accuracy in the first few months, with residents acting as their own controls (directly comparing performance with and without the checklist). Adherence to the checklist at program A (where it originated and was required) was 85% of reports compared to 9% of reports at program B (where it was suggested). When using program B as a secondary control, there was no significant difference in resident accuracy with or without using the checklist (comparing different residents using the checklist to those not using the checklist). Our results suggest that there is no automatic value of checklists for improving radiology resident reporting accuracy. They also suggest the importance of focused training, checklist flexibility, and a period of adjustment to a new reporting style. Mandatory checklists were readily adopted by residents but not when simply suggested. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

  14. Does Gender Influence Electroconvulsive Therapy Sessions Required across Psychiatric Diagnoses? A 5-Year Experience from a Single Center

    Science.gov (United States)

    Manohar, Harshini; Subramanian, Karthick; Menon, Vikas; Kattimani, Shivanand

    2017-01-01

    Context: There is a paucity of systematic data reflecting the practice of electroconvulsive therapy (ECT) from developing countries. Aim: We aimed to identify the number of ECT sessions required to yield response and gender diffeferences in the number of sessions across various diagnostic categories. Setting and Design: A record-based study from a teaching cum tertiary care hospital in South India. Subjects and Methods: Case records of patients who received modified ECT from January 2011 to January 2016 were reviewed. The sociodemographic details and ECT-related data were collected. Psychiatric diagnoses were ascertained as per the International Classification of Diseases, 10th Revision criteria. Statistical Analysis Used: Kruskal–Wallis test and Mann–Whitney U-test. Results: Among 148 patients, 82 (55.4%) had mood disorder (bipolar disorder and recurrent depressive disorder), 43 (29.1%) had schizophrenia, and 22 (14.9%) had other acute and transient psychotic disorders (ATPDs). Patients with mood disorders, schizophrenia, and other ATPD received 7.3 (± 3.8), 9.7 (± 6.1), and 5.4 (± 2.0) ECT sessions, respectively, to achieve response. There was no gender difference in the number of sessions received. Conclusion: Our findings show that number of ECT sessions required to yield response may be disorder-specific. Gender does not influence the ECT dose requirement. Variations in ECT parameters across settings may limit the generalizability of results. PMID:28694625

  15. Minimally Invasive Transaortic Mitral Decalcification During Aortic Valve Replacement.

    Science.gov (United States)

    Totsugawa, Toshinori; Sakaguchi, Taichi; Hiraoka, Arudo; Matsushita, Hiroshi; Hirai, Yuki; Yoshitaka, Hidenori

    2015-01-01

    Mitral annular calcification accompanied by aortic stenosis is hazardous for both double-valve replacement and transcatheter aortic valve implantation. Less invasive mitral procedure is required in this condition, and minimally invasive approach may further reduce the operative risk in high-risk patients. Here, we report minimally invasive transaortic mitral decalcification during aortic valve replacement through minithoracotomy. We believe that this option is feasible in patients who are at prohibitive risk for double-valve replacement or transcatheter aortic valve implantation because of severe mitral annular calcification.

  16. Knee Replacement: What you can Expect

    Science.gov (United States)

    ... improves function lessen with each additional surgery. Artificial knees can wear out Another risk of knee replacement ... replacement surgery to last about two hours. After knee replacement surgery After surgery, you're wheeled to ...

  17. Transcatheter aortic valve prosthesis surgically replaced 4 months after implantation

    DEFF Research Database (Denmark)

    Thyregod, Hans Gustav; Lund, Jens Teglgaard; Engstrøm, Thomas;

    2010-01-01

    Transcatheter aortic valve implantation is a new and rapidly evolving treatment option for high-risk surgical patients with degenerative aortic valve stenosis. Long-term results with these new valve prostheses are lacking, and potential valve dysfunction and failure would require valve replacement....... We report the first case of surgical valve replacement in a patient with a dysfunctional transcatheter-implanted aortic valve prosthesis 4 months after implantation....

  18. Renal Replacement Therapy in Support of Combat Operations

    Science.gov (United States)

    2008-07-01

    was used to create viable sets; pediatric chest tubes were used as PD catheters and dialysate was made using either intravenous saline solution with...important logistic factor in performing RRT is the volume of fluid required for dialysate (for hemodi- alysis and peritoneal dialysis) or replace- ment...treatment may range on the order of 100 to 1000 L per day per patient. Both the dialysate and replacement fluid must be sterile, and no approach for

  19. Optimization criteria for the design of orbital replacement units (ORUs)

    Science.gov (United States)

    Schulze, Manfred W.

    A reduction of life cycle costs of spacecraft or Space Station elements can be achieved by a modular build up which allows an in orbit replacement, maintenance, and service of functional units named Orbital Replacement Units (ORUs). The criteria for an optimal design for an ORU is presented. Requirements involving the user spacecraft configuration, the servicing vehicle, the handling by astronauts and remote manipulator system are considered.

  20. Experimental replacement of an obligate insect symbiont.

    Science.gov (United States)

    Moran, Nancy A; Yun, Yueli

    2015-02-17

    Symbiosis, the close association of unrelated organisms, has been pivotal in biological diversification. In the obligate symbioses found in many insect hosts, organisms that were once independent are permanently and intimately associated, resulting in expanded ecological capabilities. The primary model for this kind of symbiosis is the association between the bacterium Buchnera and the pea aphid (Acyrthosiphon pisum). A longstanding obstacle to efforts to illuminate genetic changes underlying obligate symbioses has been the inability to experimentally disrupt and reconstitute symbiont-host partnerships. Our experiments show that Buchnera can be experimentally transferred between aphid matrilines and, furthermore, that Buchnera replacement has a massive effect on host fitness. Using a recipient pea aphid matriline containing Buchnera that are heat sensitive because of an allele eliminating the heat shock response of a small chaperone, we reduced native Buchnera through heat exposure and introduced a genetically distinct Buchnera from another matriline, achieving complete replacement and stable inheritance. This transfer disrupted 100 million years (∼ 1 billion generations) of continuous maternal transmission of Buchnera in its host aphids. Furthermore, aphids with the Buchnera replacement enjoyed a dramatic increase in heat tolerance, directly demonstrating a strong effect of symbiont genotype on host ecology.

  1. Homologous gene replacement in Physarum

    Energy Technology Data Exchange (ETDEWEB)

    Burland, T.G. [Univ. of Wisconsin, Madison, WI (United States); Pallotta, D. [Laval Univ., Quebec (Canada)

    1995-01-01

    The protist Physarum polycephalum is useful for analysis of several aspects of cellular and developmental biology. To expand the opportunities for experimental analysis of this organism, we have developed a method for gene replacement. We transformed Physarum amoebae with plasmid DNA carrying a mutant allele, ardD{Delta}1, of the ardD actin gene; ardD{Delta}1 mutates the critical carboxy-terminal region of the gene product. Because ardD is not expressed in the amoeba, replacement of ardD{sup +} with ardD{Delta}1 should not be lethal for this cell type. Transformants were obtained only when linear plasmid DNA was used. Most transformants carried one copy of ardD{Delta}1 in addition to ardD{sup +}, but in two (5%), ardD{sup +} was replaced by a single copy of ardD{Delta}1. This is the first example of homologous gene replacement in Physarum. ardD{Delta}1 was stably maintained in the genome through growth, development and meiosis. We found no effect of ardD{Delta}l on viability, growth, or development of any of the various cell types of Physarum. Thus, the carboxy-terminal region of the ardD product appears not to perform a unique essential role in growth or development. Nevertheless, this method for homologous gene replacement can be applied to analyze the function of any cloned gene. 38 refs., 6 figs., 1 tab.

  2. Experience in initial training required for the recognition of the qualified RP expert in Spain; Experiencia en la formacion requerida para el reconocimiento del experto cualificado en Espana

    Energy Technology Data Exchange (ETDEWEB)

    Rodriguez Suarez, M.; Marco Arboli, M.; Menarguez, J.

    2003-07-01

    An important point of the actions inside the European framework to achieve the harmonisation of the training programmes and recognition was included in the European directive 96/29/Euratom which includes definition and specific tasks of the European Qualified Expert on Radiation Protection (RP). Basic syllabus for training of those experts was developed in the communication 98/C 133/03 concerning BSS applications. Although, in the Spanish education system, the training and recognition requirements of the high level qualified experts on RP was defined since 1977, until 2001, the figure of the Technical Qualified Expert on RP does not appear in the legal framework. In December 2002, a new regulation of the Spanish Regulatory Body, CSN, about qualifications to obtain the recognition of RP Expert in Spain (both high qualified and technical RP experts) was published. Concerning the qualified expert on RP, (RP Officer), responsible of the RP Service, which takes charge of the effective protection and advise radioactive and nuclear facilities in Rp aspects,has to be authorised by the regulatory body. to obtain the RP officer diploma, conceded by the CSN, an initial training of 300 hours and a three-year minimum experience are required (for X-ray installation a 6-month experience is enough). The technical qualified expert on RP is the worker who carried out the tasks in the a RP Service under the supervision of the RP officer. A Technician Qualified Expert on RP does not need an specific accreditation of the Regulatory Body, but an initial RP training and a three-month minimum experience are required and has hold a certificate by the RP officer. Continuous training is also required and as well has to receive a certificate from the RP officer. Since 1977, The Institute for energy Studies has been implementing specific training courses for those professionals who want to obtain the diploma of RP officer (high degree qualified RP expert), conceded by the CSN. Since then

  3. Development of Replacements for Phoscoating Used in Forging, Extrusion and Metal Forming Processes

    Energy Technology Data Exchange (ETDEWEB)

    Kerry Barnett

    2003-03-01

    Many forging, extrusion, heading and other metal forming processes use graphite-based lubricants, phosphate coatings, and other potentially hazardous or harmful substances to improve the tribology of the metal forming process. The application of phosphate-based coatings has long been studied to determine if other synthetic ''clean'' lubricants could provide the same degree of protection afforded by phoscoatings and its formulations. So far, none meets the cost and performance objectives provided by phoscoatings as a general aid to the metal forming industry. In as much as phoscoatings and graphite have replaced lead-based lubricants, the metal forming industry has had previous experience with a legislated requirement to change processes. However, without a proactive approach to phoscoating replacement, many metal forming processes could find themselves without a cost effective tribology material necessary for the metal forming process

  4. Efficient four fragment cloning for the construction of vectors for targeted gene replacement in filamentous fungi

    DEFF Research Database (Denmark)

    Frandsen, Rasmus John Normand; Andersson, Jens A.; Kristensen, Matilde Bylov

    2008-01-01

    Background: The rapid increase in whole genome fungal sequence information allows large scale functional analyses of target genes. Efficient transformation methods to obtain site-directed gene replacement, targeted over-expression by promoter replacement, in-frame epitope tagging or fusion...... of coding sequences with fluorescent markers such as GFP are essential for this process. Construction of vectors for these experiments depends on the directional cloning of two homologous recombination sequences on each side of a selection marker gene. Results: Here, we present a USER Friendly cloning based...... technique that allows single step cloning of the two required homologous recombination sequences into different sites of a recipient vector. The advantages are: A simple experimental design, free choice of target sequence, few procedures and user convenience. The vectors are intented for Agrobacterium...

  5. Flow boiling test of GDP replacement coolants

    Energy Technology Data Exchange (ETDEWEB)

    Park, S.H. [comp.

    1995-08-01

    The tests were part of the CFC replacement program to identify and test alternate coolants to replace CFC-114 being used in the uranium enrichment plants at Paducah and Portsmouth. The coolants tested, C{sub 4}F{sub 10} and C{sub 4}F{sub 8}, were selected based on their compatibility with the uranium hexafluoride process gas and how well the boiling temperature and vapor pressure matched that of CFC-114. However, the heat of vaporization of both coolants is lower than that of CFC-114 requiring larger coolant mass flow than CFC-114 to remove the same amount of heat. The vapor pressure of these coolants is higher than CFC-114 within the cascade operational range, and each coolant can be used as a replacement coolant with some limitation at 3,300 hp operation. The results of the CFC-114/C{sub 4}F{sub 10} mixture tests show boiling heat transfer coefficient degraded to a minimum value with about 25% C{sub 4}F{sub 10} weight mixture in CFC-114 and the degree of degradation is about 20% from that of CFC-114 boiling heat transfer coefficient. This report consists of the final reports from Cudo Technologies, Ltd.

  6. Retention Benefit Based Intelligent Cache Replacement

    Institute of Scientific and Technical Information of China (English)

    李凌达; 陆俊林; 程旭

    2014-01-01

    The performance loss resulting from different cache misses is variable in modern systems for two reasons: 1) memory access latency is not uniform, and 2) the latency toleration ability of processor cores varies across different misses. Compared with parallel misses and store misses, isolated fetch and load misses are more costly. The variation of cache miss penalty suggests that the cache replacement policy should take it into account. To that end, first, we propose the notion of retention benefit. Retention benefits can evaluate not only the increment of processor stall cycles on cache misses, but also the reduction of processor stall cycles due to cache hits. Then, we propose Retention Benefit Based Replacement (RBR) which aims to maximize the aggregate retention benefits of blocks reserved in the cache. RBR keeps track of the total retention benefit for each block in the cache, and it preferentially evicts the block with the minimum total retention benefit on replacement. The evaluation shows that RBR can improve cache performance significantly in both single-core and multi-core environment while requiring a low storage overhead. It also outperforms other state-of-the-art techniques.

  7. Immunoglobulin Replacement Therapy for Primary Immunodeficiency.

    Science.gov (United States)

    Sriaroon, Panida; Ballow, Mark

    2015-11-01

    Immunoglobulin replacement therapy has been standard treatment in patients with primary immunodeficiency diseases for the past 3 decades. The goal of therapy is to reduce serious bacterial infections in individuals with antibody function defects. Approximately one-third of patients receiving intravenous immunoglobulin treatment experience adverse reactions. Recent advances in manufacturing processes have resulted in products that are safer and better tolerated. Self-infusion by the subcutaneous route has become popular and resulted in better quality of life. This review summarizes the use of immunoglobulin therapy in primary immunodeficiency diseases including its properties, dosing, adverse effects, and different routes of administration.

  8. Trials and Tribulations with VH Replacement.

    Science.gov (United States)

    Meng, Wenzhao; Jayaraman, Sahana; Zhang, Bochao; Schwartz, Gregory W; Daber, Robert D; Hershberg, Uri; Garfall, Alfred L; Carlson, Christopher S; Luning Prak, Eline T

    2014-01-01

    VH replacement (VHR) is a type of antibody gene rearrangement in which an upstream heavy chain variable gene segment (VH) invades a pre-existing rearrangement (VDJ). In this Hypothesis and Theory article, we begin by reviewing the mechanism of VHR, its developmental timing and its potential biological consequences. Then we explore the hypothesis that specific sequence motifs called footprints reflect VHR versus other processes. We provide a compilation of footprint sequences from different regions of the antibody heavy chain, and include data from the literature and from a high throughput sequencing experiment to evaluate the significance of footprint sequences. We conclude by discussing the difficulties of attributing footprints to VHR.

  9. A Required Rotation in Clinical Laboratory Management for Pathology Residents: Five-Year Experience at Hofstra Northwell School of Medicine.

    Science.gov (United States)

    Rishi, Arvind; Hoda, Syed T; Crawford, James M

    2016-01-01

    Leadership and management training during pathology residency have been identified repeatedly by employers as insufficient. A 1-month rotation in clinical laboratory management (CLM) was created for third-year pathology residents. We report on our experience and assess the value of this rotation. The rotation was one-half observational and one-half active. The observational component involved being a member of department and laboratory service line leadership, both at the departmental and institutional level. Observational participation enabled learning of both the content and principles of leadership and management activities. The active half of the rotation was performance of a project intended to advance the strategic trajectory of the department and laboratory service line. In our program that matriculates 4 residents per year, 20 residents participated from April 2010 through December 2015. Their projects either activated a new priority area or helped propel an existing strategic priority forward. Of the 16 resident graduates who had obtained their first employment or a fellowship position, 9 responded to an assessment survey. The majority of respondents (5/9) felt that the rotation significantly contributed to their ability to compete for a fellowship or their first employment position. The top reported benefits of the rotation included people management; communication with staff, departmental, and institutional leadership; and involvement in department and institutional meetings and task groups. Our 5-year experience demonstrates both the successful principles by which the CLM rotation can be established and the high value of this rotation to residency graduates.

  10. Cobra Probes Containing Replaceable Thermocouples

    Science.gov (United States)

    Jones, John; Redding, Adam

    2007-01-01

    A modification of the basic design of cobra probes provides for relatively easy replacement of broken thermocouples. Cobra probes are standard tube-type pressure probes that may also contain thermocouples and that are routinely used in wind tunnels and aeronautical hardware. They are so named because in side views, they resemble a cobra poised to attack. Heretofore, there has been no easy way to replace a broken thermocouple in a cobra probe: instead, it has been necessary to break the probe apart and then rebuild it, typically at a cost between $2,000 and $4,000 (2004 prices). The modified design makes it possible to replace the thermocouple, in minimal time and at relatively low cost, by inserting new thermocouple wire in a tube.

  11. Superfluid helium orbital resupply - The status of the SHOOT flight experiment and preliminary user requirements. [Superfluid Helium On-Orbit Transfer

    Science.gov (United States)

    Dipirro, Michael J.; Kittel, Peter

    1989-01-01

    The Superfluid Helium On-Orbit Transfer (SHOOT) flight experiment is designed to demonstrate the components and techniques necessary to resupply superfluid helium to satellites or Space Station based facilities. A top level description as well as the development status of the critical components to be used in SHOOT are discussed. Some of these components include the thermomechanical pump, the fluid acquisition system, the normal helium and superfluid helium phase separators, Venturi flow meter, cryogenic valves, burst disks, and astronaut-compatible EVA coupler and transfer line. The requirements for the control electronics and software are given. A preliminary description of the requirements that must be met by a satellite requiring superfluid helium servicing is given. In particular, minimum and optimum plumbing arrangements are shown, transfer line flow impedance and heat input impacts are assessed, instrumentation is described, and performance parameters are considered.

  12. Renal replacement therapy in ICU

    Directory of Open Access Journals (Sweden)

    C Deepa

    2012-01-01

    Full Text Available Diagnosing and managing critically ill patients with renal dysfunction is a part of the daily routine of an intensivist. Acute kidney insufficiency substantially contributes to the morbidity and mortality of critically ill patients. Renal replacement therapy (RRT not only does play a significant role in the treatment of patients with renal failure, acute as well as chronic, but also has spread its domains to the treatment of many other disease conditions such as myaesthenia gravis, septic shock and acute on chronic liver failure. This article briefly outlines the role of renal replacement therapy in ICU.

  13. Wafer Replacement Cluster Tool (Presentation);

    Energy Technology Data Exchange (ETDEWEB)

    Branz, H. M.

    2008-04-01

    This presentation on wafer replacement cluster tool discusses: (1) Platform for advanced R and D toward SAI 2015 cost goal--crystal silicon PV at area costs closer to amorphous Si PV, it's 15% efficiency, inexpensive substrate, and moderate temperature processing (<800 C); (2) Why silicon?--industrial and knowledge base, abundant and environmentally benign, market acceptance, and good efficiency; and (3) Why replace wafers?--expensive, high embedded energy content, and uses 50-100 times more silicon than needed.

  14. Flexible attosecond beamline for high harmonic spectroscopy and XUV/near-IR pump probe experiments requiring long acquisition times

    Energy Technology Data Exchange (ETDEWEB)

    Weber, S. J., E-mail: sebastien.weber@cea.fr; Manschwetus, B.; Billon, M.; Bougeard, M.; Breger, P.; Géléoc, M.; Gruson, V.; Lin, N.; Ruchon, T.; Salières, P.; Carré, B. [Commissariat l’Energie Atomique, Laser, Interactions and Dynamics Laboratory (LIDyL), DSM/IRAMIS, CEA-Saclay, 91191 Gif sur Yvette (France); Böttcher, M.; Huetz, A.; Picard, Y. J. [ISMO, UMR 8214, Université Paris-Sud, Batiment 350, Orsay (France)

    2015-03-15

    We describe the versatile features of the attosecond beamline recently installed at CEA-Saclay on the PLFA kHz laser. It combines a fine and very complete set of diagnostics enabling high harmonic spectroscopy (HHS) through the advanced characterization of the amplitude, phase, and polarization of the harmonic emission. It also allows a variety of photo-ionization experiments using magnetic bottle and COLTRIMS (COLd Target Recoil Ion Momentum Microscopy) electron spectrometers that may be used simultaneously, thanks to a two-foci configuration. Using both passive and active stabilization, special care was paid to the long term stability of the system to allow, using both experimental approaches, time resolved studies with attosecond precision, typically over several hours of acquisition times. As an illustration, applications to multi-orbital HHS and electron-ion coincidence time resolved spectroscopy are presented.

  15. Experimental replacement of aragonite by hydroxyapatite

    Science.gov (United States)

    Kasioptas, A.; Perdikouri, C.; Geisler, T.; Putnis, A.

    2009-04-01

    Hydrothermal treatment of aragonite with (NH4)2HPO4 solution has been shown to produce hydroxyapatite (HAP) with an overall identical and thus pre-determined morphology (Kasioptas et al, 2008). The preservation of the morphology is an outcome of the pseudomorphic nature of this particular reaction. We have investigated the mechanism of the replacement of aragonite by HAP using single, natural, inorganic aragonite crystals. Isothermal experiments were carried out with small crystals placed and sealed in autoclaves with (NH4)2HPO4 solution. After the experiments the aragonite crystals are partly replaced by a new phase. X-ray powder diffraction confirmed that the product phase is indeed HAP; however electron microprobe measurements revealed that the HAP is probably non-stoichiometric. Even when completely converted to HAP, scanning electron microscopy showed that the fine-structure of the aragonite has perfectly been retained. It was also observed that the HAP product phase exhibited a high porosity and was separated from the aragonite parent phase by a sharp interface (on the micrometer scale). The replacement of aragonite by HAP in an aqueous solution can be described in terms of a coupled dissolution-reprecipitation mechanism that takes place at an inward moving reaction front (Putnis& Putnis, 2007). The porosity in the HAP product phase allows the solution to reach the reaction interface. In addition, we have performed experiments with (NH4)2HPO4 solutions prepared with H2O enriched with 97 at.% 18O. The solutions were pre-heated separately to equilibrate the oxygen isotopes in the solution. Raman spectroscopy of the HAP product was used to identify the different vibration modes in the PO43-molecule due to the exchange of 16O with 18O atoms. Apart from the main ?1(PO4) band located near 962 cm-1, we observed four new bands near 945, 931, 919 and 908 cm-1. We have attributed the generation of these new bands to four different degrees of 18O atomic substitutions in

  16. Paraplegia in a patient with bladder stoma replacement of indwelling catheter nursing experience%菌状导尿管在截瘫患者膀胱造瘘的护理体会

    Institute of Scientific and Technical Information of China (English)

    张瑾; 孙英; 刘冰

    2013-01-01

    目的:探讨菌状导尿管在截瘫患者膀胱造瘘口应用的护理体会。方法:系统回顾13位截瘫患者167人次造瘘口使用菌状导尿管的操作护理。结论:本组操作成功率95﹪,院内感染发生率94%,说明正确的操作方法及护理措施,能减轻截瘫患者的痛苦,减少院内感染的发生。提高了工作效率,适应临床值得推广。%purpose:Discussion of paraplegia patients with bladder stoma replacement of indwelling catheter nursing.Method:A systematic review of 13 patients with paraplegia and 167 person-time stoma catheter nursing.Conclusion: The success rate of the operation is 95% and incidence rate of nosocomial infection in 94%. This means the correct method of operation and nursing measures can reduce paraplegia patients' pain and the occurrence of nosocomial infection. This way can Improve work efficiency and worthy to worth to populate and apply

  17. Double emulsions as fat replacers

    NARCIS (Netherlands)

    Oppermann, Anika

    2017-01-01

    The use of double (w1/o/w2) emulsions, in which part of the oil is replaced by small water droplets, is a promising strategy to reduce oil content in food products. For successful applications, (1) significant levels of fat reduction (i.e. significant amounts of water inside the oil droplets) have

  18. Replacement policies for dairy cows

    DEFF Research Database (Denmark)

    Nielsen, Lars Relund

    In a recent paper a hierarchical Markov decision processes (MDP) with finite state and action space was formulated for the dairy cow replacement problem with stage lengths of 1 d. Bayesian updating was used to predict the performance of each cow in the herd and economic decisions were based...

  19. Electrocatalysts Prepared by Galvanic Replacement

    Directory of Open Access Journals (Sweden)

    Athanasios Papaderakis

    2017-03-01

    Full Text Available Galvanic replacement is the spontaneous replacement of surface layers of a metal, M, by a more noble metal, Mnoble, when the former is treated with a solution containing the latter in ionic form, according to the general replacement reaction: nM + mMnoblen+ → nMm+ + mMnoble. The reaction is driven by the difference in the equilibrium potential of the two metal/metal ion redox couples and, to avoid parasitic cathodic processes such as oxygen reduction and (in some cases hydrogen evolution too, both oxygen levels and the pH must be optimized. The resulting bimetallic material can in principle have a Mnoble-rich shell and M-rich core (denoted as Mnoble(M leading to a possible decrease in noble metal loading and the modification of its properties by the underlying metal M. This paper reviews a number of bimetallic or ternary electrocatalytic materials prepared by galvanic replacement for fuel cell, electrolysis and electrosynthesis reactions. These include oxygen reduction, methanol, formic acid and ethanol oxidation, hydrogen evolution and oxidation, oxygen evolution, borohydride oxidation, and halide reduction. Methods for depositing the precursor metal M on the support material (electrodeposition, electroless deposition, photodeposition as well as the various options for the support are also reviewed.

  20. Outcome of Recipients of Hematopoietic Stem Cell Transplants Who Require Intensive Care Unit Support: A Single Institution Experience.

    Science.gov (United States)

    Galindo-Becerra, Samantha; Labastida-Mercado, Nancy; Rosales-Padrón, Jaime; García-Chavez, Jessica; Soto-Vega, Elena; Rivadeneyra-Espinoza, Liliana; León-Peña, Andres A; Fernández-Lara, Danitza; Dominguez-Cid, Monica; Anthon-Méndez, Javier; Arizpe-Bravo, Daniel; Ruiz-Delgado, Guillermo J; Ruiz-Argüelles, Guillermo J

    2015-01-01

    Admission to the intensive care unit (ICU) of a patient who has been grafted with hematopoietic stem cells is a serious event, but the role of the ICU in this setting remains controversial. Data were analyzed from patients who underwent autologous or allogeneic bone marrow transplantation at the Centro de Hematología y Medicina Interna de Puebla, México, between May 1993 and October 2014. In total, 339 patients were grafted: 150 autografts and 189 allografts; 68 of the grafted patients (20%) were admitted to the ICU after transplantation: 27% of the allografted and 11% of the autografted patients (p = 0.2). Two of 17 autografted patients (12%) and 5 of 51 allografted patients (10%) survived. All patients who required insertion of an endotracheal tube died, whereas 7 of 11 patients without invasive mechanical ventilation survived (p = 0.001). Only 10% of the grafted patients survived their stay in the ICU; this figure is lower than those reported from other centers and may reflect several facts, varying from the quality of the ICU support to ICU admission criteria to the initial management of all the grafts in an outpatient setting, which could somehow delay the arrival of patients to the hospital. © 2015 S. Karger AG, Basel.

  1. [Reduction of animal experiments in experimental drug testing].

    Science.gov (United States)

    Behrensdorf-Nicol, H; Krämer, B

    2014-10-01

    In order to ensure the quality of biomedical products, an experimental test for every single manufactured batch is required for many products. Especially in vaccine testing, animal experiments are traditionally used for this purpose. For example, efficacy is often determined via challenge experiments in laboratory animals. Safety tests of vaccine batches are also mostly performed using laboratory animals. However, many animal experiments have clear inherent disadvantages (low accuracy, questionable transferability to humans, unclear significance). Furthermore, for ethical reasons and animal welfare aspects animal experiments are also seen very critical by the public. Therefore, there is a strong trend towards replacing animal experiments with methods in which no animals are used ("replacement"). If a replacement is not possible, the required animal experiments should be improved in order to minimize the number of animals necessary ("reduction") and to reduce pain and suffering caused by the experiment to a minimum ("refinement"). This "3R concept" is meanwhile firmly established in legislature. In recent years many mandatory animal experiments have been replaced by alternative in vitro methods or improved according to the 3R principles; numerous alternative methods are currently under development. Nevertheless, the process from the development of a new method to its legal implementation takes a long time. Therefore, supplementary regulatory measures to facilitate validation and acceptance of new alternative methods could contribute to a faster and more consequent implementation of the 3R concept in the testing of biomedical products.

  2. Bonding over Dentin Replacement Materials.

    Science.gov (United States)

    Meraji, Naghmeh; Camilleri, Josette

    2017-08-01

    Dentin replacement materials are necessary in large cavities to protect the pulp and reduce the bulk of filling material. These materials are layered with a composite resin restorative material. Microleakage caused by poor bonding of composite resin to underlying dentin replacement material will result in pulp damage. The aim of this study was to characterize the interface between dentin replacement materials and composite resin and to measure the shear bond strength after dynamic aging. Biodentine (Septodont, Saint Maur-des-Fosses, France), Theracal LC (Bisco, Schaumburg, IL), and Fuji IX (GC, Tokyo, Japan) were used as dentin replacement materials. They were then overlaid with a total-etch and bonding agent or a self-etch primer and composite resin or a glass ionomer cement. All combinations were thermocycled for 3000 cycles. The interface was characterized using scanning electron microscopy and elemental mapping. Furthermore, the shear bond strength was assessed. The Biodentine surface was modified by etching. The Theracal LC and Fuji IX microstructure was unchanged upon the application of acid etch. The Biodentine and glass ionomer interface showed an evident wide open space, and glass particles from the glass ionomer adhered to the Biodentine surface. Elemental migration was shown with aluminum, barium, fluorine, and ytterbium present in Biodentine from the overlying composite resin. Calcium was more stable. The bond strength between Theracal LC and composite using a total-etch technique followed by self-etch primer achieved the best bond strength values. Biodentine exhibited the weakest bond with complete failure of bonding shown after demolding and thermocycling. Dynamic aging is necessary to have clinically valid data. Bonding composite resin to water-based dentin replacement materials is still challenging, and further alternatives for restoration of teeth using such materials need to be developed. Copyright © 2017 American Association of Endodontists

  3. Requirement Analysis of Data Preprocessing in Exploratory Simulation Experiment%探索性仿真数据预处理需求分析

    Institute of Scientific and Technical Information of China (English)

    李斌; 李春洪; 刘苏洋; 谢涌纹

    2012-01-01

    探索性仿真是一种研究复杂系统的科学手段,而数据挖掘是处理探索性仿真所产生的海量数据,而在实施数据挖掘前如何进行有效的数据预处理成为当前仿真领域面临的难题.为解决目前在探索性仿真中数据预处理工作存在的目标不够明确、重点不够突出等问题,提出了探索性仿真数据预处理需求分析,结合探索性仿真数据的特点,首先分析了通用数据预处理需求,之后对决策树挖掘、关联规则挖掘、聚类分析三种典型数据挖掘算法的数据预处理需求进行了分析.研究成果较好地满足了探索性仿真数据预处理工作的需求.%Exploratory simulation experiment is a scientific method to research complicated system, while data mining is an important method to process a great deal of data produced in an exploratory simulation experiment. How to preprocess data effectively before data mining is a problem to be solved for the domestic simulation realm. In order to solve the problem of the ambiguity of goal and unapparent emphasis of data preprocessing, requirement analysis of data preprocessing in exploratory simulation experiment was put forward. Combing with the specialty of data produced in exploratory simulation experiment, the general requirement of data preprocessing was analyzed in the paper firstly. The requirements of the algorithms of decision tree, association rules, and cluster analysis of data preprocessing were analyzed then. The research results of this paper can meet the requirement of data preprocessing in exploratory simulation experiment.

  4. Concomitant aortic valve replacement and myocardial revascularization.

    Science.gov (United States)

    Craver, J M; Jones, E L; Hatcher, C R; Farmer, J H

    1977-01-01

    Twenty-six consecutive patients underwent combined aortic valve replacement and myocardial revascularization at the Emory University Affiliated Hospitals between May, 1973 and March, 1976. Acute myocardial infarction resulted in two operative deaths (8%). There have been four late deaths, all Class IV preoperative. The age range was 37 to 79 years with an average age of 60. Preoperatively all patients were Class IV or late Class III. Twenty-three patients had symptoms of angina pectoris; congestive heart failure was evident in 56%. Postoperatively, 70% are now Class 1 or II. Single coronary bypass was performed in 16 patients, double in 6, and triple in three. Double bypass plus mitral valve replacement was required in two with aneurysmectomy in one. The rate of intraoperative infarction was 27% for the series but only 7% in the last year. The methods of intraoperative myocardial preservation and the technical approach for the operative procedures were variable. Results with each method are correlated, and currently preferred techniques are presented and discussed. Best results were obtained in patients who presented early in their symptomatic course with isolated proximal coronary lesions and good renoff vessels. Excellent results could be achieved despite advanced age of patients, requirement for multiple bypass grafts, and correction of other associated cardiac lesions. Poorest results were obtained when long-standing ventricular failure was combined with poor vessels distal to coronary stenoses. PMID:860881

  5. Controversy in mitral valve repair, resection or chordal replacement?

    Science.gov (United States)

    Sawazaki, Masaru; Tomari, Shiro; Zaikokuji, Kenta; Imaeda, Yusuke

    2014-10-01

    Mitral valve plasty has superseded valve replacement as the standard technique for treating degenerative mitral valve prolapse. Quadrangular resection is considered the gold standard for posterior leaflet prolapse. Chordal replacement was first developed to treat the anterior leaflet and subsequently became widely used for the posterior leaflet, after which a new version of posterior leaflet resection was developed that did not involve local annular plication. In the era of the mini-thoracotomy, the premeasured loop technique is simple to adopt and is as durable as quadrangular resection. However, there is controversy surrounding whether resection or chordal replacement is the optimal technique. The resection technique is curative because it removes the main pathologic lesion. The disadvantage of the resection is that it can be complicated and often requires advanced surgical skills. In contrast, chordal replacement is not pathologically curative because it leaves behind a redundant leaflet. However, the long-term results appear to be equivalent in many reports. Functionally, chordal replacement retains greater posterior leaflet motion with a lower trans-mitral pressure gradient than quadrangular resection. Moreover, chordal replacement is simple and yields uniform results. The optimal technique depends on whether the anterior leaflet or posterior leaflet is involved, the Barlow or non-Barlow disease state, and whether a mini-thoracotomy or standard sternotomy approach is used. For mitral valve repair, the most superior and reliable technique for the posterior leaflet is resection using the newer resection technique with a sternotomy approach, which requires a skilled surgeon.

  6. Replacement Condition Detection of Railway Point Machines Using an Electric Current Sensor.

    Science.gov (United States)

    Sa, Jaewon; Choi, Younchang; Chung, Yongwha; Kim, Hee-Young; Park, Daihee; Yoon, Sukhan

    2017-01-29

    Detecting replacement conditions of railway point machines is important to simultaneously satisfy the budget-limit and train-safety requirements. In this study, we consider classification of the subtle differences in the aging effect-using electric current shape analysis-for the purpose of replacement condition detection of railway point machines. After analyzing the shapes of after-replacement data and then labeling the shapes of each before-replacement data, we can derive the criteria that can handle the subtle differences between "does-not-need-to-be-replaced" and "needs-to-be-replaced" shapes. On the basis of the experimental results with in-field replacement data, we confirmed that the proposed method could detect the replacement conditions with acceptable accuracy, as well as provide visual interpretability of the criteria used for the time-series classification.

  7. Evaluating the Charged Background Rejection Requirement in an Experiment to Measure BR(K L → π0 νν -) at the CERN SPS

    Science.gov (United States)

    Bradley, A.

    2016-11-01

    Measuring the rate at which the long-lived, neutral kaon decays into a neutral pion, neutrino, and anti-neutrino allows physicists an opportunity to test precise predictions made by the Standard Model. Differences between theoretical predictions and experimental measurements may point to new physics. Not only does the Standard Model predict a very low probability at approximately 3 KL→ π0 νν -) decay in 100 billion KL decays, but many of the common decays leave false signals in the detector that look the same as the true signal. Charged decays have been studied to determine the required detection efficiency necessary to eliminate them. The conclusion of these studies is that a reduction by a factor of 1/(3 × 109) will be required to achieve the 10:1 signal to charged background ratio necessary for the experiment.

  8. Experiences in certification of packages for transportation of fresh nuclear fuel in the context of new safety requirements established by IAEA regulations (IAEA-96 regulations, ST-1) for air transportation of nuclear materials (requirements to C-type packages)

    Energy Technology Data Exchange (ETDEWEB)

    Dudai, V.I.; Kovtun, A.D.; Matveev, V.Z.; Morenko, A.I.; Nilulin, V.M.; Shapovalov, V.I.; Yakushev, V.A.; Bobrovsky, V.S.; Rozhkov, V.V.; Agapov, A.M.; Kolesnikov, A.S. [Russian Federal Nuclear Centre - All-Russian Research Inst. of Experimental Physics, Sarov (Russian Federation)]|[JSC ' ' MSZ' ' , Electrostal (Russian Federation)]|[JSC ' ' NPCC' ' , Novosibirsk (Russian Federation)]|[Minatom of Russia, Moscow (Russian Federation)]|[Gosatomnadzor of Russia, Moscow (Russian Federation)

    2004-07-01

    Every year in Russia, a large amount of domestic and international transportation of fresh nuclear fuel (FNF) used in Russian and foreign energy and research atomic reactors and referred to fissile materials based on IAEA Regulations is performed. Here, bulk transportation is performed by air, and it concerns international transportation in particular. According to national ''Main Regulations for Safe Transport and physical Protection of Nuclear Materials (OPBZ- 83)'' and ''Regulations for the Safe Transport of Radioactive Materials'' of the International Atomic Energy Agency (IAEA Regulations), nuclear and radiation security under normal (accident free) and accident conditions of transport must be completely provided by the package design. In this context, high requirements to fissile packages exposed to heat and mechanical loads in transport accidents are imposed. A long-standing experience in accident free transportation of FM has shown that such approach to provide nuclear and radiation security pays for itself completely. Nevertheless, once in 10 years the International Atomic Energy Agency on every revision of the ''Regulations for the Safe Transport of Radioactive Materials'' places more stringent requirements upon the FM and transportation thereof, resulting from the objectively increasing risk associated with constant rise in volume and density of transportation, and also strained social and economical situation in a number of regions in the world. In the new edition of the IAEA Regulations (ST-1), published in 1996 and brought into force in 2001 (IAEA-96 Regulations), the requirements to FM packages conveyed by aircraft were radically changed. These requirements are completely presented in new Russian ''Regulations for the Safe Transport of Radioactive Materials'' (PBTRM- 2004) which will be brought into force in the time ahead.

  9. Urbanization, Ikization, and Replacement Dynamics

    CERN Document Server

    Chen, Yanguang

    2015-01-01

    The phenomenon of Iks was first found by anthropologists and biologists, but it is actually a problem of human geography. However, it has not yet drawn extensive attention of geographers. In this paper, a hypothesis of ikization is presented that sudden and violent change of geographical environments results in dismantling of traditional culture, which then result in collective depravity of a nationality. By quantitative analysis and mathematical modeling, the causality between urbanization and ikization is discussed, and the theory of replacement dynamics is employed to interpret the process of ikization. Urbanization is in essence a nonlinear process of population replacement. Urbanization may result in ikization because that the migration of population from rural regions to urban regions always give rise to abrupt changes of geographical environments and traditional culture. It is necessary to protect the geographical environment against disruption, and to inherit and develop traditional culture in order t...

  10. [MINIMALLY INVASIVE AORTIC VALVE REPLACEMENT].

    Science.gov (United States)

    Tabata, Minoru

    2016-03-01

    Minimally invasive aortic valve replacement (MIAVR) is defined as aortic valve replacement avoiding full sternotomy. Common approaches include a partial sternotomy right thoracotomy, and a parasternal approach. MIAVR has been shown to have advantages over conventional AVR such as shorter length of stay and smaller amount of blood transfusion and better cosmesis. However, it is also known to have disadvantages such as longer cardiopulmonary bypass and aortic cross-clamp times and potential complications related to peripheral cannulation. Appropriate patient selection is very important. Since the procedure is more complex than conventional AVR, more intensive teamwork in the operating room is essential. Additionally, a team approach during postoperative management is critical to maximize the benefits of MIAVR.

  11. 46 CFR 56.97-35 - Pneumatic tests (replaces 137.5).

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 2 2010-10-01 2010-10-01 false Pneumatic tests (replaces 137.5). 56.97-35 Section 56.97... SYSTEMS AND APPURTENANCES Pressure Tests § 56.97-35 Pneumatic tests (replaces 137.5). (a) General Requirements. When a pneumatic test is performed, it must be conducted in accordance with the requirements of...

  12. 人工肱骨头置换治疗肱骨外科颈骨折17例体会%Experience in 17 cases of fracture of surgical neck of humerus replacement by artificial humeral head

    Institute of Scientific and Technical Information of China (English)

    邹文

    2013-01-01

    Objective To investigate the clinical efficacy of humeral head replacement treatment for fracture of surgical neck of humerus and the technical application notes .Methods From June 2008 to June 2012 ,the clinical da-tas from 17 patients with fracture of surgical neck of humerus were analyzed .Results Followed up for 6 -36 months ,average 20 months ,there was no neurological damage ,fractures around the prostheses and complications of dislocations .According to Rowe's score system evaluation ,5 cases score were excellent ,8 cases score were good ,3 ca-ses score were general ,1 cases score was poor ,and the excellent and good rate was 76 .5% (13/17) .Conclusion The arthroplasty of artificial humerus might be an effective method for surgical treatment of fracture of surgical neck of humerus .%  目的探讨人工肱骨头置换术治疗肱骨外科颈骨折的临床疗效以及该技术的应用和注意事项。方法回顾性分析2008年6月至2012年6月本院收治的17例肱骨外科颈骨折患者的临床资料,对手术进程、伤口愈合情况及并发症进行回顾分析。结果手术顺利,术后伤口均一期愈合,随访6~36个月,平均20个月,无神经损伤、假体周围骨折及脱位并发症。按Ro w e氏评分系统评价:优5例,良8例,一般3例,差1例,优良率76.5%(13/17)。结论人工肱骨头置换术是治疗肱骨外科颈骨折的一种有效方法。

  13. Mitochondrial Replacement: Ethics And Identity

    OpenAIRE

    Wrigley, Anthony; Wilkinson, Stephen; Appleby, John B

    2015-01-01

    Mitochondrial replacement techniques (MRTs) have the potential to allow prospective parents who are at risk of passing on debilitating or even life-threatening mitochondrial disorders to have healthy children to whom they are genetically related. Ethical concerns have however been raised about these techniques. This article focuses on one aspect of the ethical debate, the question of whether there is any moral difference between the two types of MRT proposed: Pronuclear Transfer (PNT) and Mat...

  14. Results of Austin Moore replacement.

    Directory of Open Access Journals (Sweden)

    Jadhav A

    1996-04-01

    Full Text Available Forty cases of Austin Moore Replacement done for transcervical fractures of the femur in patients were reviewed after a period of 12 to 48 months postoperatively (mean 26 mth. 30 cases (75% had mild to severe pain of non-infective origin, starting as early as 6 months postoperatively. This was irrespective of the make, size or position (varus/valgus of the prosthesis. Though the Aufranc and Sweet clinical scoring was satisfactory in 65% cases, radiological evidence of complications like sinking, protrusion, etc. were seen in majority of the cases. Calcar resorption was seen in 34 cases (85% as early as 4 months postoperatively. Results of THR and bipolar replacement done for transcervical fractures in recent literature show 85% pain-free cases at 5 years. We feel that Austin Moore Replacement should be reserved for patients more than 65 years of age and those who are less active or debilitated because of other factors, because of increased acetabular wear with time in the younger individual. This is corroborated by unsatisfactory results in patients less than 65 years of age (p < 0.05.

  15. The caudal septum replacement graft.

    Science.gov (United States)

    Foda, Hossam M T

    2008-01-01

    To describe a technique for reconstructing the lost tip support in cases involving caudal septal and premaxillary deficiencies. The study included 120 patients with aesthetic and functional nasal problems resulting from the loss of caudal septal and premaxillary support. An external rhinoplasty approach was performed to reconstruct the lost support using a cartilaginous caudal septum replacement graft and premaxillary augmentation with Mersilene mesh. The majority of cases (75%) involved revisions in patients who had previously undergone 1 or more nasal surgical procedures. A caudal septum replacement graft was combined with premaxillary augmentation in 93 patients (77.5%). The mean follow-up period was 3 years (range, 1-12 years). The technique succeeded in correcting the external nasal deformities in all patients and resulted in a significant improvement in breathing in 74 patients (86%) with preoperative nasal obstruction. There were no cases of infection, displacement, or extrusion. The caudal septum replacement graft proved to be very effective in restoring the lost tip support in patients with caudal septal deficiency. Combining the graft with premaxillary augmentation using Mersilene mesh helped increase support and stability over long-term follow-up.

  16. Substituição valvar aórtica percutânea para o tratamento da estenose aórtica: experiência inicial no Brasil Sustitución percutánea de la válvula aórtica para el tratamiento de la estenosis aórtica: experiencia inicial en Brasil Percutaneous aortic valve replacement for the treatment of aortic stenosis: early experience in Brazil

    Directory of Open Access Journals (Sweden)

    Marco Antonio Perin

    2009-09-01

    la reducción del gradiente transvalvular aórtico (de 82 para 50 mmHg e de 94 para 31 mmHg inmediatamente después de la intervención. Durante la internación hospitalaria se hizo necesario implantar marcapasos definitivos en ambos pacientes, a causa de bloqueo atrioventricular. Se observó seis meses después una queda aún más grande del gradiente transvalvular aórtico (gradiente BACKGROUND: Percutaneous aortic valve replacement for the treatment of aortic stenosis is an available and efficient alternative for patients at high surgical risk, especially those with advanced age and comorbidities. OBJECTIVE: The authors report the first experience made in our midst with the use of the CoreValve endoprosthesis. METHODS: In January 2008, two patients underwent percutaneous aortic valve replacement due to symptomatic aortic stenosis. They were selected for being elderly (77 and 87 years and presenting comorbidities and a high surgical risk (EuroScore 7.7% and 12.1%. RESULTS: Percutaneous implantations of the CoreValve device were successfully performed. Enlargement of the valve area (from 0.7 to 1.5 cm² and from 0.5 to 1.3 cm² and reduction of the aortic transvalvular gradient (from 82 to 50 mmHg and from 94 to 31 mmHg were observed immediately after the intervention. During hospital stay, permanent pacemaker implantation was required in both patients due to atrioventricular block. At six months, an even greater drop in the aortic transvalvular gradient (gradient < 20 mmHg and remission of symptoms of heart failure (NYHA III to NYHA I were observed. CONCLUSION: The use of the CoreValve endoprosthesis for the treatment of aortic stenosis proved to be feasible and showed encouraging results in this early experience made in our midst.

  17. Mactaquac intake tendons removal and replacement

    Energy Technology Data Exchange (ETDEWEB)

    Campbell, I. [NB Power Generation Corp., Mactaquac Generating Station, Keswick Ridge, NB (Canada); Mee, A. [Hatch Energy, Niagara Falls, ON (Canada)

    2007-07-01

    In 1988 and 1989, multi-strand tendons were installed in the intake structure of the Mactaquac generating station. In order to control displacements caused by alkali aggregate reaction (AAR), they were installed in preparation for a slot cutting program in the intake structure to guard against the possibility of a sliding failure of a section of the structure along a plane coincident with the bottom of the water passage. Unique problems for the designers were present in the expansion affect of AAR that were compounded by field conditions that resulted in further difficulties. For example, concrete expansion required the installation of a thick shim pack under the upper anchor head and the periodic testing of the tendons. Once tested, shims could be gradually removed to maintain the correct load over the life of the tendon. However, during the first round of testing and de-stressing five years after the original installation, it was found that some of the tendons had already failed. Over half of the tendons have been replaced in the 20 years since the installation. This paper discussed the original design considerations and examined the conditions that contributed to the premature failure of the tendons. It outlined the history of tendon testing procedures, tendon failure modes and tendon replacement methods. Specifically, the paper discussed the remedial techniques that were employed and the iterations that lead to the current repair approach, while considering the unique field conditions. The application of various corrosion protection schemes and installation and testing methodologies were discussed. It was concluded that tendons were successfully installed in numerous concrete dams around the world but have needed replacement for a variety of reasons. 1 ref., 10 figs.

  18. Clinical Pharmacists' Experience about the Practice of Anticoagulation Management of the Patients Who Had Been Discharged from Hospital after Undergoing Mechanical Heart Valve Replacement%临床药师参与心脏机械瓣膜置换术患者出院后抗凝管理的实践与体会

    Institute of Scientific and Technical Information of China (English)

    张海燕; 罗万慰; 马守梅

    2009-01-01

    To explore the function and approach of clinical pharmacists' participating in the anticoagulation management of patients who had been discharged from hospital after undergoing mechanical heart valve replacement. METHODS: The experiences of clinical pharmacists obtained through first-hand practice in the anticoagulation management and pharmaceutical care of the patients who had been discharged from hospital after undergoing mechanical heart valve replacement were introduced by illustrating examples. RESULTS & CONCLUSION: Clinical pharmacists' participating in the anticoagulation management of patients who had been discharged from hospital after undergoing mechanical heart valve replacement provide physicians and patients with pharmaceutical information and pharmaceutical care and enhance the effectiveness and safety of anticoagulative therapy accordingly.%目的:探讨临床药师参与心脏机械瓣膜置换术患者出院后抗凝治疗管理的作用和方法.方法:通过亲身实践,介绍我院临床药师参与抗凝管理工作及开展药学服务的体会,并结合典型实例分析说明.结果与结论:临床药师通过参与心脏机械瓣膜置换术患者出院后的抗凝管理工作,为医师及患者提供药学信息和药学服务,可提高抗凝治疗的安全性和有效性.

  19. The replacement of serum by hormones in cell culture media.

    Science.gov (United States)

    Sato, G; Hayashi, I

    1976-12-01

    The replacement of serum by hormones in cell culture media. (Reemplazo del suero por hormonas en el medio de cultivo de células). Arch. Biol. Med. Exper. 10: 120-121, 1976. The serum used in cell culture media can be replaced by a mixture of hormones and some accesory blood factors. The pituitary cell line GH3 can be grown in a medium in which serum is replaced by triiodothyronine, transferrin, parathormone, tyrotrophin releasing hormone and somatomedins. Hela and BHK cell strains can also be grown in serum free medium supplemented with hormones. Each cell type appears to have different hormonal requirements yet it may found that some hormones are required for most cell types.

  20. Recombinant Enzyme Replacement Therapy in Hypophosphatasia.

    Science.gov (United States)

    Hofmann, Christine; Jakob, Franz; Seefried, Lothar; Mentrup, Birgit; Graser, Stephanie; Plotkin, Horacio; Girschick, Hermann J; Liese, Johannes

    2015-01-01

    Hypophosphatasia (HPP) is a rare monogenetic and multisystemic disease with involvement of different organs, including bone, muscle, kidney, lung, gastrointestinal tract and the nervous system. The exact metabolic mechanisms of the effects of TNAP deficiency in different tissues are not understood in detail. There is no approved specific treatment for HPP; therefore symptomatic treatment in order to improve the clinical features is of major interest. Enzyme replacement therapy (ERT) is a relatively new type of treatment based on the principle of administering a medical treatment replacing a defective or absent enzyme. Recently ERT with a bone targeted recombinant human TNAP molecule has been reported to be efficient in ten severely affected patients and improved survival of life threatening forms. These results are very promising especially with regard to the skeletal phenotype but it is unclear whether ERT also has beneficial effects for craniosynostosis and in other affected tissues in HPP such as brain and kidney. Long-term data are not yet available and further systematic clinical trials are needed. It is also necessary to establish therapeutic approaches to help patients who are affected by less severe forms of HPP but also suffer from a significant reduction in quality of life. Further basic research on TNAP function and role in different tissues and on its physiological substrates is critical to gain a better insight in the pathogenesis in HPP. This and further experiences in new therapeutic strategies may improve the prognosis and quality of life of patients with all forms of HPP.

  1. Fusion following failed total ankle replacement.

    Science.gov (United States)

    Wünschel, Markus; Leichtle, Ulf G; Leichtle, Carmen I; Walter, Christian; Mittag, Falk; Arlt, Eva; Suckel, Andreas

    2013-04-01

    Although mid- to long-term results after total ankle replacement have improved because of available second- and third-generation devices, failure of total ankle replacement is still more common compared with total hip replacement and total knee replacement. The portfolio of available total ankle replacement revision component options is small. Furthermore, the bone stock of the tibiotalar region is scarce making it difficult and in some situations impossible to perform revision total ankle replacement. In these cases tibiotalar and tibiotalocalcaneal fusions are valuable options. This article describes which surgical procedures should be performed depending on the initial situation and gives detailed advice on surgical technique, postoperative care, and clinical results.

  2. Near-term lander experiments for growing plants on Mars: requirements for information on chemical and physical properties of Mars regolith

    Science.gov (United States)

    Schuerger, Andrew C.; Ming, Douglas W.; Newsom, Horton E.; Ferl, Robert J.; McKay, Christopher P.

    2002-01-01

    In order to support humans for long-duration missions to Mars, bioregenerative Advanced Life Support (ALS) systems have been proposed that would use higher plants as the primary candidates for photosynthesis. Hydroponic technologies have been suggested as the primary method of plant production in ALS systems, but the use of Mars regolith as a plant growth medium may have several advantages over hydroponic systems. The advantages for using Mars regolith include the likely bioavailability of plant-essential ions, mechanical support for plants, and easy access of the material once on the surface. We propose that plant biology experiments must be included in near-term Mars lander missions in order to begin defining the optimum approach for growing plants on Mars. Second, we discuss a range of soil chemistry and soil physics tests that must be conducted prior to, or in concert with, a plant biology experiment in order to properly interpret the results of plant growth studies in Mars regolith. The recommended chemical tests include measurements on soil pH, electrical conductivity and soluble salts, redox potential, bioavailability of essential plant nutrients, and bioavailability of phytotoxic elements. In addition, a future plant growth experiment should include procedures for determining the buffering and leaching requirements of Mars regolith prior to planting. Soil physical tests useful for plant biology studies in Mars regolith include bulk density, particle size distribution, porosity, water retention, and hydraulic conductivity.

  3. Experiences in Eliciting Security Requirements

    Science.gov (United States)

    2006-12-01

    FODA ) FODA is a domain analysis and engineer- ing method that focuses on developing reusable assets [9]. By examining related software systems and...systems in the form of a domain model, and a set of approaches for their implementation. The FODA method was founded on two modeling concepts...SSM QFD CORE IBIS JAD FODA CDA ARM Adaptability 3 1 3 2 2 3 2 1 2 CASE Tool 1 2 1 1 3 2 1 1 1 Stakeholder Acceptance 2 2 2 2 3 2 1 3 3 Easy

  4. Radiology of total hip replacement

    Energy Technology Data Exchange (ETDEWEB)

    Griffiths, H.J.; Lovelock, J.E.; McCollister Evarts, C.; Geyer, D.

    1984-06-01

    The radiology of total hip replacement (THR) and its complications is reviewed in conjunction with a long-term follow-up study on 402 patients with 501 prostheses. The indications, contraindications, biomechanics, and operative management of these patients is discussed. Clinical complications such as deep vein thrombosis, pulmonary embolism, and hemorrhage are mentioned. Postoperative infections including granulomatous pseudotumors, dislocations and fractures, true loosening of the prosthesis, and heterotopic bone formation (HBF) are discussed and illustrated. The importance of differentiating the lucent line from true loosening is stressed. Mechanical and other clinical complications which are largely ignored by radiologists are also discussed. The uses of arthrography and bone scanning are included.

  5. [Proximal and total femur replacement].

    Science.gov (United States)

    Pennekamp, P H; Wirtz, D C; Dürr, H R

    2012-07-01

    Reconstruction of segmental bone defects of the proximal femur following wide tumor resection or revision arthroplasty. Aggressive benign or primary malignant bone tumors of the proximal femur; destructive metastases; massive segmental bone defects of the proximal femur; periprosthetic fractures. Local infection; very short life expectancy (acetabular bone stock. Anterolateral approach. Exposure and detachment of the iliopsoas and gluteus medius muscle from the proximal femur with a sufficient safety margin to the bone; distal transsection of the vastus lateralis/intermedius and rectus femoris muscle according to the extraosseous tumor extension; distal femur osteotomy al least 3 cm beyond the farthest point of tumor extension; in case of total femur replacement, additional lateral arthrotomy of the knee with resection of the ligaments and menisci; reaming of the medullary canal after securing the shaft with a Verbrugge clamp; trial assembly and reduction followed by the definitive implantation of the prosthesis with adjustment of the femoral neck anteversion in 5° increments; soft tissue reconstruction and fixation to an attachment tube covering the prosthesis; in case of total femur replacement, the preparation of the tibia is followed by the coupling of the tibial and femoral components. Infection prophylaxis, 20 kg partial weight bearing, continuous passive motion. A total of 20  patients with proximal femur replacement and 2 patients with total femur replacement implanted between June 2007 and December 2011 were retrospectively reviewed. Three patients had primary malignant bone tumors, while 19 patients underwent resection for metastatic disease. The mean age at surgery was 62.0 ± 18.1 years (18-82 years). Fifteen patients with a mean follow-up of 20.3 ± 17.2 months (4-51 months) were studied. Among the 22 cases, periprosthetic infection occurred in 3 patients (13.6%), dislocation in 2 patients (9.1%). Evaluation of the functional

  6. Modeling Outcome of Patients on Renal Replacement Therapy

    NARCIS (Netherlands)

    Y.S. Liem (Ylian Serina)

    2008-01-01

    textabstractThe incidence of end-stage renal disease is increasing and therefore, the number of patients requiring renal replacement therapy (RRT), renal dialysis or renal transplantation (RTx), has been rising. The various forms of RRT are associated with differences in survival and quality of life

  7. Replacement of Natural Sand with Efficient Alternatives: Recent Advances in Concrete Technology

    Directory of Open Access Journals (Sweden)

    Anzar Hamid Mir

    2015-03-01

    Full Text Available Concrete is the most undisputable material being used in infrastructure development throughout the world. It is a globally accepted construction material in all types of Civil Engineering structures. Natural sand is a prime material used for the preparation of concrete and also plays an important role in Mix Design. Now a day‟s river erosion and other environmental issues have led to the scarcity of river sand. The reduction in the sources of natural sand and the requirement for reduction in the cost of concrete production has resulted in the increased need to find new alternative materials to replace river sand so that excess river erosion is prevented and high strength concrete is obtained at lower cost. Partial or full replacement of natural sand by the other alternative materials like quarry dust, foundry sand and others are being researched from past two decades, in view of conserving the ecological balance. This paper summarizes conclusions of experiments conducted for the properties like strength, durability etc. It was observed the results have shown positive changes and improvement in mechanical properties of the conventional concrete due to the addition or replacement of fine sand with efficient alternatives.

  8. Renal Replacement Therapy in Austere Environments

    Directory of Open Access Journals (Sweden)

    Christina M. Yuan

    2011-01-01

    Full Text Available Myoglobinuric renal failure is the classically described acute renal event occurring in disaster environments—commonly after an earthquake—which most tests the ingenuity and flexibility of local and regional nephrology resources. In recent decades, several nephrology organizations have developed response teams and planning protocols to address disaster events, largely focusing on patients at risk for, or with, acute kidney injury (AKI. In this paper we briefly review the epidemiology and outcomes of patients with dialysis-requiring AKI after such events, while providing greater focus on the management of the end-stage renal disease population after a disaster which incapacitates a pre-existing nephrologic infrastructure (if it existed at all. “Austere” dialysis, as such, is defined as the provision of renal replacement therapy in any setting in which traditional, first-world therapies and resources are limited, incapacitated, or nonexistent.

  9. 肘关节置换术操作技术的进展%The progress of the surgical technique of total elbow replacement

    Institute of Scientific and Technical Information of China (English)

    查晔军; 蒋协远

    2016-01-01

    Total elbow replacement is designed for the elbow joint articular surface damage and degenerative joint changes, but in recent years, it is widely used in the treatment of the distal humeral articular comminuted fracture in elderly patients. The purpose is to provide a stable, painless elbow joint with good functions. Total elbow replacement is a dififcult operation with its special surgical indications, requiring rich surgical experience. Even if the surgical technique is mature, there are still a lot of controversies in the surgical indication, prosthesis selection, surgical approach, condylar management and the disposal of the ulnar nerve. Based on the literature reviewed and the author’s experience, this paper analyzes some disputes. Although many scholars have conducted many prospective controlled studies, there are still some authors with different views, requiring prospective randomized controlled studies with a greater number of cases to clarify.

  10. B Plant process piping replacement feasibility study

    Energy Technology Data Exchange (ETDEWEB)

    Howden, G.F.

    1996-02-07

    Reports on the feasibility of replacing existing embedded process piping with new more corrosion resistant piping between cells and between cells and a hot pipe trench of a Hanford Site style canyon facility. Provides concepts for replacement piping installation, and use of robotics to replace the use of the canyon crane as the primary means of performing/supporting facility modifications (eg, cell lining, pipe replacement, equipment reinstallation) and operational maintenenace.

  11. REMINDER REPLACEMENT OF FRENCH CARDS

    CERN Multimedia

    Human Resources Division; Cards.Service@cern.ch

    2001-01-01

    The French Ministry of Foreign Affairs is currently replacing all diplomatic cards, special cards and employment permits («attestations de fonctions») held by members of the personnel and their families. These cards are replaced by secure, computerized equivalents. The old cards may no longer be used after 31 December 2001. For the purposes of the handover, members of the personnel must go personally to the cards office (33/1-015) between 8h30 and 12h30, in order to fill in a «fiche individuelle» form, taking the following documents for themselves and members of their families already in possession of a French card : A recent identity photograph in 4.5 cm x 3.5 cm format, the French card in their possession, an A4 photocopy of the same French card, certified by the cards office as being a true copy. Those members of the personnel whose cards (and/or cards belonging to members of their families) are shortly due to expire, or have recently done so, are also requested...

  12. Total hip replacement in dancers.

    Science.gov (United States)

    Buyls, Inge R A E; Rietveld, A B M Boni; Ourila, Tiia; Emerton, Mark E; Bird, H A

    2013-04-01

    A case report of a professional contemporary dancer who successfully returned to the stage after bilateral total hip replacements (THR) for osteoarthritis is presented, together with her own commentary and a retrospective cohort study of total hip replacements in dancers. In the presented cohort, there were no post-operative dislocations or infections, the original pain had been relieved, rehabilitation was objectively normal and all resumed their dance (teaching) activities. Nevertheless, they were disappointed about the prolonged rehabilitation. Due to their high demands as professional dancers, post-operative expectations were too optimistic in view of the usual quick and favourable results of THR in the older and less physically active, general population. In all dancers with unilateral osteoarthritis, the left hip was involved, which may reflect the tendency to use the left leg as standing leg and be suggestive that strenuous physical activity may lead to osteoarthritis. Better rehabilitation guidelines are needed for dancer patients undergoing THR, especially drawing their attention to realistic post-operative expectations.

  13. The instability of wrist joint and total wrist replacement

    Institute of Scientific and Technical Information of China (English)

    Jin-xing Ma; Yong-Qing Xu

    2016-01-01

    Total wrist arthroplasty are not used as widely as total knee and hip replacement.The functional hands are requiring surgeons to design a durable and functional satisfying prosthesis.This article will list the main reasons that cause the failure of the prosthesis.Some remarkable and representative prostheses are listed to show the devolvement of total wrist prosthesis and their individual special innovations to fix the problems,And the second part we will discuss the part that biomechanical elements act in the total wrist replacement (TWA).Summarize and find out what the real problem is and how we can find a way to fix it.

  14. Total knee replacement in the fixed valgus deformity using a lateral approach: role of the automatic iliotibial band release for a successful balancing.

    Science.gov (United States)

    Boyer, P; Boublil, D; Magrino, B; Massin, P; Huten, D

    2009-12-01

    The purpose of this work was to document eleven years of experience in knee replacement for fixed knee valgus through a lateral approach with special emphasis on the balancing procedures. At a mean follow-up of seven years, only one revision for sepsis was required in this series of 63 knee replacements. The mean knee score improved from 37 (range 20-45) to 91 (range 65-100) at the last review (p iliotibial band was automatically released in the approach, only four of 63 knees required additional release for tightness in extension. These results underline the appeal of the lateral approach with the automatic release of the iliotibial band. If required, additional ligament release is recommended step-by-step after bone section to avoid postoperative instability.

  15. OPTIMUM ORDERING POLICY FOR PREVENTIVE AGE REPLACEMENT

    Institute of Scientific and Technical Information of China (English)

    Young T.PARK; Jing SUN

    2009-01-01

    Most of the spare ordering policies treated up to now have assumed that preventive and corrective replacement costs are equal, which implies in essential that there is no significant need for preventive replacement. This paper presents an ordering policy for preventive age replacement with minimal repair. Introducing the replacement, repair, inventory holding and shortage costs, the expected cost rate is derived. A procedure to determine jointly the ordering time for a spare and the preventive replacement time for the operating unit so as to minimize the expected cost rate is proposed. To explain the ordering policy and the optimization procedure, a numerical example is also included.

  16. Medium-term outcomes of artificial disc replacement for severe cervical disc narrowing

    Directory of Open Access Journals (Sweden)

    Chao-Hung Yeh

    2014-01-01

    Conclusions: Acceptable clinical outcome for treatment of severe cervical disc narrowing with cervical disc replacement technique has been performed in current study. Most patients maintained good postoperative mobility and no significant adjacent level degeneration were found. Cervical disc replacement may be applicable in treatment of severe cervical disc narrowing; however, longer follow-ups are required for ensuring the long-term efficacy of cervical disc replacement.

  17. Aorto-right ventricular fistula: a complication of aortic valve replacement.

    Science.gov (United States)

    Najib, Mohammad Q; Ng, Daniel; Vinales, Karyne L; Chaliki, Hari P

    2012-01-01

    The occurrence of aorto-right ventricular (aorto-RV) fistula after prosthetic aortic valve replacement is rare. Transthoracic echocardiography (TTE) with color-flow Doppler, transesophageal echocardiography (TEE), or both may be required for diagnosis. A 42-year-old woman sought care for palpitations and dyspnea due to atrial flutter 2 weeks after prosthetic aortic valve replacement and graft replacement of the ascending aorta. TTE and TEE revealed left-to-right shunt due to aorto-RV fistula.

  18. ORO. The physical developer replacement?

    Science.gov (United States)

    Wood, Michael A; James, Tim

    2009-12-01

    In the process of fingerprint development Physical Developer has been largely the method of choice on porous surfaces after coming into contact with wet environments. It is only recently that a new technique has been identified which could replace this standard technique. This study aims to build on previous research and expand knowledge regarding the technique. The study built on previous research and compared Physical Developer to Oil Red O, testing both on four paper types, while being placed in three different water types and an accelerant for various amounts of time. Marks were placed with both heavily 'loaded' sebaceous fingers and 'normal' un-washed fingers. Results show that Oil Red O consistently produced clearer more detailed marks from the 'loaded' fingers, but neither technique proved to work better on the 'normal' marks. Neither technique developed any prints from the accelerant.

  19. Optimal randomized scheduling by replacement

    Energy Technology Data Exchange (ETDEWEB)

    Saias, I.

    1996-05-01

    In the replacement scheduling problem, a system is composed of n processors drawn from a pool of p. The processors can become faulty while in operation and faulty processors never recover. A report is issued whenever a fault occurs. This report states only the existence of a fault but does not indicate its location. Based on this report, the scheduler can reconfigure the system and choose another set of n processors. The system operates satisfactorily as long as, upon report of a fault, the scheduler chooses n non-faulty processors. We provide a randomized protocol maximizing the expected number of faults the system can sustain before the occurrence of a crash. The optimality of the protocol is established by considering a closely related dual optimization problem. The game-theoretic technical difficulties that we solve in this paper are very general and encountered whenever proving the optimality of a randomized algorithm in parallel and distributed computation.

  20. Replacement reactor to revolutionise magnets

    CERN Document Server

    Atkins, G

    2002-01-01

    Electric motors, hearing aids and magnetic resonance imaging are only some of the applications that will benefit from the first advances in magnets in a quarter of a century. Magnets achieve their characteristics when electrons align themselves to produce a unified magnetic field. Neutrons can probe these magnetic structures. The focus is not just on making more powerful magnets, but also identifying the characteristics that make magnets cheaper and easier for industry to manufacture. Staff from the ANSTO's Neutron Scattering Group have already performed a number of studies on the properties of magnets using using HIFAR, but the Replacement Research Reactor that will produce cold neutrons would allow scientists to investigate the atomic properties of materials with large molecules. A suite of equipment will enable studies at different temperatures, pressures and magnetic fields

  1. Renal replacement therapy in Europe

    DEFF Research Database (Denmark)

    Noordzij, Marlies; Kramer, Anneke; Abad Diez, José M

    2014-01-01

    BACKGROUND: This article provides a summary of the 2011 ERA-EDTA Registry Annual Report (available at www.era-edta-reg.org). METHODS: Data on renal replacement therapy (RRT) for end-stage renal disease (ESRD) from national and regional renal registries in 30 countries in Europe and bordering the .......6-47.0], and on dialysis 39.3% (95% CI 39.2-39.4). The unadjusted 5-year patient survival after the first renal transplantation performed between 2002 and 2006 was 86.7% (95% CI 86.2-87.2) for kidneys from deceased donors and 94.3% (95% CI 93.6-95.0) for kidneys from living donors....

  2. Sustainable use of industrial-waste as partial replacement of fine aggregate for preparation of concrete – A review

    Directory of Open Access Journals (Sweden)

    Manoj Kumar Dash

    2016-12-01

    Full Text Available Utilisation of industrial waste materials in concrete compensates the lack of natural resources, solving the disposal problem of waste and to find alternative technique to safeguard the nature. There are a number of industrial wastes used as fully or partial replacement of coarse aggregate or fine aggregate. This review carries out a thorough assessment about industrial waste substances, which can be adequately utilised in concrete as fine aggregate substitution. This paper reviewed some of these industrial wastes like waste foundry sand, steel slag, copper slag, imperial smelting furnace slag (ISF slag, blast furnace slag, coal bottom ash, ferrochrome slag, palm oil clinker etc. Out of these materials, maximum number of experiments have been conducted using waste foundry sand and copper slag as fine aggregate replacement, but still more examinations are required for other waste materials as replacement of sand in concrete. Different physical and mechanical properties of industrial waste as well as of industrial waste concrete, in which natural sand is substituted have been reviewed and comparisons are made between them. Deflection and leaching study review are carried out additionally and compared. It can be observed that the concrete where sand is replaced by copper slag, imperial smelting furnace slag, class F fly ash exhibits improved strength and durability properties, but it’s slump increases as the rate of replacement increases in the case of copper slag and the slump decreases in the case of class F fly ash. There is a less research work reported on ferrochrome slag and palm oil clinker used as sand substitution, so it is felt that further detailed investigations are required.

  3. Leptin replacement improves cognitive development.

    Directory of Open Access Journals (Sweden)

    Gilberto J Paz-Filho

    Full Text Available BACKGROUND: Leptin changes brain structure, neuron excitability and synaptic plasticity. It also regulates the development and function of feeding circuits. However, the effects of leptin on neurocognitive development are unknown. OBJECTIVE: To evaluate the effect of leptin on neurocognitive development. METHODOLOGY: A 5-year-old boy with a nonconservative missense leptin gene mutation (Cys-to-Thr in codon 105 was treated with recombinant methionyl human leptin (r-metHuLeptin at physiologic replacement doses of 0.03 mg/kg/day. Cognitive development was assessed using the Differential Ability Scales (DAS, a measure of general verbal and nonverbal functioning; and selected subtests from the NEPSY, a measure of neuropsychological functioning in children. PRINCIPAL FINDINGS: Prior to treatment, the patient was morbidly obese, hypertensive, dyslipidemic, and hyperinsulinemic. Baseline neurocognitive tests revealed slower than expected rates of development (developmental age lower than chronological age in a majority of the areas assessed. After two years, substantial increases in the rates of development in most neurocognitive domains were apparent, with some skills at or exceeding expectations based on chronological age. We also observed marked weight loss and resolution of hypertension, dyslipidemia and hyperinsulinemia. CONCLUSIONS: We concluded that replacement with r-metHuLeptin is associated with weight loss and changes in rates of development in many neurocognitive domains, which lends support to the hypothesis that, in addition to its role in metabolism, leptin may have a cognitive enhancing role in the developing central nervous system. TRIAL REGISTRATION: ClinicalTrials.gov NCT00659828.

  4. Stochastic Ratchet Mechanisms for Replacement of Proteins Bound to DNA

    Science.gov (United States)

    Cocco, S.; Marko, J.F.; Monasson, R.

    2014-01-01

    Experiments indicate that unbinding rates of proteins from DNA can depend on the concentration of proteins in nearby solution. Here we present a theory of multi-step replacement of DNA-bound proteins by solution-phase proteins. For four different kinetic scenarios we calculate the dependence of protein unbinding and replacement rates on solution protein concentration. We find (1) strong effects of progressive ‘rezipping’ of the solution-phase protein onto DNA sites liberated by ‘unzipping’ of the originally bound protein; (2) that a model in which solution-phase proteins bind non-specifically to DNA can describe experiments on exchanges between the non specific DNA-binding proteins Fis-Fis and Fis-HU; (3) that a binding specific model describes experiments on the exchange of CueR proteins on specific binding sites. PMID:24972228

  5. Greedy feature replacement for online value function approximation

    Institute of Scientific and Technical Information of China (English)

    Feng-fei ZHAO; Zheng QIN; Zhuo SHAO; Jun FANG; Bo-yan REN

    2014-01-01

    Reinforcement learning (RL) in real-world problems requires function approximations that depend on selecting the appropriate feature representations. Representational expansion techniques can make linear approximators represent value functions more effectively;however, most of these techniques function well only for low dimensional problems. In this paper, we present the greedy feature replacement (GFR), a novel online expansion technique, for value-based RL algorithms that use binary features. Given a simple initial representation, the feature representation is expanded incrementally. New feature dependencies are added automatically to the current representation and conjunctive features are used to replace current features greedily. The virtual temporal difference (TD) error is recorded for each conjunctive feature to judge whether the replacement can improve the approximation. Correctness guarantees and computational complexity analysis are provided for GFR. Experimental results in two domains show that GFR achieves much faster learning and has the capability to handle large-scale problems.

  6. In this issue: Time to replace doctors’ judgement with computers

    Directory of Open Access Journals (Sweden)

    Simon de Lusignan

    2015-11-01

    Full Text Available Informaticians continue to rise to the challenge, set by the English Health Minister, of trying to replace doctors’ judgement with computers. This issue describes successes and where there are barriers. However, whilst there is progress this tends to be incremental and there are grand challenges to be overcome before computers can replace clinician. These grand challenges include: (1 improving usability so it is possible to more readily incorporate technology into clinical workflow; (2 rigorous new analytic methods that make use of the mass of available data, ‘Big data’, to create real-world evidence; (3 faster ways of meeting regulatory and legal requirements including ensuring privacy; (4 provision of reimbursement models to fund innovative technology that can substitute for clinical time and (5 recognition that innovations that improve quality also often increase cost. Informatics more is likely to support and augment clinical decision making rather than replace clinicians.

  7. Intraoperative Radiation Exposure During Revision Total Ankle Replacement.

    Science.gov (United States)

    Roukis, Thomas S; Iceman, Kelli; Elliott, Andrew D

    2016-01-01

    Intraoperative C-arm image intensification is required for primary total ankle replacement implantation. Significant radiation exposure has been linked to these procedures; however, the radiation exposure during revision total ankle replacement remains unknown. Therefore, we sought to evaluate the radiation exposure encountered during revision total ankle replacement. The data from 41 patients were retrospectively analyzed from a prospective database: 19 Agility(™) to Agility(™); 4 Agility(™) to Custom Agility(™); 9 Agility(™) to INBONE(®) II; 5 Agility(™) to Salto Talaris(®) XT; 2 Scandinavian Total Ankle Replacement Prosthesis to Salto Talaris(®) XT; and 2 INBONE(®) I to INBONE(®) II revision total ankle replacements were performed. Two broad categories were identified: partial revision (Agility(™) to Agility(™), Agility(™) to Custom Agility(™), INBONE(®) I to INBONE(®) II) and complete conversion (Agility(™) to INBONE(®) II, Agility(™) to Salto Talaris(®) XT, Scandinavian Total Ankle Replacement Prosthesis to Salto Talaris(®) XT). The mean radiation exposure per case was significant at 3.49 ± 2.21 mGy. Complete conversions, specifically Agility(™) to INBONE(®) II, exhibited the greatest radiation exposure and C-arm time. Revision implant selection and revision type (complete or partial) directly contributed to radiation exposure. Accordingly, revision systems requiring less radiation exposure are preferable. Surgeons should strive to minimize intraoperative complications and limit additional procedures to those necessary, because both lead to additional radiation exposure.

  8. Meal Replacement Mass Reduction and Integration Acceptability Study

    Science.gov (United States)

    Sirmons, T.; Barrett, A.; Richardson, M.; Arias, D.; Schneiderman, J.; Slack, K.; Williams, T.; Douglas, G.

    2017-01-01

    NASA, in planning for long-duration missions, has an imperative to provide a food system with the necessary nutrition, acceptability, and safety to ensure sustainment of crew health and performance. The Orion Multi-Purpose Crew Vehicle (MPCV) and future exploration missions are mass constrained; therefore the team is challenged to reduce the mass of the food system by 10% while maintaining product safety, nutrition, and acceptability. Commercially available products do not meet the nutritional requirements for a full meal replacement in the spaceflight food system, and it is currently unknown if daily meal replacements will impact crew food intake and psychosocial health over time. The purpose of this study was to develop a variety of nutritionally balanced breakfast replacement bars that meet spaceflight nutritional, microbiological, sensorial, and shelf-life requirements, while enabling a 10% savings in food mass. To date, six nutrient-dense meal replacement bars (approximately 700 calories per bar) have been developed, using traditional methods of compression as well as novel ultrasonic compression technologies developed by Creative Resonance Inc. (Phoenix, AZ). The four highest rated bars were evaluated in the Human Exploration Research Analog (HERA) to assess the frequency with which actual meal replacement options may be implemented. Specifically, overall impact of bars on mood, satiety, digestive discomfort, and satisfaction with food. These factors are currently being analyzed to inform successful implementation strategies where crew maintain adequate food intake. In addition, these bars are currently undergoing shelf-life testing to determine long-term sensory acceptability, nutritional stability, qualitative stability of analytical measurements (i.e. water activity and texture), and microbiological compliance over two years of storage at room temperature and potential temperature abuse conditions to predict long-term acceptability. It is expected that

  9. Neonatal varicella pneumonia, surfactant replacement therapy

    Directory of Open Access Journals (Sweden)

    Mousa Ahmadpour-kacho

    2015-12-01

    Full Text Available Background: Chickenpox is a very contagious viral disease that caused by varicella-zoster virus, which appears in the first week of life secondary to transplacental transmission of infection from the affected mother. When mother catches the disease five days before and up to two days after the delivery, the chance of varicella in neonate in first week of life is 17%. A generalized papulovesicular lesion is the most common clinical feature. Respiratory involvement may lead to giant cell pneumonia and respiratory failure. The mortality rate is up to 30% in the case of no treatment, often due to pneumonia. Treatment includes hospitalization, isolation and administration of intravenous acyclovir. The aim of this case report is to introduce the exogenous surfactant replacement therapy after intubation and mechanical ventilation for respiratory failure in neonatal chickenpox pneumonia and respiratory distress. Case Presentation: A seven-day-old neonate boy was admitted to the Neonatal Intensive Care Unit at Amirkola Children’s Hospital, Babol, north of Iran, with generalized papulovesicular lesions and respiratory distress. His mother has had a history of Varicella 4 days before delivery. He was isolated and given supportive care, intravenous acyclovir and antibiotics. On the second day, he was intubated and connected to mechanical ventilator due to severe pneumonia and respiratory failure. Because of sever pulmonary involvement evidenced by Chest X-Ray and high ventilators set-up requirement, intratracheal surfactant was administered in two doses separated by 12 hours. He was discharged after 14 days without any complication with good general condition. Conclusion: Exogenous surfactant replacement therapy can be useful as an adjunctive therapy for the treatment of respiratory failure due to neonatal chickenpox.

  10. Utilizing inheritance in requirements engineering

    Science.gov (United States)

    Kaindl, Hermann

    1994-01-01

    The scope of this paper is the utilization of inheritance for requirements specification, i.e., the tasks of analyzing and modeling the domain, as well as forming and defining requirements. Our approach and the tool supporting it are named RETH (Requirements Engineering Through Hypertext). Actually, RETH uses a combination of various technologies, including object-oriented approaches and artificial intelligence (in particular frames). We do not attempt to exclude or replace formal representations, but try to complement and provide means for gradually developing them. Among others, RETH has been applied in the CERN (Conseil Europeen pour la Rechereche Nucleaire) Cortex project. While it would be impossible to explain this project in detail here, it should be sufficient to know that it deals with a generic distributed control system. Since this project is not finished yet, it is difficult to state its size precisely. In order to give an idea, its final goal is to substitute the many existing similar control systems at CERN by this generic approach. Currently, RETH is also tested using real-world requirements for the Pastel Mission Planning System at ESOC in Darmstadt. First, we outline how hypertext is integrated into a frame system in our approach. Moreover, the usefulness of inheritance is demonstrated as performed by the tool RETH. We then summarize our experiences of utilizing inheritance in the Cortex project. Lastly, RETH will be related to existing work.

  11. Experiência com dois tipos de técnicas para o tratamento cirúrgico da insuficiência mitral: I. Prótese com preservação de elementos do sistema valvar. II. Plastia valvar com reconstrução e avanço da cúspide posterior Experience with two techniques for valve replacement: I. Prosthesis with preservation of the valvar elements. II. Valvar repair with reconstruction and advancement of the posterior leaflet

    Directory of Open Access Journals (Sweden)

    Paulo Roberto Barbosa Évora

    1988-04-01

    Full Text Available Na integridade funcional do ventrículo esquerdo, é importante a continuidade entre a valva mitral e a parede ventricular mantida pelas cordas tendíneas e os músculos papilares. Por outro lado, além de maior mortalidade cirúrgica da insuficiência mitral, quando comparada com as próteses aórticas e a revascularização do miocárdio, observa-se menor morbi-mortalidade nos casos de valvoplastias em relação às próteses mitrais. Estes fatos constituem um desafio para a moderna cirurgia cardíaca, justificando-se todos os esforços de ampliação dos estudos no tratamento do refluxo valvar, tanto pelas correções plásticas, como pelo implante de prótese. No presente trabalho, apresenta-se a experiência com dois tipos de técnicas para o tratamento cirúrgico da insuficiência mitral: prótese com preservação de elementos do sistema valvar e plastia valvar com ampliação e avanço da cúspide posterior. Preocupou-se mais com os detalhes cirúrgicos, não tendo sido realizados estudos da função ventricular esquerda. Apresentam-se as diversas táticas para garantir a continuidade entre o anel valvar e parede do ventrículo nas trocas valvares. Ressalta-s a importância, nem sempre lembrada, da ampliação da cúspide posterior e a sua associação com outras técnicas de plastias valvares, tais como: comissurotomias, papilarotomias, anuloplatias e encurtamento de cordas tendíneas.The continuity between mitral valve and the left ventricular wall through chordae tendinae and papillary muscles plays a role in left ventricular function. The morbity and mortality for mitral valve replacement remain much higher than other cardiac procedures such as aortic valve replacement, mitral valvuloplasty and coronary artery bypass grafts. These facts justify all possible studies related to the correction of mitral valve insufficiency. The present paper presents our experience with two techniques for correction of mitral valve insufficiency: valve

  12. 78 FR 67086 - Safety Zone, Submarine Cable Replacement Operations, Kent Island Narrows; Queen Anne's County, MD

    Science.gov (United States)

    2013-11-08

    ... SECURITY Coast Guard 33 CFR Part 165 RIN 1625-AA00 Safety Zone, Submarine Cable Replacement Operations... safety of mariners and their vessels on navigable waters during submarine cable replacement operations at... installation of a submarine cable within a federal navigation channel requiring divers, a barge, and...

  13. ANDROGEN REPLACEMENT THERAPY IN POSTMENOPAUSE

    Directory of Open Access Journals (Sweden)

    Helena Meden Vrtovec

    2008-12-01

    Scientific studies and clinical experiences have not provided until now the answers to thequestion: »Whom to treat, when, why and for how long should androgens be used for HRTin postmenopausal women?«

  14. Adaptive introductions: How multiple experiments and comparisons to wild populations provide insights into requirements for long-term introduction success of an endangered shrub

    Directory of Open Access Journals (Sweden)

    Eric S. Menges

    2016-10-01

    Full Text Available Recovery of an imperiled plant species may require augmentation of existing populations or creation of new ones. Hundreds of such projects have been conducted over the last few decades, but there is a bias in the literature favoring successes over failures. In this paper, we evaluate a series of introductions that experimentally manipulated microhabitat and fire in an adaptive introduction framework. Between 2002 and 2012, we (and our collaborators carried out ten introductions and augmentations of Florida ziziphus Pseudoziziphus (Condalia, Ziziphus celata, a clonal shrub limited to very small populations and narrowly endemic to pyrogenic central Florida sandhills. Six of the introductions were designed as experiments to test hypotheses about how demographic performance was affected by microhabitat, fire, and propagule type. Introduced transplants had high survival (<90% annually, inconsistent growth, and little transition to reproduction, while introduced seeds had low germination and survival. Transplants were more efficient than seeds as translocation propagules. Shaded (vs. open sites supported generally higher transplant and seedling survival and seed germination percentages, but growth responses varied among experiments. Supplemental irrigation increased transplant survival and seed germination, but otherwise seedling and plant survival and growth were not significantly affected. Contrary to expectations based on wild populations, introduced propagules have not been more successful in unshaded sites, suggesting that Florida ziziphus has broader microhabitat preferences than hypothesized. Compared to wild plants, introduced plants had similar survival and responses to fire, slower growth, and more delayed flowering. Introduced plants had no clonal spread. While no introduced population has demonstrated a capacity for long-term viability, one augmented population has flowered and produced viable fruits. Given that Florida ziziphus genets are

  15. Transapical Mitral Valve-in-Valve Replacement in Patient With Previous Complex Sternal Reconstruction.

    Science.gov (United States)

    Hynes, Conor F; Fatemi, Omid; Sharma, Aditya C; Nagy, Christian D; Trachiotis, Gregory D

    2016-01-01

    We present a complex case of a transapical redo mitral valve-in-valve replacement. Repeat mitral valve replacement was indicated for severe symptomatic bioprosthetic stenosis. In addition to the patient's numerous comorbidities that included diabetes, hepatic cirrhosis, ischemic cardiomyopathy, and atrial flutter, he had undergone a previous open mitral valve replacement that was complicated by sternal dehiscence requiring extensive chest wall reconstruction. Transapical approach was performed through left minithoracotomy incision with balloon-expandable valve. Transapical valve-in-valve replacement of a stenotic mitral bioprosthesis is a viable solution in a patient with previous complex chest wall reconstruction and multiple comorbidities.

  16. VNR CMS Pixel detector replacement

    CERN Document Server

    2017-01-01

    Joel Butler, spokesperson of the CMS collaboration explains how a team from many different partner institutes installed a new detector in CMS. This detector is the silicon pixel detector and they’ve been working on it for about five years, to replace one of our existing detectors. This detectors measures particles closer to the beam than any of the other components of this huge detector behind me. It gives us the most precise picture of tracks as they come out of the collisions and expand and travel through the detector. This particular device has twice as many pixels, 120 million, as opposed to about 68 million in the old detector and it can take data faster and pump it out to the analysis more quickly. 00’53’’ Images of the descent, insertion and installation of first piece of the Pixel detector on Tue Feb 28. Images of the descent, insertion and installation of second piece of the Pixel and the two cylinders being joined.

  17. Orthogonal Matching Pursuit with Replacement

    CERN Document Server

    Jain, Prateek; Dhillon, Inderjit S

    2011-01-01

    In this paper, we consider the problem of compressed sensing where the goal is to recover almost all the sparse vectors using a small number of fixed linear measurements. For this problem, we propose a novel partial hard-thresholding operator that leads to a general family of iterative algorithms. While one extreme of the family yields well known hard thresholding algorithms like ITI (Iterative Thresholding with Inversion) and HTP (Hard Thresholding Pursuit), the other end of the spectrum leads to a novel algorithm that we call Orthogonal Matching Pursuit with Replacement (OMPR). OMPR, like the classic greedy algorithm OMP, adds exactly one coordinate to the support at each iteration, based on the correlation with the current residual. However, unlike OMP, OMPR also removes one coordinate from the support. This simple change allows us to prove that OMPR has the best known guarantees for sparse recovery in terms of the Restricted Isometry Property (a condition on the measurement matrix). In contrast, OMP is kn...

  18. Visual Image Sensor Organ Replacement

    Science.gov (United States)

    Maluf, David A.

    2014-01-01

    This innovation is a system that augments human vision through a technique called "Sensing Super-position" using a Visual Instrument Sensory Organ Replacement (VISOR) device. The VISOR device translates visual and other sensors (i.e., thermal) into sounds to enable very difficult sensing tasks. Three-dimensional spatial brightness and multi-spectral maps of a sensed image are processed using real-time image processing techniques (e.g. histogram normalization) and transformed into a two-dimensional map of an audio signal as a function of frequency and time. Because the human hearing system is capable of learning to process and interpret extremely complicated and rapidly changing auditory patterns, the translation of images into sounds reduces the risk of accidentally filtering out important clues. The VISOR device was developed to augment the current state-of-the-art head-mounted (helmet) display systems. It provides the ability to sense beyond the human visible light range, to increase human sensing resolution, to use wider angle visual perception, and to improve the ability to sense distances. It also allows compensation for movement by the human or changes in the scene being viewed.

  19. A Natural Experiment on the Effect of Time Given for Quizzes on Veterinary Student Performance in a Required Principles of Anesthesia Course.

    Science.gov (United States)

    Hofmeister, Erik H

    2017-09-08

    Assessments can cause significant distress in veterinary students and are listed as some of the greatest causes of academic stress. The purpose of this natural experiment was to determine if there is a relationship between amount of time given to complete quizzes and the students' score on the quiz. The Principles of Anesthesia course is required of all students. Quizzes are administered at the start of a class period and spaced throughout the course to cover 2-4 lectures per quiz. Once the allotted time has passed (3-6 minutes), students are notified they have 2 minutes to return the quiz to the instructor. To complete the quiz, students had 3 minutes in 2012 and 2013, 4 minutes in 2014, 5 minutes in 2015, and 6 minutes in 2016. The average quiz score was significantly lower with 3 minutes than with 4 or 6 minutes. Students in the bottom quartile scored significantly higher with 4, 5, or 6 minutes than with 3 minutes. Students in the upper quartile scored significantly higher with 4 minutes than with 3 minutes and with 4 minutes than with 5 minutes. The time provided for students to complete a free-response quiz was not associated with student performance once a certain minimum time (4 minutes) was provided. Providing students an appropriate, but not excessive, amount of time to complete assessments will allow for appropriately applied assessments and preserve time dedicated to instruction.

  20. 导管室护士的素质要求及护理体会%Quality Requirements and Nursing Experience of Catheter Room Nurses

    Institute of Scientific and Technical Information of China (English)

    张丽珈

    2015-01-01

    随着21世纪老龄化社会的到来,心血管病已成为威胁人类生命的头号杀手,以心导管为基础的介入性诊疗技术逐渐成为临床诊治心血管疾病的有效方法。心血管介入诊疗工作离不开相应的护理技术的发展,而心导管室护理则是从心血管病护理中演变出来的一门全新的技术。本文从医疗角度阐明导管室护士的素质要求与护理配合。%With aging society coming in 21st century, cardiovascular disease had been the leading murder of human life threat, at present, interventional diagnosis and treatment technology, based on the cardiac catheterization, was getting the most effective methods of clinical diagnosis and treatment of cardiovascular diseases. Cardiovascular interventional diagnosis and treatment work was closely related to the corresponding nursing technology development, and, conduit room nursing was a kind of whole new cardiovascular nursing plan. For that, in this paper, it will be discussed that conduit room nursing workers’ quality requirement and nursing experience.

  1. Biology of tooth replacement in amniotes

    Institute of Scientific and Technical Information of China (English)

    John A Whitlock; Joy M Richman

    2013-01-01

    Tooth replacement is a common trait to most vertebrates, including mammals. Mammals, however, have lost the capacity for continuous tooth renewal seen in most other vertebrates, and typically have only 1–2 generations of teeth. Here, we review the mechanisms of tooth replacement in reptiles and mammals, and discuss in detail the current and historical theories on control of timing and pattern of tooth replacement and development.

  2. Optimal replacement of residential air conditioning equipment to minimize energy, greenhouse gas emissions, and consumer cost in the US

    Energy Technology Data Exchange (ETDEWEB)

    De Kleine, Robert D. [Center for Sustainable Systems, School of Natural Resources and Environment, University of Michigan, 440 Church St., Dana Bldg., Ann Arbor, MI 48109-1041 (United States); Keoleian, Gregory A., E-mail: gregak@umich.edu [Center for Sustainable Systems, School of Natural Resources and Environment, University of Michigan, 440 Church St., Dana Bldg., Ann Arbor, MI 48109-1041 (United States); Kelly, Jarod C. [Center for Sustainable Systems, School of Natural Resources and Environment, University of Michigan, 440 Church St., Dana Bldg., Ann Arbor, MI 48109-1041 (United States)

    2011-06-15

    A life cycle optimization of the replacement of residential central air conditioners (CACs) was conducted in order to identify replacement schedules that minimized three separate objectives: life cycle energy consumption, greenhouse gas (GHG) emissions, and consumer cost. The analysis was conducted for the time period of 1985-2025 for Ann Arbor, MI and San Antonio, TX. Using annual sales-weighted efficiencies of residential CAC equipment, the tradeoff between potential operational savings and the burdens of producing new, more efficient equipment was evaluated. The optimal replacement schedule for each objective was identified for each location and service scenario. In general, minimizing energy consumption required frequent replacement (4-12 replacements), minimizing GHG required fewer replacements (2-5 replacements), and minimizing cost required the fewest replacements (1-3 replacements) over the time horizon. Scenario analysis of different federal efficiency standards, regional standards, and Energy Star purchases were conducted to quantify each policy's impact. For example, a 16 SEER regional standard in Texas was shown to either reduce primary energy consumption 13%, GHGs emissions by 11%, or cost by 6-7% when performing optimal replacement of CACs from 2005 or before. The results also indicate that proper servicing should be a higher priority than optimal replacement to minimize environmental burdens. - Highlights: > Optimal replacement schedules for residential central air conditioners were found. > Minimizing energy required more frequent replacement than minimizing consumer cost. > Significant variation in optimal replacement was observed for Michigan and Texas. > Rebates for altering replacement patterns are not cost effective for GHG abatement. > Maintenance levels were significant in determining the energy and GHG impacts.

  3. [Redo Aortic and Mitral Valve Replacement by Manouguian's Procedure for Active Prosthetic Valve Infection].

    Science.gov (United States)

    Kunitomo, Ryuji; Okamoto, Ken; Moriyama, Shuji; Sakaguchi, Hisashi; Tazume, Hirokazu; Yoshinaga, Takashi; Kawasuji, Michio

    2016-03-01

    The damage to the intervalvular fibrous trigone (IVFT) by infective endocarditis makes combined aortic and mitral valve replacement difficult. We performed Manouguian's double valve replacement for such a case and obtained a good result. A 81-year-old male underwent emergency operation due to active prosthetic valve endocarditis. He had a history of receiving combined aortic and mitral valve replacement because of active infective endocarditis at the age of 74 and redo aortic valve replacement 3 years after that. The infectious lesion extended from the mitral annulus to the IVFT and the aortic annulus, and it caused the prosthetic valve detachment from the aortic annulus. Manouguian's double valve replacement was required for radical resection and reconstruction of the IVFT. No recurrent infection or paravalvular leakage was observed during 49months follow up period. Manouguian's procedure is useful for complete resection of the infected IVFT and makes combined aortic and mitral valve replacement safer.

  4. Research on Construction Monitoring Techniques for Cable Replacement of the Cable-Stayed Bridge

    Directory of Open Access Journals (Sweden)

    Dai Pu

    2013-09-01

    Full Text Available Due to various reasons, some cable-stayed bridges require the replacement of part or all stay cables after operating for a period of time. In this study, based on some engineering practices of stay cable replacement, the condition of bridge structure before replacement is analyzed with Finite Element Analysis method for plane member system. The theoretical calculations, cable force measurement, replacement methods and process monitoring for cable replacement are introduced to find out the key technical problems. From the specified bridge monitoring practices, we suggest monitoring cable tension and the main beam alignment during the process of cable replacement, to make sure the cable-stayed bridge reaches its design conditions.

  5. Aortic valve replacement in octogenarians

    Directory of Open Access Journals (Sweden)

    Dark John H

    2007-07-01

    Full Text Available Abstract Background and Aims As our population ages and life expectancy increases the number of people aged over 80 and more referred for cardiac surgery is growing. This study sought to identify the outcome of aortic valve replacement (AVR in octogenarians. Methods 68 patients aged 80 years or more underwent AVR at the Freeman Hospital, between April 2001 and April 2004. A retrospective review of the notes and outcomes from the patients' GP and the NHS strategic tracking service was performed. 54% (37 underwent isolated AVR whilst 46% (31 underwent combined AVR and CABG. Results Follow up was 100% complete. The mean age was 83.1 ± s.d. 2.9 years, a mean gradient of 83 ± s.d. 31 mmHg and mean AVA of 0.56 cm2. The mean additive EuroSCORE was 8.6 ± s.d. 1.2, the logistic EuroSCORE mean 12.0 ± s.d. 5.9. In hospital 30 day mortality was 13 %. Survival was 80% at 1 year and 78% at 2 years. Median follow up was for 712 days. Stepwise logistic regression identified chronic obstructive airways disease as an independent predictor of mortality (p Conclusion Our study demonstrates that the operative mortality for AVR in the over eighties is good, whilst the mid to long term outcome is excellent There is a very low attrition rate with those undergoing the procedure living as long than their age matched population. This study confirms AVR is a safe, acceptable treatment for octogenarians with excellent mid term outcomes.

  6. Menopause and hormone replacement therapy

    Directory of Open Access Journals (Sweden)

    Ali Baziad

    2001-12-01

    Full Text Available The global population in the 21st century has reached 6.2 billion people, by the year 2025 it is to be around 8.3-8.5 billion, and will increase further. Elderly people are expected to grow rapidly than other groups. The fastest increase in the elderly population will take place in Asia. Life expectancy is increasing steadily throughout developed and developing countries. For many  menopausal women, increased life expectancy will accompanied by many health problems. The consequences of estrogen deficiency are the menopausal symptoms. The treatment of menopause related complaints and diseases became an  important socioeconomic and medical issue. Long term symptoms, such as the increase in osteoporosis fractures, cardio and cerebrovascular disesses and dementia, created a large financial burden on individuals and society. All these health problems can be lreated or prevented by hormone replacement therapy (HRT. Natural HRT is usually prefened. Synthetic  estrogen in oral contraceptives (oc are not recommended for HRT. Many contra-indications for oc, but now it is widely usedfor HRT. The main reasons for discontinuing HRT are unwanted bleeding, fear of cancer, and negative side effects. Until now there are sill debates about the rebrtonship between HRT and the incidence of breast cancer. Many data showed that there were no clear relationship between the use of HRT and breast cancer. ThereÎore, nwny experts advocate the use of HRTfrom the first sign of climacteric complaints until death. (Med J Indones 2001;10: 242-51Keywords: estrogen deficiency, climacteric phases, tibolone.

  7. Tricuspid Valve Replacement, Mechnical vs. Biological Valve, Which Is Better?

    Directory of Open Access Journals (Sweden)

    Haitham Akram Altaani

    2013-06-01

    Full Text Available Background: The initial trial in tricuspid surgery is repair; however, replacement is done whenever the valve is badly diseased. Tricuspid valve replacement comprises 1.7% of all tricuspid valve surgeries. Materials and Methods: The present retrospective study was performed using the medical records of 21 cases who underwent tricuspid valve replacement from January 2002 until the end of December 2010. The mean age of the participants was 52.3±8.8 years and 66.7% were females. In addition, tricuspid valve replacement was associated with mitral valve surgery, aortic valve surgery, and both in 14.3%, 4.8%, and 33.3% of the cases, respectively. Yet, isolated tricuspid valve replacement and redo surgery were performed in 10 cases (47.6% and 8 cases (38.1%, respectively. Besides, trial of repair was done in 14 cases (66.7%. Moreover, biological and mechanical valves were used in 76.2% and 23.8% of the patients, respectively. Results: According to the results, early mortality was 23.8% and one year survival was 66.7%. Moreover, early mortality was caused by right ventricular failure, multiorgan failure, medistinitis, and intracerbral bleeding in 42%, 28.6%, 14.3%, and 14.3% of the cases, respectively. In addition, 57.1% of the deaths had occurred in the cases where the biological valve was used, while 42.9% of the deaths had taken place where the mechanical one was utilized. Conclusions: The patients who require tricuspid valve replacement are usually high risk surgical candidates with early and long term mortality. The findings of the current study showed no significant hemodynamic difference between mechanical and biological valves.

  8. Primary hypothyroidism in the community: Lower daily dosages of levothyroxine replacement therapy for Asian patients.

    Science.gov (United States)

    Tan, Ngiap Chuan; Chew, Rong Quan; Koh, Yi Ling Eileen; Subramanian, Reena Chandini; Sankari, Usha; Meyappan, Meykkumar; Cho, Li Wei

    2017-02-01

    The goal of treatment in patients with primary hypothyroidism is to attain euthyroidism guided by the stipulated thyroid-stimulating hormone (TSH) levels range so as to minimize any potential long-term adverse effects. However, various factors may result in their Levothyroxine (T4) under and over-replacement.Our study aimed to evaluate the mean daily dose of L-T4 replacement for Asian patients with primary hypothyroidism. The secondary aims were to determine the proportion of those who were either over or under-replaced, and the factors associated with their thyroid function status and replacement adherence.Data collected using questionnaire survey from targeted patients managed in a typical public primary care center in Singapore: socio-demographic characteristics, clinical parameters, laboratory investigations, mean daily L-T4-replacement doses, and replacement regimens. The thyroid status of patients was classified based on thyroid function investigations.Complete data of 229 patients were analyzed. A total of 59.8% of patients had TSH within the normal range, 27.5% and 12.7% were under and over-replaced, respectively. About 60% of Asian patients with primary hypothyroidism achieved normal TSH status requiring average of 1.1 μg of daily L-T4/kgBW (kg body weight). Subjects who were over-replaced had a higher daily L-T4 dose/kgBW when compared to the euthyroid and the under replaced groups. Those with L-T4 over-replacement were largely due to excessive dosage. Patients who were younger, from lower socioeconomic strata, and higher BMI were more likely to be over or under-replaced.Majority of Asian patients with hypothyroidism required replacement of 1.1 μg of daily L-T4/kgBW. Their thyroid status was influenced by demographic and dosing factors.

  9. Pain Measurement and Brain Activity: Will Neuroimages Replace Pain Ratings?

    OpenAIRE

    Robinson, Michael E; Staud, Roland; Price, Donald D.

    2013-01-01

    Arguments made for the advantages of replacing pain ratings with brain imaging data include assumptions that pain ratings are less reliable and objective and that brain image data would greatly benefit the measurement of treatment efficacy. None of these assumptions are supported by available evidence. Self-report of pain is predictable and does not necessarily reflect unreliability or error. Since pain is defined as an experience, magnitudes of its dimensions can be estimated by well establi...

  10. Apicoaortic conduit for severe hemolytic anemia after aortic valve replacement.

    Science.gov (United States)

    Hatori, Kyohei; Ohki, Satoshi; Obayashi, Tamiyuki; Koyano, Tetsuya; Yasuhara, Kiyomitsu; Hirai, Hanako

    2015-06-01

    We describe the case of an 82-year-old woman who had undergone aortic mechanical valve replacement for aortic stenosis with a small annulus, and coronary artery bypass grafting. Four years after the operation, she began to experience hemolysis. Prosthetic valve obstruction was observed but there was no paravalvular leakage or aortic regurgitation through the mechanical valve. We elected to perform apicoaortic bypass in this patient with severe hemolytic anemia secondary to a mechanical valve malfunction.

  11. Aortic and Mitral Valve Replacement Through a Single Transverse Aortotomy: A Useful Approach in Difficult Mitral Valve Exposure

    OpenAIRE

    Carmichael, Michael J.; Cooley, Denton A.; Favor, Arsenio S.

    1983-01-01

    Replacement of the mitral valve through a standard vertical left atriotomy in patients requiring both aortic and mitral valve replacement can be very difficult. This is especially true in patients who have undergone previous median sternotomy. Replacement of the mitral valve through the aortic root after excision of the aortic valve is described in two case reports. This is a convenient approach when traditional exposure of the mitral valve is impractical in patients requiring double valve re...

  12. Salivary cortisol day curves in assessing glucocorticoid replacement therapy in Addison's disease

    NARCIS (Netherlands)

    Smans, L.; Lentjes, E.G.W.M.; Hermus, A.R.; Zelissen, P.

    2013-01-01

    OBJECTIVE: Patients with Addison's disease require lifelong treatment with glucocorticoids. At present, no glucocorticoid replacement therapy (GRT) can exactly mimic normal physiology. As a consequence, under- and especially overtreatment can occur. Suboptimal GRT may lead to various side effects.

  13. Salivary cortisol day curves in assessing glucocorticoid replacement therapy in Addison's disease

    NARCIS (Netherlands)

    Smans, L.; Lentjes, E.G.W.M.; Hermus, A.R.; Zelissen, P.

    2013-01-01

    OBJECTIVE: Patients with Addison's disease require lifelong treatment with glucocorticoids. At present, no glucocorticoid replacement therapy (GRT) can exactly mimic normal physiology. As a consequence, under- and especially overtreatment can occur. Suboptimal GRT may lead to various side effects. T

  14. [Extracorporeal renal replacement therapies in acute renal failure].

    Science.gov (United States)

    Schaefer, R M; Barenbrock, M; Teschner, M; Bahner, U

    2000-05-15

    The most serious forms of acute renal failure (ARF) are nowadays encountered in the intensive care unit (ICU), where up to 25% of new patients are reported to develop ARF. Lethality rates may reach 50 to 90% when the ARF is part of a multiple organ dysfunction syndrome. A multitude of extracorporeal procedures have been introduced into intensive care medicine. Applied with adequate skills and experience, most of these techniques will suffice to replace excretory renal function. However, because of low efficacy arterio-venous procedures (CAVH and CAVHD) have been abandoned for the veno-venous, pump-driven techniques (CVVH and CVVHD). Up to now, there is no consensus whether continuous or intermittent renal replacement therapy is more advantageous. In many cases, oliguric patients with circulatory instability will be treated by CVVH, even though there is no prospective study to show that in terms of outcome continuous treatment is superior to intermittent hemodialysis. It is equally conceivable to treat such patients with daily, prolonged (intermittent) hemodialysis. Apparently, the dose of replacement therapy, be it continuous filtration (36 to 48 l/24 h) or intermittent hemodialysis (daily 3 to 4 h) with a target BUN of less than 50 mg/dl, is more important than the modality of treatment. Moreover, there is good evidence that the use of biocompatible membranes (no complement- or leukocyte activation) is preferable and that with high-volume hemofiltration bicarbonate-containing replacement fluids should be used. However, despite all the technical advances, we firmly believe that the skills and the experience of those physicians and nurses who actually perform renal replacement therapy in the ICU are more important than the modality of treatment applied.

  15. Autogenous tooth transplantation for replacing a lost tooth: case reports

    OpenAIRE

    Kang, Ji-Youn; Chang, Hoon-Sang; Hwang,Yun-Chan; Hwang, In-Nam; Oh, Won-Mann; LEE, Bin-Na

    2013-01-01

    The autogenous tooth transplantation is an alternative treatment replacing a missing tooth when a suitable donor tooth is available. It is also a successful treatment option to save significant amount of time and cost comparing implants or conventional prosthetics. These cases, which required single tooth extraction due to deep caries and severe periodontal disease, could have good results by transplanting non-functional but sound donor tooth to the extraction site.

  16. QUALITY OF LIFE PARAMETERS IMPROVEMENT FOLLOWING TOTAL HIP REPLACEMENT

    OpenAIRE

    Grierosu, Carmen

    2012-01-01

    Large joint replacement regarding lower limbs include hip and knee arthroplasty surgical procedures, meant toimprove Quality Of Life (QOL) parameters, an optimal representation for patient recovery toward an independent lifestyle. The present study is a consequence of an imperative requirement from the nursing staff, which, in closecooperation with the surgeon, the physical therapist and the psychologist intend a better understanding regardingpatient perception of the so-called post-discharge...

  17. Meal Replacement Mass Reduction and Integration Acceptability Study

    Science.gov (United States)

    Sirmons, T.; Cooper, M.; Douglas, G.; Barrett, A.; Richardson, M.; Arias, D.; Schneiderman, J.; Slack, K.; Ploutz-Snyder R.

    2016-01-01

    NASA, in planning for long duration missions, has an imperative to provide a food system with the necessary nutrition, acceptability, and safety to ensure sustainment of crew health and performance. The Orion Multi-Purpose Crew Vehicle (MPCV) and future exploration missions are mass constrained; therefore we are challenged to reduce the mass of the food system by 10% while maintaining safety, nutrition, and acceptability for exploration missions. Food bars have previously been used to supplement meals in the Skylab food system, indicating that regular consumption of bars will be acceptable. However, commercially available products do not meet the requirements for a full meal replacement in the spaceflight food system. The purpose of this task is to develop a variety of nutritionally balanced breakfast replacement bars, which meet spaceflight nutritional, microbiological, sensorial, and shelf-life requirements, while enabling a 10% food mass savings. To date, six nutrient-dense meal replacement bars have been developed, using both traditional methods of compression as well as novel ultrasonic compression technologies developed by Creative Resonance Inc. (Phoenix, AZ). All bars will be prioritized based on acceptability and the four top candidates will be evaluated in the Human Exploration Research Analog (HERA) to assess the frequency with which actual meal replacement options may be implemented. Specifically, overall impact to mood, satiety, dietary discomfort, and satisfaction with food will be analyzed to inform successful implementation strategies. In addition, these bars will be evaluated based on final product sensory acceptability, nutritional stability, qualitative stability of analytical measurements (i.e. water activity and texture), and microbiological compliance over two years of storage at room temperature and potential temperature abuse conditions to predict long-term acceptability. It is expected that this work will enable a successful meal

  18. Ulnar Head Replacement and Related Biomechanics

    Science.gov (United States)

    Sauerbier, Michael; Arsalan-Werner, Annika; Enderle, Elena; Vetter, Miriam; Vonier, Daniel

    2013-01-01

    A stable distal radioulnar joint (DRUJ) is mandatory for the function and load transmission in the wrist and forearm. Resectional salvage procedures such as the Darrach procedure, Bowers arthroplasty, and Sauvé-Kapandji procedure include the potential risk of radioulnar instability and impingement, which can lead to pain and weakness. Soft tissue stabilizing techniques have only limited success rates in solving these problems. In an attempt to stabilize the distal forearm mechanically following ulnar head resection, various endoprostheses have been developed to replace the ulnar head. The prostheses can be used for secondary treatment of failed ulnar head resection, but they can also achieve good results in the primary treatment of osteoarthritis of the DRUJ. Our experience consists of twenty-five patients (follow-up 30 months) with DRUJ osteoarthritis who were treated with an ulnar head prosthesis, with improvement in pain, range of motion, and grip strength. An ulnar head prosthesis should be considered as a treatment option for a painful DRUJ. PMID:24436786

  19. Can Clouds Replace Grids? Will Clouds Replace Grids?

    CERN Document Server

    Shiers, J

    2010-01-01

    The world’s largest scientific machine – comprising dual 27km circular proton accelerators cooled to 1.9oK and located some 100m underground – currently relies on major production Grid infrastructures for the offline computing needs of the 4 main experiments that will take data at this facility. After many years of sometimes difficult preparation the computing service has been declared “open” and ready to meet the challenges that will come shortly when the machine restarts in 2009. But the service is not without its problems: reliability – as seen by the experiments, as opposed to that measured by the official tools – still needs to be significantly improved. Prolonged downtimes or degradations of major services or even complete sites are still too common and the operational and coordination effort to keep the overall service running is probably not sustainable at this level. Recently “Cloud Computing” – in terms of pay-per-use fabric provisioning – has emerged as a potentially viable al...

  20. Delivering enhanced testosterone replacement therapy through nanochannels.

    Science.gov (United States)

    Ferrati, Silvia; Nicolov, Eugenia; Bansal, Shyam; Zabre, Erika; Geninatti, Thomas; Ziemys, Arturas; Hudson, Lee; Ferrari, Mauro; Goodall, Randal; Khera, Mohit; Palapattu, Ganesh; Grattoni, Alessandro

    2015-02-18

    Primary or secondary hypogonadism results in a range of signs and symptoms that compromise quality of life and requires life-long testosterone replacement therapy. In this study, an implantable nanochannel system is investigated as an alternative delivery strategy for the long-term sustained and constant release of testosterone. In vitro release tests are performed using a dissolution set up, with testosterone and testosterone:2-hydroxypropyl-β-cyclodextrin (TES:HPCD) 1:1 and 1:2 molar ratio complexes release from the implantable nanochannel system and quantify by HPLC. 1:2 TES:HPCD complex stably achieve 10-15 times higher testosterone solubility with 25-30 times higher in vitro release. Bioactivity of delivered testosterone is verified by LNCaP/LUC cell luminescence. In vivo evaluation of testosterone, luteinizing hormone (LH), and follicle stimulating hormone (FSH) levels by liquid chromatography mass spectrometry (LC/MS) and multiplex assay is performed in castrated Sprague-Dawley rats over 30 d. Animals are treated with the nanochannel implants or degradable testosterone pellets. The 1:2 TES:HPCD nanochannel implant exhibits sustained and clinically relevant in vivo release kinetics and attains physiologically stable plasma levels of testosterone, LH, and FSH. In conclusion, it is demonstrated that by providing long-term steady release 1:2 TES:HPCD nanochannel implants may represent a major breakthrough for the treatment of male hypogonadism.

  1. Total ankle replacement for posttraumatic arthritis

    Science.gov (United States)

    Weme, Rebecca A Nieuwe; van Solinge, Guido; N Doornberg, Job; Sierevelt, Inger; Haverkamp, Daniël; Doets, H Cornelis

    2015-01-01

    Background and purpose Most studies on total ankle replacement (TAR) have used a case mix of patients. We evaluated the outcome of TAR performed for end-stage arthritis either because of fracture or ligamentous injury. Patients and methods We prospectively followed 88 consecutive patients (50 postfracture ankles and 40 ankles with instability arthritis (2 bilateral)) who underwent TAR between 2001 and 2009. Mean follow-up for both groups was 5 years. Results Preoperative varus deformity of 10° or more was present in 23 ankles in the instability group. At 6 years, survival with revision or salvage fusion as an endpoint was 87% (95% CI: 74–99) in the postfracture group and 79% (95% CI: 63–94) in the instability group. Progressive periprosthetic osteolysis was seen in 23 ankles, and required salvage fusion in 6. The number of reoperations was similar in both groups. Clinical outcome, as assessed with 2 ankle scores and 2 questionnaires, showed good results and was similar at the latest follow-up. Interpretation The outcome was similar in the postfracture and instability groups and also similar to that reported in series including a case mix of patients. In contrast to earlier reports, preoperative frontal plane deformity in this series was not identified as a risk factor for failure. PMID:25772269

  2. Replacement of Swiss "Attestations de fonctions"

    CERN Multimedia

    DG Unit

    2009-01-01

    The Swiss Permanent Mission has informed CERN that the "attestations de fonctions" issued to certain members of the personnel and the "attestations" issued to their family members will gradually be replaced by P-type "cartes de légitimation" (see specimen copies in the printed Bulletin). This card’s name, together with its more contemporary design compared with old-style "Attestations" issued in the 1970s, will make the holder’s daily life much easier, e.g. when crossing borders, renting accommodation or setting up a telephone line. The Users Office (PH Department) and the Cards Office (HR Department), which are responsible for handling requests for "cartes de légitimation", will provide information in due course on how they intend to organise the exchange of "attestations" (priority will be given to residents of Switzerland, in particular those requiring a visa for the Schengen area). In this context, we remind you that the Swiss Permanent Mission is systematically in...

  3. Transcatheter Aortic Valve Replacement in Europe

    DEFF Research Database (Denmark)

    Mylotte, Darren; Osnabrugge, Ruben L J; Windecker, Stephan;

    2013-01-01

    The authors sought to examine the adoption of transcatheter aortic valve replacement (TAVR) in Western Europe and investigate factors that may influence the heterogeneous use of this therapy.......The authors sought to examine the adoption of transcatheter aortic valve replacement (TAVR) in Western Europe and investigate factors that may influence the heterogeneous use of this therapy....

  4. Microcontroller-based locking in optics experiments

    Energy Technology Data Exchange (ETDEWEB)

    Huang, K. [Laboratoire Kastler Brossel, UPMC-Sorbonne Universités, CNRS, ENS-PSL Research University, Collège de France, 4 place Jussieu, 75005 Paris (France); State Key Laboratory of Precision Spectroscopy, East China Normal University, Shanghai 200062 (China); Le Jeannic, H.; Ruaudel, J.; Morin, O.; Laurat, J., E-mail: julien.laurat@upmc.fr [Laboratoire Kastler Brossel, UPMC-Sorbonne Universités, CNRS, ENS-PSL Research University, Collège de France, 4 place Jussieu, 75005 Paris (France)

    2014-12-15

    Optics experiments critically require the stable and accurate locking of relative phases between light beams or the stabilization of Fabry-Perot cavity lengths. Here, we present a simple and inexpensive technique based on a stand-alone microcontroller unit to perform such tasks. Easily programmed in C language, this reconfigurable digital locking system also enables automatic relocking and sequential functioning. Different algorithms are detailed and applied to fringe locking and to low- and high-finesse optical cavity stabilization, without the need of external modulations or error signals. This technique can readily replace a number of analog locking systems advantageously in a variety of optical experiments.

  5. Microcontroller-based locking in optics experiments

    CERN Document Server

    Huang, K; Ruaudel, J; Morin, O; Laurat, J

    2014-01-01

    Optics experiments critically require the stable and accurate locking of relative phases between light beams or the stabilization of Fabry-Perot cavity lengths. Here, we present a simple and inexpensive technique based on a stand-alone microcontroller unit to perform such tasks. Easily programmed in C language, this reconfigurable digital locking system also enables automatic relocking and sequential functioning. Different algorithms are detailed and applied to fringe locking and to low- and high-finesse optical cavity stabilization, without the need of external modulations or error signals. This technique can readily replace a number of analog locking systems advantageously in a variety of optical experiments.

  6. Microcontroller-based locking in optics experiments.

    Science.gov (United States)

    Huang, K; Le Jeannic, H; Ruaudel, J; Morin, O; Laurat, J

    2014-12-01

    Optics experiments critically require the stable and accurate locking of relative phases between light beams or the stabilization of Fabry-Perot cavity lengths. Here, we present a simple and inexpensive technique based on a stand-alone microcontroller unit to perform such tasks. Easily programmed in C language, this reconfigurable digital locking system also enables automatic relocking and sequential functioning. Different algorithms are detailed and applied to fringe locking and to low- and high-finesse optical cavity stabilization, without the need of external modulations or error signals. This technique can readily replace a number of analog locking systems advantageously in a variety of optical experiments.

  7. Atrioventricular valve replacement in functional single-ventricle patients

    Institute of Scientific and Technical Information of China (English)

    ZHANG Zhong; CEN Jian-zheng; XU Gang; WEN Shu-sheng; CHEN Ji-mei

    2016-01-01

    Background This article summarized the experience of atrioventricular valve replacement operation for functional single ventricle patients whose atrioventricular valve was insufficiency.The follow-up time of operation was arranged from early-to medium-term.Methods From July 2009 to July 2015,there were 40 patients of functional single ventricle receiving the operation of atrioventricular valve replacement,including 23 male and 17 female patients.The age at A-Ⅴ valve replacement was ranged from 6 days to 32 years (the medium age of 9 years),and the body weight ranged from 2.7 to 57 kg (the medium body weight of 21.5 kg).Moreover,the atrioventricular valve replacement was performed on all patients under extracorporeal circulation.Results Atrioventricular valve replacement was performed on 40 patients with function single ventricle in hospital,of which eight (20.0%) died in hospital including two neonate and infant (age range:6 days-2 years old) accounting for 25% (2/8),Among them,seven patients died of low cardiac output syndrome two patients with repeated hypoxemia concurrent infection after operation,and one with bilateral diaphragmatic paralysis and malignant arrhythmia.For the patients suffering the severe perivalvular leakage,there was a reoperation,and the cardiac function before the first operation was class Ⅳ.One patient received heart transplantation finally for severe heart failure after AV valve replacement.For the rest of patients,their cardiac function recovered to class Ⅰ-Ⅱ after operation.Conclusions For function single ventricle patients with atrioventricular valve regurgitation,the mortality rate of atrioventricular valve replacement can be accepted if the operation was indicated.For patients with severe atrioventricular value regurgitation,the result of the operation in the early and medium term was satisfying.Thus,the atrioventricular valve replacement served as a useful treatment for patients diagnosed of A-Ⅴ valve regurgitation and

  8. A New Replacement for the Deep Diving Submersible ALVIN: Initial Project Update and Concept

    Science.gov (United States)

    Brown, R.; Tivey, M. A.; Walden, B.; Detrick, R. S.

    2004-12-01

    In August 2004, the National Science Foundation (NSF) funded the first phase of a 4-year project proposed by Woods Hole Oceanographic Institution (WHOI) to build a replacement submersible for the present human occupied vehicle (HOV) ALVIN operated by WHOI as part of the National Deep Submergence Facility. The design of the replacement HOV is the result of almost 10 years of deliberations among the scientific community and several studies including a recent 2004 National Research Council report on the "Future Needs of Deep Submergence Science". The over-riding design philosophy was to enhance capabilities and not to detract from the present ALVIN capabilities that have made it one of the premier research tools in oceanography. The replacement submersible will have a nominal depth capability of 6500 meters allowing access to over 99% of the world's ocean floor. The submersible is planned to have a sphere diameter of 2.1 m providing 27 cu. ft. of additional internal volume over the present ALVIN. A key improvement will be the viewport design with five viewports for a total 245 degree viewing area and with the forward three viewports having overlapping fields of view. This will provide an unprecedented view of the seafloor. The central pilot viewport is 7" in diameter with two forward 6" observer viewports and two lateral 5" observer viewports. The replacement vehicle will continue to operate with 1 pilot and 2 scientists inside the sphere. In order for the submersible to reach the greater depths will require increased descent and ascent rates. The new vehicle will operate with a variable water ballast system that can provide trim angles of up to +/-25 degrees to use on descent and ascent and will also enable the vehicle to stop in midwater to conduct experiments and sampling. Important design constraints are imposed by the capacity of the present ALVIN mother ship, Atlantis and the A-frame launch system. Due to these restrictions the replacement HOV will weigh 44

  9. Mineral replacement reactions and element mobilization

    Science.gov (United States)

    Putnis, Christine V.; Ruiz-Agudo, Encarnacion; King, Helen E.; Hövelmann, Jörn; Renard, François

    2016-04-01

    ) The replacement of plagioclase feldspars by albite: observations from hydrothermal experiments. Contrib. Min. and Pet. 159, 43-59.

  10. Replacing lactose from calf milk replacers : effects on digestion and post-absorptive metabolism

    NARCIS (Netherlands)

    Gilbert, M.S.

    2015-01-01

    Summary PhD thesis Myrthe S. Gilbert Replacing lactose from calf milk replacers – Effects on digestion and post-absorptive metabolism Veal calves are fed milk replacer (MR) and solid feed. The largest part of the energy provided to veal calves originates from

  11. Aortic valve replacement with the Nicks annulus enlargement procedure 12 years after mitral valve replacement.

    Science.gov (United States)

    Kazama, S; Kurata, A; Yamashita, Y

    1999-10-01

    An aortic valve replacement was successfully performed employing the Nicks annulus enlargement procedure in a case of aortic valve stenosis with small annulus 12 years after mitral valve replacement. Previous mitral valve replacement does not preclude feasibility of the Nicks procedure.

  12. Surfactant replacement therapy--economic impact.

    Science.gov (United States)

    Pejaver, R K; al Hifzi, I; Aldussari, S

    2001-06-01

    Surfactant replacement is an effective treatment for neonatal respiratory distress syndrome. (RDS). As widespread use of surfactant is becoming a reality, it is important to assess the economic implications of this new form of therapy. A comparison study was carried out at the Neonatal Intensive Care Unit (NICU) of Northwest Armed Forces Hospital, Saudi Arabia. Among 75 infants who received surfactant for RDS and similar number who were managed during time period just before the surfactant was available, but by set criteria would have made them eligible for surfactant. All other management modalities except surfactant were the same for all these babies. Based on the intensity of monitoring and nursing care required by the baby, the level of care was divided as: Level IIIA, IIIB, Level II, Level I. The cost per day per bed for each level was calculated, taking into account the use of hospital immovable equipment, personal salaries of nursing, medical, ancillary staff, overheads and maintenance, depreciation and replacement costs. Medications used, procedures done, TPN, oxygen, were all added to individual patient's total expenditure. 75 infants in the Surfactant group had 62 survivors. They spent a total of 4300 days in hospital. (av 69.35) Out of which 970 d (av 15.65 per patient) were ventilated days. There were 56 survivors in the non-surfactant group of 75. They had spent a total of 5023 days in the hospital (av 89.69/patient) out of which 1490 were ventilated days (av 26.60 d). Including the cost of surfactant (two doses), cost of hospital stay for each infant taking the average figures of stay would be SR 118, 009.75 per surfactant treated baby and SR 164, 070.70 per non-surfactant treated baby. The difference of 46,061 SR is 39.03% more in non-surfactant group. One Saudi rial = 8 Rs (approx at the time study was carried out.) Medical care cost varies from place to place. However, it is definitely cost-effective where surfactant is concerned. Quality adjusted

  13. Vascular access for extracorporeal renal replacement therapy in veterinary patients.

    Science.gov (United States)

    Chalhoub, Serge; Langston, Cathy E; Poeppel, Karen

    2011-01-01

    Vascular access is the first and most basic requirement for successful extracorporeal renal replacement therapy (ERRT). Dual-lumen catheters are the most commonly used method of vascular access for ERRT in veterinary patients. An adequately functioning dialysis catheter allows for smooth and efficient patient management, whereas a poorly functioning catheter frustrates the technician, doctor, and patient. These catheters are fairly quick to place but require meticulous care for optimal function. The most common complications are thrombosis and infection. Monitoring catheter performance should be a routine part of dialysis patient care.

  14. Rheological properties of rice-blackgram batter while replacing white rice with brown rice.

    Science.gov (United States)

    Manickavasagan, Annamalai; Al-Marhubi, Insaaf Mohd; Dev, Satyanarayan

    2014-06-01

    Rice-blackgram batter is a raw material for many traditional convenience foods in Asia. Reformulation of traditional convenience food by replacing white rice with whole rice (brown rice) is a novel method to reduce the consumption of refined grain and increase the intake of whole grain in our diet. In this study, rheological properties of rice-blackgram batter was investigated while replacing white rice with brown rice at five levels (T1--0% replacement (control), T2--25% replacement, T3--50% replacement, T4--75% replacement, and T5--100% replacement). The shear stress versus shear rate plot indicates that the rice-blackgram batter exhibited non-Newtonian fluid behavior (shear thinning property) even after 100% replacement of white rice with brown rice. The rheological characteristics of rice-blackgram batters fitted reasonably well in Cassan (r2 = 0.8521-0.9856) and power law (r2 = 0.8042-0.9823) models. Brown rice replacement at all levels did not affect the flow behavior index, yield stress, consistency coefficient, and apparent viscosity of batter at 25 degrees C. However, at higher temperature, the viscosity was greater for T4 and T5 (no difference between them) than T1, T2, and T3 (no difference between them) batters. Further research is required to determine the sensory attributes and acceptability of the cooked products with brown rice-blended batter.

  15. [Treatment of acute renal failure--concepts and controversies. 2. Extracorporeal renal replacement and peritoneal dialysis].

    Science.gov (United States)

    Gabriel, A; Müller, E; Tarnow, J

    2001-04-01

    Therapy of prolonged acute renal failure regularly requires a renal replacement therapy. This can be achieved by different extracorporal renal replacement therapies (ERRT) or by peritoneal dialysis. ERRT are classified according to the physical principle underlying toxin elimination as hemodialysis (diffusion) and hemofiltration (convection). Another classification refers to intermittent or continuous application modes. Biocompatibility of membranes is judged according to their activation of the complement system. Prospective randomized studies did not consolidate the assumptions about the benefit of particular modalities proposed on theoretical foundations. Mortality, duration and complication rates of acute renal failure are not significantly decreased by use of biocompatible membranes. Continuous modalities are not generally preferable but optimize treatment in hemodynamically unstable patients, in whom they endorse fluid balancing and maintenance of sufficient arterial blood pressure. The use of demanding hemofiltration techniques for cytokine removal should be limited to clinical studies. The effects of ERRT-"intensity" and the best timing for initiation of ERRT have not been evaluated sufficiently. The choice of the ERRT modality is subject to clinical judgement (criterion: hemodynamic situation), practical aspects (criteria: availability of equipment and handling experience), and costs. Prior to their general use new and expensive technical modalities and membrane types should be thoroughly evaluated in studies with regard to outcome-related aspects such as patient survival and preservation of renal function.

  16. Subcutaneous immunoglobulin replacement therapy in the treatment of patients with primary immunodeficiency disease

    Directory of Open Access Journals (Sweden)

    Suzanne Skoda-Smith

    2009-12-01

    Full Text Available Suzanne Skoda-Smith, Troy R Torgerson, Hans D OchsSeattle Children’s Research Institute and Department of Pediatrics, University of Washington, Seattle, WashingtonAbstract: Antibody deficiency is the most frequently encountered primary immunodeficiency disease (PIDD and patients who lack the ability to make functional immunoglobulin require life-long replacement therapy to prevent serious bacterial infections. Human serum immunoglobulin manufactured from pools of donated plasma can be administered intramuscularly, intravenously or subcutaneously. With the advent of well-tolerated preparations of intravenous immunoglobulin (IVIg in the 1980s, the suboptimal painful intramuscular route of administration is no longer used. However, some patients continued to experience unacceptable adverse reactions to the intravenous preparations, and for others, vascular access remained problematic. Subcutaneously administered immunoglobulin (SCIg provided an alternative delivery method to patients experiencing difficulties with IVIg. By 2006, immunoglobulin preparations designed exclusively for subcutaneous administration became available. They are therapeutically equivalent to intravenous preparations and offer patients the additional flexibility for the self-administration of their product at home. SCIg as replacement therapy for patients with primary antibody deficiencies is a safe and efficacious method to prevent serious bacterial infections, while maximizing patient satisfaction and improving quality of life.Keywords: subcutaneous immunoglobulin, primary immunodeficiency disease, antibody deficiency, X-linked agammaglobulinemia, common variable immune deficiency

  17. Percutaneous tricuspid valve replacement in childhood

    Directory of Open Access Journals (Sweden)

    Mathias Emmel

    2015-01-01

    Full Text Available Percutaneous replacement of the tricuspid valve with a bovine jugular venous valve (melody valve was successfully undertaken in a 9-year-old boy. The patient had a previous history of bacterial endocarditis of the native tricuspid valve in infancy. Initially, a pericardial patch valve was created, followed by surgical replacement of the valve using a biological tissue valve at 4 years of age. Progressive stenosis and regurgitation of the biological valve, with severe venous congestion and resulting hepatic dysfunction prompted percutaneous valve replacement.

  18. Replacement of filters for respirable quartz measurement in coal mine dust by infrared spectroscopy.

    Science.gov (United States)

    Farcas, Daniel; Lee, Taekhee; Chisholm, William P; Soo, Jhy-Charm; Harper, Martin

    2016-01-01

    The objective of this article is to compare and characterize nylon, polypropylene (PP), and polyvinyl chloride (PVC) membrane filters that might be used to replace the vinyl/acrylic co-polymer (DM-450) filter currently used in the Mine Safety and Health Administration (MSHA) P-7 method (Quartz Analytical Method) and the National Institute for Occupational Safety and Health (NIOSH) Manual of Analytical Methods 7603 method (QUARTZ in coal mine dust, by IR re-deposition). This effort is necessary because the DM-450 filters are no longer commercially available. There is an impending shortage of DM-450 filters. For example, the MSHA Pittsburgh laboratory alone analyzes annually approximately 15,000 samples according to the MSHA P-7 method that requires DM-450 filters. Membrane filters suitable for on-filter analysis should have high infrared (IR) transmittance in the spectral region 600-1000 cm(-1). Nylon (47 mm, 0.45 µm pore size), PP (47 mm, 0.45 µm pore size), and PVC (47 mm, 5 µm pore size) filters meet this specification. Limits of detection and limits of quantification were determined from Fourier transform infrared spectroscopy (FTIR) measurements of blank filters. The average measured quartz mass and coefficient of variation were determined from test filters spiked with respirable α-quartz following MSHA P-7 and NIOSH 7603 methods. Quartz was also quantified in samples of respirable coal dust on each test filter type using the MSHA and NIOSH analysis methods. The results indicate that PP and PVC filters may replace the DM-450 filters for quartz measurement in coal dust by FTIR. PVC filters of 5 µm pore size seemed to be suitable replacement although their ability to retain small particulates should be checked by further experiment.

  19. Valve replacement in children: a challenge for a whole life.

    Science.gov (United States)

    Henaine, Roland; Roubertie, François; Vergnat, Mathieu; Ninet, Jean

    2012-10-01

    Valvular pathology in infants and children poses numerous challenges to the paediatric cardiac surgeon. Without question, valvular repair is the goal of intervention because restoration of valvular anatomy and physiology using native tissue allows for growth and a potentially better long-term outcome. When reconstruction fails or is not feasible, valve replacement becomes inevitable. Which valve for which position is controversial. Homograft and bioprosthetic valves achieve superior haemodynamic results initially but at the cost of accelerated degeneration. Small patient size and the risk of thromboembolism limit the usefulness of mechanical valves, and somatic outgrowth is an universal problem with all available prostheses. The goal of this article is to address valve replacement options for all four valve positions within the paediatric population. We review current literature and our practice to support our preferences. To summarize, a multitude of opinions and surgical experiences exist. Today, the valve choices that seem without controversy are bioprosthetic replacement of the tricuspid valve and Ross or Ross-Konno procedures when necessary for the aortic valve. On the other hand, bioprostheses may be implanted when annular pulmonary diameter is adequate; if not or in case of right ventricular outflow tract discontinuity, it is better to use a pulmonary homograft with the Ross procedure. Otherwise, a valved conduit. Mitral valve replacement remains the most problematic; the mechanical prosthesis must be placed in the annular position, avoiding oversizing. Future advances with tissue-engineered heart valves for all positions and new anticoagulants may change the landscape for valve replacement in the paediatric population.

  20. The welfare implications of using exotic tortoises as ecological replacements.

    Directory of Open Access Journals (Sweden)

    Christine J Griffiths

    Full Text Available BACKGROUND: Ecological replacement involves the introduction of non-native species to habitats beyond their historical range, a factor identified as increasing the risk of failure for translocations. Yet the effectiveness and success of ecological replacement rely in part on the ability of translocatees to adapt, survive and potentially reproduce in a novel environment. We discuss the welfare aspects of translocating captive-reared non-native tortoises, Aldabrachelys gigantea and Astrochelys radiata, to two offshore Mauritian islands, and the costs and success of the projects to date. METHODOLOGY/PRINCIPAL FINDINGS: Because tortoises are long-lived, late-maturing reptiles, we assessed the progress of the translocation by monitoring the survival, health, growth, and breeding by the founders. Between 2000 and 2011, a total of 26 A. gigantea were introduced to Ile aux Aigrettes, and in 2007 twelve sexually immature A. gigantea and twelve male A. radiata were introduced to Round Island, Mauritius. Annual mortality rates were low, with most animals either maintaining or gaining weight. A minimum of 529 hatchlings were produced on Ile aux Aigrettes in 11 years; there was no potential for breeding on Round Island. Project costs were low. We attribute the success of these introductions to the tortoises' generalist diet, habitat requirements, and innate behaviour. CONCLUSIONS/SIGNIFICANCE: Feasibility analyses for ecological replacement and assisted colonisation projects should consider the candidate species' welfare during translocation and in its recipient environment. Our study provides a useful model for how this should be done. In addition to serving as ecological replacements for extinct Mauritian tortoises, we found that releasing small numbers of captive-reared A. gigantea and A. radiata is cost-effective and successful in the short term. The ability to release small numbers of animals is a particularly important attribute for ecological

  1. Evaluation of mitral valve replacement anchoring in a phantom

    Science.gov (United States)

    McLeod, A. Jonathan; Moore, John; Lang, Pencilla; Bainbridge, Dan; Campbell, Gordon; Jones, Doug L.; Guiraudon, Gerard M.; Peters, Terry M.

    2012-02-01

    Conventional mitral valve replacement requires a median sternotomy and cardio-pulmonary bypass with aortic crossclamping and is associated with significant mortality and morbidity which could be reduced by performing the procedure off-pump. Replacing the mitral valve in the closed, off-pump, beating heart requires extensive development and validation of surgical and imaging techniques. Image guidance systems and surgical access for off-pump mitral valve replacement have been previously developed, allowing the prosthetic valve to be safely introduced into the left atrium and inserted into the mitral annulus. The major remaining challenge is to design a method of securely anchoring the prosthetic valve inside the beating heart. The development of anchoring techniques has been hampered by the expense and difficulty in conducting large animal studies. In this paper, we demonstrate how prosthetic valve anchoring may be evaluated in a dynamic phantom. The phantom provides a consistent testing environment where pressure measurements and Doppler ultrasound can be used to monitor and assess the valve anchoring procedures, detecting pararvalvular leak when valve anchoring is inadequate. Minimally invasive anchoring techniques may be directly compared to the current gold standard of valves sutured under direct vision, providing a useful tool for the validation of new surgical instruments.

  2. Renal replacement therapy in yemen.

    Science.gov (United States)

    Sheiban, A K; Yehia, A; Mohamed, Y A; Hajar, A R

    1996-01-01

    In this report we present the current status of dialysis and transplantation in Yemen. The reported incidence of end stage renal disease (ESRD) in one region of Yemen was estimated as 385 per million population (PMP) per year. The total population of Yemen is also estimated as 16,000,000. Peritoneal dialysis was started in 1980, while hemodialysis was started in 1981. At present there are around 36 hemodialysis machines distributed in the large cities of Yemen. Intermittent peritoneal dialysis is commonly used; however, continuous ambulatory peritoneal dialysis has been out of practice since 1992. Renal transplantation has not yet been started in Yemen; however, at present there are 327 transplant patients being followed up in it. The majority of patients had their grafts from living non related donors abroad. In our experience, such transplantations were associated with high morbidity and mortality, in addition to acquisition of serious, potentially lethal extra-renal medical problems. We believe that there is a wide shortage of renal services in Yemen. Establishing a National Kidney Foundation to organize these services may be helpful.

  3. Gyrator-type circuits replace ungrounded inductors

    Science.gov (United States)

    Deboo, G. J.

    1968-01-01

    Gyrator circuits using only transistors, capacitors, and resistors which can replace both grounded and ungrounded inductors have been developed to permit complete microminiaturization of circuitry by integration of the components.

  4. Total ankle replacement. Design evolution and results.

    Science.gov (United States)

    van den Heuvel, Alexander; Van Bouwel, Saskia; Dereymaeker, Greta

    2010-04-01

    The ankle joint has unique anatomical, biomechanical and cartilaginous structural characteristics that allow the joint to withstand the very high mechanical stresses and strains over years. Any minor changes to any of these features predispose the joint to osteoarthritis. Total ankle replacement (TAR) is evolving as an alternative to ankle arthrodesis for the treatment of end-stage ankle osteoarthritis. Initial implant designs from the early 1970s had unacceptably high failure and complication rates. As a result many orthopaedic surgeons have restricted the use of TAR in favour of ankle arthrodesis. Long term follow-up studies following ankle arthrodesis show risks of developing adjacent joint osteoarthritis. Therefore research towards a successful ankle replacement continues. Newer designs and longer-term outcome studies have renewed the interest in ankle joint replacement. We present an overview of the evolution, results and current concepts of total ankle replacement.

  5. Minimally Invasive Transcatheter Aortic Valve Replacement (TAVR)

    Medline Plus

    Full Text Available Watch a Broward Health surgeon perform a minimally invasive Transcatheter Aortic Valve Replacement (TAVR) Click Here to view the BroadcastMed, Inc. Privacy Policy and Legal Notice © 2017 BroadcastMed, Inc. ...

  6. Total ankle replacement - surgical treatment and rehabilitation.

    Science.gov (United States)

    Prusinowska, Agnieszka; Krogulec, Zbigniew; Turski, Piotr; Przepiórski, Emil; Małdyk, Paweł; Księżopolska-Orłowska, Krystyna

    2015-01-01

    Functions of the ankle joint are closely connected with the gait and ability to maintain an upright position. Degenerative lesions of the joint directly contribute to postural disorders and greatly restrict propulsion of the foot, thus leading to abnormal gait. Development of total ankle replacement is connected with the use of the method as an efficient treatment of joint injuries and continuation of achievements in hip and knee surgery. The total ankle replacement technique was introduced as an alternative to arthrodesis, i.e. surgical fixation, which made it possible to preserve joint mobility and to improve gait. Total ankle replacement is indicated in post-traumatic degenerative joint disease and joint destruction secondary to rheumatoid arthritis. In this paper, total ankle replacement and various types of currently used endoprostheses are discussed. The authors also describe principles of early postoperative rehabilitation as well as rehabilitation in the outpatient setting.

  7. 47 CFR 13.17 - Replacement license.

    Science.gov (United States)

    2010-10-01

    ... Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMERCIAL RADIO OPERATORS General § 13.17 Replacement... Operator License, Marine Radio Operator Permit, First Class Radiotelegraph Operator's Certificate, Second... Radio Operator's License, Restricted GMDSS Radio Operator License, GMDSS Radio Maintainer's License,...

  8. Minimally Invasive Transcatheter Aortic Valve Replacement (TAVR)

    Medline Plus

    Full Text Available Watch a Broward Health surgeon perform a minimally invasive Transcatheter Aortic Valve Replacement (TAVR) Click Here to view the BroadcastMed, Inc. Privacy Policy and Legal Notice © 2017 BroadcastMed, Inc. ...

  9. SYNERGISTIC WOOD PRESERVATIVES FOR REPLACEMENT OF CCA

    Science.gov (United States)

    The objective of this project was to evaluate the potential synergistic combinations of environmentally-safe biocides as wood preservatives. These wood preservatives could be potential replacements for the heavy-metal based CCA.Didecyldimethylammonium chloride [DDAC] was...

  10. Bone Marrow Transplantation (BMT) and Gene Replacement ...

    African Journals Online (AJOL)

    Bone Marrow Transplantation (BMT) and Gene Replacement Therapy (GRT) In Sickle Cell Anemia. ... manifesting clinical disease, while the heterozygoste(AS) are clinically ... medicine, we argue here the case for Bone marrow transplantation

  11. Surgical phantom for off-pump mitral valve replacement

    Science.gov (United States)

    McLeod, A. Jonathan; Moore, John; Guiraudon, Gerard M.; Jones, Doug L.; Campbell, Gordon; Peters, Terry M.

    2011-03-01

    Off-pump, intracardiac, beating heart surgery has the potential to improve patient outcomes by eliminating the need for cardiopulmonary bypass and aortic cross clamping but it requires extensive image guidance as well as the development of specialized instrumentation. Previously, developments in image guidance and instrumentation were validated on either a static phantom or in vivo through porcine models. This paper describes the design and development of a surgical phantom for simulating off-pump mitral valve replacement inside the closed beating heart. The phantom allows surgical access to the mitral annulus while mimicking the pressure inside the beating heart. An image guidance system using tracked ultrasound, magnetic instrument tracking and preoperative models previously developed for off-pump mitral valve replacement is applied to the phantom. Pressure measurements and ultrasound images confirm the phantom closely mimics conditions inside the beating heart.

  12. The hip and knee replacement operation: an extensive life event.

    Science.gov (United States)

    Gustafsson, Birgitta Åkesdotter; Ekman, Sirkka-Liisa; Ponzer, Sari; Heikkilä, Kristiina

    2010-12-01

    A total hip replacement and a total knee replacement have shown to effectively reduce pain and disability in patients with osteoarthritis of the hip and knee joint despite associated risks. Even though the intervention primarily concerns older people with additional health problems, the patients stand on their feet the day after the operation and are discharged a few days later. Previous research indicates that reflections about life are related to the operation. The aim of this study was to illuminate the meaning of reflections related to hip and knee replacement surgery. A phenomenological hermeneutical approach with a longitudinal design was chosen in order to study the participants' experiences of the hip and knee replacement intervention across the entire perioperative period. Four themes emerged from the structural analysis; choosing the challenge, past memories connect to the current situation, moving from happiness to ordinary everyday life and moving from despair towards reluctant acceptance of unexpected bad conditions for everyday life. There was inner negotiations about having surgery or not, and existential anxiety that reminded people that life cannot be taken for granted. Our findings indicate the operation was seen as an extensive life event including reflections about life and death and about hope and fear. Previous bad experiences of care seemed to influence the way patients dealt with fear and hope. Fear had to be overcome by inner negotiations about undergoing surgery or not. Relief was expressed about surviving the actual operation, but soon after fears arose about how to manage on the actual road to recovery. Hope for a good life grew either stronger or weaker, depending on the progress following the operation. The outcome eventually generated a transition from happiness to ordinary everyday life, or a transition from despair towards reluctant acceptance of unfulfilled expectations. © 2010 The Authors. Scandinavian Journal of Caring Sciences

  13. Infective endocarditis following percutaneous pulmonary valve replacement

    DEFF Research Database (Denmark)

    Cheung, Gary; Vejlstrup, Niels; Ihlemann, Nikolaj;

    2013-01-01

    Infective endocarditis (IE) following percutaneous pulmonary valve replacement (PPVR) with the Melody valve is rarely reported. Furthermore, there are challenges in this diagnosis; especially echocardiographic evidence of vegetation within the prosthesis may be difficult.......Infective endocarditis (IE) following percutaneous pulmonary valve replacement (PPVR) with the Melody valve is rarely reported. Furthermore, there are challenges in this diagnosis; especially echocardiographic evidence of vegetation within the prosthesis may be difficult....

  14. Strategic vehicle fleet management - the replacement problem

    Directory of Open Access Journals (Sweden)

    Adam Redmer

    2016-03-01

    Full Text Available Background: Fleets constitute the most important production means in transportation. Their appropriate management is crucial for all companies having transportation duties. The paper is the third one of a series of three papers that the author dedicates to the strategic vehicle fleet management topic. Material and methods: The paper discusses ways of building replacement strategies for companies' fleets of vehicles. It means deciding for how long to exploit particular vehicles in a fleet (the fleet replacement problem - FR. The essence of this problem lies in the minimization of vehicle / fleet exploitation costs by balancing ownership and utilization costs and taking into account budget limitations. In the paper an original mathematical model (an optimization method allowing for the FR analysis is proposed. Results: An application of the proposed optimization method in a real-life decision situation (the case study within the Polish environment and the obtained solution are presented. The solution shows that there exist optimal exploitation periods of particular vehicles in a fleet. However, combination of them gives a replacement plan for an entire fleet violating budget constraints. But it is possible to adjust individual age to replacement of particular vehicles to fulfill budget constraints without losing economical optimality of a developed replacement plan for an entire fleet. Conclusions: The paper is the last one of a series of three papers that the author dedicated to the strategic vehicle fleet management topic including the following managerial decision problems: MAKE-or-BUY, sizing / composition and replacement.

  15. Valuing insect pollination services with cost of replacement.

    Science.gov (United States)

    Allsopp, Mike H; de Lange, Willem J; Veldtman, Ruan

    2008-09-10

    Value estimates of ecosystem goods and services are useful to justify the allocation of resources towards conservation, but inconclusive estimates risk unsustainable resource allocations. Here we present replacement costs as a more accurate value estimate of insect pollination as an ecosystem service, although this method could also be applied to other services. The importance of insect pollination to agriculture is unequivocal. However, whether this service is largely provided by wild pollinators (genuine ecosystem service) or managed pollinators (commercial service), and which of these requires immediate action amidst reports of pollinator decline, remains contested. If crop pollination is used to argue for biodiversity conservation, clear distinction should be made between values of managed- and wild pollination services. Current methods either under-estimate or over-estimate the pollination service value, and make use of criticised general insect and managed pollinator dependence factors. We apply the theoretical concept of ascribing a value to a service by calculating the cost to replace it, as a novel way of valuing wild and managed pollination services. Adjusted insect and managed pollinator dependence factors were used to estimate the cost of replacing insect- and managed pollination services for the Western Cape deciduous fruit industry of South Africa. Using pollen dusting and hand pollination as suitable replacements, we value pollination services significantly higher than current market prices for commercial pollination, although lower than traditional proportional estimates. The complexity associated with inclusive value estimation of pollination services required several defendable assumptions, but made estimates more inclusive than previous attempts. Consequently this study provides the basis for continued improvement in context specific pollination service value estimates.

  16. Valuing insect pollination services with cost of replacement.

    Directory of Open Access Journals (Sweden)

    Mike H Allsopp

    Full Text Available Value estimates of ecosystem goods and services are useful to justify the allocation of resources towards conservation, but inconclusive estimates risk unsustainable resource allocations. Here we present replacement costs as a more accurate value estimate of insect pollination as an ecosystem service, although this method could also be applied to other services. The importance of insect pollination to agriculture is unequivocal. However, whether this service is largely provided by wild pollinators (genuine ecosystem service or managed pollinators (commercial service, and which of these requires immediate action amidst reports of pollinator decline, remains contested. If crop pollination is used to argue for biodiversity conservation, clear distinction should be made between values of managed- and wild pollination services. Current methods either under-estimate or over-estimate the pollination service value, and make use of criticised general insect and managed pollinator dependence factors. We apply the theoretical concept of ascribing a value to a service by calculating the cost to replace it, as a novel way of valuing wild and managed pollination services. Adjusted insect and managed pollinator dependence factors were used to estimate the cost of replacing insect- and managed pollination services for the Western Cape deciduous fruit industry of South Africa. Using pollen dusting and hand pollination as suitable replacements, we value pollination services significantly higher than current market prices for commercial pollination, although lower than traditional proportional estimates. The complexity associated with inclusive value estimation of pollination services required several defendable assumptions, but made estimates more inclusive than previous attempts. Consequently this study provides the basis for continued improvement in context specific pollination service value estimates.

  17. Halide test agent replacement study

    Energy Technology Data Exchange (ETDEWEB)

    Banks, E.M.; Freeman, W.P.; Kovach, B.J. [and others

    1995-02-01

    The intended phaseout of the chlorofluorocarbons (CFCs) from commercial use required the evaluation of substitute materials for the testing for leak paths through both individual adsorbers and installed adsorbent banks. The American Society of Mechanical Engineers (ASME) Committee on Nuclear Air and Gas Treatment (CONAGT) is in charge of maintaining the standards and codes specifying adsorbent leak test methods for the nuclear safety related air cleaning systems. The currently published standards and codes cite the use of R-11, R-12 and R-112 for leak path test agents. All of these compounds are CFCs. There are other agencies and organizations (USDOE, USDOD and USNRC) also specifying testing for leak paths or in some cases for special life tests using the above compounds. The CONAGT has recently developed criteria for the suitability evaluation of substitute test agents. On the basis of these criteria, several compounds were evaluated for their acceptability as adsorbent bed leak and life test agents. The ASME CONAGT Test Agent Qualification Criteria. The test agent qualification is based on the following parameters: (1) Similar retention times on activated carbons at the same concentration levels as one of the following: R-11, R-12, R-112 or R-112a. (2) Similar lower detection limit sensitivity and precision in the concentration range of use as R-11, R-12, R-112 and R-112a. (3) Gives the same in-place leak test results as R-11, R-12, R-112, or R-112a. (4) Chemical and radiological stability under the use conditions. (5) Causes no degradation of the carbon and its impregnant or of the other NATS components under the use conditions. (6) Is listed in the USEPA Toxic Substances Control Act (TSCA) inventory for commercial use.

  18. 'Emerging technologies for the changing global market' - Prioritization methodology for chemical replacement

    Science.gov (United States)

    Cruit, Wendy; Schutzenhofer, Scott; Goldberg, Ben; Everhart, Kurt

    1993-01-01

    This project served to define an appropriate methodology for effective prioritization of technology efforts required to develop replacement technologies mandated by imposed and forecast legislation. The methodology used is a semiquantitative approach derived from quality function deployment techniques (QFD Matrix). This methodology aims to weight the full environmental, cost, safety, reliability, and programmatic implications of replacement technology development to allow appropriate identification of viable candidates and programmatic alternatives. The results will be implemented as a guideline for consideration for current NASA propulsion systems.

  19. Potential of ZrO clusters as replacement Pd catalyst

    Energy Technology Data Exchange (ETDEWEB)

    Behera, Swayamprabha; King, Nicholas; Jena, Puru, E-mail: pjena@vcu.edu [Department of Physics, Virginia Commonwealth University, Richmond, Virginia 23284 (United States); Samanta, Devleena [Department of Chemistry, Virginia Commonwealth University, Richmond, Virginia 23284, USA and Department of Chemistry, Stanford University, Stanford, California 94305 (United States)

    2014-07-21

    Atomic clusters with specific size and composition and mimicking the chemistry of elements in the periodic table are commonly known as superatoms. It has been suggested that superatoms could be used to replace elements that are either scarce or expensive. Based on a photoelectron spectroscopy experiment of negatively charged ions, Castleman and co-workers [Proc. Natl. Acad. Sci. U.S.A. 107, 975 (2010)] have recently shown that atoms of Ni, Pd, and Pt which are well known for their catalytic properties, have the same electronic structure as their counterpart isovalent diatomic species, TiO, ZrO, and WC, respectively. Based on this similarity they have suggested that ZrO, for example, could be a replacement catalyst for Pd. Since catalysts are seldom single isolated atoms, one has to demonstrate that clusters of ZrO also have the same electronic structure as same sized Pd clusters. To examine if this is indeed the case, we have calculated the geometries, electronic structure, electron affinity, ionization potential, and hardness of Pd{sub n} and (ZrO){sub n} clusters (n = 1-5). We further studied the reaction of these clusters in neutral and charged forms with H{sub 2}, O{sub 2}, and CO and found it to be qualitatively different in most cases. These results obtained using density functional theory with hybrid B3LYP functional do not support the view that ZrO clusters can replace Pd as a catalyst.

  20. Physiology and Endocrinology Symposium: Nutritional aspects of developing replacement heifers.

    Science.gov (United States)

    Funston, R N; Martin, J L; Larson, D M; Roberts, A J

    2012-04-01

    Studies in numerous species provide evidence that diet during development can mediate physiological changes necessary for puberty. In cattle, several studies have reported inverse correlations between postweaning growth rate and age at puberty and heifer pregnancy rates. Thus, postweaning growth rate was determined to be an important factor affecting age of puberty, which in turn influences pregnancy rates. This and other research conducted during the late 1960s through the early 1980s indicated puberty occurs at a genetically predetermined size, and only when heifers reach their target BW can increased pregnancy rates be obtained. Guidelines were established indicating replacement heifers should achieve 60 to 65% of their expected mature BW by breeding. Traditional approaches for postweaning development of replacement heifers used during the last several decades have primarily focused on feeding heifers to achieve or exceed an appropriate target BW and thereby maximize heifer pregnancy rates. Intensive heifer development systems may maximize pregnancy rates, but not necessarily optimize profit or sustainability. Since inception of target BW guidelines, subsequent research demonstrated that the growth pattern heifers experience before achieving a critical target BW could be varied. Altering rate and timing of BW gain can result in compensatory growth periods, providing an opportunity to decrease feed costs. Recent research has demonstrated that feeding replacement heifers to traditional target BW increased development costs without improving reproduction or subsequent calf production relative to development systems in which heifers were developed to lighter target BW ranging from 50 to 57% of mature BW.

  1. 36 CFR 72.72 - Conversion requirements.

    Science.gov (United States)

    2010-07-01

    ..., replacement property should be immediately acquired. Exceptions to this rule would occur only when it is not... tennis courts to basketball courts, for example, would not require NPS approval. A change from a swimming...

  2. Total Humeral Endoprosthetic Replacement following Excision of Malignant Bone Tumors

    Directory of Open Access Journals (Sweden)

    Suhel Kotwal

    2016-01-01

    Full Text Available Humerus is a common site for malignant tumors. Advances in adjuvant therapies and reconstructive methods provide salvage of the upper limb with improved outcomes. Reports of limb salvage with total humeral replacement in extensive humeral tumors are sparse. We undertook a retrospective study of 20 patients who underwent total humeral endoprosthetic replacement as limb salvage following excision of extensile malignant tumor from 1990 to 2011. With an average followup of 42.9, functional and oncological outcomes were analyzed. Ten patients were still alive at the time of review. Mean estimated blood loss was 1131 mL and duration of surgery was 314 minutes. Deep infection was encountered in one patient requiring debridement while mechanical loosening of ulnar component was identified in one patient. Subluxation of prosthetic humeral head was noted in 3 patients. Mean active shoulder abduction was 12.5° and active flexion was 15°. Incompetence of abduction mechanism was the major determinant of poor active functional outcome. Mean elbow flexion was 103.5° with 30.5° flexion contracture in 10 patients with good and useful hand function. Average MSTS score was 71.5%. Total humeral replacement is a reliable treatment option in restoring mechanical stability and reasonable functional results without compromising patient survival, with low complication rate.

  3. Cell replacement therapy for central nervous system diseases

    Institute of Scientific and Technical Information of China (English)

    Danju Tso; Randall D. McKinnon

    2015-01-01

    The brain and spinal cord can not replace neurons or supporting glia that are lost through trau-matic injury or disease. In pre-clinical studies, however, neural stem and progenitor cell transplants can promote functional recovery. Thus the central nervous system is repair competent but lacks endogenous stem cell resources. To make transplants clinically feasible, this ifeld needs a source of histocompatible, ethically acceptable and non-tumorgenic cells. One strategy to generate pa-tient-speciifc replacement cells is to reprogram autologous cells such as ifbroblasts into pluripotent stem cells which can then be differentiated into the required cell grafts. However, the utility of pluripotent cell derived grafts is limited since they can retain founder cells with intrinsic neoplastic potential. A recent extension of this technology directly reprograms ifbroblasts into the ifnal graft-able cells without an induced pluripotent stem cell intermediate, avoiding the pluripotent caveat. For both types of reprogramming the conversion efficiency is very low resulting in the need to amplify the cells in culture which can lead to chromosomal instability and neoplasia. Thus to make reprogramming biology clinically feasible, we must improve the efifciency. The ultimate source of replacement cells may reside in directly reprogramming accessible cells within the brain.

  4. Software for handling and replacement of missing data

    Directory of Open Access Journals (Sweden)

    Mayer, Benjamin

    2009-10-01

    Full Text Available In medical research missing values often arise in the course of a data analysis. This fact constitutes a problem for different reasons, so e.g. standard methods for analyzing data lead to biased estimates and a loss of statistical power due to missing values, since those methods require complete data sets and therefore omit incomplete cases for the analyses. Furthermore missing values imply a certain loss of information for what reason the validity of results of a study with missing values has to be rated less than in a case where all data had been available. For years there are methods for replacement of missing values (Rubin, Schafer to tackle these problems and solve them in parts. Hence in this article we want to present the existing software to handle and replace missing values on the one hand and give an outline about the available options to get information on the other hand. The methodological aspects of the replacement strategies are delineated just briefly in this article.

  5. The Application of Acupuncture in Replacement of Hormonotherapy

    Institute of Scientific and Technical Information of China (English)

    Cheng Lihong; Wang Xinzhong

    2007-01-01

    @@ By means of oral administration or external application, hormone can be widely used in clinical treatment of various diseases. However, along with the therapeutic effects, hormonotherapy can also bring about certain side effects to the human body.In the two years of clinical practice in Germany from 2002-2004, the author of this article had applied acupuncture in replacement of hormonotherapy to treat many diseases, and obtained certain therapeutic effects. The following is an introduction of the clinical experience in this aspect.

  6. Radiological assessment of steam generator repair and replacement

    Energy Technology Data Exchange (ETDEWEB)

    Parkhurst, M.A.; Rathbun, L.A.; Murphy, D.W.

    1983-12-01

    Previous analyses of the radiological impact of removing and replacing corroded steam generators have been updated based on experience at Surry Units 1 and 2 and Turkey Point Units 3 and 4. The sleeving repairs of degraded tubes at San Onofre Unit 1, Point Beach Unit 2, and R.E. Ginna are also analyzed. Actual occupational doses incurred during application of the various technologies used in repairs have been included, along with radioactive waste quantities and constituents. Considerable progress has been made in improving radiation protection and reducing worker dose by the development of remotely controlled equipment and the implementation of dose reduction strategies that have been successful in previous repair operations.

  7. Posterior Ankle Structure Injury During Total Ankle Replacement.

    Science.gov (United States)

    Reb, Christopher W; McAlister, Jeffrey E; Hyer, Christopher F; Berlet, Gregory C

    2016-01-01

    Total ankle replacement studies have focused on reporting complications that are directly observed clinically or radiographically, including wound problems, technical errors, implant loosening, subsidence, infection, bone fractures, and heterotopic ossification. However, patients can still experience unresolved pain even when these problems have been ruled out. We initiated a study to more clearly define the relative risk of injury to the anatomic structures in the posterior ankle during total ankle replacement using a third-generation implant system. Ten fresh-frozen adult cadaveric below-the-knee specimens were positioned in the intraoperative positioning frame of an approved total ankle replacement system and adjusted to achieve proper foot alignment using fluoroscopic imaging. The relationship between the tibial cutting guide pins and the posterior neurovascular and tendon structures was measured using digital calipers. High rates of posterior structural injury were found. Nearly all proximal-medial pins encountered a posteromedial neurovascular structure, most commonly the tibial nerve. The distal-medial pins mainly encountered posteromedial tendinous structures, in particular, the flexor digitorum longus tendon. The proximal lateral pins were highly likely to encounter the Achilles tendon and the sural nerve. Our results support our hypothesis that the tibial neurovascular structures are at the greatest risk when preparing for and completing the bony resection, particularly with the medial and proximal cuts. Posterior ankle soft tissue structure injuries can occur during implantation but currently with unknown frequency and undetermined significance. Further study of posterior structural injuries could result in a more informed approach to post-total ankle replacement complications and management.

  8. Testosterone replacement therapy and prostate health.

    Science.gov (United States)

    Polackwich, A Scott; Ostrowski, Kevin A; Hedges, Jason C

    2012-12-01

    There is an emerging evolution in the understanding of the relationship between the prostate and testosterone. It has long been generally believed that with testosterone replacement therapy (TRT), increasing serum testosterone levels led to prostatic growth and worsening of voiding dysfunction and associated complications. A new theory, the Saturation Model of Testosterone and its effect on the Prostate has gained attention. This theory suggests that the prostate's response to increasing levels of serum testosterone reaches a limit beyond which there is minimal effect. This model predicts that testosterone replacement therapy occurs above this saturation point, and replacing testosterone to eugonadal levels should not worsen prostate related benign disease. We evaluated the recent published data, with an emphasis on clinical studies done within the last 3 years, for the effects of testosterone supplementation on benign prostatic disease.

  9. Postmenopausal hormone replacement therapy--clinical implications

    DEFF Research Database (Denmark)

    Ravn, S H; Rosenberg, J; Bostofte, E

    1994-01-01

    in the urogenital tract. Women at risk of osteoporosis will benefit from hormone replacement therapy. The treatment should start as soon after menopause as possible and it is possible that it should be maintained for life. The treatment may be supplemented with extra calcium intake, vitamin D, and maybe calcitonin....... Physical activity should be promoted, and cigarette smoking reduced if possible. Women at risk of cardiovascular disease will also benefit from hormone replacement therapy. There is overwhelming evidence that hormone therapy will protect against both coronary heart disease and stroke...... suggest that every woman showing any signs of hormone deprivation should be treated with hormone replacement therapy. This includes women with subjective or objective vaso-motor symptoms, genito-urinary symptoms, women at risk of osteoporosis (fast bone losers), and women at risk of cardiovascular...

  10. Renal function after elective total hip replacement

    DEFF Research Database (Denmark)

    Perregaard, Helene; Damholt, Mette B; Solgaard, Søren

    2016-01-01

    and the prevalence of chronic kidney disease (CKD) in an elective population of orthopedic patients undergoing primary total hip replacement, hypothesizing that chronic kidney disease predisposes to AKI. Patients and methods - This was a single-center, population-based, retrospective, registry-based cohort study...... involving all primary elective total hip replacements performed from January 2003 through December 2012. Patient demographics and creatinine values were registered. We evaluated the presence of CKD and AKI according to the international guidelines for kidney disease (KDIGO Acute Kidney Injury Workgroup 2013...... ). Results - 3,416 patients were included (2,064 females (60%)). AKI (according to KDIGO criteria) was seen in 75 patients (2.2%, 95% CI: 1.7-2.7) in the course of primary total hip replacement. Of these, 26 had pre-existing CKD of class 3-5. Pre-existing CKD of class 3-5, indicating moderately to severely...

  11. Dead pixel replacement in LWIR microgrid polarimeters.

    Science.gov (United States)

    Ratliff, Bradley M; Tyo, J Scott; Boger, James K; Black, Wiley T; Bowers, David L; Fetrow, Matthew P

    2007-06-11

    LWIR imaging arrays are often affected by nonresponsive pixels, or "dead pixels." These dead pixels can severely degrade the quality of imagery and often have to be replaced before subsequent image processing and display of the imagery data. For LWIR arrays that are integrated with arrays of micropolarizers, the problem of dead pixels is amplified. Conventional dead pixel replacement (DPR) strategies cannot be employed since neighboring pixels are of different polarizations. In this paper we present two DPR schemes. The first is a modified nearest-neighbor replacement method. The second is a method based on redundancy in the polarization measurements.We find that the redundancy-based DPR scheme provides an order-of-magnitude better performance for typical LWIR polarimetric data.

  12. Maintainability design criteria for packaging of spacecraft replaceable electronic equipment.

    Science.gov (United States)

    Kappler, J. R.; Folsom, A. B.

    1972-01-01

    Maintainability must be designed into long-duration spacecraft and equipment to provide the required high probability of mission success with the least cost and weight. The ability to perform repairs quickly and easily in a space environment can be achieved by imposing specific maintainability design criteria on spacecraft equipment design and installation. A study was funded to investigate and define design criteria for electronic equipment that would permit rapid removal and replacement in a space environment. The results of the study are discussed together with subsequent simulated zero-g demonstration tests of a mockup with new concepts for packaging.

  13. Maintainability design criteria for packaging of spacecraft replaceable electronic equipment.

    Science.gov (United States)

    Kappler, J. R.; Folsom, A. B.

    1972-01-01

    Maintainability must be designed into long-duration spacecraft and equipment to provide the required high probability of mission success with the least cost and weight. The ability to perform repairs quickly and easily in a space environment can be achieved by imposing specific maintainability design criteria on spacecraft equipment design and installation. A study was funded to investigate and define design criteria for electronic equipment that would permit rapid removal and replacement in a space environment. The results of the study are discussed together with subsequent simulated zero-g demonstration tests of a mockup with new concepts for packaging.

  14. Hip or knee replacement - after - what to ask your doctor

    Science.gov (United States)

    ... replacement Hip pain Knee joint replacement Knee pain Osteoarthritis ... Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, ...

  15. Hip or knee replacement - before - what to ask your doctor

    Science.gov (United States)

    ... replacement Hip pain Knee joint replacement Knee pain Osteoarthritis ... Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, ...

  16. The echocardiography of replacement heart valves

    Science.gov (United States)

    2016-01-01

    This is a practical description of how replacement valves are assessed using echocardiography. Normal transthoracic appearances including normal variants are described. The problem of differentiating normal function, patient–prosthesis mismatch and pathological obstruction in aortic replacement valves with high gradients is discussed. Obstruction and abnormal regurgitation is described for valves in the aortic, mitral and right-sided positions and when to use echocardiography in suspected infective endocarditis. The roles of transoesophageal and stress echocardiography are described and finally when other imaging techniques may be useful. PMID:27600454

  17. Putting User Stories First: Experiences Adapting the Legacy Data Models and Information Architecture at NASA JPL's PO.DAAC to Accommodate the New Information Lifecycle Required by SWOT

    Science.gov (United States)

    McGibbney, L. J.; Hausman, J.; Laurencelle, J. C.; Toaz, R., Jr.; McAuley, J.; Freeborn, D. J.; Stoner, C.

    2016-12-01

    The Surface Water & Ocean Topography (SWOT) mission brings together two communities focused on a better understanding of the world's oceans and its terrestrial surface waters. U.S. and French oceanographers and hydrologists and international partners have joined forces to develop this new space mission. At NASA JPL's PO.DAAC, the team is currently engaged in the gathering of SWOT User Stores (access patterns, metadata requirements, primary and value added product requirements, data access protocols, etc.) to better inform the adaptive planning of what will be known as the next generation PO.DAAC Information Architecture (IA). The IA effort acknowledges that missions such as SWOT (and NISAR) have few or no precedent in terms of data volume, hot and cold storage, archival, analysis, existing system engineering complexities, etc. and that the only way we can better understand the projected impacts of such requirements is to interface directly with the User Community. Additionally, it also acknowledges that collective learning has taken place to understand certain limitations in the existing data models (DM) underlying the existing PO.DAAC Data Management and Archival System. This work documents an evolutionary, use case based, standards driven approach to adapting the legacy DM and accompanying knowledge representation infrastructure at NASA JPL's PO.DAAC to address forthcoming DAAC mission requirements presented by missions such as SWOT. Some of the topics covered in this evolution include, but are not limited to: How we are leveraging lessons learned from the development of existing DM (such as that generated for SMAP) in an attempt to map them to SWOT. What is the governance model for the SWOT IA? What are the `governing' entities? What is the hierarchy of the `governed entities'? How are elements grouped? How is the design-working group formed? How is model independence maintained and what choices/requirements do we have for the implementation language? The use of

  18. Upgrade or replace?: The effect of the EPBD on the choice between improvement or replacement

    NARCIS (Netherlands)

    Thomsen, A.F.; Van der Flier, C.L.

    2010-01-01

    What is better: improvement or replacement by new construction? The choice between life cycle extension and replacement of existing buildings is at itself a vital but very difficult decision, involving a wide range of different aspects and affecting several contrary and often conflicting interests.

  19. Breakfast replacement with a low-glycaemic response liquid formula in patients with type 2 diabetes : a randomised clinical trial

    NARCIS (Netherlands)

    Stenvers, Dirk J; Schouten, Lydia J; Jurgens, Jordy; Endert, Erik; Kalsbeek, A.; Fliers, Eric; Bisschop, Peter H

    2014-01-01

    Low-glycaemic index diets reduce glycated Hb (HbA1c) in patients with type 2 diabetes, but require intensive dietary support. Using a liquid meal replacement with a low glycaemic response (GR) may be an alternative dietary approach. In the present study, we investigated whether breakfast replacement

  20. Anti-ischemic effect of chronic oestrogen replacement therapy alone or in combination with medroxyprogesterone acetate in different replacement schemes.

    Science.gov (United States)

    Cerquetani, E; Leonardo, F; Pagnotta, P; Galetta, P; Onorati, D; Fini, M; Rosano, G M

    2001-09-28

    Oestrogen replacement therapy in postmenopausal women has a protective effect upon the cardiovascular system and improves exercise-induced myocardial ischemia. Although in hormone replacement schemes progestins are required to reduce the likelihood of uterine malignancies, little is known on the cardiovascular effect of progestins. The purpose of this study was to evaluate the effect of oestrogen replacement alone and two different estrogen-progestin replacement therapy schemes upon exercise induced myocardial ischemia. The study population included 18 female menopausal patients with coronary artery disease. After a baseline exercise test patients received conjugated equine estrogens (CEE) 0.625 mg alone for 30 days when they underwent a second exercise test and were randomized to receive in a cross-over design medroxyprogesterone acetate (MPA) either in continuous combined therapy (2.5 mg/daily) for 28 days or in cyclical therapy (10 mg o.d. from day 16 to day 28). After CEE alone two patients with a previously positive exercise test showed a negative exercise test. CEE increased time to 1 mm ST compared to baseline (352+/-185 vs 265+/-133 s, Pexercise test was negative after CEE the test remained negative during continuous combined MPA therapy while become positive during cyclical MPA. CEE+continuous combined MPA increased both time to 1 mm ST and exercise time compared to baseline (386+/-165 vs 265+/-133 s, Pexercise time (268+/-164 vs 265+/-133 s, P=NS and 455+/-223 vs 465+/-186 s, P=NS, respectively). Continuous combined therapy with CEE+MPA improves exercise-induced myocardial ischemia in female patients with coronary artery disease while the beneficial effect of CEE is reduced by cyclical therapy.

  1. Potential of Microbubbles as Fat Replacer

    NARCIS (Netherlands)

    Rovers, T.A.M.; Sala, Guido; Linden, Van der Erik; Meinders, M.B.J.

    2016-01-01

    The potential of microbubbles as fat replacers and texture modifiers was assessed by comparison of the rheological and tribological properties of model food systems that contained (1) microbubbles, (2) emulsion droplets or (3) no added colloidal structures. We used (a) liquids with thickener, (b)

  2. Predictors of mortality after aortic valve replacement

    NARCIS (Netherlands)

    Tjang, Yanto Sandy; van Hees, Yvonne; Koerfer, Reiner; Grobbee, Diederick E.; van der Heijden, Geert J. M. G.

    Aortic valve replacement (AVR) is recommended as a standard surgical procedure for aortic valve disease. Still the evidence for commonly claimed predictors of post-AVR prognosis, in particular mortality, appears scant. This systematic review reports on the evidence for predictors of post-AVR

  3. Is physiological glucocorticoid replacement important in children?

    Science.gov (United States)

    Porter, John; Blair, Joanne; Ross, Richard J

    2017-01-01

    Cortisol has a distinct circadian rhythm with low concentrations at night, rising in the early hours of the morning, peaking on waking and declining over the day to low concentrations in the evening. Loss of this circadian rhythm, as seen in jetlag and shift work, is associated with fatigue in the short term and diabetes and obesity in the medium to long term. Patients with adrenal insufficiency on current glucocorticoid replacement with hydrocortisone have unphysiological cortisol concentrations being low on waking and high after each dose of hydrocortisone. Patients with adrenal insufficiency complain of fatigue, a poor quality of life and there is evidence of poor health outcomes including obesity potentially related to glucocorticoid replacement. New technologies are being developed that deliver more physiological glucocorticoid replacement including hydrocortisone by subcutaneous pump, Plenadren, a once-daily modified-release hydrocortisone and Chronocort, a delayed and sustained absorption hydrocortisone formulation that replicates the overnight profile of cortisol. In this review, we summarise the evidence regarding physiological glucocorticoid replacement with a focus on relevance to paediatrics. PMID:27582458

  4. 25 CFR 700.53 - Dwelling, replacement.

    Science.gov (United States)

    2010-04-01

    ... § 700.55. (b) May include existing dwellings for resale, new construction, modular homes, mobile homes... person if, after he receives a replacement housing payment and any available housing assistance payments... supplemental income payments received from public agencies. If the person's monthly income pattern is...

  5. Prosthesis infections after orthopedic joint replacement

    DEFF Research Database (Denmark)

    Song, Zhijun; Borgwardt, Lotte; Høiby, Niels

    2013-01-01

    Prosthesis-related infection is a serious complication for patients after orthopedic joint replacement, which is currently difficult to treat with antibiotic therapy. Consequently, in most cases, removal of the infected prosthesis is the only solution to cure the infection. It is, therefore...

  6. Criteria for the replacement of restorations

    DEFF Research Database (Denmark)

    Wilson, Nairn; Lynch, Christopher; Brunton, Paul Brunton

    2016-01-01

    The replacement of a restoration is one of the most common procedures in dentistry. However, the criteria for such intervention, excluding catastrophic failure and persistent discomfort and pain, continue to be the subject of considerable debate. The decision-making process remains subjective...

  7. Measure Guideline: Window Repair, Rehabilitation, and Replacement

    Energy Technology Data Exchange (ETDEWEB)

    Baker, P.

    2012-12-01

    This measure guideline provides information and guidance on rehabilitating, retrofitting, and replacing existing window assemblies in residential construction. The intent is to provide information regarding means and methods to improve the energy and comfort performance of existing wood window assemblies in a way that takes into consideration component durability, in-service operation, and long term performance of the strategies.

  8. Segmental blood pressure after total hip replacement

    DEFF Research Database (Denmark)

    Gebuhr, Peter Henrik; Soelberg, M; Henriksen, Jens Henrik Sahl

    1992-01-01

    Twenty-nine patients due to have a total hip replacement had their systemic systolic and segmental blood pressures measured prior to operation and 1 and 6 weeks postoperatively. No patients had signs of ischemia. The segmental blood pressure was measured at the ankle and at the toes. A significant...

  9. Method of replacing corrupted audio data

    NARCIS (Netherlands)

    Stemerdink, J.; Meijerink, Arjan

    2006-01-01

    A decoding method for coded data representing original data. Corrupted data is detected and replaced with buffered data. The buffered data is stored in the buffer a time interval corresponding to an estimated periodicity or an integer multiple thereof before the corrupted data was received. The esti

  10. Analogue Assessment of the Replacement Behavior

    Science.gov (United States)

    Cipani, Ennio

    2008-01-01

    The use of experimental analyses in determining behavioral function for problems behaviors is well established. Such analyses lead to functional treatment prescriptions for the target problem behavior. However, data indicative of the strength of the replacement behavior are often not collected during a functional behavioral assessment. I examine…

  11. Hormone replacement therapy and risk of glioma

    DEFF Research Database (Denmark)

    Andersen, Lene; Friis, Søren; Hallas, Jesper;

    2013-01-01

    Aim: Several studies indicate that use of hormone replacement therapy (HRT) is associated with an increased risk of intracranial meningioma, while associations between HRT use and risk of other brain tumors have been less explored. We investigated the influence of HRT use on the risk of glioma...

  12. Aggression Replacement Training and Childhood Trauma

    Science.gov (United States)

    Amendola, A. Mark; Oliver, Robert W.

    2013-01-01

    Aggression Replacement Training (ART) was developed by the late Arnold Goldstein of Syracuse University to teach positive alternatives to children and youth with emotional and behavioral problems (Glick & Gibbs, 2011; Goldstein, Glick, & Gibbs, 1998). ART provides cognitive, affective, and behavioral interventions to build competence in…

  13. Probability Issues in without Replacement Sampling

    Science.gov (United States)

    Joarder, A. H.; Al-Sabah, W. S.

    2007-01-01

    Sampling without replacement is an important aspect in teaching conditional probabilities in elementary statistics courses. Different methods proposed in different texts for calculating probabilities of events in this context are reviewed and their relative merits and limitations in applications are pinpointed. An alternative representation of…

  14. [Acute renal replacement therapy in pediatrics].

    Science.gov (United States)

    Gaillot, T; Ozanne, B; Bétrémieux, P; Tirel, O; Ecoffey, C

    2013-12-01

    In pediatric intensive care unit, the available modalities of acute renal replacement therapy include intermittent hemodialysis, peritoneal dialysis and continuous renal replacement therapies. No prospective studies have evaluated to date the effect of dialysis modality on the outcomes of children. The decision about dialysis modality should therefore be based on local expertise, resources available, and the patient's clinical status. Poor hemodynamic tolerance of intermittent hemodialysis is a common problem in critically ill patients. Moreover, many pediatric intensive care units are not equipped with dedicated water circuit. Peritoneal dialysis, a simple and inexpensive alternative, is the most widely available form of acute renal replacement therapy. However, its efficacy may be limited in critically ill patients. The use of continuous renal replacement therapy permits usually to reach a greater estimated dialysis dose, a better control of fluid balance, and additionally, to provide adequate nutrition. Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

  15. Revision Total Hip Replacement: A Case Report

    Directory of Open Access Journals (Sweden)

    Md Hafizur Rahman

    2013-07-01

    Full Text Available Total hip replacement is a reconstructive procedure that has improved the management of those diseases of the hip joint that have responded poorly to conventional medical therapy. Conventional, primary total hip replacement is a durable operation in the majority of patients. A hip replacement is a mechanical device with parts that are assembled before and during the operation. But the possible complications of total hip arthroplasty, and its clinical performance over time, is a challenging occasion to the surgeons, and such a challenge we faced with our presenting patient. A 68 year old lady with history of cemented bipolar hemiarthroplasty done in a tertiary care hospital, due to fracture neck of the left femur having the history of diabetes, chronic kidney disease, heart disease, anaemia, and mental disorders presented with loosened prosthesis, thinning of medial proximal cortex of the femur which had broken within few months after surgery. She complained of painful walking at left hip joint. There was also evidence of chronic infective and degenerative arthritis of acetabular component of the affected hip joint. Cemented revision total hip replacement surgery was performed with expert multidisciplinary involvement. On 2nd postoperative day the patient was allowed to walk on operated limb with the aid of walker. On 12th postoperative day all the stitches were removed and wound was found healthy.

  16. [Hormone replacement therapy: curse or blessing?].

    Science.gov (United States)

    Schmidt, M; Fink, D; Lang, U; Kimmig, R

    2006-01-01

    There is a controversial discussion on the risks and benefits of hormonal replacement therapy (HRT), and many women and doctors have revised their opinions of HRT over the last few years. Complementary and alternative therapies can be considered an option to treat menopausal symptoms. The following issue summarizes the actual knowledge of treatment options of menopausal symptoms.

  17. Enzyme replacement therapy for alpha-mannosidosis

    DEFF Research Database (Denmark)

    Borgwardt, Line Gutte; Dali, Christine I.; Fogh, J

    2013-01-01

    Alpha-mannosidosis (OMIM 248500) is a rare lysosomal storage disease (LSD) caused by alpha-mannosidase deficiency. Manifestations include intellectual disabilities, facial characteristics and hearing impairment. A recombinant human alpha-mannosidase (rhLAMAN) has been developed for weekly intrave...... intravenous enzyme replacement therapy (ERT). We present the preliminary data after 12 months of treatment....

  18. New experiences on the time required for the appearance of fluoric cachexia in the guinea pig following ingestion of various fluorine salts

    Energy Technology Data Exchange (ETDEWEB)

    Cristiani, H.; Chausse, P.

    1926-01-01

    Experiments were performed to compare the time it took guinea pigs to develop cachexia after being given sodium fluosilicate or sodium fluoride. Results indicate that a dose-response relationship existed following the ingestion of the fluorine salts in relation to the time it took to produce cachexia. In addition, sodium fluosilicate was found to be more toxic than sodium fluoride. In guinea pigs which were given approximately 1/30 to 1/36 of the lethal dose, cachexia was produced from 44 to 70 days later. In guinea pigs given even smaller doses, cachexia did not appear for one to two years.

  19. Evaluation of Different CH4-CO2 Replacement Processes in Hydrate-Bearing Sediments by Measuring P-Wave Velocity

    Directory of Open Access Journals (Sweden)

    Bei Liu

    2013-11-01

    Full Text Available The replacement of methane with carbon dioxide in natural gas hydrate-bearing sediments is considered a promising technology for simultaneously recovering natural gas and entrapping CO2. During the CH4-CO2 replacement process, the variations of geophysical property of the hydrate reservoir need to be adequately known. Since the acoustic wave velocity is an important geophysical property, in this work, the variations of P-wave velocity of hydrate-bearing sediments were measured during different CH4-CO2 replacement processes using pure gaseous CO2 and CO2/N2 gas mixtures. Our experimental results show that P-wave velocity continually decreased during all replacement processes. Compared with injecting pure gaseous CO2, injection of CO2/N2 mixture can promote the replacement process, however, it is found that the sediment experiences a loss of stiffness during the replacement process, especially when using CO2/N2 gas mixtures.

  20. Development of an internally braced prosthesis for total talus replacement.

    Science.gov (United States)

    Regauer, Markus; Lange, Mirjam; Soldan, Kevin; Peyerl, Steffen; Baumbach, Sebastian; Böcker, Wolfgang; Polzer, Hans

    2017-03-18

    Total loss of talus due to trauma or avascular necrosis, for example, still remains to be a major challenge in foot and ankle surgery with severely limited treatment options. Implantation of a custom made total talar prosthesis has shown promising results so far. Most important factors for long time success are degree of congruence of articular surfaces and ligamentous stability of the ankle. Therefore, our aim was to develop an optimized custom made prosthesis for total talus replacement providing a high level of primary stability. A custom made hemiprosthesis was developed using computed tomography and magnetic resonance imaging data of the affected and contralateral talus considering the principles and technology for the development of the S.T.A.R. prosthesis (Stryker). Additionally, four eyelets for fixation of artificial ligaments were added at the correspondent footprints of the most important ligaments. Two modifications can be provided according to the clinical requirements: A tri-articular hemiprosthesis or a bi-articular hemiprosthesis combined with the tibial component of the S.T.A.R. total ankle replacement system. A feasibility study was performed using a fresh frozen human cadaver. Maximum range of motion of the ankle was measured and ligamentous stability was evaluated by use of standard X-rays after application of varus, valgus or sagittal stress with 150 N. Correct implantation of the prosthesis was technically possible via an anterior approach to the ankle and using standard instruments. Malleolar osteotomies were not required. Maximum ankle dorsiflexion and plantarflexion were measured as 22-0-28 degrees. Maximum anterior displacement of the talus was 6 mm, maximum varus tilt 3 degrees and maximum valgus tilt 2 degrees. Application of an internally braced prosthesis for total talus replacement in humans is technically feasible and might be a reasonable procedure in carefully selected cases with no better alternatives left.

  1. Replacement of outboard main steam isolation valves in a boiling water reactor plant

    Energy Technology Data Exchange (ETDEWEB)

    Schlereth, J.R.; Pennington, D.

    1996-12-01

    Most Boiling Water Reactor plants utilize wye pattern globe valves for main steam isolation valves for both inboard and outboard isolation. These valves have required a high degree of maintenance attention in order to pass the plant local leakage rate testing (LLRT) requirements at each outage. Northern States Power made a decision in 1993 to replace the outboard valves at it`s Monticello plant with double disc gate valves. The replacement of the outboard valves was completed during the fall outage in 1994. During the spring outage in April of 1996 the first LLRT testing was performed with excellent results. This presentation will address the decision process, time requirements and planning necessary to accomplish the task as well as the performance results and cost effectiveness of replacing these components.

  2. Drug dosing during intermittent hemodialysis and continuous renal replacement therapy : special considerations in pediatric patients.

    Science.gov (United States)

    Veltri, Michael A; Neu, Alicia M; Fivush, Barbara A; Parekh, Rulan S; Furth, Susan L

    2004-01-01

    Chronic renal failure is, fortunately, an unusual occurrence in children; however, many children with various underlying illnesses develop acute renal failure, and transiently require renal replacement therapy - peritoneal dialysis, intermittent hemodialysis (IHD), or continuous renal replacement therapy (CRRT). As children with acute and chronic renal failure often have multiple comorbid conditions requiring drug therapy, generalists, intensivists, nephrologists, and pharmacists need to be aware of the issues surrounding the management of drug therapy in pediatric patients undergoing renal replacement therapy. This article summarizes the pharmacokinetics and dosing of many drugs commonly prescribed for pediatric patients, and focuses on the management of drug therapy in pediatric patients undergoing IHD and CRRT in the intensive care unit setting. Peritoneal dialysis is not considered in this review. Finally, a summary table with recommended initial dosages for drugs commonly encountered in pediatric patients requiring IHD or CRRT is presented.

  3. Influence of Total Knee Arthroplasty on Gait Mechanics of the Replaced and Non-Replaced Limb During Stair Negotiation.

    Science.gov (United States)

    Standifird, Tyler W; Saxton, Arnold M; Coe, Dawn P; Cates, Harold E; Reinbolt, Jeffrey A; Zhang, Songning

    2016-01-01

    This study compared biomechanics during stair ascent in replaced and non-replaced limbs of total knee arthroplasty (TKA) patients with control limbs of healthy participants. Thirteen TKA patients and fifteen controls performed stair ascent. Replaced and non-replaced knees of TKA patients were less flexed at contact compared to controls. The loading response peak knee extension moment was greater in control and non-replaced knees compared with replaced. The push-off peak knee abduction moment was elevated in replaced limbs compared to controls. Loading and push-off peak hip abduction moments were greater in replaced limbs compared to controls. The push-off peak hip abduction moment was greater in non-replaced limbs compared to controls. Future rehabilitation protocols should consider the replaced knee and also the non-replaced knee and surrounding joints.

  4. The minimum information required for a glycomics experiment (MIRAGE) project: improving the standards for reporting mass-spectrometry-based glycoanalytic data.

    Science.gov (United States)

    Kolarich, Daniel; Rapp, Erdmann; Struwe, Weston B; Haslam, Stuart M; Zaia, Joseph; McBride, Ryan; Agravat, Sanjay; Campbell, Matthew P; Kato, Masaki; Ranzinger, Rene; Kettner, Carsten; York, William S

    2013-04-01

    The MIRAGE guidelines are being developed in response to a critical need in the glycobiology community to clarify glycoanalytic results so that they are more readily evaluated (in terms of their scope and depth) and to facilitate the reproduction of important results in the laboratory. The molecular and biological complexity of the glycosylation process makes thorough reporting of the results of a glycomics experiment a highly challenging endeavor. The resulting data specify the identity and quantity of complex structures, the precise molecular features of which are sometimes inferred using prior knowledge, such as familiarity with a particular biosynthetic mechanism. Specifying the exact methods and assumptions that were used to assign and quantify reported structures allows the interested scientist to appreciate the scope and depth of the analysis. Mass spectrometry (MS) is the most widely used tool for glycomics experiments. The interpretation and reproducibility of MS-based glycomics data depend on comprehensive meta-data describing the instrumentation, instrument setup, and data acquisition protocols. The MIRAGE guidelines for MS-based glycomics have been designed to facilitate the collection and sharing of this critical information in order to assist the glycoanalyst in generating data sets with maximum information content and biological relevance.

  5. Competitive analysis of soybean and sudangrass using replacement series design

    Directory of Open Access Journals (Sweden)

    Mauro Antônio Rizzardi

    Full Text Available ABSTRACT Competition is the best known form of direct interference of weeds on agricultural crops. However, there is relatively little information on the competition of the weed sudangrass on soybean, which has been common in agricultural areas in the southern of Rio Grande do Sul. The objective of this study was to evaluate the competition between sudangrass and soybeans using replacement series experiments. The experiment was carried out in a greenhouse in a completely randomized design with four replications. The treatments consisted of soybean and sudangrass associations. The experimental units were 8-L plastic pots, in the proportions 0: 8, 2: 6, 4: 4, 6: 2, 8: 0, corresponding to 0, 25, 50, 75 and 100% of the crop and weed respectively. Shoot, root and total dry matter and plant height were analyzed through diagrams applied to replacement series and competitive indices. Soybean showed competitive superiority in coexistence with sudangrass in relation to shoot, root and total dry matter. The intraspecific competition was more significant for the crop and inter-specific competition was more important for the weed.

  6. Identifying the learning curve for total ankle replacement using a mobile bearing prosthesis.

    Science.gov (United States)

    Usuelli, Federico G; Maccario, Camilla; Pantalone, Andrea; Serra, Nicola; Tan, Eric W

    2017-06-01

    Total ankle arthroplasty remains a technically demanding surgery highly influenced by the operator experience. However, no consensus exists regarding the ideal number of cases that need to be performed before a surgeon is considered proficient. The aim of this study was to identify the learning curve of a specific replacement system with regards to intraoperative and postoperative outcomes. The first 31 patients undergoing total ankle arthroplasty were examined. No additional procedures were performed at the time of the TAA. Intraoperative characteristics, postoperative complications, as well as clinical and radiologic outcomes were assessed with 24-month follow-up. Learning curves, examining the relationship between surgeon experience and patient outcomes, were determined using the Moving Average Method. The operatory time, and the risk of intraoperative fractures decreased with increasing surgeon experience with the learning curve stabilizing after the 14th and 24th patient, respectively. Furthermore, there appeared to be a learning curve associated with most of the important clinical and radiological outcomes. The number of patients required to stabilize the learning curve for the VAS, ROM, and AOFAS was 11, 14 and 28, respectively. Radiographically, there appeared to be a learning curve of 22 patients required to stabilize the tibio-talar ratio. There was no learning curve associated with the SF-12 PCS and MCS as well as the α-, β-, and γ-angle. This study demonstrates that a surgical learning curve does indeed exist when performing TAA. Most of the operative variables as well as clinical and radiological outcomes stabilize after a surgeon has performed 28 cases. Copyright © 2016 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  7. Foley Catheters as Temporary Gastrostomy Tubes: Experience of a Nurse-Led Service.

    Science.gov (United States)

    Metussin, Adli; Sia, Rusanah; Bakar, Suriawati; Chong, Vui Heng

    2016-01-01

    Percutaneous endoscopic gastrostomy tube is the modality of choice for long-term enteral nutrition. In the event that replacement tubes are not available, urinary catheters can be used to maintain patency of the gastrostomy tract. This study reports our experience in a nurse-led service using Foley catheters as temporary gastrostomy tubes and the associated complications. Patients who had used Foley catheter as gastrostomy tube over a 2-year period (Jan 2011 to December 2012) were studied. Twenty-one patients had used Foley catheters as a temporary gastrostomy tube, and 12 (57.4%) did not experience any complications, including three patients who were still using Foley catheters at a median of 15 months (range 3-18). Two patients preferred the Foley catheter as feeding tubes. Six patients had replacements with formal balloon replacement tubes, and two patients did not require replacement. Complications occurred in nine (42.6%) patients: repeated burst Foley catheter balloon with peristomal leakage (n = 4), lumen blockage (n = 1), and catheter migration resulting in small bowel obstruction (n = 4). All complications were successfully managed with tube replacements. We showed that in a nurse-led service, using a Foley catheter as a temporary feeding gastrostomy tube is safe, but requires monitoring for complications.

  8. Hypoparathyroidism: clinical features, skeletal microstructure and parathyroid hormone replacement

    Science.gov (United States)

    Rubin, Mishaela R.; Bilezikian, John P.

    2013-01-01

    Objective Hypoparathyroidism is a disorder in which parathyroid hormone is deficient in the circulation due most often to immunological destruction of the parathyroids or to their surgical removal. The objective of this work was to define the abnormalities in skeletal microstructure as well as to establish the potential efficacy of PTH(1-84) replacement in this disorder. Subjects and methods Standard histomorphometric and μCT analyses were performed on iliac crest bone biopsies obtained from patients with hypoparathyroidism. Participants were treated with PTH(1-84) for two years. Results Bone density was increased and skeletal features reflected the low turnover state with greater BV/TV, Tb. Wi and Ct. Wi as well as suppressed MS and BFR/BS as compared to controls. With PTH(1-84), bone turnover and bone mineral density increased in the lumbar spine. Requirements for calcium and vitamin D fell while serum and urinary calcium concentrations did not change. Conclusion Abnormal microstructure of the skeleton in hypoparathyroidism reflects the absence of PTH. Replacement therapy with PTH has the potential to correct these abnormalities as well as to reduce the requirements for calcium and vitamin D. PMID:20485912

  9. [Pharmacokinetics of antibiotics in continuous renal replacement therapies (CRRT)].

    Science.gov (United States)

    Morabito, Santo; Pistolesi, Valentina; Maggiore, Umberto; Fiaccadori, Enrico; Pierucci, Alessandro

    2012-01-01

    In the critically ill patient, acute kidney injury (AKI) is frequently associated with infective complications requiring appropriate antimicrobial treatment. AKI and multiple organ dysfunction syndrome can affect the pharmacokinetic parameters of many drugs. Furthermore, the start of renal replacement therapy (RRT) is an additional variable to be taken into consideration to avoid inappropriate antimicrobial therapy. Continuous renal replacement therapies (CRRT) are widely adopted in the intensive care unit (ICU) and antibiotics that are significantly eliminated by the kidney are likely to be removed during RRT. Generally, drug-dosing adjustments are required if the extracorporeal clearance accounts for more than 25-30% of the total body clearance. The molecular weight cutoffs of the more widely used membranes are much higher than the molecular weight of most drugs. Therefore, molecular size will not be a limitation for the removal of the unbound fraction of the antibiotics most commonly used in ICU patients. However, CRRTs are still not standardized and the impact of RRT on plasma drug concentrations can be substantially different depending on the CRRT modality (diffusive, convective or both), membrane characteristics and delivered dialysis dose. In any case, drug-dosing adjustments should be based on the knowledge of the pharmacokinetic and pharmacodynamic properties of the different classes of antimicrobials, taking into account that high extracorporeal clearances could lead to drug underexposure in clinical conditions where appropriate antibiotic treatment is essential.

  10. 25 CFR 700.183 - Determination of replacement housing benefit.

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 2 2010-04-01 2010-04-01 false Determination of replacement housing benefit. 700.183... RELOCATION PROCEDURES Replacement Housing Payments § 700.183 Determination of replacement housing benefit. (a) Amount of benefit. The replacement housing benefit for a certified eligible head-of-household is...

  11. Nuclear facilities: repair and replacement technologies; Installations nucleaires: technologies de reparation et de remplacement

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2005-07-01

    The oldest operating reactors are more than 35 years old and are now facing major maintenance operations. The first replacement of a pressurizer took place in autumn 2005 at the St-Lucie plant (Usa) while steam generators have been currently replaced since 1983. Nuclear industry has to adapt to this new market by proposing innovative technological solutions in the reactor maintenance field. This document gathers the 9 papers presented at the conference. The main improvements concern repair works on internal components of PWR-type reactors, the replacement of major components of the primary coolant circuit and surface treatments to limit the propagation of damages. The first paper shows that adequate design and feedback experience are good assets to manage the ageing of a nuclear unit. Another paper shows that a new repair method of a relief valve can avoid its replacement. (A.C.)

  12. MS2Grouper: Group Assessment and Synthetic Replacement of Duplicate Proteomic Tandem Mass Spectra

    Energy Technology Data Exchange (ETDEWEB)

    Tabb, Dave L [ORNL; Thompson, Melissa R [ORNL; Khalsa-Moyers, Gurusahai K [ORNL; Verberkmoes, Nathan C [ORNL; McDonald, W Hayes [ORNL

    2005-01-01

    Shotgun proteomics experiments require the collection of thousands of tandem mass spectra; these sets of data will continue to grow as new instruments become available that can scan at even higher rates. Such data contain substantial amounts of redundancy with spectra from a particular peptide being acquired many times during a single LC-MS/MS experiment. In this article, we present MS2Grouper, an algorithm that detects spectral duplication, assesses groups of related spectra, and replaces these groups with synthetic representative spectra. Errors in detecting spectral similarity are corrected using a paraclique criterion -- spectra are only assessed as groups if they are part of a clique of at least three completely interrelated spectra or are subsequently added to such cliques by being similar to all but one of the clique members. A greedy algorithm constructs a representative spectrum for each group by iteratively removing the tallest peaks from the spectral collection and matching to peaks in the other spectra. This strategy is shown to be effective in reducing spectral counts by up to 20% in LC-MS/MS datasets from protein standard mixtures and proteomes, reducing database search times without a concomitant reduction in identified peptides.

  13. Esophageal tissue engineering: A new approach for esophageal replacement

    Institute of Scientific and Technical Information of China (English)

    Giorgia Totonelli; Panagiotis Maghsoudlou; Jonathan M Fishman; Giuseppe Orlando; Tahera Ansari; Paul Sibbons; Martin A Birchall

    2012-01-01

    A number of congenital and acquired disorders require esophageal tissue replacement.Various surgical techniques,such as gastric and colonic interposition,are standards of treatment,but frequently complicated by stenosis and other problems.Regenerative medicine approaches facilitate the use of biological constructs to replace or regenerate normal tissue function.We review the literature of esophageal tissue engineering,discuss its implications,compare the methodologies that have been employed and suggest possible directions for the future.Medline,Embase,the Cochrane Library,National Research Register and ClinicalTrials.gov databases were searched with the following search terms:stem cell and esophagus,esophageal replacement,esophageal tissue engineering,esophageal substitution.Reference lists of papers identified were also examined and experts in this field contacted for further information.All full-text articles in English of all potentially relevant abstracts were reviewed.Tissue engineering has involved acellular scaffolds that were either transplanted with the aim of being repopulated by host cells or seeded prior to transplantation.When acellular scaffolds were used to replace patch and short tubular defects they allowed epithelial and partial muscular migration whereas when employed for long tubular defects the results were poor leading to an increased rate of stenosis and mortality.Stenting has been shown as an effective means to reduce stenotic changes and promote cell migration,whilst omental wrapping to induce vascularization of the construct has an uncertain benefit.Decellularized matrices have been recently suggested as the optimal choice for scaffolds,but smart polymers that will incorporate signalling to promote cell-scaffold interaction may provide a more reproducible and available solution.Results in animal models that have used seeded scaffolds strongly suggest that seeding of both muscle and epithelial cells on scaffolds prior to implantation is a

  14. Replacing the NIH test for rabies vaccine potency testing: a synopsis of drivers and barriers.

    Science.gov (United States)

    Schiffelers, Marie-Jeanne; Blaauboer, Bas; Bakker, Wieger; Hendriksen, Coenraad

    2014-07-01

    Approximately 70% of animal use is utilized to demonstrate quality control of vaccines. Especially rabies vaccine potency testing, using the NIH challenge test, involves objections in terms of scientific relevance, animal welfare concern and costs. Several 3R models have been proposed to refine, reduce or replace this test. Some are formally incorporated into regulatory requirements, but actual regulatory acceptance and use by industry lags behind, raising the question concerning which factors influence this process. This question is answered by a combination of literature review, interviews and a survey among 50 rabies vaccine experts. The findings are analyzed using the multilevel perspective on technology transition, which distinguishes 3 levels of factors influencing innovation acceptance. At the micro level (where 3R models are developed and validated) the dis-advantages of, and fractional experience with, 3R models, scarce data sharing and demanding validation processes exist. The meso level (existing regulatory regime) encloses the barriers of the 'gold standard', the lack of harmonization and the driving force of legislation stimulating 3Rs use. The macro level (the societal context) combines risk aversion and increased concern for animal welfare. Regulatory acceptance and use of 3R models requires dedicated stakeholder communication, cooperation and coordination at all three levels.

  15. Transarterial embolization of massive gastric ulcer bleeding in gastrostomy patients caused by a balloon replacement tube: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Youn, Byong Jong; Hur, Jin; Lee, Kwang Hun; Won, Jong Yun [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2007-02-15

    We present the case of a 77-year-old woman with massive gastric ulcer bleeding caused by a balloon replacement tube that required emergent transcatheter left gastric arterial embolization in stop the ulcer bleeding.

  16. FastMG: a simple, fast, and accurate maximum likelihood procedure to estimate amino acid replacement rate matrices from large data sets.

    Science.gov (United States)

    Dang, Cuong Cao; Le, Vinh Sy; Gascuel, Olivier; Hazes, Bart; Le, Quang Si

    2014-10-24

    Amino acid replacement rate matrices are a crucial component of many protein analysis systems such as sequence similarity search, sequence alignment, and phylogenetic inference. Ideally, the rate matrix reflects the mutational behavior of the actual data under study; however, estimating amino acid replacement rate matrices requires large protein alignments and is computationally expensive and complex. As a compromise, sub-optimal pre-calculated generic matrices are typically used for protein-based phylogeny. Sequence availability has now grown to a point where problem-specific rate matrices can often be calculated if the computational cost can be controlled. The most time consuming step in estimating rate matrices by maximum likelihood is building maximum likelihood phylogenetic trees from protein alignments. We propose a new procedure, called FastMG, to overcome this obstacle. The key innovation is the alignment-splitting algorithm that splits alignments with many sequences into non-overlapping sub-alignments prior to estimating amino acid replacement rates. Experiments with different large data sets showed that the FastMG procedure was an order of magnitude faster than without splitting. Importantly, there was no apparent loss in matrix quality if an appropriate splitting procedure is used. FastMG is a simple, fast and accurate procedure to estimate amino acid replacement rate matrices from large data sets. It enables researchers to study the evolutionary relationships for specific groups of proteins or taxa with optimized, data-specific amino acid replacement rate matrices. The programs, data sets, and the new mammalian mitochondrial protein rate matrix are available at http://fastmg.codeplex.com.

  17. Effects of replacing lactose from milk replacer by glucose, fructose, or glycerol on energy partitioning in veal calves

    NARCIS (Netherlands)

    Gilbert, M. S.; Pantophlet, A. J.; van den Borne, J. J. G. C.; Hendriks, W. H.; Schols, H. A.; Gerrits, W. J. J.

    2016-01-01

    Calf milk replacers contain 40 to 50% lactose. Fluctuating dairy prices are a major economic incentive to replace lactose from milk replacers by alternative energy sources. Our objective was, therefore, to determine the effects of replacement of lactose with glucose, fructose, or glycerol on energy

  18. Effects of replacing lactose from milk replacer by glucose, fructose, or glycerol on energy partitioning in veal calves

    NARCIS (Netherlands)

    Gilbert, M.S.; Pantophlet, A.J.; Borne, van den J.J.G.C.; Hendriks, W.H.; Schols, H.A.; Gerrits, W.J.J.

    2016-01-01

    Calf milk replacers contain 40 to 50% lactose. Fluctuating dairy prices are a major economic incentive to replace lactose from milk replacers by alternative energy sources. Our objective was, therefore, to determine the effects of replacement of lactose with glucose, fructose, or glycerol on

  19. Effects of replacing lactose from milk replacer by glucose, fructose, or glycerol on energy partitioning in veal calves

    NARCIS (Netherlands)

    Gilbert, M. S.; Pantophlet, A. J.; van den Borne, J. J. G. C.; Hendriks, W. H.; Schols, H. A.; Gerrits, W. J. J.

    Calf milk replacers contain 40 to 50% lactose. Fluctuating dairy prices are a major economic incentive to replace lactose from milk replacers by alternative energy sources. Our objective was, therefore, to determine the effects of replacement of lactose with glucose, fructose, or glycerol on energy

  20. An evolutionary view on tooth development and replacement in wild Atlantic salmon (Salmo salar L.).

    Science.gov (United States)

    Huysseune, A; Witten, P E

    2008-01-01

    To gain an insight into the evolution of tooth replacement mechanisms, we studied the development of first-generation and replacement teeth on the dentary of wild Atlantic salmon (Salmo salar L.), a protacanthopterygian teleost, using serially sectioned heads of early posthatching stages as well as adults. First-generation teeth develop within the oral epithelium. The anlage of the replacement tooth is first seen as a placode-like thickening of the outer dental epithelium of the predecessor, at its lingual and caudal side. Ongoing development of the replacement tooth germ is characterized by the elaboration of a population of epithelial cells, termed here the middle dental epithelium, apposed to the inner dental epithelium on the lingual side of the tooth germ. Before the formation of the new successor, a single-layered outer dental epithelium segregates from the middle dental epithelium. The dental organs of the predecessor and the successor remain broadly interconnected. The absence of a discrete successional dental lamina in salmon stands in sharp contrast to what is observed in other teleosts, even those that share with salmon the extraosseous formation of replacement teeth. The mode of tooth replacement in Atlantic salmon displays several characters similar to those observed in the shark Squalus acanthias. To interpret similarities in tooth replacement between Atlantic salmon and chondrichthyans as a case of convergence, or to see them as a result of a heterochronic shift, requires knowledge on the replacement process in more basal actinopterygian lineages. The possibility that the middle dental epithelium functionally substitutes for a successional lamina, and could be a source of stem cells, whose descendants subsequently contribute to the placode of the new replacement tooth, needs to be explored.

  1. Cost-effectiveness analysis of clinically indicated versus routine replacement of peripheral intravenous catheters.

    Science.gov (United States)

    Tuffaha, Haitham W; Rickard, Claire M; Webster, Joan; Marsh, Nicole; Gordon, Louisa; Wallis, Marianne; Scuffham, Paul A

    2014-02-01

    Millions of peripheral intravenous catheters are used worldwide. The current guidelines recommend routine catheter replacement every 72-96 h. This practice requires increasing healthcare resource use. The clinically indicated catheter replacement strategy is proposed as an alternative. To assess the cost effectiveness of clinically indicated versus routine replacement of peripheral intravenous catheters. A cost-effectiveness analysis from the perspective of Queensland Health, Australia, was conducted alongside a randomized controlled trial. Adult patients with an intravenous catheter of expected use for longer than 4 days were randomly assigned to receive either clinically indicated replacement or third-day routine replacement. The primary outcome was phlebitis during catheterization or within 48 h after catheter removal. Resource use data were prospectively collected and valued (2010 prices). The incremental net monetary benefit was calculated with uncertainty characterized using bootstrap simulations. Additionally, value of information (VOI) and value of implementation analyses were performed. The clinically indicated replacement strategy was associated with a cost saving per patient of AU$7.60 (95% confidence interval [CI] 4.96-10.62) and a non-significant difference in the phlebitis rate of 0.41% (95% CI -1.33 to 2.15). The incremental net monetary benefit was AU$7.60 (95% CI 4.96-10.62). The expected VOI was zero, whereas the expected value of perfect implementation of the clinically indicated replacement strategy was approximately AU$5 million over 5 years. The clinically indicated catheter replacement strategy is cost saving compared with routine replacement. It is recommended that healthcare organizations consider changing to a policy whereby catheters are changed only if clinically indicated.

  2. Lactose in milk replacer can partly be replaced by glucose, fructose, or glycerol without affecting insulin sensitivity in veal calves.

    Science.gov (United States)

    Pantophlet, A J; Gilbert, M S; van den Borne, J J G C; Gerrits, W J J; Roelofsen, H; Priebe, M G; Vonk, R J

    2016-04-01

    Calf milk replacer (MR) contains 40 to 50% lactose. Lactose strongly fluctuates in price and alternatives are desired. Also, problems with glucose homeostasis and insulin sensitivity (i.e., high incidence of hyperglycemia and hyperinsulinemia) have been described for heavy veal calves (body weight >100 kg). Replacement of lactose by other dietary substrates can be economically attractive, and may also positively (or negatively) affect the risk of developing problems with glucose metabolism. An experiment was designed to study the effects of replacing one third of the dietary lactose by glucose, fructose, or glycerol on glucose homeostasis and insulin sensitivity in veal calves. Forty male Holstein-Friesian (body weight=114 ± 2.4 kg; age=97 ± 1.4 d) calves were fed an MR containing 462 g of lactose/kg (CON), or an MR in which 150 g of lactose/kg of MR was replaced by glucose (GLU), fructose (FRU), or glycerol (GLY). During the first 10d of the trial, all calves received CON. The CON group remained on this diet and the other groups received their experimental diets for a period of 8 wk. Measurements were conducted during the first (baseline) and last week of the trial. A frequently sampled intravenous glucose tolerance test was performed to assess insulin sensitivity and 24 h of urine was collected to measure glucose excretion. During the last week of the trial, a bolus of 1.5 g of [U-(13)C] substrates was added to their respective meals and plasma glucose, insulin, and (13)C-glucose responses were measured. Insulin sensitivity was low at the start of the trial and remained low [1.2 ± 0.1 and 1.0 ± 0.1 (mU/L)(-1) × min(-1)], and no treatment effect was noted. Glucose excretion was low at the start of the trial (3.4 ± 1.0 g/d), but increased in CON and GLU calves (26.9 ± 3.9 and 43.0 ± 10.6g/d) but not in FRU and GLY calves. Postprandial glucose was higher in GLU, lower in FRU, and similar in GLY compared with CON calves. Postprandial insulin was lower in FRU

  3. Computational Experiments for Science and Engineering Education

    Science.gov (United States)

    Xie, Charles

    2011-01-01

    How to integrate simulation-based engineering and science (SBES) into the science curriculum smoothly is a challenging question. For the importance of SBES to be appreciated, the core value of simulations-that they help people understand natural phenomena and solve engineering problems-must be taught. A strategy to achieve this goal is to introduce computational experiments to the science curriculum to replace or supplement textbook illustrations and exercises and to complement or frame hands-on or wet lab experiments. In this way, students will have an opportunity to learn about SBES without compromising other learning goals required by the standards and teachers will welcome these tools as they strengthen what they are already teaching. This paper demonstrates this idea using a number of examples in physics, chemistry, and engineering. These exemplary computational experiments show that it is possible to create a curriculum that is both deeper and wider.

  4. Transcatheter aortic valve replacement in elderly patients

    Institute of Scientific and Technical Information of China (English)

    Dimytri Siqueira; Alexandre Abizaid; Magaly Arrais J.; Eduardo Sousa

    2012-01-01

    Aortic stenosis is the most common native valve disease, affecting up to 5% of the elderly population. Surgical aortic valve replacement reduces symptoms and improves survival, and is the definitive therapy in patients with symptomatic severe aortic stenosis. However, despite the good results of classic surgery, risk is markedly increased in elderly patients with co-morbidities. Transcatheter aortic valve replacement (TAVR) allows implantation of a prosthetic heart valve within the diseased native aortic valve without the need for open heart surgery and cardiopulmonary bypass, offering a new therapeutic option to elderly patients considered at high surgical risk or with contraindications to surgery. To date, several multicenter registries and a randomized trial have confirmed the safety and efficacy of TAVR in those patients. In this chapter, we review the background and clinical applications of TAVR in elderly patients.

  5. Mitochondrial replacement therapy in reproductive medicine.

    Science.gov (United States)

    Wolf, Don P; Mitalipov, Nargiz; Mitalipov, Shoukhrat

    2015-02-01

    Mitochondrial dysfunction is implicated in disease and age-related infertility. Mitochondrial replacement therapies (MRT) in oocytes or zygotes, such as pronuclear (PNT), spindle (ST), or polar body (PBT) transfer, could prevent second-generation transmission of mitochondrial DNA (mtDNA) defects. PNT, associated with high levels of mtDNA carryover in mice but low levels in human embryos, carries ethical issues secondary to donor embryo destruction. ST, developed in primates, supports normal development to adults and low mtDNA carryover. PBT in mice, coupled with PN or ST, may increase the yield of reconstructed embryos with low mtDNA carryover. MRT also offers replacement of the deficient cytoplasm in oocytes from older patients, with the expectation of high pregnancy rates following in vitro fertilization.

  6. Nicotine replacement therapies: patient safety and persistence

    Directory of Open Access Journals (Sweden)

    Ferguson SG

    2011-06-01

    Full Text Available Stuart G Ferguson1,2, Saul Shiffman3,4, Joseph G Gitchell51School of Pharmacy, 2Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia; 3Pinney Associates, 4University of Pittsburgh, Pittsburgh, PA, USA; 5Pinney Associates, Bethesda, MD, USAAbstract: Nicotine replacement therapy (NRT has become a central part of the treatment of nicotine dependence. However, NRT’s potential efficacy is limited to some extent by patient adherence and persistence. Here we review the relationship between NRT compliance and adherence, and overall treatment outcome. We then examine the factors that likely impact on treatment compliance and persistence, with a special focus on users’ perceptions of treatment safety and efficacy as possible mediators. Potential clinical strategies for improving suboptimal medication use are also discussed.Keywords: nicotine replacement therapy, compliance, safety

  7. Replacements For Ozone-Depleting Foaming Agents

    Science.gov (United States)

    Blevins, Elana; Sharpe, Jon B.

    1995-01-01

    Fluorinated ethers used in place of chlorofluorocarbons and hydrochlorofluorocarbons. Replacement necessary because CFC's and HCFC's found to contribute to depletion of ozone from upper atmosphere, and manufacture and use of them by law phased out in near future. Two fluorinated ethers do not have ozone-depletion potential and used in existing foam-producing equipment, designed to handle liquid blowing agents soluble in chemical ingredients that mixed to make foam. Any polyurethane-based foams and several cellular plastics blown with these fluorinated ethers used in processes as diverse as small batch pours, large sprays, or double-band lamination to make insulation for private homes, commercial buildings, shipping containers, and storage tanks. Fluorinated ethers proved useful as replacements for CFC refrigerants and solvents.

  8. The pure relationship and below replacement fertility

    Directory of Open Access Journals (Sweden)

    David R. Hall

    2003-12-01

    interest from demographers. Despite the fact that researchers have extensively modeled recent demographic changes such as skyrocketing divorce rates, rising common-law union formation, delayed childbearing, and the decline to belowreplacement fertility levels, our understanding of the causes of these trends, and the possible connections between them remains theoretically fragmented and incomplete. The goal of this paper is to advance our understanding in this area by exploring the insights on modern family formation of prominent sociologist Anthony Giddens. Specifically, this study examines whether Giddens’ “pure relationship” concept can shed light on the trend toward very low fertility. The results of this inquiry suggest that couples in both marriages and common-law unions who conform to key aspects of Giddens pure relationship are more likely to have uncertain or below-replacement fertility intentions, and less likely to embrace above-replacement fertility goals.

  9. Autogenous Transplantation for Replacing a Hopeless Tooth

    Science.gov (United States)

    Zakershahrak, Mehrsa; Moshari, Amirabbas; Vatanpour, Mehdi; Khalilak, Zohreh; Jalali Ara, Afsoon

    2017-01-01

    Autogenous tooth transplantation (ATT) is a simple and reasonable choice for replacing the missing teeth when a proper donor tooth is available. This report presents a case of successful ATT of a maxillary right third molar for replacement of mandibular right second molar with a concomitant endodontic-periodontal disease. The mandibular second molar was believed to be hopeless due to a severe damage to coronal tooth structure, inappropriate root canal treatment and apical radiolucency. After extraction of mandibular second molar and maxillary third molar (the donor), the tooth was re-implanted into the extracted socket of second molar site. Root canal therapy was then performed. After 3 years, clinical and radiographic examinations revealed satisfying results, with no signs and symptoms. The patient is asymptomatic and the transplanted tooth is still functional with no signs of marginal periodontal pathosis. Radiographies showed bone regeneration in the site of previous extensive periapical lesion, normal periodontal ligament with no signs of root resorption. PMID:28179939

  10. Liver replacement for alpha1-antitrypsin deficiency

    Science.gov (United States)

    Putnam, Charles W.; Porter, Kendrick A.; Peters, Robert L.; Ashcavai, Mary; Redeker, Allan G.; Starzl, Thomas E.

    2010-01-01

    A 16-year-old girl with advanced cirrhosis and severe alpha1-antitrypsin deficiency of the homozygous PiZZ phenotype was treated by orthotopic liver transplantation. After replacement of the liver with a homograft from a donor with the normal PiMM phenotype, the alpha1-antitrypsin concentration in the recipient’s serum rose to normal; it had the PiMM phenotype. Two and a third years later, chronic rejection necessitated retransplantation. Insertion of a homograft from a heterozygous PiMZ donar was followed by the identification of that phenotype in the recipient’s serum. Neither liver graft developed the alpha1-antitrypsin glycoprotein deposits seen with the deficiency state. These observations confirm that this hepatic- based inborn error metabolism is metabolically cured by liver replacement. PMID:320694

  11. Current practice in primary total hip replacement: results from the National Hip Replacement Outcome Project

    OpenAIRE

    Best, A. J.; Fender, D.; Harper, W. M.; McCaskie, A. W.; Oliver, K; Gregg, P J

    1999-01-01

    As part of the National Study of Primary Hip Replacement Outcome, 402 consultant orthopaedic surgeons from three regions were contacted by postal questionnaire which covered all aspects of total hip replacement (THR). There was a 70% response rate of which 71 did not perform hip surgery, a further 33 refused to take part, leaving 181 valid responses. Preoperative assessment clinics were used by 89% of surgeons, but anaesthetists and rehabilitation services were rarely involved at this stage. ...

  12. Risks of testosterone replacement therapy in men

    Directory of Open Access Journals (Sweden)

    E Charles Osterberg

    2014-01-01

    Full Text Available Testosterone replacement therapy (TRT is a widely used treatment for men with symptomatic hypogonadism. The benefits seen with TRT, such as increased libido and energy level, beneficial effects on bone density, strength and muscle as well as cardioprotective effects, have been well-documented. TRT is contraindicated in men with untreated prostate and breast cancer. Men on TRT should be monitored for side-effects such as polycythemia, peripheral edema, cardiac and hepatic dysfunction.

  13. Alternatives to testosterone replacement: testosterone restoration.

    Science.gov (United States)

    McCullough, Andrew

    2015-01-01

    The European Male Aging Study has demonstrated that the hypogonadism of male aging is predominantly secondary. Theoretically with appropriate stimulation from the pituitary, the aging testis should be able to produce eugonadal levels of testosterone. The strategies for the treatment of late onset hypogonadism (LOH) have focused on replacement with exogenous testosterone versus restoration of endogenous production. The purpose of this article is to review existing peer-reviewed literature supporting the concept of restoration of endogenous testosterone in the treatment of LOH.

  14. Alternatives to testosterone replacement: testosterone restoration

    OpenAIRE

    Andrew McCullough

    2014-01-01

    The European Male Aging Study has demonstrated that the hypogonadism of male aging is predominantly secondary. Theoretically with appropriate stimulation from the pituitary, the aging testis should be able to produce eugonadal levels of testosterone. The strategies for the treatment of late onset hypogonadism (LOH) have focused on replacement with exogenous testosterone versus restoration of endogenous production. The purpose of this article is to review existing peer-reviewed literature supp...

  15. Current concepts in total femoral replacement

    OpenAIRE

    Ramanathan, Deepak; Siqueira, Marcelo BP; Klika, Alison K.; Higuera, Carlos A.; Barsoum, Wael K.; Joyce, Michael J

    2015-01-01

    Total femoral replacement (TFR) is a salvage arthroplasty procedure used as an alternative to lower limb amputation. Since its initial description in the mid-20th century, this procedure has been used in a variety of oncologic and non-oncologic indications. The most compelling advantage of TFR is the achievement of immediate fixation which permits early mobilization. It is anticipated that TFR will be increasingly performed as the rate of revision arthroplasty rises worldwide. The existing li...

  16. Mitochondrial Replacement Therapy in Reproductive Medicine

    OpenAIRE

    Wolf, Don P; Mitalipov, Nargiz; Mitalipov, Shoukhrat

    2014-01-01

    Mitochondrial dysfunction is implicated in disease and in age-related infertility. Mitochondrial replacement therapies (MRT) in oocytes or zygotes such as pronuclear (PNT), spindle (ST) or polar body (PBT) transfer could prevent second generation transmission of mitochondrial DNA (mtDNA) defects. PNT, associated with high levels of mtDNA carryover in mice but low levels in human embryos, carries ethical issues secondary to donor embryo destruction. ST, developed in primates, supports normal d...

  17. Mineralogical correlation between primary and replacement dolomites

    Institute of Scientific and Technical Information of China (English)

    黄志诚; 杨守业; 陈智娜

    1997-01-01

    Primary dolostones occur in the Upper Sinian Dengying Formation. Based on mineralogieal study the indicators for correlation between the primary dolomites which are not influenced by the diagenesis and the replacement dolomites of different periods have been obtained. It is shown that the primary dolomites are characterized by crystal forms precipitated and deposited directly from sea water, stable and homogeneous distribution of Mg and Ca, ideal chemical composition, regular modulated microstructures, low positive δ13C and low negative δ18O.

  18. Drug Dosing During Continuous Renal Replacement Therapies

    OpenAIRE

    Thompson, A. Jill

    2008-01-01

    Continuous renal replacement therapies (CRRT) are used to manage fluid overload and/or renal failure. The continuous nature of the fluid and solute removal has less impact on hemodynamic variables in critically ill patients, making CRRT preferred over intermittent hemodialysis for some patients in the intensive care arena. The impact of CRRT on drug removal is variable depending on the CRRT modality, the ultrafiltrate and dialysate flow rates, the filter, and the patient's residual renal func...

  19. VH replacement in primary immunoglobulin repertoire diversification.

    Science.gov (United States)

    Sun, Amy; Novobrantseva, Tatiana I; Coffre, Maryaline; Hewitt, Susannah L; Jensen, Kari; Skok, Jane A; Rajewsky, Klaus; Koralov, Sergei B

    2015-02-01

    The genes encoding the variable (V) region of the B-cell antigen receptor (BCR) are assembled from V, D (diversity), and J (joining) elements through a RAG-mediated recombination process that relies on the recognition of recombination signal sequences (RSSs) flanking the individual elements. Secondary V(D)J rearrangement modifies the original Ig rearrangement if a nonproductive original joint is formed, as a response to inappropriate signaling from a self-reactive BCR, or as part of a stochastic mechanism to further diversify the Ig repertoire. VH replacement represents a RAG-mediated secondary rearrangement in which an upstream VH element recombines with a rearranged VHDHJH joint to generate a new BCR specificity. The rearrangement occurs between the cryptic RSS of the original VH element and the conventional RSS of the invading VH gene, leaving behind a footprint of up to five base pairs (bps) of the original VH gene that is often further obscured by exonuclease activity and N-nucleotide addition. We have previously demonstrated that VH replacement can efficiently rescue the development of B cells that have acquired two nonproductive heavy chain (IgH) rearrangements. Here we describe a novel knock-in mouse model in which the prerearranged IgH locus resembles an endogenously rearranged productive VHDHJH allele. Using this mouse model, we characterized the role of VH replacement in the diversification of the primary Ig repertoire through the modification of productive VHDHJH rearrangements. Our results indicate that VH replacement occurs before Ig light chain rearrangement and thus is not involved in the editing of self-reactive antibodies.

  20. Transdermal testosterone replacement therapy in men

    Directory of Open Access Journals (Sweden)

    Ullah MI

    2014-01-01

    Full Text Available M Iftekhar Ullah,1 Daniel M Riche,1,2 Christian A Koch1,31Department of Medicine, University of Mississippi Medical Center, 2Department of Pharmacy Practice, The University of Mississippi, 3GV (Sonny Montgomery VA Medical Center, Jackson, MS, USAAbstract: Androgen deficiency syndrome in men is a frequently diagnosed condition associated with clinical symptoms including fatigue, decreased libido, erectile dysfunction, and metabolic syndrome. Serum testosterone concentrations decline steadily with age. The prevalence of androgen deficiency syndrome in men varies depending on the age group, known and unknown comorbidities, and the respective study group. Reported prevalence rates may be underestimated, as not every man with symptoms of androgen deficiency seeks treatment. Additionally, men reporting symptoms of androgen deficiency may not be correctly diagnosed due to the vagueness of the symptom quality. The treatment of androgen deficiency syndrome or male hypogonadism may sometimes be difficult due to various reasons. There is no consensus as to when to start treating a respective man or with regards to the best treatment option for an individual patient. There is also lack of familiarity with treatment options among general practitioners. The formulations currently available on the market are generally expensive and dose adjustment protocols for each differ. All these factors add to the complexity of testosterone replacement therapy. In this article we will discuss the general indications of transdermal testosterone replacement therapy, available formulations, dosage, application sites, and recommended titration schedule.Keywords: hypogonadism, transdermal, testosterone, sexual function, testosterone replacement therapy, estradiol

  1. The pure relationship and below replacement fertility

    Directory of Open Access Journals (Sweden)

    Hall, David R.

    2003-01-01

    Full Text Available Of the many changes which have characterized the second demographic transition, shifts in fertility and union formation have attracted a great deal of interest from demographers. Despite the fact that researchers have extensively modeled recent demographic changes such as skyrocketing divorce rates, rising common-law union formation, delayed childbearing, and the decline to below-replacement fertility levels, our understanding of the causes of these trends, and the possible connections between them remains theoretically fragmented and incomplete. The goal of this paper is to advance our understanding in this area by exploring the insights on modern family formation of prominent sociologist Anthony Giddens. Specifically, this study examines whether Giddens' "pure relationship" concept can shed light on the trend toward very low fertility. The results of this inquiry suggest that couples in both marriages and common-law unions who conform to key aspects of Giddens pure relationship are morel likely to have uncertain or below-replacement fertility intentions, and less likely to embrace above-replacement fertility goals.

  2. Fragile X mental retardation protein is required for rapid experience-dependent regulation of the potassium channel Kv3.1b.

    Science.gov (United States)

    Strumbos, John G; Brown, Maile R; Kronengold, Jack; Polley, Daniel B; Kaczmarek, Leonard K

    2010-08-04

    Fragile X mental retardation protein (FMRP) is an RNA-binding protein that regulates synaptic plasticity by repressing translation of specific mRNAs. We found that FMRP binds mRNA encoding the voltage-gated potassium channel Kv3.1b in brainstem synaptosomes. To explore the regulation of Kv3.1b by FMRP, we investigated Kv3.1b immunoreactivity and potassium currents in the auditory brainstem sound localization circuit of male mice. The unique features of this circuit allowed us to control neuronal activity in vivo by exposing animals to high-frequency, amplitude-modulated stimuli, which elicit predictable and stereotyped patterns of input to the anterior ventral cochlear nucleus (AVCN) and medial nucleus of the trapezoid body (MNTB). In wild-type (WT) animals, Kv3.1b is expressed along a tonotopic gradient in the MNTB, with highest levels in neurons at the medial, high-frequency end. At baseline, Fmr1(-/-) mice, which lack FMRP, displayed dramatically flattened tonotopicity in Kv3.1b immunoreactivity and K(+) currents relative to WT controls. Moreover, after 30 min of acoustic stimulation, levels of Kv3.1b immunoreactivity were significantly elevated in both the MNTB and AVCN of WT, but not Fmr1(-/-), mice. These results suggest that FMRP is necessary for maintenance of the gradient in Kv3.1b protein levels across the tonotopic axis of the MNTB, and are consistent with a role for FMRP as a repressor of protein translation. Using numerical simulations, we demonstrate that Kv3.1b tonotopicity may be required for accurate encoding of stimulus features such as modulation rate, and that disruption of this gradient, as occurs in Fmr1(-/-) animals, degrades processing of this information.

  3. The benefits and risks of testosterone replacement therapy: a review

    Directory of Open Access Journals (Sweden)

    Nazem Bassil

    2009-06-01

    Full Text Available Nazem Bassil1, Saad Alkaade2, John E Morley1,31Division of Geriatric Medicine; 2Internal Medicine, Saint Louis University Health Sciences Center, St. Louis, Missouri, USA; 3GRECC, VA Medical Center, St. Louis, Missouri, USAAbstract: Increased longevity and population aging will increase the number of men with late onset hypogonadism. It is a common condition, but often underdiagnosed and undertreated. The indication of testosterone-replacement therapy (TRT treatment requires the presence of low testosterone level, and symptoms and signs of hypogonadism. Although controversy remains regarding indications for testosterone supplementation in aging men due to lack of large-scale, long-term studies assessing the benefits and risks of testosterone-replacement therapy in men, reports indicate that TRT may produce a wide range of benefits for men with hypogonadism that include improvement in libido and sexual function, bone density, muscle mass, body composition, mood, erythropoiesis, cognition, quality of life and cardiovascular disease. Perhaps the most controversial area is the issue of risk, especially possible stimulation of prostate cancer by testosterone, even though no evidence to support this risk exists. Other possible risks include worsening symptoms of benign prostatic hypertrophy, liver toxicity, hyperviscosity, erythrocytosis, worsening untreated sleep apnea or severe heart failure. Despite this controversy, testosterone supplementation in the United States has increased substantially over the past several years. The physician should discuss with the patient the potential benefits and risks of TRT. The purpose of this review is to discuss what is known and not known regarding the benefits and risks of TRT.Keywords: hypogonadism, testosterone replacement therapy, erectile dysfunction, osteoporosis, cardiovascular disease

  4. OPAL Cold Neutron Guide In-Pile Replacement

    Energy Technology Data Exchange (ETDEWEB)

    Rownes, T.; Eltobaji, A.; Bell, M.; Klose, F. [Nuclear Operations, Baitain (Australia)

    2013-07-01

    The 20 MW{sub th} OPAL research reactor has five neutron beam assemblies. These provide cold and thermal neutrons to various neutron guides and associated neutron beam instruments. In 2010 a project was initiated to install a new cold neutron guide, CG2, in one of the assemblies. This installation would allow up to four new neutron beam instruments to be built, significantly expanding the reactor's capabilities. The project concluded in December 2012 with the successful installation of CG2. Each neutron beam assembly has an in-pile plug, a primary shutter and a front cover. Together these constitute the neutron guide's in-pile components, with a total mass of over 12 tonnes. The CG2 installation required the complete replacement of the existing components. This replacement was scheduled to coincide with OPAL's first major shutdown. With a budget of $2.3 million and an expected dose of 50 man.mSv, the CG2 installation was a large and complex task. Work during the shutdown involved over 40 ANSTO personnel and radiation fields approached 1 Sv/h in some areas. Despite this, the installation team received a collective dose of only 10 man.mSv, and the project was completed to budget and within schedule. This paper will outline the details of the project, focusing on lessons learned and recommended practices. Each OPAL in-pile plug has a design life of 10 years at full power operation, and similar replacements will be performed regularly as the reactor ages. It is hoped that this information will be useful for other research reactors planning large capital engineering projects.

  5. Modular endoprosthetic replacement for metastatic tumours of the proximal femur

    Directory of Open Access Journals (Sweden)

    Carter Simon R

    2008-11-01

    Full Text Available Abstract Background and aims Endoprosthetic replacements of the proximal femur are commonly required to treat destructive metastases with either impending or actual pathological fractures at this site. Modular prostheses provide an off the shelf availability and can be adapted to most reconstructive situations for proximal femoral replacements. The aim of this study was to assess the clinical and functional outcomes following modular tumour prosthesis reconstruction of the proximal femur in 100 consecutive patients with metastatic tumours and to compare them with the published results of patients with modular and custom made endoprosthetic replacements. Methods 100 consecutive patients who underwent modular tumour prosthetic reconstruction of the proximal femur for metastases using the METS system from 2001 to 2007 were studied. The patient, tumour and treatment factors in relation to overall survival, local control, implant survival and complications were analysed. Functional scores were obtained from surviving patients. Results and conclusion There were 45 male and 55 female patients. The mean age was 60.2 years. The indications were metastases. Seventy five patients presented with pathological fracture or with failed fixation and 25 patients were at a high risk of developing a fracture. The mean follow up was 15.9 months [range 0–77]. Three patients died within 2 weeks following surgery. 69 patients have died and 31 are alive. Of the 69 patients who were dead 68 did not need revision surgery indicating that the implant provided single definitive treatment which outlived the patient. There were three dislocations (2/5 with THR and 1/95 with unipolar femoral heads. 6 patients had deep infections. The estimated five year implant survival (Kaplan-Meier analysis was 83.1% with revision as end point. The mean TESS score was 64% (54%–82%. We conclude that METS modular tumour prosthesis for proximal femur provides versatility; low implant related

  6. Unilateral vs one stage bilateral total knee replacement in rheumatoid and osteoarthritis - A comparative study

    Directory of Open Access Journals (Sweden)

    Kiran E

    2005-01-01

    Full Text Available Background : A controversy exists regarding simultaneous or staged bilateral total knee replacement. Methods: Fifty patients undergoing simultaneous bilateral and 50 undergoing unilateral total knee arthroplasty were evaluated prospectively to compare the clinical, radiological results and complication rates. Eighty-four patients belonged to ASA category II or III preoperatively. The study included a high proportion of rheumatoid patients and osteoarthritis patients with severe deformities. Results: Bilateral group had greater blood loss and required more blood transfusion, but there was no difference in requirement of postoperative intensive care and the complication rates. Rheumatoid knees had lower pre and postoperative knee score and functional score as compared to osteoarthritic knees. Morbidity and mortality of one stage bilateral knee replacement was no greater than unilateral operation. Conclusion: Simultaneous bilateral knee replacement in younger patients with advanced rheumatoid arthritis is safe and effective

  7. Effect of replacing alfalfa with panicled-tick clover or sericea lespedeza in corn-alfalfa-based substrates on in vitro ruminal methane production.

    Science.gov (United States)

    Naumann, H D; Lambert, B D; Armstrong, S A; Fonseca, M A; Tedeschi, L O; Muir, J P; Ellersieck, M R

    2015-06-01

    Methane emissions from ruminant livestock contribute to total anthropogenic greenhouse gas emissions and reduce metabolizable energy intake by the animal. Condensed tannins (CT) are polyphenolic plant secondary compounds commonly produced by some perennial forage legumes that characteristically bind to protein, carbohydrates, and minerals. The degree to which CT may affect ruminant nutrition depends upon the concentration, structural composition, and biological activity of the CT. The objective of our experiment was to determine the effect of replacing alfalfa in a corn-alfalfa-based substrate with a legume containing CT on in vitro CH4 production and the dynamics of fermentation using an in vitro gas production technique. All fermented substrates contained 50% ground corn as the energy concentrate portion, whereas the forage portion (50%) of each diet was comprised of alfalfa (control) or some combination of alfalfa and sericea lespedeza (SL) or panicled-tick clover (PTC). Our treatments consisted of PTC or SL 15, 30, and 45, which corresponded with 15, 30, or 45% replacement of the diet (alfalfa component) with either PTC or SL. Substrates containing 45% PTC or SL reduced in vitro CH4 production. Treatments did not affect total gas production as compared with that of the control. Replacement of alfalfa with SL or PTC increased fermentable organic matter (FOM). The PTC treatment increased FOM by as much as 1.8% at the 45% replacement level, whereas FOM of SL 45 was increased by less than 1%. The replacement of alfalfa with PTC increased substrate nutritive value greater than replacement with SL. There were no correlations between any physicochemical constituent of the substrates and CH4 production. A combination of factors associated with the inclusion of PTC and SL contributed to the in vitro CH4 production, and CT in these forages was likely a major contributing factor. Further confirmation of these results on in situ or in vivo animal systems is required. If

  8. Feed water distribution pipe replacement at Loviisa NPP

    Energy Technology Data Exchange (ETDEWEB)

    Savolainen, S.; Elsing, B. [Imatran Voima Loviisa NPP (Finland)

    1995-12-31

    Imatran Voima Oy operates two WWER-440 reactors. Unit 1 has been operating since 1977 and unit 2 since 1981. First damages of feed water distribution (FWD) pipe were observed in 1989. The FWD-pipe T-connection had suffered from severe erosion corrosion damages. Similar damages have been been found also in other WWER-440 type NPPs. In 1989 the nozzles of the steam generator YB11 were inspected. No signs of the damages or signs of erosion were detected. The first damaged nozzles were found in 1992 in steam generators of both units. In 1992 it was started studying different possibilities to either repair or replace the damaged FWD-pipes. Due to the difficult conditions for repairing the damaged nozzles it was decided to study different FWD-pipe constructions. In 1991 two new feedwater distributors had been implemented at Dukovany NPP designed by Vitckovice company. Additionally OKB Gidropress had presented their design for new collector. In spring 1994 all the six steam generators of Rovno NPP unit 1 were replaced with FWD-pipes designed by OKB Gidropress. After the implementation an experimental program with the new systems was carried out. Due to the successful experiments at Rovno NPP Unit 1 it was decided to implement `Gidropress solution` during 1994 refueling outage into the steam generator YB52 at Loviisa 2. The object of this paper is to discuss the new FWD-pipe and its effects on the plant safety during normal and accident conditions. (orig.).

  9. A Cost Analysis of Kidney Replacement Therapy Options in Palestine

    Directory of Open Access Journals (Sweden)

    Mustafa Younis Ph.D.

    2015-03-01

    Full Text Available This study provides a cost analysis of kidney replacement therapy options in Palestine. It informs evidence-based resource allocation decisions for government-funded kidney disease services where transplant donors are limited, and some of the common modalities, i.e., peritoneal dialysis (PD and home hemodialysis (HD, are not widely available due to shortages of qualified staff, specialists, and centers to follow the patient cases, provide training, make home visits, or provide educational programs for patients. The average cost of kidney transplant was US$16 277 for the first year; the estimated cost of HD per patient averaged US$16 085 per year—nearly as much as a transplant. Consistent with prior literature and experience, while live, related kidney donors are scarce, we found that kidney transplant was more adequate and less expensive than HD. These results have direct resource allocation implications for government-funded kidney disease services under Palestinian Ministry of Health. Our findings strongly suggest that investing in sufficient qualified staff, equipment, and clinical infrastructure to replace HD services with transplantation whenever medically indicated and suitable kidney donors are available, as well as deploying PD programs and Home HD programs, will result in major overall cost savings. Our results provide a better understanding of the costs of kidney disease and will help to inform Ministry of Health and related policy makers as they develop short- and long-term strategies for the population, in terms of both cost savings and enhanced quality of life.

  10. Feasibility analysis of replacing full factorial design with Taguchi method in mini-plot soil erosion experiments%微小区土壤侵蚀试验中田口方法代替全因子设计的可行性分析

    Institute of Scientific and Technical Information of China (English)

    张风宝; 杨明义; 李占斌

    2015-01-01

    During plot experiments with full factorial designs in order to understand the effects of factors such as soil type, slope gradient, slope length, rainfall characteristics, hydraulic factors, vegetation cover and human activities on soil erosion processes, the number of tests increases with the increasing number of factors and their levels, often leading to time, cost and labor consuming. Taguchi method has been evidenced as a simple, economical and efficient experiment design method in fields of engineering, environment and others, but not in soil erosion studies. This study investigated the feasibility of using Taguchi design method in studies on soil erosion under different conditions. To achieve this objective, a published dataset of mini-plot soil erosion by Meyer and Harmon in 1989 was used. This dataset included four factors and four levels of soil type (Brooksville, Dubbs, Atwood and Loring), slope gradient (5%, 10%, 20 and 30%), slope length (0.15, 0.3, 0.45 and 0.6 m) and rainfall intensity (13.6-14、26.4-27、74.3-76.3 and 112-115 mm/h). Results from Taguchi method, orthogonal design and full factorial design were compared. For comparison, the results from full factorial design were considered as measured values. Results showed that the test numbers used for Taguchi method/orthogonal design were only 6.3% of that for full factorial design, but there was no significant difference in mean of runoff and erosion rate between Taguchi method and the other methods. The maximum, minimum and variation coefficient and standard deviation for the erosion and runoff rates between the methods were slightly different. The main effect of each factor on the erosion and runoff rates obtained from Taguchi method followed the same trends with those obtained from full factorial design, but different from the orthogonal design sometimes. The three methods all could identify that rain intensity was the main contributor to slope erosion. However, the contribution rates from

  11. Neck Pain One Week after Pacemaker Generator Replacement.

    Science.gov (United States)

    Graham, Ross F; Wightman, John M

    2015-07-01

    The incidence of cardiac pacemaker implantation has risen markedly in the past three decades, making awareness of possible postprocedural complications critical to the emergency physician. This case is the first documented instance of internal jugular (IJ) deep vein thrombosis (DVT) from an uncomplicated pacemaker generator replacement. A patient presented to an Emergency Department with a 2-day history of mild left temporal headache migrating to his left neck. The patient did not volunteer this information, but review of systems revealed a temporary transvenous pacemaker inserted through the right IJ vein 1 week previously during a routine exchange of a left-sided cardiac pacemaker generator. Manipulation of the existing pacemaker wires entering the left subclavian vein was minimal. Computed tomographic angiography of the neck demonstrated near-complete thrombotic occlusion of the entire length of his left IJ vein. This required hospital admission for observation and treatment with anticoagulation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: DVT, with thrombotic extension into adjacent vessels anywhere along the course of pacemaker wires, should be considered by the emergency provider in the evaluation of head, neck, or upper extremity symptoms after recent or remote implantation or manipulation of a transvenous cardiac pacemaker, including generator replacement. Failure to identify and treat appropriately could result in significant morbidity and mortality from airway edema, septic thrombophlebitis, superior vena cava syndrome, superior sagittal sinus thrombosis, or pulmonary embolism. Published by Elsevier Inc.

  12. Experience with CORBA communication middleware in the ATLAS DAQ.

    CERN Document Server

    Kolos, S; Amorim, A; Badescu, E; Burckhart-Chromek, Doris; Caprini, M; Dobson, M; Fiuza de Barrosb, N; Flammerd, J; Jones, R; Kazarov, A; Klose, D; Korobov, S; Kotov, V; Liko, D; Mapelli, L; Mineev, M; Pedro, L; Ryabov, Yu; Soloviev, I; Computing In High Energy Physics

    2005-01-01

    As modern High Energy Physics (HEP) experiments require more distributed computing power to fulfill their demands, the need of an efficient distributed online services for control, configuration and monitoring in such experiments becomes increasingly important. This paper describes experience of using standard Common Object Request Broker Architecture (CORBA) middleware for providing a high performance and scalable software, which will be used for the online control, configuration and monitoring in the ATLAS Data Acquisition (DAQ) system. It also recites the experience, which was gained from using several CORBA implementations together and replacing one CORBA broker with another. Finally the paper presents the results of the large scale tests, demonstrating the performance and scalability of the ATLAS DAQ online services. These results show that the standard CORBA is truly appropriate for the highly efficient online distributed computing in the HEP experiments area.

  13. Oxford Partial Knee Replacement as a Gateway to Outpatient Arthroplasty “Lessons Learned along the Journey”

    Directory of Open Access Journals (Sweden)

    Michael E Berend

    2016-09-01

    Full Text Available The Oxford Partial Knee Replacement was approved for implantation in the US in 2004 after the surgeon completed an educational training requirement.  Since then my knee practiced has expanded to over 50% partial knee.  This experience coupled with refinement of surgical techniques, anesthesia protocols, and patient selection has facilitated the transformation to same day discharge for partial knee cases and has quickly transitioned to total hip, total knee, and selected revision surgeries.  Patient selection has also expanded for outpatient joints and is now based on medical screening criteria and insurance access.  Over a two-year period we have performed over 1,000 outpatient arthroplasty procedures with no readmissions for pain control.   Overall readmission rate for all reasons was 2%.  Patient satisfaction scores were 98% Great-Good for 2014-15.  The combination of a partial knee replacement practice and an outpatient joint program brings the best VALUE to the patients, surgeons, and the arthroplasty system and represents the future of arthroplasty care.

  14. Replacement of mineral fertilizers with anaerobically digested pig slurry in paddy fields: assessment of plant growth and grain quality.

    Science.gov (United States)

    Zhang, Jin; Wang, Minyan; Cao, Yucheng; Liang, Peng; Wu, Shengchun; Leung, Anna Oi Wah; Christie, Peter

    2017-04-01

    Rice cultivation requires large quantities of irrigation water and mineral fertilizers. This provides an opportunity for the recycling of the plant nutrients in anaerobically digested pig slurry, large amounts of which are generated in Chinese pig farms. Hence, to promote the sustainable development of livestock and poultry breeding and rice production, a micro-plot field experiment was carried out to assess whether or not slurry can replace mineral fertilizers in rice paddy production in terms of plant tillering, grain quality, and yields. The results indicate that the total N content of the slurry can serve as an alternative source of N when compared to the control (450 kg ha(-1) commercial compound fertilizer (N/P2O5/K2O = 15:15:15) as basal fertilizer, 300 kg ha(-1) urea (N% = 46), and 150 kg ha(-1) commercial compound fertilizer as top-dressed fertilizer). No negative effects on plant growth or grain yield were observed, although there may be a potential risk due to an increase in grain Cu concentration. The amylose content and gel consistency of the rice grains were enhanced significantly by the use of slurry as a basal fertilizer, but the grain protein and total amino acid contents decreased. The results suggest that anaerobically digested pig slurry can replace mineral fertilizers in rice production when applied as a basal dressing together with urea and commercial compound fertilizer as top-dressed fertilizers.

  15. Main steam inlet sleeves on steam turbines: External ultrasonic test and external sleeve replacement (closed HP-IP casing)

    Energy Technology Data Exchange (ETDEWEB)

    Lauro, M.; Arrighi, L.; Gaibazzi, I.

    1996-12-31

    ENEL has gained extensive experience on turbines with bell seals in relation to defect diagnosis and the conducting of on-site repairs on the main steam inlet sleeves. Several cases of cracking in the trepan radius area, and of retainer nut breakage, on this type of sleeve have caused very significant levels of turbine downtime that have demanded costly unscheduled work in order to open the HP-IP housing. These are related phenomena which were initially diagnosed by using temperature sensing at the IP turbine exhaust. As a consequence of the above, a technique was developed for detecting defects from outside the turbine by using non-destructive ultrasonic inspection (UT). A procedure for replacing the sleeves while the casing is closed was developed in conjunction with the manufacturer. The time required and the scope of operation are both of a limited nature. Initial trials were held with inspections carried out on an open turbine when there was a planned outage and then on a real case. Since completing these trials, periodic UT inspections have been made on (all) the sleeves and this check is being carried out on a continuing basis. Any changes in relevant indications are noted during these inspections, thereby allowing any replacement operation to be planned on site and at any time.

  16. Comparison between major repair and replacement options for a bridge deck life cycle assessment: A case study

    Directory of Open Access Journals (Sweden)

    Abu Dabous Saleh

    2017-01-01

    Full Text Available Material production, manufacturing, transportation, usage, and end of lifeprocessing are usually the main contributors defining the life cycle assessment (LCA. Bridge infrastructure is important to the economy and the society. Over their life cycle, highway bridges experience several stressors that can significantly affect their structural performance and therefore require rehabilitation. This paper discusses the life cycle analysis of bridge rehabilitation decisions and demonstrates the analysis with a case study of a bridge located in Ontario, Canada. The LCA of the bridge deck is analyzed for two rehabilitation strategies: major repair and replacement. The study focuses on evaluating the different life cycle phases of the bridge deck by assessing their carbon dioxide emission, energy consumption and cost. Also, the paper presents the impact of the different elements within each phase to identify the most contributing elements. The LCA of the bridge deck is analyzed and estimated with the aid of CES EduPack 2016 software that includes a database of more than 4000 different materials and more than 200 manufacturing processes. Analysis of the case study shows that material phase causes significant life cycle impact. The study concluded that the deck replacement yields higher environmental impact and life cycle cost compared to repairing and strengthening the deck.

  17. A Computationally Efficient P-LRU based Optimal Cache Heap Object Replacement Policy

    Directory of Open Access Journals (Sweden)

    Burhan Ul Islam Khan

    2017-01-01

    Full Text Available The recent advancement in the field of distributed computing depicts a need of developing highly associative and less expensive cache memories for the state-of-art processors i.e., Intel Core i6, i7, etc. Hence, various conventional studies introduced cache replacement policies which are one of the prominent key factors to determine the effectiveness of a cache memory. Most of the conventional cache replacement algorithms are found to be as not so efficient on memory management and complexity analysis. Therefore, a significant and thorough analysis is required to suggest a new optimal solution for optimizing the state-of-the-art cache replacement issues. The proposed study aims to conceptualize a theoretical model for optimal cache heap object replacement. The proposed model incorporates Tree based and MRU (Most Recently Used pseudo-LRU (Least Recently Used mechanism and configures it with JVM’s garbage collector to replace the old referenced objects from the heap cache lines. The performance analysis of the proposed system illustrates that it outperforms the conventional state of art replacement policies with much lower cost and complexity. It also depicts that the percentage of hits on cache heap is relatively higher than the conventional technologies.

  18. Patient outcome and valve performance following a second aortic valve homograft replacement.

    Science.gov (United States)

    Hasnat, K; Birks, E J; Liddicoat, J; Hon, J K; Edwards, S; Glennon, S; Yacoub, M H

    1999-11-09

    Homograft valves offer many advantages; however, there is concern about their use in second aortic valve replacement because of the complexity of the procedure and the possibility of accelerated degeneration. One hundred and forty-four patients underwent a second aortic homograft replacement between 1973 and 1997 (mean follow-up 6.5+/-5 years, range 1 to 20 years). Eighty-three were male, and 61 were female, aged 17 to 77 years, mean 49.0 years. All patients had undergone previous aortic valve replacement with a homograft. The indication for reoperation was aortic regurgitation in 75 patients (52.1%), aortic stenosis in 28 (19.4%), and mixed aortic valve disease in 41 (28.5%). Root replacement was performed in 54 patients (38%) and subcoronary in 90 (62.5%). Early mortality was 3.4%. The actuarial survival rate was 93% and 82% at 5 and 10 years, respectively. Freedom from tissue degeneration was 96% and 80% at 5 and 10 years, respectively, and freedom from reoperation was 97% and 82% at 5 and 10 years, respectively. This study shows that a second aortic valve homograft replacement results in good early and long-term survival. Accelerated degeneration does not occur. Left ventricular performance is improved, and earlier surgery could further improve outcome, indicating that an aortic homograft is a safe, durable option for patients requiring a second aortic valve replacement.

  19. Subtrochanteric femoral shortening osteotomy combined with cementless total hip replacement for Crowe type IV developmental dysplasia: a retrospective study.

    Science.gov (United States)

    Rollo, Giuseppe; Solarino, Giuseppe; Vicenti, Giovanni; Picca, Girolamo; Carrozzo, Massimiliano; Moretti, Biagio

    2017-07-24

    Total hip replacement for high dislocation of the hip presents some difficulties, considering patients' young ages, the abnormal hip anatomy and the high rate of complications. In this study, we present our experience in terms of clinical and radiological results in the treatment of Crowe type IV hips with subtrochanteric femoral shortening osteotomy and cementless total hip replacement. We retrospectively reviewed 15 patients with Crowe type IV hip dysplasia (two bilateral cases for a total of 17 hips) treated with cementless total hip replacement associated with shortening subtrochanteric osteotomies (nine transversal and eight Z-shape osteotomies) between March 2000 to February 2006. The mean follow-up was 88 months (range 63-133). Harris hip score, leg length discrepancy, neurological status, union status of the osteotomy and the component stability were the criteria of the evaluation. All complications were noted. The mean HHS improved from 38.3 (range 32-52) to 85.6 (range 69-90). The mean preoperative leg length discrepancy was of 45 mm (range 38-70) and reduced to a mean of 12 mm (range 9-1.6) postoperatively. All osteotomies resulted healed at an average of 12.3 weeks (range 10-15). No cases of delayed union or nonunion were detected. Two patients (11%) showed early symptoms of sciatic nerve palsy which resolved uneventfully in 6 months. There was no migrations and none of the implants required revision. Cementless THA with shortening subtrochanteric osteotomy is an effective method in the treatment of patients with Crowe type IV development dysplasia of the hip. IV.

  20. Patients' Perceptions of Joint Replacement Care in a Changing Healthcare System: A Qualitative Study

    OpenAIRE

    Webster, Fiona; Bremner, Samantha; Katz, Joel; Watt-Watson, Judy; Kennedy, Deborah; Sawhney, Mona; McCartney, Colin

    2014-01-01

    Background: Ontario has introduced strategies over the past decade to reduce wait times and length of stay and improve access to physiotherapy for orthopaedic and other patients. The aim of this study is to explore patients' experiences of joint replacement care during a significant system change in their care setting.