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Sample records for revised staging system

  1. Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System: Revised Pressure Injury Staging System.

    Science.gov (United States)

    Edsberg, Laura E; Black, Joyce M; Goldberg, Margaret; McNichol, Laurie; Moore, Lynn; Sieggreen, Mary

    Our understanding of pressure injury etiology and development has grown in recent years through research, clinical expertise, and global interdisciplinary expert collaboration. Therefore, the National Pressure Ulcer Advisory Panel (NPUAP) has revised the definition and stages of pressure injury. The revision was undertaken to incorporate the current understanding of the etiology of pressure injuries, as well as to clarify the anatomical features present or absent in each stage of injury. An NPUAP-appointed Task Force reviewed the literature and created drafts of definitions, which were then reviewed by stakeholders and the public, including clinicians, educators, and researchers around the world. Using a consensus-building methodology, these revised definitions were the focus of a multidisciplinary consensus conference held in April 2016. As a result of stakeholder and public input, along with the consensus conference, important changes were made and incorporated into the new staging definitions. The revised staging system uses the term injury instead of ulcer and denotes stages using Arabic numerals rather than Roman numerals. The revised definition of a pressure injury now describes the injuries as usually occurring over a bony prominence or under a medical or other device. The revised definition of a Stage 2 pressure injury seeks to clarify the difference between moisture-associated skin damage and injury caused by pressure and/or shear. The term suspected has been removed from the Deep Tissue Pressure Injury diagnostic label. Each definition now describes the extent of tissue loss present and the anatomical features that may or may not be present in the stage of injury. These important revisions reflect the methodical and collaborative approach used to examine the available evidence and incorporate current interdisciplinary clinical expertise into better defining the important phenomenon of pressure injury etiology and development.

  2. Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System

    OpenAIRE

    Edsberg, Laura E.; Black, Joyce M.; Goldberg, Margaret; McNichol, Laurie; Moore, Lynn; Sieggreen, Mary

    2016-01-01

    Our understanding of pressure injury etiology and development has grown in recent years through research, clinical expertise, and global interdisciplinary expert collaboration. Therefore, the National Pressure Ulcer Advisory Panel (NPUAP) has revised the definition and stages of pressure injury. The revision was undertaken to incorporate the current understanding of the etiology of pressure injuries, as well as to clarify the anatomical features present or absent in each stage of injury. An N...

  3. Single-stage Acetabular Revision During Two-stage THA Revision for Infection is Effective in Selected Patients.

    Science.gov (United States)

    Fink, Bernd; Schlumberger, Michael; Oremek, Damian

    2017-08-01

    The treatment of periprosthetic infections of hip arthroplasties typically involves use of either a single- or two-stage (with implantation of a temporary spacer) revision surgery. In patients with severe acetabular bone deficiencies, either already present or after component removal, spacers cannot be safely implanted. In such hips where it is impossible to use spacers and yet a two-stage revision of the prosthetic stem is recommended, we have combined a two-stage revision of the stem with a single revision of the cup. To our knowledge, this approach has not been reported before. (1) What proportion of patients treated with single-stage acetabular reconstruction as part of a two-stage revision for an infected THA remain free from infection at 2 or more years? (2) What are the Harris hip scores after the first stage and at 2 years or more after the definitive reimplantation? Between June 2009 and June 2014, we treated all patients undergoing surgical treatment for an infected THA using a single-stage acetabular revision as part of a two-stage THA exchange if the acetabular defect classification was Paprosky Types 2B, 2C, 3A, 3B, or pelvic discontinuity and a two-stage procedure was preferred for the femur. The procedure included removal of all components, joint débridement, definitive acetabular reconstruction (with a cage to bridge the defect, and a cemented socket), and a temporary cemented femoral component at the first stage; the second stage consisted of repeat joint and femoral débridement and exchange of the femoral component to a cementless device. During the period noted, 35 patients met those definitions and were treated with this approach. No patients were lost to followup before 2 years; mean followup was 42 months (range, 24-84 months). The clinical evaluation was performed with the Harris hip scores and resolution of infection was assessed by the absence of clinical signs of infection and a C-reactive protein level less than 10 mg/L. All

  4. Two-stage revision of septic knee prosthesis with articulating knee spacers yields better infection eradication rate than one-stage or two-stage revision with static spacers.

    Science.gov (United States)

    Romanò, C L; Gala, L; Logoluso, N; Romanò, D; Drago, L

    2012-12-01

    The best method for treating chronic periprosthetic knee infection remains controversial. Randomized, comparative studies on treatment modalities are lacking. This systematic review of the literature compares the infection eradication rate after two-stage versus one-stage revision and static versus articulating spacers in two-stage procedures. We reviewed full-text papers and those with an abstract in English published from 1966 through 2011 that reported the success rate of infection eradication after one-stage or two-stage revision with two different types of spacers. In all, 6 original articles reporting the results after one-stage knee exchange arthoplasty (n = 204) and 38 papers reporting on two-stage revision (n = 1,421) were reviewed. The average success rate in the eradication of infection was 89.8% after a two-stage revision and 81.9% after a one-stage procedure at a mean follow-up of 44.7 and 40.7 months, respectively. The average infection eradication rate after a two-stage procedure was slightly, although significantly, higher when an articulating spacer rather than a static spacer was used (91.2 versus 87%). The methodological limitations of this study and the heterogeneous material in the studies reviewed notwithstanding, this systematic review shows that, on average, a two-stage procedure is associated with a higher rate of eradication of infection than one-stage revision for septic knee prosthesis and that articulating spacers are associated with a lower recurrence of infection than static spacers at a comparable mean duration of follow-up. IV.

  5. 2005 PRETEXT: a revised staging system for primary malignant liver tumours of childhood developed by the SIOPEL group

    Energy Technology Data Exchange (ETDEWEB)

    Roebuck, Derek J.; McHugh, Kieran; Olsen, Oeystein E. [Great Ormond Street Hospital, Department of Radiology, London (United Kingdom); Aronson, Daniel [Academisch Medisch Centrum/Universiteit van Amsterdam, Amsterdam (Netherlands); Clapuyt, Philippe; Ville de Goyet, Jean de; Otte, Jean-Bernard [Universite Catholique de Louvain, Cliniques Universitaires Saint-Luc, Departments of Surgery and Medical Imaging, Brussels (Belgium); Czauderna, Piotr [Medical University of Gdansk, Department of Pediatric Surgery, Gdansk (Poland); Gauthier, Frederic; Pariente, Daniele [Centre Hospital-Universitaire de Bicetre APHP, Le Kremlin-Bicetre cedex (France); MacKinlay, Gordon [Royal Hospital for Sick Children, Department of Surgery, Edinburgh (United Kingdom); Maibach, Rudolf [SIAK Coordinating Center, Bern (Switzerland); Plaschkes, Jack [Inselspital, Department of Pediatric Surgery, Bern (Switzerland); Childs, Margaret [United Kingdom Children' s Cancer Study Group, Leicester (United Kingdom); Perilongo, Giorgio [Padua University Hospital, Division of Hematology/Oncology, Department of Pediatrics, Padua (Italy)

    2007-02-15

    Over the last 15 years, various oncology groups throughout the world have used the PRETEXT system for staging malignant primary liver tumours of childhood. This paper, written by members of the radiology and surgery committees of the International Childhood Liver Tumor Strategy Group (SIOPEL), presents various clarifications and revisions to the original PRETEXT system. (orig.)

  6. 2005 PRETEXT: a revised staging system for primary malignant liver tumours of childhood developed by the SIOPEL group

    International Nuclear Information System (INIS)

    Roebuck, Derek J.; McHugh, Kieran; Olsen, Oeystein E.; Aronson, Daniel; Clapuyt, Philippe; Ville de Goyet, Jean de; Otte, Jean-Bernard; Czauderna, Piotr; Gauthier, Frederic; Pariente, Daniele; MacKinlay, Gordon; Maibach, Rudolf; Plaschkes, Jack; Childs, Margaret; Perilongo, Giorgio

    2007-01-01

    Over the last 15 years, various oncology groups throughout the world have used the PRETEXT system for staging malignant primary liver tumours of childhood. This paper, written by members of the radiology and surgery committees of the International Childhood Liver Tumor Strategy Group (SIOPEL), presents various clarifications and revisions to the original PRETEXT system. (orig.)

  7. Revised FIGO staging system for cancer of the ovary, fallopian tube, and peritoneum: important implications for radiologists.

    Science.gov (United States)

    Saida, Tsukasa; Tanaka, Yumiko Oishi; Matsumoto, Koji; Satoh, Toyomi; Yoshikawa, Hiroyuki; Minami, Manabu

    2016-02-01

    Ovarian cancer is the seventh most common cancer diagnosis among women worldwide. The International Federation of Gynecology and Obstetrics recently significantly revised staging criteria for cancer of the ovary. The latest revision was based on the concept that high-grade serous tubal intraepithelial carcinoma (STIC) may be the origin of some high-grade serous carcinomas of the ovary and peritoneum. Therefore, staging criteria for the ovary, fallopian tube, and peritoneum have been unified. Understanding this background and other important revised points are essential for radiologists concerned with imaging diagnosis in gynecologic oncology. Through this review, we introduce the STIC theory and show examples of diseases in accordance with the new staging criteria based on magnetic resonance imaging (MRI) and computed tomography (CT) results.

  8. Managing uncertainty - a qualitative study of surgeons' decision-making for one-stage and two-stage revision surgery for prosthetic hip joint infection.

    Science.gov (United States)

    Moore, Andrew J; Blom, Ashley W; Whitehouse, Michael R; Gooberman-Hill, Rachael

    2017-04-12

    Approximately 88,000 primary hip replacements are performed in England and Wales each year. Around 1% go on to develop deep prosthetic joint infection. Between one-stage and two-stage revision arthroplasty best treatment options remain unclear. Our aims were to characterise consultant orthopaedic surgeons' decisions about performing either one-stage or two-stage revision surgery for patients with deep prosthetic infection (PJI) after hip arthroplasty, and to identify whether a randomised trial comparing one-stage with two-stage revision would be feasible. Semi-structured interviews were conducted with 12 consultant surgeons who perform revision surgery for PJI after hip arthroplasty at 5 high-volume National Health Service (NHS) orthopaedic departments in England and Wales. Surgeons were interviewed before the development of a multicentre randomised controlled trial. Data were analysed using a thematic approach. There is no single standardised surgical intervention for the treatment of PJI. Surgeons balance multiple factors when choosing a surgical strategy which include multiple patient-related factors, their own knowledge and expertise, available infrastructure and the infecting organism. Surgeons questioned whether it was appropriate that the two-stage revision remained the best treatment, and some surgeons' willingness to consider more one-stage revisions had increased over recent years and were influenced by growing evidence showing equivalence between surgical techniques, and local observations of successful one-stage revisions. Custom-made articulating spacers was a practice that enabled uncertainty to be managed in the absence of definitive evidence about the superiority of one surgical technique over the other. Surgeons highlighted the need for research evidence to inform practice and thought that a randomised trial to compare treatments was needed. Most surgeons thought that patients who they treated would be eligible for trial participation in instances

  9. Chronic infections in hip arthroplasties: comparing risk of reinfection following one-stage and two-stage revision: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Lange J

    2012-03-01

    Full Text Available Jeppe Lange1,2, Anders Troelsen3, Reimar W Thomsen4, Kjeld Søballe1,51Lundbeck Foundation Centre for Fast-Track Hip and Knee Surgery, Aarhus C, 2Center for Planned Surgery, Silkeborg Regional Hospital, Silkeborg, 3Department of Orthopaedics, Hvidovre Hospital, Hvidovre, 4Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg, 5Department of Orthopaedics, Aarhus University Hospital, Aarhus C, DenmarkBackground: Two-stage revision is regarded by many as the best treatment of chronic infection in hip arthroplasties. Some international reports, however, have advocated one-stage revision. No systematic review or meta-analysis has ever compared the risk of reinfection following one-stage and two-stage revisions for chronic infection in hip arthroplasties.Methods: The review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Relevant studies were identified using PubMed and Embase. We assessed studies that included patients with a chronic infection of a hip arthroplasty treated with either one-stage or two-stage revision and with available data on occurrence of reinfections. We performed a meta-analysis estimating absolute risk of reinfection using a random-effects model.Results: We identified 36 studies eligible for inclusion. None were randomized controlled trials or comparative studies. The patients in these studies had received either one-stage revision (n = 375 or two-stage revision (n = 929. Reinfection occurred with an estimated absolute risk of 13.1% (95% confidence interval: 10.0%–17.1% in the one-stage cohort and 10.4% (95% confidence interval: 8.5%–12.7% in the two-stage cohort. The methodological quality of most included studies was considered low, with insufficient data to evaluate confounding factors.Conclusions: Our results may indicate three additional reinfections per 100 reimplanted patients when performing a one-stage versus two-stage revision. However, the

  10. Evaluation of Revised International Staging System (R-ISS) for transplant-eligible multiple myeloma patients.

    Science.gov (United States)

    González-Calle, Verónica; Slack, Abigail; Keane, Niamh; Luft, Susan; Pearce, Kathryn E; Ketterling, Rhett P; Jain, Tania; Chirackal, Sintosebastian; Reeder, Craig; Mikhael, Joseph; Noel, Pierre; Mayo, Angela; Adams, Roberta H; Ahmann, Gregory; Braggio, Esteban; Stewart, A Keith; Bergsagel, P Leif; Van Wier, Scott A; Fonseca, Rafael

    2018-04-06

    The International Myeloma Working Group has proposed the Revised International Staging System (R-ISS) for risk stratification of multiple myeloma (MM) patients. There are a limited number of studies that have validated this risk model in the autologous stem cell transplant (ASCT) setting. In this retrospective study, we evaluated the applicability and value for predicting survival of the R-ISS model in 134 MM patients treated with new agents and ASCT at the Mayo Clinic in Arizona and the University Hospital of Salamanca in Spain. The patients were reclassified at diagnosis according to the R-ISS: 44 patients (33%) had stage I, 75 (56%) had stage II, and 15 (11%) had stage III. After a median follow-up of 60 months, R-ISS assessed at diagnosis was an independent predictor for overall survival (OS) after ASCT, with median OS not reached, 111 and 37 months for R-ISS I, II and III, respectively (P R-ISS II and having high-risk chromosomal abnormalities (CA) had a significant shorter median OS than those with R-ISS II without CA: 70 vs. 111 months, respectively. Therefore, this study lends further support for the R-ISS as a reliable prognostic tool for estimating survival in transplant myeloma patients and suggests the importance of high-risk CA in the R-ISS II group.

  11. One-stage or two-stage revision surgery for prosthetic hip joint infection--the INFORM trial: a study protocol for a randomised controlled trial.

    Science.gov (United States)

    Strange, Simon; Whitehouse, Michael R; Beswick, Andrew D; Board, Tim; Burston, Amanda; Burston, Ben; Carroll, Fran E; Dieppe, Paul; Garfield, Kirsty; Gooberman-Hill, Rachael; Jones, Stephen; Kunutsor, Setor; Lane, Athene; Lenguerrand, Erik; MacGowan, Alasdair; Moore, Andrew; Noble, Sian; Simon, Joanne; Stockley, Ian; Taylor, Adrian H; Toms, Andrew; Webb, Jason; Whittaker, John-Paul; Wilson, Matthew; Wylde, Vikki; Blom, Ashley W

    2016-02-17

    Periprosthetic joint infection (PJI) affects approximately 1% of patients following total hip replacement (THR) and often results in severe physical and emotional suffering. Current surgical treatment options are debridement, antibiotics and implant retention; revision THR; excision of the joint and amputation. Revision surgery can be done as either a one-stage or two-stage operation. Both types of surgery are well-established practice in the NHS and result in similar rates of re-infection, but little is known about the impact of these treatments from the patient's perspective. The main aim of this randomised controlled trial is to determine whether there is a difference in patient-reported outcome measures 18 months after randomisation for one-stage or two-stage revision surgery. INFORM (INFection ORthopaedic Management) is an open, two-arm, multi-centre, randomised, superiority trial. We aim to randomise 148 patients with eligible PJI of the hip from approximately seven secondary care NHS orthopaedic units from across England and Wales. Patients will be randomised via a web-based system to receive either a one-stage revision or a two-stage revision THR. Blinding is not possible due to the nature of the intervention. All patients will be followed up for 18 months. The primary outcome is the WOMAC Index, which assesses hip pain, function and stiffness, collected by questionnaire at 18 months. Secondary outcomes include the following: cost-effectiveness, complications, re-infection rates, objective hip function assessment and quality of life. A nested qualitative study will explore patients' and surgeons' experiences, including their views about trial participation and randomisation. INFORM is the first ever randomised trial to compare two widely accepted surgical interventions for the treatment of PJI: one-stage and two-stage revision THR. The results of the trial will benefit patients in the future as the main focus is on patient-reported outcomes: pain, function

  12. TWO-STAGE REVISION HIP REPLACEMENT PATIENS WITH SEVERE ACETABULUM DEFECT (CASE REPORT

    Directory of Open Access Journals (Sweden)

    V. V. Pavlov

    2017-01-01

    Full Text Available Favorable short-term results of arthroplasty are observed in 80–90% of cases, however, over the longer follow up period the percentage of positive outcomes is gradually reduced. Need for revision of the prosthesis or it’s components increases in proportion to time elapsed from the surgery. In addition, such revision is accompanied with a need to substitute the bone defect of the acetabulum. As a solution the authors propose to replace pelvic defects in two stages. During the first stage the defect was filled with bone allograft with platelet-rich fibrin (allografting with the use of PRF technology. After the allograft remodeling during the second stage the revision surgery is performed by implanting standard prostheses. The authors present a clinical case of a female patient with aseptic loosening of acetabular component of prosthesis in the right hip joint, with failed hip function of stage 2, right limb shortening of 2 cm. Treatment results confirm the efficiency and rationality of the proposed bone grafting option. The authors conclude bone allograft in combination with the PRF technology proves to be an alternative to the implantation of massive metal implants in the acetabulum while it reduces the risk of implant-associated infection, of metallosis in surrounding tissues and expands further revision options.

  13. T4 category revision enhances the accuracy and significance of stage III breast cancer.

    Science.gov (United States)

    Güth, Uwe; Singer, Gad; Langer, Igor; Schötzau, Andreas; Herberich, Linda; Holzgreve, Wolfgang; Wight, Edward

    2006-06-15

    Because of the considerable heterogeneity in breast carcinoma with noninflammatory skin involvement (T4b/Stage IIIB), a revision was proposed of the TNM staging system that would classify these tumors exclusively based on their tumor size and lymph node status. In the current study, the authors evaluated how implementation of this proposal will affect Stage III noninflammatory breast cancer. Two hundred seven patients who were classified with noninflammatory Stage III breast cancer were treated consecutively between 1990 and 1999 at the University Hospital Basel, Switzerland. To assess the extent of T4b/Stage IIIB tumors independent of the clinicopathologic feature of skin involvement, the reclassification was undertaken. Of 68 patients who had nonmetastatic T4b breast cancer, 37 patients (54.4%) had a tumor extent in accordance with Stage I/II and had improved disease-specific survival (DSS) compared with patients who had Stage III breast cancer (P = .008). Excluding those patients from Stage III led to a 17.9% reduction of the number of patients in this group (n = 170 patients). The 10-year DSS declined from 48.5% to 42.9%. Considerable numbers of patients who are classified with noninflammatory Stage IIIB breast cancer show only a limited disease extent. Through a revision of the T4 category, these low-risk patients were excluded from the highest nonmetastatic TNM stage, and overstaging could be avoided. This procedure decreased the degree of heterogeneity of the entire Stage III group and may result in a more precise assessment of this disease entity. Copyright 2006 American Cancer Society.

  14. One-stage Revision ACL reconstruction with hamstring autograft results in satisfactory outcome

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    Kejriwal, Ritwik; Buelow, Jens

    2017-01-01

    Objectives: Revision anterior cruciate ligament (ACL) reconstruction is associated with poorer outcomes and higher rerupture rates when compared to primary ACL reconstruction. There is also a significant heterogeneity in surgical technique, number of stages, and graft options. We report a large single surgeon case series with hamstring autograft as a graft option. Methods: Observational series of revision ACL reconstructions performed by the senior author between 2005 and 2015 was carried out. Chart reviews and clinic follow-ups were performed with the following recorded – re-rupture rate, radiographic grading of osteoarthritis, KT-1000 arthrometer test, IKDC outcome scores and knee range of motion. All patients underwent single bundle four-strand hamstring autograft performed in one stage with use of new tunnels in majority of the cases. Results: 66 patients underwent hamstring autograft one-stage revision ACL reconstruction by Dr Jens Buelow. Chart review was carried out on all patients, and 26 (39%) were followed up in clinic and/or by phone with a mean follow up of 4.7 years. Outcomes included re-rupture rate of 4.5%, reoperation rate of 12%, mean visual analogue scale score of 7.6, mean side-to-side difference of 2.6 mm for KT-1000 arthrometer test, and mean IKDC score of 79. Of the 17 patients with radiographs, 40% had moderate osteoarthritis (grade 2 or 3) at follow-up. Conclusion: Revision ACL reconstruction can result in a satisfactory outcome when performed with a hamstring autograft in one stage.

  15. Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision

    Science.gov (United States)

    Kasch, Richard; Merk, Sebastian; Assmann, Grit; Lahm, Andreas; Napp, Matthias; Merk, Harry; Flessa, Steffen

    2017-01-01

    Background The most common intermediate and long-term complications of total knee arthroplasty (TKA) include aseptic and septic failure of prosthetic joints. These complications cause suffering, and their management is expensive. In the future the number of revision TKA will increase, which involves a greater financial burden. Little concrete data about direct costs for aseptic and two-stage septic knee revisions with an in depth-analysis of septic explantation and implantation is available. Questions/Purposes A retrospective consecutive analysis of the major partial costs involved in revision TKA for aseptic and septic failure was undertaken to compare 1) demographic and clinical characteristics, and 2) variable direct costs (from a hospital department’s perspective) between patients who underwent single-stage aseptic and two-stage septic revision of TKA in a hospital providing maximum care. We separately analyze the explantation and implantation procedures in septic revision cases and identify the major cost drivers of knee revision operations. Methods A total of 106 consecutive patients (71 aseptic and 35 septic) was included. All direct costs of diagnosis, surgery, and treatment from the hospital department’s perspective were calculated as real purchase prices. Personnel involvement was calculated in units of minutes. Results Aseptic versus septic revisions differed significantly in terms of length of hospital stay (15.2 vs. 39.9 days), number of reported secondary diagnoses (6.3 vs. 9.8) and incision-suture time (108.3 min vs. 193.2 min). The management of septic revision TKA was significantly more expensive than that of aseptic failure ($12,223.79 vs. $6,749.43) (p costs of explantation stage ($4,540.46) were lower than aseptic revision TKA ($6,749.43) which were again lower than those of the septic implantation stage ($7,683.33). All mean costs of stays were not comparable as they differ significantly (p cost drivers were the cost of the implant and

  16. One-stage revision of infected hip arthroplasty: outcome of 39 consecutive hips.

    Science.gov (United States)

    Ilchmann, Thomas; Zimmerli, Werner; Ochsner, Peter Emil; Kessler, Bernhard; Zwicky, Lukas; Graber, Peter; Clauss, Martin

    2016-05-01

    There are various options for treating periprosthetic joint infection (PJI). Two-stage exchange has traditionally been the gold standard. However, if the appropriate surgical intervention is chosen according to a rational algorithm, the outcome is similar when using all types of interventions. In an observational cohort study, the outcome of patients with PJI after hip replacement treated with one-stage revision was analysed. All patients fulfilling all criteria for one-stage exchange according to the Infectious Diseases Society of America (IDSA) guidelines and six without preoperative identification of a microorganism were included. Implant removal, debridement and cemented or uncemented reimplantations were performed in a single intervention. If a cemented device was implanted, commercially available gentamicin cement was used in all cases. Antibiotic treatment was administered intravenously for at least 2 weeks, followed by oral therapy for a total duration of 3 months. Patients had standardised clinical and radiological follow-up visits. Between 1996 and 2011, 38 patients (39 hips) were treated with a one-stage procedure and followed for at least 2 years. Coagulase-negative staphylococci were the most frequent pathogens, and polymicrobial infection was observed in five cases. In 25 hips, an uncemented revision stem was implanted, and 37 hips received an acetabular reinforcement ring. The mean follow-up was 6.6 (2.0-15.1) years. No patient had persistent, recurrent or new infection. There were four stem revisions for aseptic loosening. The mean Harris Hip Score was 81 points (26-99) at the final follow-up. Excellent cure rate and function seen in our study suggest that one-stage exchange is a safe procedure, even without local antibiotic treatment, provided that the patient has no sinus tract or severe soft tissue damage, no major bone grafting is required and the microorganism is susceptible to orally administered agents with high bioavailability.

  17. Responding to the Challenges of Active Citizenship through the Revised UK Early Years Foundation Stage Curriculum

    Science.gov (United States)

    Baker, Fiona S.

    2013-01-01

    The revised UK Early Years Foundation Stage (EYFS) now places a stronger emphasis on personal, social and emotional development (PSED) as one of its three prime areas. PSED has three characteristics of learning: active learning, creating and thinking critically, and playing and exploring. These aspects of the revised EYFS closely align with the…

  18. Revised licensee event report system

    International Nuclear Information System (INIS)

    Mays, G.T.; Poore, W.P.

    1985-01-01

    Licensee Event Reports (LERs) provide the basis for evaluating and assessing operating experience information from nuclear power plants. The reporting requirements for submitting LERs to the Nuclear Regulatory Commission have been revised. Effective Jan. 1, 1984, all events were to be submitted in accordance with 10 CFR 50.73 of the Code of Federal Regulations. Report NUREG-1022, Licensee Event Report System-Description of System and Guidelines for Reporting, describes the guidelines on reportability of events. This article summarizes the reporting requirements as presented in NUREG-1022, high-lights differences in data reported between the revised and previous LER systems, and presents results from a preliminary assessment of LERs submitted under the revised LER reporting system

  19. One- and two-stage surgical revision of peri-prosthetic joint infection of the hip: a pooled individual participant data analysis of 44 cohort studies.

    Science.gov (United States)

    Kunutsor, Setor K; Whitehouse, Michael R; Blom, Ashley W; Board, Tim; Kay, Peter; Wroblewski, B Mike; Zeller, Valérie; Chen, Szu-Yuan; Hsieh, Pang-Hsin; Masri, Bassam A; Herman, Amir; Jenny, Jean-Yves; Schwarzkopf, Ran; Whittaker, John-Paul; Burston, Ben; Huang, Ronald; Restrepo, Camilo; Parvizi, Javad; Rudelli, Sergio; Honda, Emerson; Uip, David E; Bori, Guillem; Muñoz-Mahamud, Ernesto; Darley, Elizabeth; Ribera, Alba; Cañas, Elena; Cabo, Javier; Cordero-Ampuero, José; Redó, Maria Luisa Sorlí; Strange, Simon; Lenguerrand, Erik; Gooberman-Hill, Rachael; Webb, Jason; MacGowan, Alasdair; Dieppe, Paul; Wilson, Matthew; Beswick, Andrew D

    2018-04-05

    One-stage and two-stage revision strategies are the two main options for treating established chronic peri-prosthetic joint infection (PJI) of the hip; however, there is uncertainty regarding which is the best treatment option. We aimed to compare the risk of re-infection between the two revision strategies using pooled individual participant data (IPD). Observational cohort studies with PJI of the hip treated exclusively by one- or two-stage revision and reporting re-infection outcomes were retrieved by searching MEDLINE, EMBASE, Web of Science, The Cochrane Library, and the WHO International Clinical Trials Registry Platform; as well as email contact with investigators. We analysed IPD of 1856 participants with PJI of the hip from 44 cohorts across four continents. The primary outcome was re-infection (recurrence of infection by the same organism(s) and/or re-infection with a new organism(s)). Hazard ratios (HRs) for re-infection were calculated using Cox proportional frailty hazards models. After a median follow-up of 3.7 years, 222 re-infections were recorded. Re-infection rates per 1000 person-years of follow-up were 16.8 (95% CI 13.6-20.7) and 32.3 (95% CI 27.3-38.3) for one-stage and two-stage strategies respectively. The age- and sex-adjusted HR of re-infection for two-stage revision was 1.70 (0.58-5.00) when compared with one-stage revision. The association remained consistently absent after further adjustment for potential confounders. The HRs did not vary importantly in clinically relevant subgroups. Analysis of pooled individual patient data suggest that a one-stage revision strategy may be as effective as a two-stage revision strategy in treating PJI of the hip.

  20. Single-stage revision for fungal peri-prosthetic joint infection: a single-centre experience.

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    Klatte, T O; Kendoff, D; Kamath, A F; Jonen, V; Rueger, J M; Frommelt, L; Gebauer, M; Gehrke, T

    2014-04-01

    Fungal peri-prosthetic infections of the knee and hip are rare but likely to result in devastating complications. In this study we evaluated the results of their management using a single-stage exchange technique. Between 2001 and 2011, 14 patients (ten hips, four knees) were treated for a peri-prosthetic fungal infection. One patient was excluded because revision surgery was not possible owing to a large acetabular defect. One patient developed a further infection two months post-operatively and was excluded from the analysis. Two patients died of unrelated causes. After a mean of seven years (3 to 11) a total of ten patients were available for follow-up. One patient, undergoing revision replacement of the hip, had a post-operative dislocation. Another patient, undergoing revision replacement of the knee, developed a wound infection and required revision 29 months post-operatively following a peri-prosthetic femoral fracture. The mean Harris hip score increased to 74 points (63 to 84; p prosthetic infection is feasible, with an acceptable rate of a satisfactory outcome.

  1. Revising Lecture Notes: How Revision, Pauses, and Partners Affect Note Taking and Achievement

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    Luo, Linlin; Kiewra, Kenneth A.; Samuelson, Lydia

    2016-01-01

    Note taking has been categorized as a two-stage process: the recording of notes and the review of notes. We contend that note taking might best involve a three-stage process where the missing stage is revision. This study investigated the benefits of revising lecture notes and addressed two questions: First, is revision more effective than…

  2. One-stage exchange with antibacterial hydrogel coated implants provides similar results to two-stage revision, without the coating, for the treatment of peri-prosthetic infection.

    Science.gov (United States)

    Capuano, Nicola; Logoluso, Nicola; Gallazzi, Enrico; Drago, Lorenzo; Romanò, Carlo Luca

    2018-03-16

    Aim of this study was to verify the hypothesis that a one-stage exchange procedure, performed with an antibiotic-loaded, fast-resorbable hydrogel coating, provides similar infection recurrence rate than a two-stage procedure without the coating, in patients affected by peri-prosthetic joint infection (PJI). In this two-center case-control, study, 22 patients, treated with a one-stage procedure, using implants coated with an antibiotic-loaded hydrogel [defensive antibacterial coating (DAC)], were compared with 22 retrospective matched controls, treated with a two-stage revision procedure, without the coating. At a mean follow-up of 29.3 ± 5.0 months, two patients (9.1%) in the DAC group showed an infection recurrence, compared to three patients (13.6%) in the two-stage group. Clinical scores were similar between groups, while average hospital stay and antibiotic treatment duration were significantly reduced after one-stage, compared to two-stage (18.9 ± 2.9 versus 35.8 ± 3.4 and 23.5 ± 3.3 versus 53.7 ± 5.6 days, respectively). Although in a relatively limited series of patients, our data shows similar infection recurrence rate after one-stage exchange with DAC-coated implants, compared to two-stage revision without coating, with reduced overall hospitalization time and antibiotic treatment duration. These findings warrant further studies in the possible applications of antibacterial coating technologies to treat implant-related infections. III.

  3. Seventh edition (2010) of the AJCC/UICC staging system for gastric adenocarcinoma: is there room for improvement?

    Science.gov (United States)

    Patel, Manali I; Rhoads, Kim F; Ma, Yifei; Ford, James M; Visser, Brendan C; Kunz, Pamela L; Fisher, George A; Chang, Daniel T; Koong, Albert; Norton, Jeffrey A; Poultsides, George A

    2013-05-01

    The gastric cancer AJCC/UICC staging system recently underwent significant revisions, but studies on Asian patients have reported a lack of adequate discrimination between various consecutive stages. We sought to validate the new system on a U.S. population database. California Cancer Registry data linked to the Office of Statewide Health Planning and Development discharge abstracts were used to identify patients with gastric adenocarcinoma (esophagogastric junction and gastric cardia tumors excluded) who underwent curative-intent surgical resection in California from 2002 to 2006. AJCC/UICC stage was recalculated based on the latest seventh edition. Overall survival probabilities were calculated using the Kaplan-Meier method. Of 1905 patients analyzed, 54 % were males with a median age of 70 years. Median number of pathologically examined lymph nodes was 12 (range, 1-90); 40 % of patients received adjuvant chemotherapy, and 31 % received adjuvant radiotherapy. The seventh edition AJCC/UICC system did not distinguish outcome adequately between stages IB and IIA (P = 0.40), or IIB and IIIA (P = 0.34). By merging stage II into 1 category and moving T2N1 to stage IB and T2N2, T1N3 to stage IIIA, we propose a new grouping system with improved discriminatory ability In this first study validating the new seventh edition AJCC/UICC staging system for gastric cancer on a U.S. population with a relatively limited number of lymph nodes examined, we found stages IB and IIA, as well as IIB and IIIA to perform similarly. We propose a revised stage grouping for the AJCC/UICC staging system that better discriminates between outcomes.

  4. Colorectal cancer and the 7th revision of the TNM staging system: review of changes and suggestions for uniform pathologic reporting.

    Science.gov (United States)

    Obrocea, F L; Sajin, Maria; Marinescu, Elena Cristina; Stoica, D

    2011-01-01

    Colorectal cancer (CRC) is a neoplastic disease with a continuously growing incidence in Romania and throughout the world. Although the surgery remains the first line treatment for most of the cases, newly discovered targeted molecular therapies - effective for some patients, but with various side effects and significant financial burden for the national health systems - requires not only stratification of patients in prognostic groups but also evaluation of some non-anatomic factors with major impact on the prognosis and therapeutic strategy. The AJCC/UICC TNM staging system, in his 7th revision, effective for cases diagnosed on or after January 1, 2010, responds to these needs. On the other hand, the role of the pathologist is increasing in terms of workload and amount of information to be included in the pathology report in order to deliver a personalized diagnosis. There are concerns worldwide regarding relevance, validity and completeness of pathologic reporting of CRC in the absence of a uniform reporting format. Therefore, suggestions for a standardized pathology report of CRC are made, based on TNM 7 and recent, up-to-date conclusive published data.

  5. Economic analysis of two-stage septic revision after total hip arthroplasty: What are the relevant costs for the hospital's orthopedic department?

    Science.gov (United States)

    Kasch, R; Assmann, G; Merk, S; Barz, T; Melloh, M; Hofer, A; Merk, H; Flessa, S

    2016-03-01

    The number of septic total hip arthroplasty (THA) revisions is increasing continuously, placing a growing financial burden on hospitals. Orthopedic departments performing septic THA revisions have no basis for decision making regarding resource allocation as the costs of this procedure for the departments are unknown. It is widely assumed that septic THA procedures can only be performed at a loss for the department. Therefore, the purpose of this study was to investigate whether this assumption is true by performing a detailed analysis of the costs and revenues for two-stage septic THA revision. Patients who underwent revision THA for septic loosening in two sessions from January 2009 through March 2012 were included in this retrospective, consecutive cost study from the orthopedic department's point of view. We analyzed variable and case-fixed costs for septic revision THA with special regard to implantation and explantation stay. By using marginal costing approach we neglected hospital-fixed costs. Outcome measures include reimbursement and daily contribution margins. The average direct costs (reimbursement) incurred for septic two-stage revision THA was €10,828 (€24,201). The difference in cost and contribution margins per day was significant (p cost for septic revision THA performed in two sessions. Disregarding hospital-fixed costs the included variable and case fixed-costs were covered by revenues. This study provides cost data, which will be guidance for health care decision makers.

  6. Outcomes of Patients With Revised Stage I Clear Cell Sarcoma of Kidney Treated in National Wilms Tumor Studies 1-5

    International Nuclear Information System (INIS)

    Kalapurakal, John A.; Perlman, Elizabeth J.; Seibel, Nita L.; Ritchey, Michael; Dome, Jeffrey S.; Grundy, Paul E.

    2013-01-01

    Purpose: To report the clinical outcomes of children with revised stage I clear cell sarcoma of the kidney (CCSK) using the National Wilms Tumor Study Group (NWTS)-5 staging criteria after multimodality treatment on NWTS 1-5 protocols. Methods and Materials: All CCSK patients enrolled in the National Wilms Tumor Study Group protocols had their pathology slides reviewed, and only those determined to have revised stage I tumors according to the NWTS-5 staging criteria were included in the present analysis. All patients were treated with multimodality therapy according to the NWTS 1-5 protocols. Results: A total of 53 children were identified as having stage I CCSK. All patients underwent primary surgery with radical nephrectomy. The chemotherapy regimens used were as follows: regimen A, C, F, or EE in 4 children (8%); regimen DD or DD4A in 33 children (62%); regimen J in 4 children (8%); and regimen I in 12 children (22%). Forty-six patients (87%) received flank radiation therapy (RT). Seven children (13%) did not receive flank RT. The median delay between surgery and the initiation of RT was 9 days (range, 3-61). The median RT dose was 10.8 Gy (range, 10-36). The flank RT doses were as follows: 10.5 or 10.8 Gy in 25 patients (47%), 11-19.9 Gy in 2 patients (4%), 20-29.9 Gy in 9 patients (17%), and 30-40 Gy in 10 patients (19%). The median follow-up for the entire group was 17 years (range, 2-36). The relapse-free and cancer-specific survival rate was 100% at the last follow-up examination. Conclusions: The present results have demonstrated that children with revised stage I CCSK using the NWTS-5 staging criteria have excellent survival rates despite the use of varying RT doses and chemotherapy regimens in the NWTS 1-5 protocols.

  7. The Influence of a Failed Irrigation and Debridement on the Outcomes of a Subsequent 2-Stage Revision Knee Arthroplasty.

    Science.gov (United States)

    Nodzo, Scott R; Boyle, Keely K; Nocon, Allina A; Henry, Michael W; Mayman, David J; Westrich, Geoffrey H

    2017-08-01

    Previous work has suggested a failed irrigation and debridement (I&D) before a 2-stage exchange negatively impacts the outcome of the subsequent 2-stage revision. This was a retrospective review of 132 patients who underwent a 2-stage exchange without prior I&D (2-Stage), and 45 patients had a failed I&D before their 2-stage exchange (I&D+2Stage) between April 2009 and April 2015. Charts were reviewed for patient demographics, presenting inflammatory laboratory values, type of antibiotic spacer used, surgical details, microbiology data, length of postoperative antibiotic treatment, and reoperation. A logistic regression was used to assess the association between I&D and reoperation. The I&D+2Stage group had an 82.2% success rate, and the 2-Stage group had an 82.5% success rate (P = .95). The odds of reoperation for infection with the use of greater than 2 grams of vancomycin was 0.33 (P = .01, 95% confidence interval 0.14-0.79) as compared with having less than 2 grams of vancomycin in the construct. Spacer type, having a prior I&D to the 2-stage procedure, being infected with an antibiotic resistant organism, total grams of aminoglycoside were not associated with a risk of failure. Success rates between the I&D+2Stage group and the 2-Stage group were similar. The use of greater than 2 grams of vancomycin in the spacer construct decreased the odds of reoperation. I&D before a 2-stage exchange may not negatively influence the outcomes of a subsequent 2-stage revision procedure and requires further investigation. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Staged licensing: An essential element of the NRC's revised regulations

    International Nuclear Information System (INIS)

    Echols, F.S.

    1997-01-01

    Over the past several years, Congress has directed the Department of Energy (DOE), the Nuclear Regulatory Commission (NRC), and the Environmental Protection Agency (EPA) to abandon their efforts to assess an array of potential candidate geologic repository sites for the permanent disposal of spent nuclear reactor fuel and high level radioactive waste, to develop generally applicable requirements for licensing geologic repositories, and to develop generally applicable radiation protection standards for geologic repositories, and instead to focus their efforts to determine whether a single site located at Yucca Mountain, Nevada can be developed as a geologic repository which providing reasonable assurance that public health and safety and the environment will be adequately protected. If the Yucca Mountain site is found to be suitable for development as a geologic repository, then at each stage of development DOE will have to provide the NRC with progressively more detailed information regarding repository design and long-term performance. NRC regulations reflect the fact that it will not be until the repository has been operated for a number of years that the NRC will be able to make a final determination as to long-term repository performance. Nevertheless, the NRC will be able to allow DOE to construct and operate a repository, provided that the NRC believes that the documented results of existing studies, together with the anticipated results from continuing and future studies, will enable the NRC to make a final determination that it has reasonable assurance that the repository system's long-term performance will not cause undue risk to the public. Thus, in its efforts to revise its current regulations to assure that the technical criteria are specifically applicable to the Yucca Mountain site, the NRC should also make sure that it preserves and clarifies the concept of staged repository development

  9. Two-stage revision surgery with preformed spacers and cementless implants for septic hip arthritis: a prospective, non-randomized cohort study

    Directory of Open Access Journals (Sweden)

    Logoluso Nicola

    2011-05-01

    Full Text Available Abstract Background Outcome data on two-stage revision surgery for deep infection after septic hip arthritis are limited and inconsistent. This study presents the medium-term results of a new, standardized two-stage arthroplasty with preformed hip spacers and cementless implants in a consecutive series of adult patients with septic arthritis of the hip treated according to a same protocol. Methods Nineteen patients (20 hips were enrolled in this prospective, non-randomized cohort study between 2000 and 2008. The first stage comprised femoral head resection, debridement, and insertion of a preformed, commercially available, antibiotic-loaded cement hip spacer. After eradication of infection, a cementless total hip arthroplasty was implanted in the second stage. Patients were assessed for infection recurrence, pain (visual analog scale [VAS] and hip joint function (Harris Hip score. Results The mean time between first diagnosis of infection and revision surgery was 5.8 ± 9.0 months; the average duration of follow up was 56.6 (range, 24 - 104 months; all 20 hips were successfully converted to prosthesis an average 22 ± 5.1 weeks after spacer implantation. Reinfection after total hip joint replacement occurred in 1 patient. The mean VAS pain score improved from 48 (range, 35 - 84 pre-operatively to 18 (range, 0 - 38 prior to spacer removal and to 8 (range, 0 - 15 at the last follow-up assessment after prosthesis implantation. The average Harris Hip score improved from 27.5 before surgery to 61.8 between the two stages to 92.3 at the final follow-up assessment. Conclusions Satisfactory outcomes can be obtained with two-stage revision hip arthroplasty using preformed spacers and cementless implants for prosthetic hip joint infections of various etiologies.

  10. Articulating spacers used in two-stage revision of infected hip and knee prostheses abrade with time.

    Science.gov (United States)

    Fink, Bernd; Rechtenbach, Annett; Büchner, Hubert; Vogt, Sebastian; Hahn, Michael

    2011-04-01

    Articulating spacers used in two-stage revision surgery of infected prostheses have the potential to abrade and subsequently induce third-body wear of the new prosthesis. We asked whether particulate material abraded from spacers could be detected in the synovial membrane 6 weeks after implantation when the spacers were removed for the second stage of the revision. Sixteen hip spacers (cemented prosthesis stem articulating with a cement cup) and four knee spacers (customized mobile cement spacers) were explanted 6 weeks after implantation and the synovial membranes were removed at the same time. The membranes were examined by xray fluorescence spectroscopy, xray diffraction for the presence of abraded particles originating from the spacer material, and analyzed in a semiquantitative manner by inductively coupled plasma mass spectrometry. Histologic analyses also were performed. We found zirconium dioxide in substantial amounts in all samples, and in the specimens of the hip synovial lining, we detected particles that originated from the metal heads of the spacers. Histologically, zirconium oxide particles were seen in the synovial membrane of every spacer and bone cement particles in one knee and two hip spacers. The observations suggest cement spacers do abrade within 6 weeks. Given the presence of abrasion debris, we recommend total synovectomy and extensive lavage during the second-stage reimplantation surgery to minimize the number of abraded particles and any retained bacteria.

  11. Failure of the first step of two-stage revision due to polymicrobial prosthetic joint infection of the hip.

    Science.gov (United States)

    Bozhkova, Svetlana; Tikhilov, Rashid; Labutin, Dmitry; Denisov, Alexey; Shubnyakov, Igor; Razorenov, Vadim; Artyukh, Vasilii; Rukina, Anna

    2016-12-01

    The unsuccessful treatment of prosthetic joint infection (PJI) with two-stage revision leads to infection recurrence. The objectives of the study were to assess the clinical and demographic characteristics of patients with polymicrobial PJI, and to evaluate the role of the microbial profile involved in PJI in the risk of infection recurrence after the first step of two-stage revision surgery. A retrospective analysis of 189 cases of culture-positive PJI following total hip replacement over a 5-year period was performed. The demographic characteristics of patients, clinical symptoms, microbiology cultures of intraoperative biopsies, laboratory values of C-reactive protein (CRP), white blood cell count and erythrocyte sedimentation rate were analyzed. Patients were divided into two groups-135 with monomicrobial and 54 with polymicrobial infection. Of all patients, 68.9 % in the monomicrobial and 83.3 % in the polymicrobial group had a body mass index >25 kg/m 2 (p = 0.05). The median CRP values were 5.7 mg/L (IQR 4.0-10.0 mg/L) in the monomicrobial compared to 8.8 mg/L (IQR 5.0-27 mg/L) in the polymicrobial group (p = 0.01). The percentage of successful outcomes was 27.8 % in patients with microbial associations (p infection recurrence (OR 4.4; 95 % CI 1.18-16.37; p = 0.03). Overweight and obese patients or those with elevated CRP had a greater risk of polymicrobial PJI. They were predisposed to recurrence of infection after the first step of two-stage revision. An unsuccessful outcome was more likely in cases with polymicrobial infection compared to those with monomicrobial infection. In addition, the presence of multidrug-resistant strains of Gram-negative bacteria substantially increased the risk of PJI treatment being unsuccessful. Level III, therapeutic study.

  12. Revised SWAT. The integrated burnup calculation code system

    International Nuclear Information System (INIS)

    Suyama, Kenya; Mochizuki, Hiroki; Kiyosumi, Takehide

    2000-07-01

    SWAT is an integrated burnup code system developed for analysis of post irradiation examination, transmutation of radioactive waste, and burnup credit problem. This report shows an outline and a user's manual of revised SWAT. This revised SWAT includes expansion of functions, increasing supported machines, and correction of several bugs reported from users of previous SWAT. (author)

  13. Revised SWAT. The integrated burnup calculation code system

    Energy Technology Data Exchange (ETDEWEB)

    Suyama, Kenya; Mochizuki, Hiroki [Department of Fuel Cycle Safety Research, Nuclear Safety Research Center, Tokai Research Establishment, Japan Atomic Energy Research Institute, Tokai, Ibaraki (Japan); Kiyosumi, Takehide [The Japan Research Institute, Ltd., Tokyo (Japan)

    2000-07-01

    SWAT is an integrated burnup code system developed for analysis of post irradiation examination, transmutation of radioactive waste, and burnup credit problem. This report shows an outline and a user's manual of revised SWAT. This revised SWAT includes expansion of functions, increasing supported machines, and correction of several bugs reported from users of previous SWAT. (author)

  14. The IASLC Lung Cancer Staging Project

    DEFF Research Database (Denmark)

    Chansky, Kari; Detterbeck, Frank C; Nicholson, Andrew G

    2017-01-01

    INTRODUCTION: Revisions to the TNM stage classifications for lung cancer, informed by the international database (N = 94,708) of the International Association for the Study of Lung Cancer (IASLC) Staging and Prognostic Factors Committee, need external validation. The objective was to externally...... demonstrated consistent ability to discriminate TNM categories and stage groups for clinical and pathologic stage. CONCLUSIONS: The IASLC revisions made for the eighth edition of lung cancer staging are validated by this analysis of the NCDB database by the ordering, statistical differences, and homogeneity...... validate the revisions by using the National Cancer Data Base (NCDB) of the American College of Surgeons. METHODS: Cases presenting from 2000 through 2012 were drawn from the NCDB and reclassified according to the eighth edition stage classification. Clinically and pathologically staged subsets of NSCLC...

  15. Development and validation of a surgical-pathologic staging and scoring system for cervical cancer.

    Science.gov (United States)

    Li, Shuang; Li, Xiong; Zhang, Yuan; Zhou, Hang; Tang, Fangxu; Jia, Yao; Hu, Ting; Sun, Haiying; Yang, Ru; Chen, Yile; Cheng, Xiaodong; Lv, Weiguo; Wu, Li; Zhou, Jin; Wang, Shaoshuai; Huang, Kecheng; Wang, Lin; Yao, Yuan; Yang, Qifeng; Yang, Xingsheng; Zhang, Qinghua; Han, Xiaobing; Lin, Zhongqiu; Xing, Hui; Qu, Pengpeng; Cai, Hongbing; Song, Xiaojie; Tian, Xiaoyu; Shen, Jian; Xi, Ling; Li, Kezhen; Deng, Dongrui; Wang, Hui; Wang, Changyu; Wu, Mingfu; Zhu, Tao; Chen, Gang; Gao, Qinglei; Wang, Shixuan; Hu, Junbo; Kong, Beihua; Xie, Xing; Ma, Ding

    2016-04-12

    Most cervical cancer patients worldwide receive surgical treatments, and yet the current International Federation of Gynecology and Obstetrics (FIGO) staging system do not consider surgical-pathologic data. We propose a more comprehensive and prognostically valuable surgical-pathologic staging and scoring system (SPSs). Records from 4,220 eligible cervical cancer cases (Cohort 1) were screened for surgical-pathologic risk factors. We constructed a surgical-pathologic staging and SPSs, which was subsequently validated in a prospective study of 1,104 cervical cancer patients (Cohort 2). In Cohort 1, seven independent risk factors were associated with patient outcome: lymph node metastasis (LNM), parametrial involvement, histological type, grade, tumor size, stromal invasion, and lymph-vascular space invasion (LVSI). The FIGO staging system was revised and expanded into a surgical-pathologic staging system by including additional criteria of LNM, stromal invasion, and LVSI. LNM was subdivided into three categories based on number and location of metastases. Inclusion of all seven prognostic risk factors improves practical applicability. Patients were stratified into three SPSs risk categories: zero-, low-, and high-score with scores of 0, 1 to 3, and ≥4 (P=1.08E-45; P=6.15E-55). In Cohort 2, 5-year overall survival (OS) and disease-free survival (DFS) outcomes decreased with increased SPSs scores (P=9.04E-15; P=3.23E-16), validating the approach. Surgical-pathologic staging and SPSs show greater homogeneity and discriminatory utility than FIGO staging. Surgical-pathologic staging and SPSs improve characterization of tumor severity and disease invasion, which may more accurately predict outcome and guide postoperative therapy.

  16. Cementless One-Stage Revision in Chronic Periprosthetic Hip Joint Infection. Ninety-One Percent Infection Free Survival in 56 Patients at Minimum 2-Year Follow-Up

    DEFF Research Database (Denmark)

    Lange, Jeppe; Troelsen, Anders; Solgaard, Søren

    2018-01-01

    was re-revision performed due to infection and was evaluated by competing risk analysis, with death and aseptic revision as competing events. All-cause mortality was evaluated by Kaplan-Meier survival analysis. Oxford Hip Score (OHS) was used as disease-specific patient-reported outcome measure. RESULTS......BACKGROUND: Cementless 1-stage revision in chronic periprosthetic hip joint infections is limited evaluated. The purpose of this study was to evaluate a specific treatment protocol in this patient group. METHODS: The study was performed as a multicenter, proof-of-concept, observational study...

  17. Revision of infected knee arthroplasties in Denmark

    DEFF Research Database (Denmark)

    Lindberg-Larsen, Martin; Jørgensen, Christoffer C; Bagger, Jens

    2016-01-01

    Background and purpose - The surgical treatment of periprosthetic knee infection is generally either a partial revision procedure (open debridement and exchange of the tibial insert) or a 2-stage exchange arthroplasty procedure. We describe the failure rates of these procedures on a nationwide...... basis. Patients and methods - 105 partial revisions (100 patients) and 215 potential 2-stage revision procedures (205 patients) performed due to infection from July 1, 2011 to June 30, 2013 were identified from the Danish Knee Arthroplasty Register (DKR). Failure was defined as surgically related death...

  18. 75 FR 81205 - Privacy Act: Revision of Privacy Act Systems of Records

    Science.gov (United States)

    2010-12-27

    ... DEPARTMENT OF AGRICULTURE Office of the Secretary Privacy Act: Revision of Privacy Act Systems of Records AGENCY: Office of the Secretary, USDA. ACTION: Notice to Revise Privacy Act Systems of Records... two Privacy Act Systems of Records entitled ``Information on Persons Disqualified from the...

  19. Revision history aware repositories of computational models of biological systems.

    Science.gov (United States)

    Miller, Andrew K; Yu, Tommy; Britten, Randall; Cooling, Mike T; Lawson, James; Cowan, Dougal; Garny, Alan; Halstead, Matt D B; Hunter, Peter J; Nickerson, David P; Nunns, Geo; Wimalaratne, Sarala M; Nielsen, Poul M F

    2011-01-14

    Building repositories of computational models of biological systems ensures that published models are available for both education and further research, and can provide a source of smaller, previously verified models to integrate into a larger model. One problem with earlier repositories has been the limitations in facilities to record the revision history of models. Often, these facilities are limited to a linear series of versions which were deposited in the repository. This is problematic for several reasons. Firstly, there are many instances in the history of biological systems modelling where an 'ancestral' model is modified by different groups to create many different models. With a linear series of versions, if the changes made to one model are merged into another model, the merge appears as a single item in the history. This hides useful revision history information, and also makes further merges much more difficult, as there is no record of which changes have or have not already been merged. In addition, a long series of individual changes made outside of the repository are also all merged into a single revision when they are put back into the repository, making it difficult to separate out individual changes. Furthermore, many earlier repositories only retain the revision history of individual files, rather than of a group of files. This is an important limitation to overcome, because some types of models, such as CellML 1.1 models, can be developed as a collection of modules, each in a separate file. The need for revision history is widely recognised for computer software, and a lot of work has gone into developing version control systems and distributed version control systems (DVCSs) for tracking the revision history. However, to date, there has been no published research on how DVCSs can be applied to repositories of computational models of biological systems. We have extended the Physiome Model Repository software to be fully revision history aware

  20. Revision history aware repositories of computational models of biological systems

    Directory of Open Access Journals (Sweden)

    Nickerson David P

    2011-01-01

    Full Text Available Abstract Background Building repositories of computational models of biological systems ensures that published models are available for both education and further research, and can provide a source of smaller, previously verified models to integrate into a larger model. One problem with earlier repositories has been the limitations in facilities to record the revision history of models. Often, these facilities are limited to a linear series of versions which were deposited in the repository. This is problematic for several reasons. Firstly, there are many instances in the history of biological systems modelling where an 'ancestral' model is modified by different groups to create many different models. With a linear series of versions, if the changes made to one model are merged into another model, the merge appears as a single item in the history. This hides useful revision history information, and also makes further merges much more difficult, as there is no record of which changes have or have not already been merged. In addition, a long series of individual changes made outside of the repository are also all merged into a single revision when they are put back into the repository, making it difficult to separate out individual changes. Furthermore, many earlier repositories only retain the revision history of individual files, rather than of a group of files. This is an important limitation to overcome, because some types of models, such as CellML 1.1 models, can be developed as a collection of modules, each in a separate file. The need for revision history is widely recognised for computer software, and a lot of work has gone into developing version control systems and distributed version control systems (DVCSs for tracking the revision history. However, to date, there has been no published research on how DVCSs can be applied to repositories of computational models of biological systems. Results We have extended the Physiome Model

  1. Continuously revised assurance cases with stakeholders’ cross-validation: a DEOS experience

    Directory of Open Access Journals (Sweden)

    Kimio Kuramitsu

    2016-12-01

    Full Text Available Recently, assurance cases have received much attention in the field of software-based computer systems and IT services. However, software changes very often, and there are no strong regulations for software. These facts are two main challenges to be addressed in the development of software assurance cases. We propose a method of developing assurance cases by means of continuous revision at every stage of the system life cycle, including in operation and service recovery in failure cases. Instead of a regulator, dependability arguments are validated by multiple stakeholders competing with each other. This paper reported our experience with the proposed method in the case of Aspen education service. The case study demonstrates that continuous revisions enable stakeholders to share dependability problems across software life cycle stages, which will lead to the long-term improvement of service dependability.

  2. A stage is a stage is a stage: a direct comparison of two scoring systems.

    Science.gov (United States)

    Dawson, Theo L

    2003-09-01

    L. Kohlberg (1969) argued that his moral stages captured a developmental sequence specific to the moral domain. To explore that contention, the author compared stage assignments obtained with the Standard Issue Scoring System (A. Colby & L. Kohlberg, 1987a, 1987b) and those obtained with a generalized content-independent stage-scoring system called the Hierarchical Complexity Scoring System (T. L. Dawson, 2002a), on 637 moral judgment interviews (participants' ages ranged from 5 to 86 years). The correlation between stage scores produced with the 2 systems was .88. Although standard issue scoring and hierarchical complexity scoring often awarded different scores up to Kohlberg's Moral Stage 2/3, from his Moral Stage 3 onward, scores awarded with the two systems predominantly agreed. The author explores the implications for developmental research.

  3. Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, and End-Stage Renal Disease Quality Incentive Program. Final rule.

    Science.gov (United States)

    2017-11-01

    This rule updates and makes revisions to the end-stage renal disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2018. It also updates the payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury (AKI). This rule also sets forth requirements for the ESRD Quality Incentive Program (QIP), including for payment years (PYs) 2019 through 2021.

  4. Revised SRAC code system

    International Nuclear Information System (INIS)

    Tsuchihashi, Keichiro; Ishiguro, Yukio; Kaneko, Kunio; Ido, Masaru.

    1986-09-01

    Since the publication of JAERI-1285 in 1983 for the preliminary version of the SRAC code system, a number of additions and modifications to the functions have been made to establish an overall neutronics code system. Major points are (1) addition of JENDL-2 version of data library, (2) a direct treatment of doubly heterogeneous effect on resonance absorption, (3) a generalized Dancoff factor, (4) a cell calculation based on the fixed boundary source problem, (5) the corresponding edit required for experimental analysis and reactor design, (6) a perturbation theory calculation for reactivity change, (7) an auxiliary code for core burnup and fuel management, etc. This report is a revision of the users manual which consists of the general description, input data requirements and their explanation, detailed information on usage, mathematics, contents of libraries and sample I/O. (author)

  5. 76 FR 16263 - Revision to Electric Reliability Organization Definition of Bulk Electric System

    Science.gov (United States)

    2011-03-23

    ...; Order No. 743-A] Revision to Electric Reliability Organization Definition of Bulk Electric System AGENCY... certain provisions of the Final Rule. Order No. 743 directed the Electric Reliability Organization (ERO) to revise the definition of the term ``bulk electric system'' through the ERO's Reliability Standards...

  6. Preliminary hazards analysis of thermal scrap stabilization system. Revision 1

    International Nuclear Information System (INIS)

    Lewis, W.S.

    1994-01-01

    This preliminary analysis examined the HA-21I glovebox and its supporting systems for potential process hazards. Upon further analysis, the thermal stabilization system has been installed in gloveboxes HC-21A and HC-21C. The use of HC-21C and HC-21A simplified the initial safety analysis. In addition, these gloveboxes were cleaner and required less modification for operation than glovebox HA-21I. While this document refers to glovebox HA-21I for the hazards analysis performed, glovebox HC-21C is sufficiently similar that the following analysis is also valid for HC-21C. This hazards analysis document is being re-released as revision 1 to include the updated flowsheet document (Appendix C) and the updated design basis (Appendix D). The revised Process Flow Schematic has also been included (Appendix E). This Current revision incorporates the recommendations provided from the original hazards analysis as well. The System Design Description (SDD) has also been appended (Appendix H) to document the bases for Safety Classification of thermal stabilization equipment

  7. Patella tendon injuries secondary to cement spacers used at first-stage revision of infected total knee replacement

    Directory of Open Access Journals (Sweden)

    Wasim S Khan

    2015-04-01

    Full Text Available We describe a series of three patients who sustained patella tendon injuries in infected TKAs following the use of a static cement spacer at first-stage knee revision. The patella tendon injuries resulted in significant compromise to wound healing and knee stability requiring multiple surgeries. The mid-term function was poor with an Oxford score at 24 months ranging from 12-20. Based on our experience, we advise caution in the use of static cement spacer blocks. If they are to be used, we recommend that they should be keyed in the bone to prevent patella tendon injuries.

  8. 78 FR 47697 - Public Water System Supervision Program Revision for the State of Louisiana

    Science.gov (United States)

    2013-08-06

    ...: 1) Long Term 2 Enhanced Surface Water Treatment Rule (LT2), 2) the Stage 2 Disinfectants and Disinfection Byproducts Rule (DBP2), and 3) the Lead and Copper Rule Short-Term Revisions and Clarifications...: Louisiana Department of Health and Hospitals, Office of Public Health, Bienville Building, 628 4th Street...

  9. One stage revision single-bundle anterior cruciate ligament reconstruction with impacted morselized bone graft following a failed double-bundle reconstruction

    Directory of Open Access Journals (Sweden)

    Ho Jong Ra

    2017-01-01

    Full Text Available Although double-bundle anterior cruciate ligament (ACL reconstruction has theoretical benefits such as more accurate reproduction of ACL anatomy, it is technically more demanding surgery. This report describes the case of a one stage revision single-bundle ACL reconstruction after primary double-bundle ACL reconstruction. A professional dancer had an ACL previously reconstructed with a double-bundle technique, but the femoral tunnels were malpositioned resulting in residual laxity and rotational instability. The previous femoral tunnel positions were vertical and widened. The previous vertical tunnels were filled with impacted bone graft and a revision single-bundle ACL reconstruction was performed via the new femoral tunnel with a 2 O'clock position between the previous two tunnels. After 10 months of postoperative rehabilitation, the patient returned to professional dancing with sound bony union and without any residual instability.

  10. 77 FR 4203 - List of Approved Spent Fuel Storage Casks: MAGNASTOR® System, Revision 2

    Science.gov (United States)

    2012-01-27

    ... Storage Casks: MAGNASTOR[supreg] System, Revision 2 AGENCY: Nuclear Regulatory Commission. ACTION: Direct... storage regulations by revising the NAC International, Inc. (NAC) MAGNASTOR[supreg] System listing within the ``List of Approved Spent Fuel Storage Casks'' to include Amendment No. 2 to Certificate of...

  11. 75 FR 33736 - List of Approved Spent Fuel Storage Casks: MAGNASTOR System, Revision 1

    Science.gov (United States)

    2010-06-15

    ... Fuel Storage Casks: MAGNASTOR System, Revision 1 AGENCY: Nuclear Regulatory Commission. ACTION... storage cask regulations by revising the NAC International, Inc. (NAC), MAGNASTOR System listing within the ``List of Approved Spent Fuel Storage Casks'' to include Amendment No. 1 to Certificate of...

  12. Revising the IDEA Student Ratings of Instruction System 2002-2011 Data. IDEA Technical Report No. 18

    Science.gov (United States)

    Benton, Stephen L.; Li, Dan; Brown, Ron; Guo, Meixi; Sullivan, Patricia

    2015-01-01

    This report describes the processes undertaken to revise the IDEA Student Ratings of Instruction (SRI) system. The previous revision occurred in 1999, as described in IDEA Technical Report No. 11, "Revising the IDEA System for Obtaining Student Ratings of Instructors and Courses" (Hoyt, Chen, Pallett, & Gross, 1999). The procedures…

  13. 75 FR 33678 - List of Approved Spent Fuel Storage Casks: MAGNASTOR System, Revision 1

    Science.gov (United States)

    2010-06-15

    ... Fuel Storage Casks: MAGNASTOR System, Revision 1 AGENCY: Nuclear Regulatory Commission. ACTION: Direct final rule. SUMMARY: The U. S. Nuclear Regulatory Commission (NRC) is amending its spent fuel storage regulations by revising the NAC International Inc. (NAC) MAGNASTOR System listing within the ``List of...

  14. Operation of staged membrane oxidation reactor systems

    Science.gov (United States)

    Repasky, John Michael

    2012-10-16

    A method of operating a multi-stage ion transport membrane oxidation system. The method comprises providing a multi-stage ion transport membrane oxidation system with at least a first membrane oxidation stage and a second membrane oxidation stage, operating the ion transport membrane oxidation system at operating conditions including a characteristic temperature of the first membrane oxidation stage and a characteristic temperature of the second membrane oxidation stage; and controlling the production capacity and/or the product quality by changing the characteristic temperature of the first membrane oxidation stage and/or changing the characteristic temperature of the second membrane oxidation stage.

  15. 75 FR 24786 - List of Approved Spent Fuel Storage Casks: NUHOMS® HD System Revision 1

    Science.gov (United States)

    2010-05-06

    ... Fuel Storage Casks: NUHOMS[supreg] HD System Revision 1 AGENCY: Nuclear Regulatory Commission. ACTION... storage regulations by revising the Transnuclear, Inc. (TN) NUHOMS[supreg] HD System listing within the... System cask design within the list of approved spent fuel storage casks that power reactor licensees can...

  16. COOLING STAGES OF CRYOGENIC SYSTEMS

    OpenAIRE

    Троценко, А. В.

    2011-01-01

    The formalized definition for cooling stage of low temperature system is done. Based on existing information about the known cryogenic unit cycles the possible types of cooling stages are single out. From analyses of these stages their classification by various characteristics is suggested. The results of thermodynamic optimization of final throttle stage of cooling, which are used as working fluids helium, hydrogen and nitrogen, are shown.

  17. 75 FR 49813 - List of Approved Spent Fuel Storage Casks: MAGNASTOR System, Revision 1, Confirmation of...

    Science.gov (United States)

    2010-08-16

    ... Storage Casks: MAGNASTOR System, Revision 1, Confirmation of Effective Date AGENCY: Nuclear Regulatory... spent fuel storage regulations at 10 CFR 72.214 to revise the MAGNASTOR System listing to include...

  18. Distinct clinical outcomes of two CIMP-positive colorectal cancer subtypes based on a revised CIMP classification system.

    Science.gov (United States)

    Bae, Jeong Mo; Kim, Jung Ho; Kwak, Yoonjin; Lee, Dae-Won; Cha, Yongjun; Wen, Xianyu; Lee, Tae Hun; Cho, Nam-Yun; Jeong, Seung-Yong; Park, Kyu Joo; Han, Sae Won; Lee, Hye Seung; Kim, Tae-You; Kang, Gyeong Hoon

    2017-04-11

    Colorectal cancer (CRC) is a heterogeneous disease in terms of molecular carcinogenic pathways. Based on recent findings regarding the multiple serrated neoplasia pathway, we revised an eight-marker panel for a new CIMP classification system. 1370 patients who received surgical resection for CRCs were classified into three CIMP subtypes (CIMP-N: 0-4 methylated markers, CIMP-P1: 5-6 methylated markers and CIMP-P2: 7-8 methylated markers). Our findings were validated in a separate set of high-risk stage II or stage III CRCs receiving adjuvant fluoropyrimidine plus oxaliplatin (n=950). A total of 1287/62/21 CRCs cases were classified as CIMP-N/CIMP-P1/CIMP-P2, respectively. CIMP-N showed male predominance, distal location, lower T, N category and devoid of BRAF mutation, microsatellite instability (MSI) and MLH1 methylation. CIMP-P1 showed female predominance, proximal location, advanced TNM stage, mild decrease of CK20 and CDX2 expression, mild increase of CK7 expression, BRAF mutation, MSI and MLH1 methylation. CIMP-P2 showed older age, female predominance, proximal location, advanced T category, markedly reduced CK20 and CDX2 expression, rare KRAS mutation, high frequency of CK7 expression, BRAF mutation, MSI and MLH1 methylation. CIMP-N showed better 5-year cancer-specific survival (CSS; HR=0.47; 95% CI: 0.28-0.78) in discovery set and better 5-year relapse-free survival (RFS; HR=0.50; 95% CI: 0.29-0.88) in validation set compared with CIMP-P1. CIMP-P2 showed marginally better 5-year CSS (HR=0.28, 95% CI: 0.07-1.22) in discovery set and marginally better 5-year RFS (HR=0.21, 95% CI: 0.05-0.92) in validation set compared with CIMP-P1. CIMP subtypes classified using our revised system showed different clinical outcomes, demonstrating the heterogeneity of multiple serrated precursors of CIMP-positive CRCs.

  19. 76 FR 70331 - List of Approved Spent Fuel Storage Casks: MAGNASTOR ® System, Revision 2

    Science.gov (United States)

    2011-11-14

    ... Fuel Storage Casks: MAGNASTOR [supreg] System, Revision 2 AGENCY: Nuclear Regulatory Commission. ACTION... its spent fuel storage regulations by revising the NAC International, Inc. (NAC) MAGNASTOR [supreg] System listing within the ``List of Approved Spent Fuel Storage Casks'' to include Amendment No. 2 to...

  20. The Impact of Royalty Contract Revision in a Multistage Strategic R&D Alliance

    OpenAIRE

    Wenqiang Xiao; Yi Xu

    2012-01-01

    This paper investigates the impact of royalty revision on incentives and profits in a two-stage (research and development (R&D) stage and marketing stage) alliance with a marketer and an innovator. The marketer offers royalty contracts to the innovator. We find that the potential for royalty revision leads to more severe distortions in the optimal initial royalty contracts offered by the marketer. We show that if the innovator plays a significant role in the marketing stage, the marketer shou...

  1. 76 FR 2243 - List of Approved Spent Fuel Storage Casks: NUHOMS ® HD System Revision 1

    Science.gov (United States)

    2011-01-13

    ... Storage Casks: NUHOMS [supreg] HD System Revision 1 AGENCY: Nuclear Regulatory Commission. ACTION: Direct... fuel storage regulations by revising the Transnuclear, Inc. (TN) NUHOMS [supreg] HD System listing... NUHOMS [supreg] HD System cask design listed in Sec. 72.214 (List of approved spent fuel storage casks...

  2. Activity Management System user reference manual. Revision 1

    International Nuclear Information System (INIS)

    Gates, T.A.; Burdick, M.B.

    1994-01-01

    The Activity Management System (AMS) was developed in response to the need for a simple-to-use, low-cost, user interface system for collecting and logging Hanford Waste Vitrification Plant Project (HWVP) activities. This system needed to run on user workstations and provide common user access to a database stored on a local network file server. Most important, users wanted a system that provided a management tool that supported their individual process for completing activities. Existing system treated the performer as a tool of the system. All AMS data is maintained in encrypted format. Users can feel confident that any activities they have entered into the database are private and that, as the originator, they retain sole control over who can see them. Once entered into the AMS database, the activities cannot be accessed by anyone other than the originator, the designated agent, or by authorized viewers who have been explicitly granted the right to look at specific activities by the originator. This user guide is intended to assist new AMS users in learning how to use the application and, after the initial learning process, will serve as an ongoing reference for experienced users in performing infrequently used functions. Online help screens provide reference to some of the key information in this manual. Additional help screens, encompassing all the applicable material in this manual, will be incorporated into future AMS revisions. A third, and most important, source of help is the AMS administrator(s). This guide describes the initial production version of AMS, which has been designated Revision 1.0

  3. CT staging of renal cell carcinoma using the revised 1997 TNM staging criteria: in comparison with the previous one

    International Nuclear Information System (INIS)

    Sung, Deuk Jae; Kim, Yun Hwan; Chung, Hwan Hoon; Chung, Kyoo Byung; Suh, Won Hyuck

    2001-01-01

    To assess the accuracy of preoperative CT staging of RCC and to compare the relationship between T stage and the incidence of metastasis on the basis of the old (1992) and the new (1997) UICC and AJCC tumor classification system. In 112 cases of surgically resected RCC, the stagings of preoperative CT scans were determined retrospectively by two radiologists and were compared with the results of pathologic examinations. In 70 cases which had been followed up over three years after surgery, the incidence of metastasis at initial diagnosis and during the follow-up period was assessed. All cases were reconsidered, and using the old and the new TNM classification, the incidence of metastasis was compared. According to the old TNM classification, 5 cases (4%) were staged at T1, 73(65%) at T2, 21(19%) at T3a, 9(8%) at T3b, 0 at T3c, and 4(4%) at T4. Using the new TNM classification, we also staged 54 cases (48%) at T1 and 24(21%) at T2. Overall, using this new classification, CT correctly staged 79% of patients (88/112) overstaged 15%(17/112) and understaged 6%(7/112). CT had a sensitivity of 84% and specificity of 91% in new T1 tumors, 71% and 95%, respectively, in new T2 tumors, 69% and 88% in T3a tumors, 78% and 98% in T3b tumors, and 75% and 99% in T4 tumors. CT had a sensitivity of 44% and a specificity of 99% in old T1 tumors, and 82% and 71%, respectively, in old T2 tumors. The incidence of metastasis in CT-staged (cT) tumors was 0% (0/4) in old cT1, 8% (3/39) in new cT1, 29% (4/14) in new cT2, 67% (6/9) in cT3a, and 75% (6/8) in cT3b. In the staging of T1 tumors, CT is more sensitive when the new TNM classification is used. Even though the cut off point between T1 and T2 tumors had been in creased from 2.5 to 7.0 cm, T1 tumors staged according to the new system did not show a significantly higher incidence of metastasis than those staged according to the old

  4. Deep prosthetic joint infection: a qualitative study of the impact on patients and their experiences of revision surgery

    Science.gov (United States)

    Blom, Ashley W; Whitehouse, Michael R; Gooberman-Hill, Rachael

    2015-01-01

    Objectives Around 1% of patients who have a hip replacement have deep prosthetic joint infection (PJI) afterwards. PJI is often treated with antibiotics plus a single revision operation (1-stage revision), or antibiotics plus a 2-stage revision process involving more than 1 operation. This study aimed to characterise the impact and experience of PJI and treatment on patients, including comparison of 1-stage with 2-stage revision treatment. Design Qualitative semistructured interviews with patients who had undergone surgical revision treatment for PJI. Patients were interviewed between 2 weeks and 12 months postdischarge. Data were audio-recorded, transcribed, anonymised and analysed using a thematic approach, with 20% of transcripts double-coded. Setting Patients from 5 National Health Service (NHS) orthopaedic departments treating PJI in England and Wales were interviewed in their homes (n=18) or at hospital (n=1). Participants 19 patients participated (12 men, 7 women, age range 56–88 years, mean age 73.2 years). Results Participants reported receiving between 1 and 15 revision operations after their primary joint replacement. Analysis indicated that participants made sense of their experience through reference to 3 key phases: the period of symptom onset, the treatment period and protracted recovery after treatment. By conceptualising their experience in this way, and through themes that emerged in these periods, they conveyed the ordeal that PJI represented. Finally, in light of the challenges of PJI, they described the need for support in all of these phases. 2-stage revision had greater impact on participants’ mobility, and further burdens associated with additional complications. Conclusions Deep PJI impacted on all aspects of patients’ lives. 2-stage revision had greater impact than 1-stage revision on participants’ well-being because the time in between revision procedures meant long periods of immobility and related psychological distress

  5. Time synchronization algorithm of distributed system based on server time-revise and workstation self-adjust

    International Nuclear Information System (INIS)

    Zhou Shumin; Sun Yamin; Tang Bin

    2007-01-01

    In order to enhance the time synchronization quality of the distributed system, a time synchronization algorithm of distributed system based on server time-revise and workstation self-adjust is proposed. The time-revise cycle and self-adjust process is introduced in the paper. The algorithm reduces network flow effectively and enhances the quality of clock-synchronization. (authors)

  6. A revised limbic system model for memory, emotion and behaviour.

    Science.gov (United States)

    Catani, Marco; Dell'acqua, Flavio; Thiebaut de Schotten, Michel

    2013-09-01

    Emotion, memories and behaviour emerge from the coordinated activities of regions connected by the limbic system. Here, we propose an update of the limbic model based on the seminal work of Papez, Yakovlev and MacLean. In the revised model we identify three distinct but partially overlapping networks: (i) the Hippocampal-diencephalic and parahippocampal-retrosplenial network dedicated to memory and spatial orientation; (ii) The temporo-amygdala-orbitofrontal network for the integration of visceral sensation and emotion with semantic memory and behaviour; (iii) the default-mode network involved in autobiographical memories and introspective self-directed thinking. The three networks share cortical nodes that are emerging as principal hubs in connectomic analysis. This revised network model of the limbic system reconciles recent functional imaging findings with anatomical accounts of clinical disorders commonly associated with limbic pathology. Copyright © 2013 Elsevier Ltd. All rights reserved.

  7. 78 FR 29209 - Revisions to Electric Reliability Organization Definition of Bulk Electric System and Rules of...

    Science.gov (United States)

    2013-05-17

    ... Commission 18 CFR Part 40 Revisions to Electric Reliability Organization Definition of Bulk Electric System... local distribution'' as set forth in the Federal Power Act (FPA). \\1\\ Revisions to Electric Reliability... Reliability Organization Definition of Bulk Electric System, Order No. 743, 133 FERC ] 61,150, at P 16 (2010...

  8. Staged membrane oxidation reactor system

    Science.gov (United States)

    Repasky, John Michael; Carolan, Michael Francis; Stein, VanEric Edward; Chen, Christopher Ming-Poh

    2012-09-11

    Ion transport membrane oxidation system comprising (a) two or more membrane oxidation stages, each stage comprising a reactant zone, an oxidant zone, one or more ion transport membranes separating the reactant zone from the oxidant zone, a reactant gas inlet region, a reactant gas outlet region, an oxidant gas inlet region, and an oxidant gas outlet region; (b) an interstage reactant gas flow path disposed between each pair of membrane oxidation stages and adapted to place the reactant gas outlet region of a first stage of the pair in flow communication with the reactant gas inlet region of a second stage of the pair; and (c) one or more reactant interstage feed gas lines, each line being in flow communication with any interstage reactant gas flow path or with the reactant zone of any membrane oxidation stage receiving interstage reactant gas.

  9. Two-stage implant systems.

    Science.gov (United States)

    Fritz, M E

    1999-06-01

    Since the advent of osseointegration approximately 20 years ago, there has been a great deal of scientific data developed on two-stage integrated implant systems. Although these implants were originally designed primarily for fixed prostheses in the mandibular arch, they have been used in partially dentate patients, in patients needing overdentures, and in single-tooth restorations. In addition, this implant system has been placed in extraction sites, in bone-grafted areas, and in maxillary sinus elevations. Often, the documentation of these procedures has lagged. In addition, most of the reports use survival criteria to describe results, often providing overly optimistic data. It can be said that the literature describes a true adhesion of the epithelium to the implant similar to adhesion to teeth, that two-stage implants appear to have direct contact somewhere between 50% and 70% of the implant surface, that the microbial flora of the two-stage implant system closely resembles that of the natural tooth, and that the microbiology of periodontitis appears to be closely related to peri-implantitis. In evaluations of the data from implant placement in all of the above-noted situations by means of meta-analysis, it appears that there is a strong case that two-stage dental implants are successful, usually showing a confidence interval of over 90%. It also appears that the mandibular implants are more successful than maxillary implants. Studies also show that overdenture therapy is valid, and that single-tooth implants and implants placed in partially dentate mouths have a success rate that is quite good, although not quite as high as in the fully edentulous dentition. It would also appear that the potential causes of failure in the two-stage dental implant systems are peri-implantitis, placement of implants in poor-quality bone, and improper loading of implants. There are now data addressing modifications of the implant surface to alter the percentage of

  10. 75 FR 27463 - List of Approved Spent Fuel Storage Casks: NUHOMS® HD System Revision 1; Correction

    Science.gov (United States)

    2010-05-17

    ... Fuel Storage Casks: NUHOMS[supreg] HD System Revision 1; Correction AGENCY: Nuclear Regulatory... fuel storage casks to add revision 1 to the NUHOMS HD spent fuel storage cask system. This action is... Federal Register on May 7, 2010 (75 FR 25120), that proposes to amend the regulations that govern storage...

  11. Revised Soil Classification System for Coarse-Fine Mixtures

    KAUST Repository

    Park, Junghee; Santamarina, Carlos

    2017-01-01

    Soil classification systems worldwide capture great physical insight and enable geotechnical engineers to anticipate the properties and behavior of soils by grouping them into similar response categories based on their index properties. Yet gravimetric analysis and data trends summarized from published papers reveal critical limitations in soil group boundaries adopted in current systems. In particular, current classification systems fail to capture the dominant role of fines on the mechanical and hydraulic properties of soils. A revised soil classification system (RSCS) for coarse-fine mixtures is proposed herein. Definitions of classification boundaries use low and high void ratios that gravel, sand, and fines may attain. This research adopts emax and emin for gravels and sands, and three distinctive void ratio values for fines: soft eF|10  kPa and stiff eF|1  MPa for mechanical response (at effective stress 10 kPa and 1 MPa, respectively), and viscous λ⋅eF|LL for fluid flow control, where λ=2log(LL−25) and eF|LL is the void ratio at the liquid limit. For classification purposes, these void ratios can be estimated from index properties such as particle shape, the coefficient of uniformity, and the liquid limit. Analytically computed and data-adjusted boundaries are soil-specific, in contrast with the Unified Soil Classification System (USCS). Threshold fractions for mechanical control and for flow control are quite distinct in the proposed system. Therefore, the RSCS uses a two-name nomenclature whereby the first letters identify the component(s) that controls mechanical properties, followed by a letter (shown in parenthesis) that identifies the component that controls fluid flow. Sample charts in this paper and a Microsoft Excel facilitate the implementation of this revised classification system.

  12. Revised Soil Classification System for Coarse-Fine Mixtures

    KAUST Repository

    Park, Junghee

    2017-04-17

    Soil classification systems worldwide capture great physical insight and enable geotechnical engineers to anticipate the properties and behavior of soils by grouping them into similar response categories based on their index properties. Yet gravimetric analysis and data trends summarized from published papers reveal critical limitations in soil group boundaries adopted in current systems. In particular, current classification systems fail to capture the dominant role of fines on the mechanical and hydraulic properties of soils. A revised soil classification system (RSCS) for coarse-fine mixtures is proposed herein. Definitions of classification boundaries use low and high void ratios that gravel, sand, and fines may attain. This research adopts emax and emin for gravels and sands, and three distinctive void ratio values for fines: soft eF|10  kPa and stiff eF|1  MPa for mechanical response (at effective stress 10 kPa and 1 MPa, respectively), and viscous λ⋅eF|LL for fluid flow control, where λ=2log(LL−25) and eF|LL is the void ratio at the liquid limit. For classification purposes, these void ratios can be estimated from index properties such as particle shape, the coefficient of uniformity, and the liquid limit. Analytically computed and data-adjusted boundaries are soil-specific, in contrast with the Unified Soil Classification System (USCS). Threshold fractions for mechanical control and for flow control are quite distinct in the proposed system. Therefore, the RSCS uses a two-name nomenclature whereby the first letters identify the component(s) that controls mechanical properties, followed by a letter (shown in parenthesis) that identifies the component that controls fluid flow. Sample charts in this paper and a Microsoft Excel facilitate the implementation of this revised classification system.

  13. Multi-Stage System for Automatic Target Recognition

    Science.gov (United States)

    Chao, Tien-Hsin; Lu, Thomas T.; Ye, David; Edens, Weston; Johnson, Oliver

    2010-01-01

    A multi-stage automated target recognition (ATR) system has been designed to perform computer vision tasks with adequate proficiency in mimicking human vision. The system is able to detect, identify, and track targets of interest. Potential regions of interest (ROIs) are first identified by the detection stage using an Optimum Trade-off Maximum Average Correlation Height (OT-MACH) filter combined with a wavelet transform. False positives are then eliminated by the verification stage using feature extraction methods in conjunction with neural networks. Feature extraction transforms the ROIs using filtering and binning algorithms to create feature vectors. A feedforward back-propagation neural network (NN) is then trained to classify each feature vector and to remove false positives. The system parameter optimizations process has been developed to adapt to various targets and datasets. The objective was to design an efficient computer vision system that can learn to detect multiple targets in large images with unknown backgrounds. Because the target size is small relative to the image size in this problem, there are many regions of the image that could potentially contain the target. A cursory analysis of every region can be computationally efficient, but may yield too many false positives. On the other hand, a detailed analysis of every region can yield better results, but may be computationally inefficient. The multi-stage ATR system was designed to achieve an optimal balance between accuracy and computational efficiency by incorporating both models. The detection stage first identifies potential ROIs where the target may be present by performing a fast Fourier domain OT-MACH filter-based correlation. Because threshold for this stage is chosen with the goal of detecting all true positives, a number of false positives are also detected as ROIs. The verification stage then transforms the regions of interest into feature space, and eliminates false positives using an

  14. Equilibrium distribution of hard-sphere systems and revised Enskog theory

    NARCIS (Netherlands)

    Beijeren, H. van

    1983-01-01

    A revised Enskog theory (RET) is shown to lead to a correct equilibrium distribution in hard-sphere systems in a stationary external potential, while the standard Enskog theory (SET) does not. Attention is given to the s-component hard-sphere mixture with constant external potential acting on

  15. Revision of the design model for a cryogenic falling liquid film helium separator

    International Nuclear Information System (INIS)

    Kinoshita, Masahiro; Bartlit, J.R.; Sherman, R.H.

    1983-05-01

    The present paper reports revision of the design model previously developed by the authors for the cryogenic falling liquid film helium separator. The revised design procedure is composed of three steps : 1) calculation of distributions of phase flow rates, temperature and phase compositions within the refrigerated section and the packed section ; 2) calculation of more detailed distributions of these variables within the refrigerated section ; and 3) estimation of column dimensions and determination of operating conditions. It is assumed that the vacant refrigerated section has two theoretical stages for hydrogen isotope separation. The mixture within the refrigerated section is considered in step 2) as two component system of He-HD. (author)

  16. 76 FR 69734 - Public Water System Supervision Program Revision for the State of New Mexico

    Science.gov (United States)

    2011-11-09

    ... Water System Supervision Program. New Mexico has adopted the Lead and Copper Rule Short Term Revisions... water. EPA has determined that this rule revision submitted by New Mexico is no less stringent than the... the following offices: New Mexico Environment Department, Drinking Water Bureau, 525 Camino De Los...

  17. 76 FR 12825 - List of Approved Spent Fuel Storage Casks: NUHOMS® HD System Revision 1; Confirmation of...

    Science.gov (United States)

    2011-03-09

    ... Storage Casks: NUHOMS[supreg] HD System Revision 1; Confirmation of Effective Date AGENCY: Nuclear... direct final rule amended the NRC's spent fuel storage regulations at Title 10 of the Code of Federal Regulations (10 CFR 72.214) to revise the NUHOMS[supreg] HD System listing to include Amendment Number 1 to...

  18. 75 FR 57841 - List of Approved Spent Fuel Storage Casks: NAC-MPC System, Revision 6, Confirmation of Effective...

    Science.gov (United States)

    2010-09-23

    ... Spent Fuel Storage Casks: NAC-MPC System, Revision 6, Confirmation of Effective Date AGENCY: Nuclear... amended the NRC's spent fuel storage regulations at 10 CFR 72.214 to revise the NAC-MPC System listing to... configuration of the NAC-MPC storage system by the incorporation of a single closure lid with a welded closure...

  19. Wide-bandwidth bilateral control using two-stage actuator system

    International Nuclear Information System (INIS)

    Kokuryu, Saori; Izutsu, Masaki; Kamamichi, Norihiro; Ishikawa, Jun

    2015-01-01

    This paper proposes a two-stage actuator system that consists of a coarse actuator driven by a ball screw with an AC motor (the first stage) and a fine actuator driven by a voice coil motor (the second stage). The proposed two-stage actuator system is applied to make a wide-bandwidth bilateral control system without needing expensive high-performance actuators. In the proposed system, the first stage has a wide moving range with a narrow control bandwidth, and the second stage has a narrow moving range with a wide control bandwidth. By consolidating these two inexpensive actuators with different control bandwidths in a complementary manner, a wide bandwidth bilateral control system can be constructed based on a mechanical impedance control. To show the validity of the proposed method, a prototype of the two-stage actuator system has been developed and basic performance was evaluated by experiment. The experimental results showed that a light mechanical impedance with a mass of 10 g and a damping coefficient of 2.5 N/(m/s) that is an important factor to establish good transparency in bilateral control has been successfully achieved and also showed that a better force and position responses between a master and slave is achieved by using the proposed two-stage actuator system compared with a narrow bandwidth case using a single ball screw system. (author)

  20. Transportation system requirements document. Revision 1 DCN01. Supplement

    International Nuclear Information System (INIS)

    1995-05-01

    The original Transportation System Requirements Document described the functions to be performed by and the technical requirements for the Transportation System to transport spent nuclear fuel (SNF) and high-level radioactive waste (HLW) from Purchaser and Producer sites to a Civilian Radioactive Waste Management System (CRWMS) site, and between CRWMS sites. The purpose of that document was to define the system-level requirements. These requirements include design and operations requirements to the extent they impact on the development of the physical segments of Transportation. The document also presented an overall description of Transportation, its functions, its segments, and the requirements allocated to the segments and the system-level interfaces with Transportation. This revision of the document contains only the pages that have been modified

  1. Two-Stage Variable Sample-Rate Conversion System

    Science.gov (United States)

    Tkacenko, Andre

    2009-01-01

    A two-stage variable sample-rate conversion (SRC) system has been pro posed as part of a digital signal-processing system in a digital com munication radio receiver that utilizes a variety of data rates. The proposed system would be used as an interface between (1) an analog- todigital converter used in the front end of the receiver to sample an intermediatefrequency signal at a fixed input rate and (2) digita lly implemented tracking loops in subsequent stages that operate at v arious sample rates that are generally lower than the input sample r ate. This Two-Stage System would be capable of converting from an input sample rate to a desired lower output sample rate that could be var iable and not necessarily a rational fraction of the input rate.

  2. Induction of micronuclei in the mouse. Revised timing of the final stage of erythropoiesis

    International Nuclear Information System (INIS)

    Hart, J.W.; Hartley-Asp, B.

    1983-01-01

    the early effects of X-rays, vincristine, cyclophosphamide, quinacrine dihydrochloride, cycloheximide, actinomycin D and hydroxyurea on the induction of micronuclei in mouse bone-marrow erythrocytes were studied. A significant increase in the incidence of micronuclei in polychromatic erythrocytes was seen as early as 5 h after a single treatment with vincristine, 6 h after treatment with X-rays and 10 h after treatment with cyclophosphamide. The cell kinetics of the mouse erythropoietic system described by Cole et al. (1981) can be modified to fit these results. According to this revised model, the final mitosis takes place only 5 h before the expulsion of the nucleus. (orig.)

  3. Induction of micronuclei in the mouse. Revised timing of the final stage of erythropoiesis

    Energy Technology Data Exchange (ETDEWEB)

    Hart, J.W. (Leo Pharmaceutical Products Ltd., Ballerup (Denmark)); Hartley-Asp, B. (AB Leo, Helsingborg (Sweden))

    1983-05-01

    the early effects of X-rays, vincristine, cyclophosphamide, quinacrine dihydrochloride, cycloheximide, actinomycin D and hydroxyurea on the induction of micronuclei in mouse bone-marrow erythrocytes were studied. A significant increase in the incidence of micronuclei in polychromatic erythrocytes was seen as early as 5 h after a single treatment with vincristine, 6 h after treatment with X-rays and 10 h after treatment with cyclophosphamide. The cell kinetics of the mouse erythropoietic system described by Cole et al. (1981) can be modified to fit these results. According to this revised model, the final mitosis takes place only 5 h before the expulsion of the nucleus.

  4. Vault Safety and Inventory System users manual, PRIME 2350. Revision 1

    International Nuclear Information System (INIS)

    Downey, N.J.

    1994-01-01

    This revision is issued to request review of the attached document: VSIS User Manual, PRIME 2350, which provides user information for the operation of the VSIS (Vault Safety and Inventory System). It describes operational aspects of Prime 2350 minicomputer and vault data acquisition equipment. It also describes the User's Main Menu and menu functions, including REPORTS. Also, system procedures for the Prime 2350 minicomputer are covered

  5. Vault Safety and Inventory System users manual, PRIME 2350. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Downey, N.J.

    1994-12-14

    This revision is issued to request review of the attached document: VSIS User Manual, PRIME 2350, which provides user information for the operation of the VSIS (Vault Safety and Inventory System). It describes operational aspects of Prime 2350 minicomputer and vault data acquisition equipment. It also describes the User`s Main Menu and menu functions, including REPORTS. Also, system procedures for the Prime 2350 minicomputer are covered.

  6. Proposed revision of the Cumberland System Power Marketing Policy and subsequent contracts

    International Nuclear Information System (INIS)

    1992-01-01

    Southeastern Power Administration has prepared an Environmental Assessment (DOE/EA-0811) evaluating the proposed revision of the Cumberland System Power Marketing Policy and Subsequent Contracts. The findings of the Environmental Assessment (EA) are: the only significant change from the existing policy will be the term of the contracts executed under the revised policy; and there will be no addition of major new generation resources; there will be no new loads; there will be no major changes in the operating parameters of power generation resources. This paper discusses the need for action, the alternative and the environmental impacts

  7. The seventh tumour-node-metastasis staging system for lung cancer: Sequel or prequel?

    Science.gov (United States)

    van Meerbeeck, Jan P; Janssens, Annelies

    2013-09-01

    , Epidemiology and End Results (SEER) database. The ten modifications and the mediastinal lymph-node map - which were proposed in 2007 and adopted by the AJCC and IUCC in their respective seventh revision of the TNM system - were implemented as of 2010 and were rapidly adopted by the thoracic oncology community and cancer registries. As expected, not all controversies could be fully addressed, and the need for a prospective data set containing more granular information was felt early on. This data set of 25,000 consecutive incident cases will form the base for the eighth revision in 2017 and is currently being collected. Other threats are the role of stage migration and the increasing number of biological factors interfering with disease extent for prognostication. The latter issue will be addressed by the creation of a prognostic index, including several prognostic factors, of which stage will be one. For the time being, the seventh TNM classification is considered the gold standard for the description of disease extent, initial treatment allocation and the reporting of treatment results. The uniform use of the TNM descriptors and the lymph-node map by all involved in lung cancer care is to be considered a process indicator of quality.

  8. Microbiological diagnosis in revision of infected knee arthroplasties in Denmark

    DEFF Research Database (Denmark)

    Lindberg-Larsen, Martin; Pitter, Frederik Taylor; Voldstedlund, Marianne

    2017-01-01

    . METHODS: One hundred and two partial revisions (open debridement and exchange of tibial insert) and 213 two-stage procedures performed due to infection in 275 patients from 1 July 2011 to 30 June 2013 were included and analysed by linkage to data from a nationwide registry on microbiological test results....... RESULTS: 78 (24.8%) revisions were culture negative, 192 (60.9%) showed monomicrobial growth and 43 (14.3%) polymicrobial growth. Staphylococcus aureus was the most frequent isolate in mono-culture in 70 (22.2%) revisions and in polymicrobial culture in 15 revisions with a total frequency of 27.0%. Only...... one case (1.4%) of methicillin-resistance was registered. Coagulase-negative staphylococci (CoNS) were frequent, sole pathogen in 65 revisions and in polymicrobial cultures in 28 revisions with a total frequency of 29.5%. A pre-operative knee aspiration was performed in 50% and preoperative blood...

  9. Staged fluidized-bed combustion and filter system

    International Nuclear Information System (INIS)

    Mei, J.S.; Halow, J.S.

    1994-01-01

    A staged fluidized-bed combustion and filter system are described for substantially reducing the quantity of waste through the complete combustion into ash-type solids and gaseous products. The device has two fluidized-bed portions, the first primarily as a combustor/pyrolyzer bed, and the second as a combustor/filter bed. The two portions each have internal baffles to define stages so that material moving therein as fluidized beds travel in an extended route through those stages. Fluidization and movement is achieved by the introduction of gases into each stage through a directional nozzle. Gases produced in the combustor/pyrolyzer bed are permitted to travel into corresponding stages of the combustor/filter bed through screen filters that permit gas flow but inhibit solids flow. Any catalyst used in the combustor/filter bed is recycled. The two beds share a common wall to minimize total volume of the system. A slightly modified embodiment can be used for hot gas desulfurization and sorbent regeneration. Either side-by-side rectangular beds or concentric beds can be used. The system is particularly suited to the processing of radioactive and chemically hazardous waste. 10 figures

  10. Staging of intestinal- and diffuse-type gastric cancers with the OLGA and OLGIM staging systems.

    Science.gov (United States)

    Cho, S-J; Choi, I J; Kook, M-C; Nam, B-H; Kim, C G; Lee, J Y; Ryu, K W; Kim, Y-W

    2013-11-01

    Operative link on gastritis assessment (OLGA) and Operative link on gastric intestinal metaplasia assessment (OLGIM) staging systems have been proposed for gastric cancer (GC) risk estimation. To validate the OLGA and OLGIM staging systems in a region with high risk of GC. This retrospective study included 474 GC patients and age- and sex-matched health screening control persons in a cancer centre hospital. We classified gastritis patterns according to the OLGA and OLGIM systems using the histological database that a pathologist prospectively evaluated using the updated Sydney system. GC risk according to the OLGA and OLGIM stages was evaluated using logistic regression analysis. More GC patients had OLGA stages III-IV (46.2%) than controls (26.6%, P diffuse-type GCs (30.9%). OLGA stages III and IV were significantly associated with increased risk of GC [odds ratios (ORs), 2.09; P = 0.008 and 2.04; P = 0.014 respectively] in multivariate analysis. The association was more significant for intestinal-type (ORs, 4.76; P = 0.001 and 4.19; P = 0.002 respectively), but not diffuse-type GC. OLGIM stages from I to IV were significantly associated with increased risk of both intestinal-type (ORs, 3.64, 5.15, 7.89 and 13.20 respectively) and diffuse-type GC (ORs, 1.84, 2.59, 5.08 and 6.32 respectively) with a significantly increasing trend. As high OLGA and OLGIM stages are independent risk factors for gastric cancer, the staging systems may be useful for risk assessment in high-risk regions, especially for intestinal-type gastric cancer. © 2013 John Wiley & Sons Ltd.

  11. May one-stage exchange for Candida albicans peri-prosthetic infection be successful?

    Science.gov (United States)

    Jenny, J-Y; Goukodadja, O; Boeri, C; Gaudias, J

    2016-02-01

    Fungal infection of a total joint arthroplasty has a low incidence but is generally considered as more difficult to cure than bacterial infection. As for bacterial infection, two-stage exchange is considered as the gold standard of treatment. We report two cases of one-stage total joint exchange for fungal peri-prosthetic infection with Candida albicans, where the responsible pathogens was only identified on intraoperative samples. This situation can be considered as a one-stage exchange for fungal peri-prosthetic infection without preoperative identification of the responsible organism, which is considered as having a poor prognosis. Both cases were free of infection after two years. One-stage revision has several potential advantages over two-stage revision, including shorter hospital stay and rehabilitation, no interim period with significant functional impairment, shorter antibiotic treatment, better functional outcome and probably lower costs. We suggest that one-stage revision for C. albicans peri-prosthetic infection may be successful even without preoperative fungal identification. Level IV-Historical cases. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  12. The Use of a Supra-Acetabular Antibiotic-Loaded Cement Shelf to Improve Hip Stability in First-Stage Infected Total Hip Arthroplasty.

    Science.gov (United States)

    Drexler, Michael; Kuzyk, Paul R T; Koo, Kevin; Gross, Allan E; Kosashvili, Yona; Reischl, Nickola; Rutenberg, Tal Frenkel; Safir, Oleg

    2016-11-01

    Antibiotic-loaded cement spacers in first-stage revision total hip arthroplasty (THA) for managing infection are associated with high dislocation and fracture rates. The aim of this study was to report the use of an antibiotic-loaded cemented supra-acetabular roof augmentation to reinforce hip stability after cement spacer insertion for first-stage total hip revision in the treatment of infected THA. We retrospectively reviewed a consecutive series of 50 THAs involving 47 patients with an infected hip requiring staged revisions of THA. We documented dislocation, reinfection, and time for revision and outcome. There were no cases of hip dislocation, cement fractures, or any other technical complications associated with the use of the roof augmentation lip. Thirteen cases (26%) had a cemented spacer for longer than 120 days. Seven (14%) cases had recurrent infection after staged revision THA. The antibiotic-loaded cemented supra-acetabular roof augment improved femoral head spacer coverage for patients requiring a staged revision THA for infection. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Survival outcomes and prognostic factors in mycosis fungoides/Sézary syndrome: validation of the revised International Society for Cutaneous Lymphomas/European Organisation for Research and Treatment of Cancer staging proposal.

    Science.gov (United States)

    Agar, Nita Sally; Wedgeworth, Emma; Crichton, Siobhan; Mitchell, Tracey J; Cox, Michael; Ferreira, Silvia; Robson, Alistair; Calonje, Eduardo; Stefanato, Catherine M; Wain, Elizabeth Mary; Wilkins, Bridget; Fields, Paul A; Dean, Alan; Webb, Katherine; Scarisbrick, Julia; Morris, Stephen; Whittaker, Sean J

    2010-11-01

    We have analyzed the outcome of mycosis fungoides (MF) and Sézary syndrome (SS) patients using the recent International Society for Cutaneous Lymphomas (ISCL)/European Organisation for Research and Treatment of Cancer (EORTC) revised staging proposal. Overall survival (OS), disease-specific survival (DSS), and risk of disease progression (RDP) were calculated for a cohort of 1,502 patients using univariate and multivariate models. The mean age at diagnosis was 54 years, and 71% of patients presented with early-stage disease. Disease progression occurred in 34%, and 26% of patients died due to MF/SS. A significant difference in survival and progression was noted for patients with early-stage disease having patches alone (T1a/T2a) compared with those having patches and plaques (T1b/T2b). Univariate analysis established that (1) advanced skin and overall clinical stage, increased age, male sex, increased lactate dehydrogenase (LDH), and large-cell transformation were associated with reduced survival and increased RDP; (2) hypopigmented MF, MF with lymphomatoid papulosis, and poikilodermatous MF were associated with improved survival and reduced RDP; and (3) folliculotropic MF was associated with an increased RDP. Multivariate analysis established that (1) advanced skin (T) stage, the presence in peripheral blood of the tumor clone without Sézary cells (B0b), increased LDH, and folliculotropic MF were independent predictors of poor survival and increased RDP; (2) large-cell transformation and tumor distribution were independent predictors of increased RDP only; and (3) N, M, and B stages; age; male sex; and poikilodermatous MF were only significant for survival. This study has validated the recently proposed ISCL/EORTC staging system and identified new prognostic factors.

  14. [Helicobacter pylori gastritis: assessment of OLGA and OLGIM staging systems].

    Science.gov (United States)

    Ben Slama, Sana; Ben Ghachem, Dorra; Dhaoui, Amen; Jomni, Mohamed Taieb; Dougui, Mohamed Hédi; Bellil, Khadija

    2016-01-01

    Helicobacter pylori (H pylori) gastritis presents a risk of cancer related to atrophy and intestinal metaplasia. Two recent classifications OLGA (Operative Link on Gastritis Assessment) and OLGIM (Operative Link on Gastritic Intestinal Metaplasia assessment) have been proposed to identify high-risk forms (stages III and IV). The aim of this study is to evaluate the OLGA and OLGIM staging systems in H pylori gastritis. A descriptive study of 100 cases of chronic H pylori gastritis was performed. The revaluation of Sydney System parameters of atrophy and intestinal metaplasia, of gastric antrum and corpus, allowed identifying respectively the stages of OLGA and OLGIM systems. The progressive risk of our H pylori gastritis was 6% according to OLGA staging and 7% according to OLGIM staging. Significant correlation was revealed between age and OLGA staging. High-risk gastritis according to OLGIM staging was significantly associated with moderate to severe atrophy. High-risk forms according to OLGA staging were associated in 80% of the cases to intestinal metaplasia. OLGA and OLGIM systems showed a highly significant positive correlation between them with a mismatch at 5% for H pylori gastritis. The OLGA and OLGIM staging systems in addition to Sydney System, allow selection of high risk forms of chronic gastritis requiring accurate observation.

  15. A simplified staging system based on the radiological findings in different stages of ochronotic spondyloarthropathy

    International Nuclear Information System (INIS)

    Jebaraj, Isaac; Chacko, Binita Riya; Chiramel, George Koshy; Matthai, Thomas; Parameswaran, Apurve

    2013-01-01

    This study describes a group of 26 patients with ochronotic spondyloarthropathy who were on regular treatment and follow-up at a tertiary level hospital and proposes a simplified staging system for ochronotic spondyloarthropathy based on radiographic findings seen in the thoracolumbar spine. This proposed classification makes it easy to identify the stage of the disease and start the appropriate management at an early stage. Four progressive stages are described: an inflammatory stage (stage 1), the stage of early discal calcification (stage 2), the stage of fibrous ankylosis (stage 3), and the stage of bony ankylosis (stage 4). To our knowledge, this is the largest reported series of radiological description of spinal ochronosis, and emphasizes the contribution of the spine radiograph in the diagnosis and staging of the disease

  16. A simplified staging system based on the radiological findings in different stages of ochronotic spondyloarthropathy

    Directory of Open Access Journals (Sweden)

    Isaac Jebaraj

    2013-01-01

    Full Text Available This study describes a group of 26 patients with ochronotic spondyloarthropathy who were on regular treatment and follow-up at a tertiary level hospital and proposes a simplified staging system for ochronotic spondyloarthropathy based on radiographic findings seen in the thoracolumbar spine. This proposed classification makes it easy to identify the stage of the disease and start the appropriate management at an early stage. Four progressive stages are described: an inflammatory stage (stage 1, the stage of early discal calcification (stage 2, the stage of fibrous ankylosis (stage 3, and the stage of bony ankylosis (stage 4. To our knowledge, this is the largest reported series of radiological description of spinal ochronosis, and emphasizes the contribution of the spine radiograph in the diagnosis and staging of the disease.

  17. Tank monitor and control system (TMACS) revision 11 acceptance test procedure

    International Nuclear Information System (INIS)

    HOLM, M.J.

    1999-01-01

    The purpose of this document is to describe tests performed to validate Revision 11 of the Tank Monitor and Control System (TMACS) and verify that the software functions as intended by design. This document is intended to test the software portion of TMACS. The tests will be performed on the development system. The software to be tested is the TMACS knowledge bases (KB) and the I/O driver/services. The development system will not be talking to field equipment; instead, the field equipment is simulated using emulators or multiplexers in the lab

  18. 76 FR 2277 - List of Approved Spent Fuel Storage Casks: NUHOMS® HD System Revision 1

    Science.gov (United States)

    2011-01-13

    ... Fuel Storage Casks: NUHOMS[supreg] HD System Revision 1 AGENCY: Nuclear Regulatory Commission. ACTION... System listing within the ``List of Approved Spent Fuel Storage Casks'' to include Amendment No. 1 to... the NUHOMS[supreg] HD Horizontal Modular Storage System for Irradiated Nuclear Fuel. [[Page 2279...

  19. Revision of failed shoulder hemiarthroplasty to reverse total arthroplasty: analysis of 157 revision implants.

    Science.gov (United States)

    Merolla, Giovanni; Wagner, Eric; Sperling, John W; Paladini, Paolo; Fabbri, Elisabetta; Porcellini, Giuseppe

    2018-01-01

    There remains a paucity of studies examining the conversion of failed hemiarthroplasty (HA) to reverse total shoulder arthroplasty (RTSA). Therefore, the purpose of this study was to examine a large series of revision HA to RTSA. A population of 157 patients who underwent conversion of a failed HA to a revision RTSA from 2006 through 2014 were included. The mean follow-up was 49 months (range, 24-121 months). The indications for revision surgery included instability with rotator cuff insufficiency (n = 127) and glenoid wear (n = 30); instability and glenoid wear were associated in 38 cases. Eight patients with infection underwent 2-stage reimplantation. Patients experienced significant improvements in their preoperative to postoperative pain and shoulder range of motion (P surgeries, secondary to glenoid component loosening (n = 3), instability (n = 3), humeral component disassembly (n = 2), humeral stem loosening (n = 1), and infection (n = 2). Implant survivorship was 95.5% at 2 years and 93.3% at 5 years. There were 4 reoperations including axillary nerve neurolysis (n = 2), heterotopic ossification removal (n = 1), and hardware removal for rupture of the metal cerclage for an acromial fracture (n = 1). At final follow-up, there were 5 "at-risk" glenoid components. Patients experience satisfactory pain relief and recovery of reasonable shoulder function after revision RTSA from a failed HA. There was a relatively low revision rate, with glenoid loosening and instability being the most common causes. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  20. A mid-term follow-up of Koutsogiannis’ osteotomy in adult-acquired flatfoot stage II and “early stage III”

    Directory of Open Access Journals (Sweden)

    Arvinius Camilla

    2017-01-01

    Full Text Available Introduction: Koutsogiannis’ osteotomy has been widely described to treat adult-acquired flatfoot. However, few articles describe its midterm follow-up. Our aim was to study clinical and radiological outcomes at least one year after surgery and to analyze whether a combined procedure on the medial soft tissue affected these outcomes. Methods: We performed a retrospective study of 30 feet of patients who underwent a Koutsogiannis’ osteotomy due to adult-acquired flatfoot stage II and “early stage III”: a stage III acquired flatfoot without any important structural deformities. The parameters studied were additional medial soft tissue procedures, clinical outcome through the American Orthopaedic Foot and Ankle Society (AOFAS ankle and midfoot score as well as complications and radiological measurements. Results: Sixteen cases were “early stage III” and 14 stage II. Thirteen patients underwent an associated posterior tibial tendon (PTT revision: in three cases an end-to-end suture was possible, seven cases needed a FDL transposition, and three underwent synovectomy. Statistically significant improvement was found in the AOFAS score although no significant changes were seen radiologically. No additional benefit was found with the revision of the posterior tibial tendon. As to clinical and radiological results, no differences were found between stage II and “early stage III”. Five cases presented a mild dysesthesia but only one patient needed neurolysis. Conclusions: We consider the Koutsogiannis’ osteotomy to be a safe and effective procedure to reduce pain in patients with stage II and “early stage III” adult-acquired flatfoot.

  1. Attainability and minimum energy of multiple-stage cascade membrane Systems

    KAUST Repository

    Alshehri, Ali

    2015-08-12

    Process design and simulation of multi-stage membrane systems have been widely studied in many gas separation systems. However, general guidelines have not been developed yet for the attainability and the minimum energy consumption of a multi-stage membrane system. Such information is important for conceptual process design and thus it is the topic of this work. Using a well-mixed membrane model, it was determined that the attainability curve of multi-stage systems is defined by the pressure ratio and membrane selectivity. Using the constant recycle ratio scheme, the recycle ratio can shift the attainability behavior between single-stage and multi-stage membrane systems. When the recycle ratio is zero, all of the multi-stage membrane processes will decay to a single-stage membrane process. When the recycle ratio approaches infinity, the required selectivity and pressure ratio reach their absolute minimum values, which have a simple relationship with that of a single-stage membrane process, as follows: View the MathML sourceSn=S1, View the MathML sourceγn=γ1, where n is the number of stages. The minimum energy consumption of a multi-stage membrane process is primarily determined by the membrane selectivity and recycle ratio. A low recycle ratio can significantly reduce the required membrane selectivity without substantial energy penalty. The energy envelope curve can provide a guideline from an energy perspective to determine the minimum required membrane selectivity in membrane process designs to compete with conventional separation processes, such as distillation.

  2. 75 FR 30309 - Revisions to the Requirements for Authority To Manufacture and Distribute Postage Evidencing Systems

    Science.gov (United States)

    2010-06-01

    ... Distribute Postage Evidencing Systems. This proposed revision clarifies the requirement for examination by an independent audit firm of a Postage Evidencing System Provider's Computerized Meter Resetting System (CMRS) or... Distribute Postage Evidencing Systems AGENCY: Postal Service\\TM\\. ACTION: Proposed rule. SUMMARY: In this...

  3. Pending revisions to ANS 56.8-81 containment systems leakage testing requirements

    International Nuclear Information System (INIS)

    Brown, T.M.

    1986-01-01

    The US Nuclear Regulatory Commission is currently processing a revision to Appendix J of Part 50, Title 10 of the Code of Federal Regulations. The revised Appendix J will not reference any ANSI standard. Processed concurrently with the revised Appendix J is a draft Regulatory Guide which does endorse ANS Standard 56.8. The draft Regulatory Guide currently takes many exceptions to the Standard. Many of the exceptions are changes the Working Group had in process and the exceptions are to bring the draft Regulatory Guide in line with the future Standard. The Working Group has completed their revisions to the Standard and its appendices. These revisions have been submitted to the Nuclear Power Plants Standards Committee (NUPPSCO). The NUPPSCO comments have recently been addressed by the Working Group and the Working Group response has been sent to the NUPPSCO commentators. This paper will discuss the revisions made to the Standard, the significance of the revisions and future tasks or Standard revisions which the ANS 56.8 Working Group may address

  4. Abridged republication of FIGO's staging classification for cancer of the ovary, fallopian tube, and peritoneum.

    Science.gov (United States)

    Prat, Jaime

    2015-10-01

    Ovarian, fallopian tube, and peritoneal cancers have a similar clinical presentation and are treated similarly, and current evidence supports staging all 3 cancers in a single system. The primary site (i.e. ovary, fallopian tube, or peritoneum) should be designated where possible. The histologic type should be recorded. Intraoperative rupture ("surgical spill") is IC1; capsule ruptured before surgery or tumor on ovarian or fallopian tube surface is IC2; and positive peritoneal cytology with or without rupture is IC3. The new staging includes a revision of stage III patients; assignment to stage IIIA1 is based on spread to the retroperitoneal lymph nodes without intraperitoneal dissemination. Extension of tumor from omentum to spleen or liver (stage IIIC) should be differentiated from isolated parenchymal metastases (stage IVB). © 2015 American Cancer Society.

  5. 75 FR 25120 - List of Approved Spent Fuel Storage Casks: NUHOMS® HD System Revision 1

    Science.gov (United States)

    2010-05-07

    ...] RIN 3150-AI75 List of Approved Spent Fuel Storage Casks: NUHOMS[supreg] HD System Revision 1 AGENCY...), NUHOMS[supreg] HD System listing within the ``List of Approved Spent Fuel Storage Casks'' to include... Modular Storage System for Irradiated Nuclear Fuel. Docket Number: 72-1030. Certificate Expiration Date...

  6. 75 FR 42292 - List of Approved Spent Fuel Storage Casks: NAC-MPC System, Revision 6

    Science.gov (United States)

    2010-07-21

    ... Fuel Storage Casks: NAC-MPC System, Revision 6 AGENCY: Nuclear Regulatory Commission. ACTION: Direct...-MPC storage system as noted in Appendix B of the Technical Specifications (TS): Incorporation of a... include the following changes to the configuration of the NAC-MPC storage system as noted in Appendix B of...

  7. Reflective Practice: Eight Stages of Publishing a Scientific Research Paper

    Directory of Open Access Journals (Sweden)

    Stephen K. Donovan

    2018-03-01

    Full Text Available This paper suggests a methodology of academic paper classification for the scientist intending to contribute to peer-reviewed scientific literature. This will enable the progress of the typescript through the publication system to be accurately determined at any stage. The publication process is split into eight subdivisions of differing worth and import: in navel contemplation; in preparation; submitted; in review; revision, revised, and resubmitted; accepted; in press; and publication. Papers in navel contemplation are referred to as in preparation by many, which can be an embarrassment when asked exactly what has been prepared. Rather than listing papers as in preparation in academic submissions, it is better to list them as unpublished data until published. Efficient authors keep a close watch on their papers between submission and the proof stage. They must be sufficiently organized to manage their publications and to be aware when things slow down. The methodology is flexible and, if it does not work for some authors, then they have a simple framework to adapt to their own preferences. In short, scientists need to show care and not be overly optimistic about the progress of any paper.

  8. [Expectation for JSPN's contribution following revision of General Principles for Suicide Prevention Policy].

    Science.gov (United States)

    Takeshima, Tadashi

    2014-01-01

    Japan's national suicide prevention efforts following the 1998 surge in the number of suicide deaths can be divided into three stages: the first stage administrated mainly by the health ministry (1998-2005), the second and transitional stage when it was upgraded to a full governmental issue (2005-2006), and the third and present stage following the promulgation of the Basic Act for Suicide Prevention in 2006. In June 2007, the General Principles for Suicide Prevention Policy (GPSP), a guideline on how the national government should act to promote suicide prevention, was announced, urging local governments to tackle the problem of suicide. The GPSP was set to be revised after around five years from its publication, and, thus, a revised GPSP was published in August of 2012. Based on the five years of challenges, the revised GPSP states that suicide prevention strategies should move on to more practical and community-oriented ones. The National Center of Neurology and Psychiatry (NCNP), through its Center for Suicide Prevention, played a coordinating role in putting forward a proposal for the revision, working with 29 academic societies including the Japanese Society of Psychiatry and Neurology (JSPN). In February 2013, by further developing the relationships with academic societies, etc., which were forged in the above-mentioned process, NCNP set up the Preparatory Committee for the Evidence-based Suicide Prevention Consortium in order to contribute to suicide prevention strategies from an academic perspective. Meanwhile, in the World Health Organization's 66th World Health Assembly held in May 2013, the Comprehensive Mental Health Action Plan 2013-2020 was approved. Its core principle is "no health without mental health", and it has the following four objectives: (1) to strengthen effective leadership and governance for mental health; (2) to provide comprehensive, integrated, and responsive mental health and social care services in community-based settings; (3) to

  9. Acetabular Cup Revision.

    Science.gov (United States)

    Kim, Young-Ho

    2017-09-01

    The use of acetabular cup revision arthroplasty is on the rise as demands for total hip arthroplasty, improved life expectancies, and the need for individual activity increase. For an acetabular cup revision to be successful, the cup should gain stable fixation within the remaining supportive bone of the acetabulum. Since the patient's remaining supportive acetabular bone stock plays an important role in the success of revision, accurate classification of the degree of acetabular bone defect is necessary. The Paprosky classification system is most commonly used when determining the location and degree of acetabular bone loss. Common treatment options include: acetabular liner exchange, high hip center, oblong cup, trabecular metal cup with augment, bipolar cup, bulk structural graft, cemented cup, uncemented cup including jumbo cup, acetabular reinforcement device (cage), trabecular metal cup cage. The optimal treatment option is dependent upon the degree of the discontinuity, the amount of available bone stock and the likelihood of achieving stable fixation upon supportive host bone. To achieve successful acetabular cup revision, accurate evaluation of bone defect preoperatively and intraoperatively, proper choice of method of acetabular revision according to the evaluation of acetabular bone deficiency, proper technique to get primary stability of implant such as precise grafting technique, and stable fixation of implant are mandatory.

  10. 77 FR 39858 - Revisions to Electric Reliability Organization Definition of Bulk Electric System and Rules of...

    Science.gov (United States)

    2012-07-05

    ... bulk electric system reliability through steady state power flow, and contain a transient stability... Commission 18 CFR Part 40 Revisions to Electric Reliability Organization Definition of Bulk Electric System... definition of ``bulk electric system'' developed by the North American Electric Reliability Corporation (NERC...

  11. 75 FR 42339 - List of Approved Spent Fuel Storage Casks: NAC-MPC System, Revision 6

    Science.gov (United States)

    2010-07-21

    ...-2010-0183] RIN 3150--AI88 List of Approved Spent Fuel Storage Casks: NAC-MPC System, Revision 6 AGENCY.... (NAC), NAC-MPC System listing within the ``List of Approved Spent Fuel Storage Casks'' to include... changes to the configuration of the NAC-MPC storage system as noted in Appendix B of the Technical...

  12. 76 FR 1431 - Public Water System Supervision Program Revision for the State of New Mexico

    Science.gov (United States)

    2011-01-10

    ... Public Water System Supervision Program. New Mexico has adopted the Ground Water Rule (GWR), the Long... the following offices: New Mexico Environment Department, Drinking Water Bureau, 525 Camino De Los... of New Mexico proposes to revise its approved Public Water System Supervision Primacy Program. This...

  13. The relationships between memory systems and sleep stages.

    Science.gov (United States)

    Rauchs, Géraldine; Desgranges, Béatrice; Foret, Jean; Eustache, Francis

    2005-06-01

    Sleep function remains elusive despite our rapidly increasing comprehension of the processes generating and maintaining the different sleep stages. Several lines of evidence support the hypothesis that sleep is involved in the off-line reprocessing of recently-acquired memories. In this review, we summarize the main results obtained in the field of sleep and memory consolidation in both animals and humans, and try to connect sleep stages with the different memory systems. To this end, we have collated data obtained using several methodological approaches, including electrophysiological recordings of neuronal ensembles, post-training modifications of sleep architecture, sleep deprivation and functional neuroimaging studies. Broadly speaking, all the various studies emphasize the fact that the four long-term memory systems (procedural memory, perceptual representation system, semantic and episodic memory, according to Tulving's SPI model; Tulving, 1995) benefit either from non-rapid eye movement (NREM) (not just SWS) or rapid eye movement (REM) sleep, or from both sleep stages. Tulving's classification of memory systems appears more pertinent than the declarative/non-declarative dichotomy when it comes to understanding the role of sleep in memory. Indeed, this model allows us to resolve several contradictions, notably the fact that episodic and semantic memory (the two memory systems encompassed in declarative memory) appear to rely on different sleep stages. Likewise, this model provides an explanation for why the acquisition of various types of skills (perceptual-motor, sensory-perceptual and cognitive skills) and priming effects, subserved by different brain structures but all designated by the generic term of implicit or non-declarative memory, may not benefit from the same sleep stages.

  14. Stage III nasopharyngeal angiofibroma: Improving results with endoscopic-assisted midfacial degloving and modification to the Fisch staging system.

    Science.gov (United States)

    Shah, Saurin R; Keshri, Amit; Patadia, Simple; Sahu, Rabi Narayan; Srivastava, Arun Kumar; Behari, Sanjay

    2015-10-01

    To study outcomes with endoscopic-assisted midfacial degloving for Fisch stage III nasopharyngeal angiofibroma and propose a new staging system. Retrospective study of patients with Fisch stage III juvenile nasopharyngeal angiofibroma (JNA) including preoperative angiography, intraoperative blood loss and residue/recurrence following surgery. Tertiary care superspecialty referral center. Fifteen consecutive patients with Fisch stage III JNA undergoing operations over a period of 18 months. Preoperative angiography details, intraoperative blood loss, residue/recurrence, complications of surgery. Transarterial embolization with particulate agents followed by endoscopic-assisted midfacial degloving provides excellent outcomes with Fisch stage III JNAs. The modified Fisch staging system proposed would allow better preoperative evaluation and comparison of outcomes with different treatment options for stage III JNAs. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  15. Ventriculoperitoneal shunt complications needing shunt revision in children: A review of 5 years of experience with 48 revisions

    Directory of Open Access Journals (Sweden)

    Rajendra K Ghritlaharey

    2012-01-01

    Full Text Available Background: The aim of this study was to review the management of ventriculoperitoneal (VP shunt complications in children. Patients and Methods: During the last 5 years (January 1, 2006 to December 31, 2010, 236 VP shunt operations were performed in children under 12 years of age; of these, 40 (16.94% developed shunt complications and those who underwent VP shunt revisions were studied. Results: This prospective study included 40 (28 boys and 12 girls children and required 48 shunt revisions. Complications following VP shunts that required shunt revisions were peritoneal catheter/peritoneal end malfunction (18, shunt/shunt tract infections (7, extrusion of peritoneal catheter through anus (5, ventricular catheter malfunction (4, cerebrospinal fluid (CSF leak from abdominal wound (4, shunt system failure (2, ventricular end/shunt displacement (2, CSF pseudocysts peritoneal cavity (2, extrusion of peritoneal catheter from neck, chest, abdominal scar and through umbilicus, one each. Four-fifth of these shunt complications occurred within 6 months of previous surgery. Surgical procedures done during shunt revisions in order of frequency were revision of peritoneal part of shunt (27, 56.25%, revision of entire shunt system (6, 12.5%, extra ventricular drainage and delayed re-shunt (5, 10.41%, shunt removal and delayed re-shunt (5, 10.41%, opposite side shunting (2, 4.16%, cysts excision and revision of peritoneal catheter (2, 4.16% and revision of ventricular catheter (1, 2.08%. The mortalities following VP shunt operations were 44 (18.64% and following shunt revisions were 4 (10%. Conclusions: VP shunt done for hydrocephalus in children is not only prone for complications and need for revision surgery but also associated with considerable mortality.

  16. 78 FR 10579 - TRICARE Revision to CHAMPUS DRG-Based Payment System, Pricing of Hospital Claims

    Science.gov (United States)

    2013-02-14

    ... 0720-AB58 TRICARE Revision to CHAMPUS DRG-Based Payment System, Pricing of Hospital Claims AGENCY... change TRICARE's current regulatory provision for hospital claims priced under the DRG-based payment... under the DRG- based payment system from the beneficiary's date of admission, to pricing such claims...

  17. Explanatory Coherence and Belief Revision in Naive Physics

    Science.gov (United States)

    1988-07-01

    continental drift (Thagard & Nowak, 1988), and debates about why the dinosaurs became extinct . Application of ECHO to the belief revisions in Pat and Hal...rewono of nocuamy Idid 4onoly by bodck number) Students of reasoning have long tried to understand how people revise systems of beliefs. We maintain...Princeton University Students of reasoning have long tried to understand how people revise systems of beliefs (see Wertheimer, 1945, for example). We will

  18. Hanford Site technical baseline database. Revision 1

    International Nuclear Information System (INIS)

    Porter, P.E.

    1995-01-01

    This report lists the Hanford specific files (Table 1) that make up the Hanford Site Technical Baseline Database. Table 2 includes the delta files that delineate the differences between this revision and revision 0 of the Hanford Site Technical Baseline Database. This information is being managed and maintained on the Hanford RDD-100 System, which uses the capabilities of RDD-100, a systems engineering software system of Ascent Logic Corporation (ALC). This revision of the Hanford Site Technical Baseline Database uses RDD-100 version 3.0.2.2 (see Table 3). Directories reflect those controlled by the Hanford RDD-100 System Administrator. Table 4 provides information regarding the platform. A cassette tape containing the Hanford Site Technical Baseline Database is available

  19. Custom-made hinged spacers in revision knee surgery for patients with infection, bone loss and instability.

    Science.gov (United States)

    Macmull, S; Bartlett, W; Miles, J; Blunn, G W; Pollock, R C; Carrington, R W J; Skinner, J A; Cannon, S R; Briggs, T W R

    2010-12-01

    Polymethyl methacrylate spacers are commonly used during staged revision knee arthroplasty for infection. In cases with extensive bone loss and ligament instability, such spacers may not preserve limb length, joint stability and motion. We report a retrospective case series of 19 consecutive patients using a custom-made cobalt chrome hinged spacer with antibiotic-loaded cement. The "SMILES spacer" was used at first-stage revision knee arthroplasty for chronic infection associated with a significant bone loss due to failed revision total knee replacement in 11 patients (58%), tumour endoprosthesis in four patients (21%), primary knee replacement in two patients (11%) and infected metalwork following fracture or osteotomy in a further two patients (11%). Mean follow-up was 38 months (range 24-70). In 12 (63%) patients, infection was eradicated, three patients (16%) had persistent infection and four (21%) developed further infection after initially successful second-stage surgery. Above knee amputation for persistent infection was performed in two patients. In this particularly difficult to treat population, the SMILES spacer two-stage technique has demonstrated encouraging results and presents an attractive alternative to arthrodesis or amputation. Copyright © 2009 Elsevier B.V. All rights reserved.

  20. CAMAC - A modular instrumentation system for data handling. Revised description and specification

    International Nuclear Information System (INIS)

    1977-03-01

    CAMAC is a modern data handling system in widespread use with on-line digital computers. It is based on a digital highway for data and control. The CAMAC specifications ensures compatibility between equipment from different sources. The revised specification introduces several new features, but is consistent with the previous version (EUR 4100e, 1969). The CAMAC system was specified by European laboratories, through the Esone Committee, and has been endorsed by the USAEC NIM Committee, who have an identical specification (TID-25875)

  1. Revised sequence components power system models for unbalanced power system studies

    Energy Technology Data Exchange (ETDEWEB)

    Abdel-Akher, M. [Tunku Abdul Rahman Univ., Kuala Lumpur (Malaysia); Nor, K.-M. [Univ. of Technology Malaysia, Johor (Malaysia); Rashid, A.H.A. [Univ. of Malaya, Kuala Lumpur (Malaysia)

    2007-07-01

    The principle method of analysis using positive, negative, and zero-sequence networks has been used to examine the balanced power system under both balanced and unbalanced loading conditions. The significant advantage of the sequence networks is that the sequence networks become entirely uncoupled in the case of balanced three-phase power systems. The uncoupled sequence networks then can be solved in independent way such as in fault calculation programs. However, the hypothesis of balanced power systems cannot be considered in many cases due to untransposed transmission lines; multiphase line segments in a distribution power system; or transformer phase shifts which cannot be incorporated in the existing models. A revised sequence decoupled power system models for analyzing unbalanced power systems based on symmetrical networks was presented in this paper. These models included synchronous machines, transformers, transmission lines, and voltage regulators. The models were derived from their counterpart's models in phase coordinates frame of reference. In these models, the three sequence networks were fully decoupled with a three-phase coordinates features such as transformer phase shifts and transmission line coupling. The proposed models were used to develop an unbalanced power-flow program for analyzing both balanced and unbalanced networks. The power flow solution was identical to results obtained from a full phase coordinate three-phase power-flow program. 11 refs., 3 tabs.

  2. Impact of chronic kidney disease stage on lower-extremity arthroplasty.

    Science.gov (United States)

    Deegan, Brian F; Richard, Raveesh D; Bowen, Thomas R; Perkins, Robert M; Graham, Jove H; Foltzer, Michael A

    2014-07-01

    End-stage renal disease and dialysis is commonly associated with poor outcomes after joint replacement surgery. The goal of this study was to evaluate postoperative complications in patients with less advanced chronic kidney disease undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). Patients who underwent THA or TKA between 2004 and 2011 with stage 1, 2, or 3 chronic kidney disease were retrospectively reviewed via an electronic medical record. The authors compared 377 patients who had stage 1 to 2 chronic kidney disease with 402 patients who had stage 3 chronic kidney disease. No significant differences in 90-day readmission or revision rates were found between the stage 1 to 2 and stage 3 patient groups. For patients with stage 3 chronic kidney disease, the overall mortality rate was greater than that in patients with stage 1 to 2 chronic kidney disease. However, when adjusted for comorbid disease, no significant increases were seen in joint infection, readmission, or early revision between patients with stage 1 to 2 chronic kidney disease vs patients with stage 3 chronic kidney disease. The overall incidence of infection was high (3.5%) but far less than reported for patients with end-stage renal disease, dialysis, and kidney transplant. In conclusion, patients with stage 1, 2, or 3 chronic kidney disease may have a higher than expected rate of prosthetic joint infection (3.5%) after total joint arthroplasty. Patients with stage 3 chronic kidney disease are at higher risk for postoperative mortality compared with those with lesser stages of kidney disease. Copyright 2014, SLACK Incorporated.

  3. The economic impact of revision otologic surgery.

    Science.gov (United States)

    Nadimi, Sahar; Leonetti, John P; Pontikis, George

    2016-03-01

    Revision otologic surgery places a significant economic burden on patients and the healthcare system. We conducted a retrospective chart analysis to estimate the economic impact of revision canal-wall-down (CWD) mastoidectomy. We reviewed the medical records of all 189 adults who had undergone CWD mastoidectomy performed by the senior author between June 2006 and August 2011 at Loyola University Medical Center in Maywood, Ill. Institutional charges and collections for all patients were extrapolated to estimate the overall healthcare cost of revision surgery in Illinois and at the national level. Of the 189 CWD mastoidectomies, 89 were primary and 100 were revision procedures. The total charge for the revision cases was $2,783,700, and the net reimbursement (collections) was $846,289 (30.4%). Using Illinois Hospital Association data, we estimated that reimbursement for 387 revision CWD mastoidectomies that had been performed in fiscal year 2011 was nearly $3.3 million. By extrapolating our data to the national level, we estimated that 9,214 patients underwent revision CWD mastoidectomy in the United States during 2011, which cost the national healthcare system roughly $76 million, not including lost wages and productivity. Known causes of failed CWD mastoidectomies that often result in revision surgery include an inadequate meatoplasty, a facial ridge that is too high, residual diseased air cells, and recurrent cholesteatoma. A better understanding of these factors can reduce the need for revision surgery, which could have a positive impact on the economic strain related to this procedure at the local, state, and national levels.

  4. A2-3: Impact of Mild Chronic Kidney Disease Stage on Outcomes after Total Hip or Knee Arthroplasty

    Science.gov (United States)

    Graham, Jove; Deegan, Brian; Bowen, Thomas; Richard, Raveesh; Perkins, Robert; Foltzer, Michael

    2014-01-01

    Background/Aims Dialysis and kidney transplantation adversely impact outcomes of total hip or knee arthroplasty (THA, TKA), but complication rates have not been reported for patients with less advanced stages of chronic kidney disease (CKD). Surgeons lack the data necessary to have informed discussions regarding anticipated outcomes of joint replacement for these patients. Methods We retrospectively reviewed electronic health records of 779 adults with stages 1, 2, and 3 CKD not requiring dialysis or transplantation who underwent THA or TKA from 2004–2011, to assess infection, revision, 90-day readmission and mortality rates. Patients with less than 12 months follow-up, open fracture, prior joint surgery, pregnancy, or acute kidney injury were excluded. Chi-square analysis and Cox survival analysis compared these outcomes between the stage 1–2 and stage 3 groups, stratified by joint replaced (THA vs TKA). All models adjusted for age, sex and BMI at surgery. Results No statistically different rates of revision or infection between Stage 3 vs. Stages 1–2 were seen, although there was a trend toward increased infections in Stage 3. THA patients with Stage 3 showed a significantly increased mortality rate compared to Stage 1–2 THA patients (HR 3.40, 95% CI = 1.25–9.23, P = 0.02). Conclusions CKD affects nearly 15% of the U.S. population many of whom undergo joint replacement. End stage kidney disease (patients post-transplant or on hemodialysis) has been consistently associated with increased rates of infection and revision in excess of our observed outcomes, but the overall rate of infection/revision in our study population was only slightly higher than reported rates in the general population (2–7% vs. 1–2%, respectively). CKD should not preclude joint replacement, but these data can help clinicians engage in meaningful informed discussions with patients with mild kidney disease regarding risks for infection, revision and death following joint

  5. Scar modification. Techniques for revision and camouflage.

    Science.gov (United States)

    Horswell, B B

    1998-09-01

    The surgery and management of scars is a protracted and staged process that includes preparation of the skin through hygienic measures, scar softening (if indicated) with steroids, massage and pressure dressings, skilled execution of the surgical plan, and thorough postoperative wound care. This process generally covers a 1-year period for the various stages mentioned. Many general host and local skin factors will directly affect the final revision result. The two most important indirect factors that the surgeon must endeavor to control are optimal patient preparation and cutaneous health, and patient compliance with, and an ability to carry out, those wound care measures that the surgeon prescribes. Keloid and burn contracture scars represent two entities that are complicated and challenging to treat owing to their abnormal morphophysiologic features. Management of these scars is prolonged, and the patient must understand that the ultimate result will usually be a compromise. New grafting techniques, such as cultured autodermal grafts, offer improved initial management of burn wounds that may subsequently optimize scar revision in these patients. Keloids, and to a lesser extent hypertrophic scars, require steroid injections, pressure treatment, careful surgery, and protracted wound support and pressure treatment (exceeding 6 months) after surgery.

  6. Comparison of five systems for staging lymph node metastasis in gastric cancer.

    Science.gov (United States)

    Yu, W; Choi, G S; Whang, I; Suh, I S

    1997-09-01

    There are several systems for staging lymph node metastasis in gastric cancer. Their relative merits are not clear. In this retrospective analysis, the nodal status was classified according to the Union Internacional Contra la Cancrum (UICC) and Japanese staging systems, the number and frequency of lymph node metastasis, and the level of involved nodes. Each staging system was scored as good (+1), fair (0) or poor (-1) with respect to prognostic value, theoretical value, convenience, reproducibility and surgical applicability. There were no differences between the five staging systems in predicting survival. The Japanese staging system was most arbitrary owing to the complexity of the system, although it had an advantage in surgical application. The same disadvantage was found in the UICC system and the level system. Determination of the number and frequency of involved nodes was convenient and reproducible, but the number of lymph nodes dissected must be considered when the number of positive nodes is used for staging. The classification of metastasis to the regional lymph nodes as N0 (no nodal metastasis), N1 (metastasis in 1-25 per cent of dissected nodes) and N2 (metastasis in more than 25 per cent of dissected nodes) would be a simple, convenient, reproducible staging system with an ability to predict surgical results.

  7. The stages of the international drug control system.

    Science.gov (United States)

    Carstairs, Catherine

    2005-01-01

    This paper argues that the history of the international drug control system of the League of Nations/United Nations can be divided into three cumulative stages. The first stage, the supply stage, dates back to early part of the 20th century, and aimed to reduce the supply of drugs through careful monitoring and trade regulations. This has remained the dominant control strategy. In the middle of the century, demand control, in the form of treatment and criminalization of the individual user, began to appear. This was the least successful stage. Finally, in the 1980s, the dangers of the drug traffic assumed an important place on the international agenda and measures to reduce drug-related organized crime were enacted. To date, this has been a process of proliferation of regulatory strategies. Recently, new challenges to the international drug control system have emerged, including well-funded non-governmental organizations critical of the war on drugs, and the adoption of harm reduction measures in national policies around the world.

  8. Intestinal diffuse large B-cell lymphoma: an evaluation of different staging systems.

    Science.gov (United States)

    Hwang, Hee Sang; Yoon, Dok Hyun; Suh, Cheolwon; Park, Chan-Sik; Huh, Jooryung

    2014-01-01

    The gastrointestinal tract is the most common primary extranodal site for diffuse large B-cell lymphoma (DLBCL). However, there is no consensus on the most appropriate staging system for intestinal DLBCL. We evaluated the utility of the modified Ann Arbor system, the Lugano system, and the Paris staging system (a modification of the Tumor, Node, Metastases [TNM] staging for epithelial tumors) in 66 cases of resected intestinal DLBCL. The cases were treated with surgery, plus either cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) chemotherapy alone (n=26) or with the addition of rituximab immunotherapy (n=40). Median follow-up time was 40.4 months (range, 2.1-171.6 months). Fifty-six patients (84.8%) achieved complete remission. The overall 5-yr survival rate was 86.4% (57/66). Of the stage categories defined for each staging system, only the T stage of the Paris classification showed prognostic significance for overall survival by univariate analysis. However, none of the stage parameters was significantly correlated with patient survival on multivariate analysis. In conclusion, the results suggest that the T stage of the Paris classification system may be a prognostic indicator in intestinal DLBCL. The results also imply that in surgically resected intestinal DLBCL, the addition of rituximab to the CHOP regimen does not confer significant survival advantage.

  9. MR staging of pelvic endometriosis. Role of fat-suppression T1-weighted images

    International Nuclear Information System (INIS)

    Oishi-Tanaka, Yumiko; Itai, Yuji; Anno, Izumi; Matsumoto, Kunihiko; Ebihara, Reiko; Nishida, Masato

    1996-01-01

    We examined whether MR can determine the stage of endometriosis according to the scoring system established and revised by the American Fertility Society (r-AFS), a system which is widely used by gynecologists. We also studied the utility of fat suppression T 1 -weighted images in improving accuracy. Seventeen patients with endometriosis examined by conventional MR were included in this study. All the patients had surgically proved stage III or IV disease. We determined the stage by MR using the following criteria according to the r-AFS system: adnexal masses without normal ovarian tissue were considered deep ovarian lesions, while those with normal tissue were considered superficial. A lack of fat between the lesion and surrounding structures was considered a dense adhesion, and hyperintense spots were considered peritoneal implants. The MR scores of patients with and without fat suppression were correlated with the surgical scores. MR staging corresponded to surgical staging in 15 of the 17 patients. In eight patients, peritoneal implants of less than 1.5 cm were depicted only by fat-suppression images. However, these lesions did not change the score significantly. MR imaging could determine the stage in advanced endometriosis. Fat-suppression could highlight smaller implants. These tiny lesions had little clinical meaning in these advanced cases; however, the clinical value of this technique should be evaluated in milder disease. (author)

  10. The International Neuroblastoma Risk Group (INRG) staging system: an INRG Task Force report.

    Science.gov (United States)

    Monclair, Tom; Brodeur, Garrett M; Ambros, Peter F; Brisse, Hervé J; Cecchetto, Giovanni; Holmes, Keith; Kaneko, Michio; London, Wendy B; Matthay, Katherine K; Nuchtern, Jed G; von Schweinitz, Dietrich; Simon, Thorsten; Cohn, Susan L; Pearson, Andrew D J

    2009-01-10

    The International Neuroblastoma Risk Group (INRG) classification system was developed to establish a consensus approach for pretreatment risk stratification. Because the International Neuroblastoma Staging System (INSS) is a postsurgical staging system, a new clinical staging system was required for the INRG pretreatment risk classification system. To stage patients before any treatment, the INRG Task Force, consisting of neuroblastoma experts from Australia/New Zealand, China, Europe, Japan, and North America, developed a new INRG staging system (INRGSS) based on clinical criteria and image-defined risk factors (IDRFs). To investigate the impact of IDRFs on outcome, survival analyses were performed on 661 European patients with INSS stages 1, 2, or 3 disease for whom IDRFs were known. In the INGRSS, locoregional tumors are staged L1 or L2 based on the absence or presence of one or more of 20 IDRFs, respectively. Metastatic tumors are defined as stage M, except for stage MS, in which metastases are confined to the skin, liver, and/or bone marrow in children younger than 18 months of age. Within the 661-patient cohort, IDRFs were present (ie, stage L2) in 21% of patients with stage 1, 45% of patients with stage 2, and 94% of patients with stage 3 disease. Patients with INRGSS stage L2 disease had significantly lower 5-year event-free survival than those with INRGSS stage L1 disease (78% +/- 4% v 90% +/- 3%; P = .0010). Use of the new staging (INRGSS) and risk classification (INRG) of neuroblastoma will greatly facilitate the comparison of risk-based clinical trials conducted in different regions of the world.

  11. Revised surveillance case definition for HIV infection--United States, 2014.

    Science.gov (United States)

    2014-04-11

    Following extensive consultation and peer review, CDC and the Council of State and Territorial Epidemiologists have revised and combined the surveillance case definitions for human immunodeficiency virus (HIV) infection into a single case definition for persons of all ages (i.e., adults and adolescents aged ≥13 years and children aged case now accommodate new multitest algorithms, including criteria for differentiating between HIV-1 and HIV-2 infection and for recognizing early HIV infection. A confirmed case can be classified in one of five HIV infection stages (0, 1, 2, 3, or unknown); early infection, recognized by a negative HIV test within 6 months of HIV diagnosis, is classified as stage 0, and acquired immunodeficiency syndrome (AIDS) is classified as stage 3. Criteria for stage 3 have been simplified by eliminating the need to differentiate between definitive and presumptive diagnoses of opportunistic illnesses. Clinical (nonlaboratory) criteria for defining a case for surveillance purposes have been made more practical by eliminating the requirement for information about laboratory tests. The surveillance case definition is intended primarily for monitoring the HIV infection burden and planning for prevention and care on a population level, not as a basis for clinical decisions for individual patients. CDC and the Council of State and Territorial Epidemiologists recommend that all states and territories conduct case surveillance of HIV infection using this revised surveillance case definition.

  12. End-Stage Renal Disease Prospective Payment System

    Data.gov (United States)

    U.S. Department of Health & Human Services — This final rule implements a case-mix adjusted bundled prospective payment system (PPS) for Medicare outpatient end-stage renal disease (ESRD) dialysis facilities...

  13. INDIRECT WRITTEN CORRECTIVE FEEDBACK, REVISION, AND LEARNING

    Directory of Open Access Journals (Sweden)

    Fatemeh Poorebrahim

    2017-01-01

    Full Text Available Corrective feedback, the necessity of providing it, and how it should be provided has been one of the hot topics in the area of ELT. Amid continuing controversies over whether providing feedback helps L2 learners improve their writing accuracy, many research studies have been undertaken to compare the relative effectiveness of different types of feedback. However, the difference between two types of indirect corrective feedback, namely indication and indication plus location, have not been properly examined yet. Motivated to narrow this gap, this study is designed to compare two groups of Iranian learners, each revising their papers based on one of the aforementioned options. For data analysis, a series of independent samples t tests were employed. The results revealed that the difference between the two groups in their reduction of errors from the original draft to the revision of each task followed a growing trend and became significant. Nonetheless, the difference in accuracy of new pieces of writing fell short of significance. Finally, it was found that error reduction in revision stage cannot be considered as learning. The results of the study, discussed in relation to that of others, implicate that the purpose for which feedback is provided is essential in determining the type of feedback; more explicit feedback is better for revising purposes while more implicit feedback is good for learning purposes.

  14. 75 FR 27401 - List of Approved Spent Fuel Storage Casks: NUHOMS® HD System Revision 1; Correction

    Science.gov (United States)

    2010-05-17

    ... Storage Casks: NUHOMS[reg] HD System Revision 1; Correction AGENCY: Nuclear Regulatory Commission. ACTION... HD spent fuel storage cask system. This action is necessary to correctly specify the effective date... on May 6, 2010 (75 FR 24786), that amends the regulations that govern storage of spent nuclear fuel...

  15. Analysis of multi-stage open shop processing systems

    NARCIS (Netherlands)

    Eggermont, C.E.J.; Schrijver, A.; Woeginger, G.J.; Schwentick, T.; Dürr, C.

    2011-01-01

    We study algorithmic problems in multi-stage open shop processing systems that are centered around reachability and deadlock detection questions. We characterize safe and unsafe system states. We show that it is easy to recognize system states that can be reached from the initial state (where the

  16. The global stability of a delayed predator-prey system with two stage-structure

    International Nuclear Information System (INIS)

    Wang Fengyan; Pang Guoping

    2009-01-01

    Based on the classical delayed stage-structured model and Lotka-Volterra predator-prey model, we introduce and study a delayed predator-prey system, where prey and predator have two stages, an immature stage and a mature stage. The time delays are the time lengths between the immature's birth and maturity of prey and predator species. Results on global asymptotic stability of nonnegative equilibria of the delay system are given, which generalize and suggest that good continuity exists between the predator-prey system and its corresponding stage-structured system.

  17. Expedited technology demonstration project. Project baseline revision 2.2 and FY96 plan

    International Nuclear Information System (INIS)

    1996-07-01

    The Expedited Technology Demonstration Project Plan, Mixed Waste Management Facility (MWMF) current baseline. The revised plan will focus efforts specifically on the demonstration of an integrated Molten Salt Oxidation (MSO) system. In addition to the MSO primary unit, offgas, and salt recycle subsystems, the demonstrations will include feed preparation and feed delivery systems, and the generation of robust final forms from process mineral residues. A simplified process flow chart for the expedited demonstration is provided. To minimize costs and to accelerate the schedule for deployment, the integrated system will be staged in an existing facility at LLNL equipped to handle hazardous and radioactive materials. The MSO systems will be activated in fiscal year 97, followed by the activation of feed preparation and final forms in fiscal year 98

  18. Revising Translations

    DEFF Research Database (Denmark)

    Rasmussen, Kirsten Wølch; Schjoldager, Anne

    2011-01-01

    The paper explains the theoretical background and findings of an empirical study of revision policies, using Denmark as a case in point. After an overview of important definitions, types and parameters, the paper explains the methods and data gathered from a questionnaire survey and an interview...... survey. Results clearly show that most translation companies regard both unilingual and comparative revisions as essential components of professional quality assurance. Data indicate that revision is rarely fully comparative, as the preferred procedure seems to be a unilingual revision followed by a more...... or less comparative rereading. Though questionnaire data seem to indicate that translation companies use linguistic correctness and presentation as the only revision parameters, interview data reveal that textual and communicative aspects are also considered. Generally speaking, revision is not carried...

  19. [Comparison of differentiated thyroid carcinoma staging systems in a Spanish population].

    Science.gov (United States)

    Andía Melero, Víctor Manuel; Martín de Santa-Olalla Llanes, María; Sambo Salas, Marcel; Percovich Hualpa, Juan Carlos; Motilla de la Cámara, Marta; Collado Yurrita, Luis

    2015-04-01

    Differentiated thyroid carcinoma staging is increasingly important due to the current trends to a less intensive therapy in low-risk patients. The TNM system is most widely used, but other systems based on follow-up of several patient cohorts have been developed. When these systems have been applied to other populations, results have been discordant. Our study evaluates the suitability of several differentiated thyroid carcinoma staging systems in a Spanish population. 729 patients with differentiated thyroid carcinoma and staging data available were enrolled. Mean follow-up time was 10.8 years. The TNM, EORTC, AMES, Clinical class, MACIS, Ohio, NTCTCS, and Spanish systems were applied to all histological types. The Kaplan-Meier survival curves for each system were analyzed, and compared using the proportion of explained variation (PEV). The demographic and clinical characteristics of our population were similar to those of other Spanish and international cohorts reported. The best systems were NTCTCS, with 74.7% PEV, and TNM (68.3%), followed by the Ohio, MACIS, EORTC, and AMES systems with minimal differences between them, while the least adequate were the Spanish (55.2%) and Clinical class (47.1%) systems. The NTCTCS staging system was found to be better than TNM in our population but, because of its simplicity and greater dissemination, the TNM appears to be recommended for staging of patients with differentiated thyroid carcinoma. Copyright © 2014 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

  20. MR staging of pelvic endometriosis. Role of fat-suppression T{sub 1}-weighted images

    Energy Technology Data Exchange (ETDEWEB)

    Oishi-Tanaka, Yumiko; Itai, Yuji; Anno, Izumi; Matsumoto, Kunihiko; Ebihara, Reiko; Nishida, Masato [Tsukuba Univ., Ibaraki (Japan). Inst. of Clinical Medicine

    1996-05-01

    We examined whether MR can determine the stage of endometriosis according to the scoring system established and revised by the American Fertility Society (r-AFS), a system which is widely used by gynecologists. We also studied the utility of fat suppression T{sub 1}-weighted images in improving accuracy. Seventeen patients with endometriosis examined by conventional MR were included in this study. All the patients had surgically proved stage III or IV disease. We determined the stage by MR using the following criteria according to the r-AFS system: adnexal masses without normal ovarian tissue were considered deep ovarian lesions, while those with normal tissue were considered superficial. A lack of fat between the lesion and surrounding structures was considered a dense adhesion, and hyperintense spots were considered peritoneal implants. The MR scores of patients with and without fat suppression were correlated with the surgical scores. MR staging corresponded to surgical staging in 15 of the 17 patients. In eight patients, peritoneal implants of less than 1.5 cm were depicted only by fat-suppression images. However, these lesions did not change the score significantly. MR imaging could determine the stage in advanced endometriosis. Fat-suppression could highlight smaller implants. These tiny lesions had little clinical meaning in these advanced cases; however, the clinical value of this technique should be evaluated in milder disease. (author)

  1. Bladder cancer staging in CT urography: effect of stage labels on statistical modeling of a decision support system

    Science.gov (United States)

    Gandikota, Dhanuj; Hadjiiski, Lubomir; Cha, Kenny H.; Chan, Heang-Ping; Caoili, Elaine M.; Cohan, Richard H.; Weizer, Alon; Alva, Ajjai; Paramagul, Chintana; Wei, Jun; Zhou, Chuan

    2018-02-01

    In bladder cancer, stage T2 is an important threshold in the decision of administering neoadjuvant chemotherapy. Our long-term goal is to develop a quantitative computerized decision support system (CDSS-S) to aid clinicians in accurate staging. In this study, we examined the effect of stage labels of the training samples on modeling such a system. We used a data set of 84 bladder cancers imaged with CT Urography (CTU). At clinical staging prior to treatment, 43 lesions were staged as below stage T2 and 41 were stage T2 or above. After cystectomy and pathological staging that is considered the gold standard, 10 of the lesions were upstaged to stage T2 or above. After correcting the stage labels, 33 lesions were below stage T2, and 51 were stage T2 or above. For the CDSS-S, the lesions were segmented using our AI-CALS method and radiomic features were extracted. We trained a linear discriminant analysis (LDA) classifier with leave-one-case-out cross validation to distinguish between bladder lesions of stage T2 or above and those below stage T2. The CDSS-S was trained and tested with the corrected post-cystectomy labels, and as a comparison, CDSS-S was also trained with understaged pre-treatment labels and tested on lesions with corrected labels. The test AUC for the CDSS-S trained with corrected labels was 0.89 +/- 0.04. For the CDSS-S trained with understaged pre-treatment labels and tested on the lesions with corrected labels, the test AUC was 0.86 +/- 0.04. The likelihood of stage T2 or above for 9 out of the 10 understaged lesions was correctly increased for the CDSS-S trained with corrected labels. The CDSS-S is sensitive to the accuracy of stage labeling. The CDSS-S trained with correct labels shows promise in prediction of the bladder cancer stage.

  2. Proposal for a new staging system for osteoradionecrosis of the mandible

    NARCIS (Netherlands)

    Karagozoglu, K.H.; Dekker, H.; Rietveld, D.H.F.; de Bree, R.; Schulten, E.A.J.M.; Kantola, S.; Forouzanfar, T.; van der Waal, I.

    2014-01-01

    The presented staging system seems well reproducible, facilitating the comparison of study groups dealing with the various issues of osteoradionecrosis of the mandible. It is yet to be evaluated whether the presently proposed staging system is useful for management purposes.

  3. Revision of FMM-Yukawa: An adaptive fast multipole method for screened Coulomb interactions

    Science.gov (United States)

    Zhang, Bo; Huang, Jingfang; Pitsianis, Nikos P.; Sun, Xiaobai

    2010-12-01

    FMM-YUKAWA is a mathematical software package primarily for rapid evaluation of the screened Coulomb interactions of N particles in three dimensional space. Since its release, we have revised and re-organized the data structure, software architecture, and user interface, for the purpose of enabling more flexible, broader and easier use of the package. The package and its documentation are available at http://www.fastmultipole.org/, along with a few other closely related mathematical software packages. New version program summaryProgram title: FMM-Yukawa Catalogue identifier: AEEQ_v2_0 Program summary URL:http://cpc.cs.qub.ac.uk/summaries/AEEQ_v2_0.html Program obtainable from: CPC Program Library, Queen's University, Belfast, N. Ireland Licensing provisions: GNU GPL 2.0 No. of lines in distributed program, including test data, etc.: 78 704 No. of bytes in distributed program, including test data, etc.: 854 265 Distribution format: tar.gz Programming language: FORTRAN 77, FORTRAN 90, and C. Requires gcc and gfortran version 4.4.3 or later Computer: All Operating system: Any Classification: 4.8, 4.12 Catalogue identifier of previous version: AEEQ_v1_0 Journal reference of previous version: Comput. Phys. Comm. 180 (2009) 2331 Does the new version supersede the previous version?: Yes Nature of problem: To evaluate the screened Coulomb potential and force field of N charged particles, and to evaluate a convolution type integral where the Green's function is the fundamental solution of the modified Helmholtz equation. Solution method: The new version of fast multipole method (FMM) that diagonalizes the multipole-to-local translation operator is applied with the tree structure adaptive to sample particle locations. Reasons for new version: To handle much larger particle ensembles, to enable the iterative use of the subroutines in a solver, and to remove potential contention in assignments for parallelization. Summary of revisions: The software package FMM-Yukawa has been

  4. SLS Block 1-B and Exploration Upper Stage Navigation System Design

    Science.gov (United States)

    Oliver, T. Emerson; Park, Thomas B.; Smith, Austin; Anzalone, Evan; Bernard, Bill; Strickland, Dennis; Geohagan, Kevin; Green, Melissa; Leggett, Jarred

    2018-01-01

    The SLS Block 1B vehicle is planned to extend NASA's heavy lift capability beyond the initial SLS Block 1 vehicle. The most noticeable change for this vehicle from SLS Block 1 is the swapping of the upper stage from the Interim Cryogenic Propulsion stage (ICPS), a modified Delta IV upper stage, to the more capable Exploration Upper Stage (EUS). As the vehicle evolves to provide greater lift capability and execute more demanding missions so must the SLS Integrated Navigation System to support those missions. The SLS Block 1 vehicle carries two independent navigation systems. The responsibility of the two systems is delineated between ascent and upper stage flight. The Block 1 navigation system is responsible for the phase of flight between the launch pad and insertion into Low-Earth Orbit (LEO). The upper stage system assumes the mission from LEO to payload separation. For the Block 1B vehicle, the two functions are combined into a single system intended to navigate from ground to payload insertion. Both are responsible for self-disposal once payload delivery is achieved. The evolution of the navigation hardware and algorithms from an inertial-only navigation system for Block 1 ascent flight to a tightly coupled GPS-aided inertial navigation system for Block 1-B is described. The Block 1 GN&C system has been designed to meet a LEO insertion target with a specified accuracy. The Block 1-B vehicle navigation system is designed to support the Block 1 LEO target accuracy as well as trans-lunar or trans-planetary injection accuracy. This is measured in terms of payload impact and stage disposal requirements. Additionally, the Block 1-B vehicle is designed to support human exploration and thus is designed to minimize the probability of Loss of Crew (LOC) through high-quality inertial instruments and Fault Detection, Isolation, and Recovery (FDIR) logic. The preliminary Block 1B integrated navigation system design is presented along with the challenges associated with

  5. A Lymph Node Staging System for Gastric Cancer: A Hybrid Type Based on Topographic and Numeric Systems.

    Directory of Open Access Journals (Sweden)

    Yoon Young Choi

    Full Text Available Although changing a lymph node staging system from an anatomically based system to a numerically based system in gastric cancer offers better prognostic performance, several problems can arise: it does not offer information on the anatomical extent of disease and cannot represent the extent of lymph node dissection. The purpose of this study was to discover an alternative lymph node staging system for gastric cancer. Data from 6025 patients who underwent gastrectomy for primary gastric cancer between January 2000 and December 2010 were reviewed. The lymph node groups were reclassified into lesser-curvature, greater-curvature, and extra-perigastric groups. Presence of any metastatic lymph node in one group was considered positive. Lymph node groups were further stratified into four (new N0-new N3 according to the number of positive lymph node groups. Survival outcomes with this new N staging were compared with those of the current TNM system. For validation, two centers in Japan (large center, n = 3443; medium center, n = 560 were invited. Even among the same pN stages, the more advanced new N stage showed worse prognosis, indicating that the anatomical extent of metastatic lymph nodes is important. The prognostic performance of the new staging system was as good as that of the current TNM system for overall advanced gastric cancer as well as lymph node-positive gastric cancer (Harrell C-index was 0.799, 0.726, and 0.703 in current TNM and 0.799, 0.727, and 0.703 in new TNM stage. Validation sets supported these outcomes. The new N staging system demonstrated prognostic performance equal to that of the current TNM system and could thus be used as an alternative.

  6. Revision total hip arthoplasty: factors associated with re-revision surgery.

    Science.gov (United States)

    Khatod, Monti; Cafri, Guy; Inacio, Maria C S; Schepps, Alan L; Paxton, Elizabeth W; Bini, Stefano A

    2015-03-04

    The survivorship of implants after revision total hip arthroplasty and risk factors associated with re-revision are not well defined. We evaluated the re-revision rate with use of the institutional total joint replacement registry. The purpose of this study was to determine patient, implant, and surgeon factors associated with re-revision total hip arthroplasty. A retrospective cohort study was conducted. The total joint replacement registry was used to identify patients who had undergone revision total hip arthroplasty for aseptic reasons from April 1, 2001, to December 31, 2010. The end point of interest was re-revision total hip arthroplasty. Risk factors evaluated for re-revision total hip arthroplasty included: patient risk factors (age, sex, body mass index, race, and general health status), implant risk factors (fixation type, bearing surface, femoral head size, and component replacement), and surgeon risk factors (volume and experience). A multivariable Cox proportional hazards model was used. Six hundred and twenty-nine revision total hip arthroplasties with sixty-three (10%) re-revisions were evaluated. The mean cohort age (and standard deviation) was 57.0 ± 12.4 years, the mean body mass index (and standard deviation) was 29.5 ± 6.1 kg/m(2), and most of the patients were women (64.5%) and white (81.9%) and had an American Society of Anesthesiologists score of associated with the risk of re-revision. For every ten-year increase in patient age, the hazard ratio for re-revision decreases by a factor of 0.72 (95% confidence interval, 0.58 to 0.90). For every five revision surgical procedures performed by a surgeon, the risk of revision decreases by a factor of 0.93 (95% confidence interval, 0.86 to 0.99). At the time of revision, a new or retained cemented femoral implant or all-cemented hip implant increases the risk of revision by a factor of 3.19 (95% confidence interval, 1.22 to 8.38) relative to a retained or new uncemented hip implant. A ceramic on a

  7. Belief Revision in the GOAL Agent Programming Language

    DEFF Research Database (Denmark)

    Spurkeland, Johannes Svante; Jensen, Andreas Schmidt; Villadsen, Jørgen

    2013-01-01

    Agents in a multiagent system may in many cases find themselves in situations where inconsistencies arise. In order to properly deal with these, a good belief revision procedure is required. This paper illustrates the usefulness of such a procedure: a certain belief revision algorithm is consider...... in order to deal with inconsistencies and, particularly, the issue of inconsistencies, and belief revision is examined in relation to the GOAL agent programming language....

  8. Self-tuning in master-slave synchronization of high-precision stage systems

    NARCIS (Netherlands)

    Heertjes, M.F.; Temizer, B.; Schneiders, M.G.E.

    2013-01-01

    For synchronization of high-precision stage systems, in particular the synchronization between a wafer and a reticle stage system of a wafer scanner, a master–slave controller design is presented. The design consists of a synchronization controller based on FIR filters and a data-driven self-tuning

  9. Parachute systems for the atmospheric reentry of launcher upper stages

    Directory of Open Access Journals (Sweden)

    Bogdan DOBRESCU

    2017-03-01

    Full Text Available Parachute systems can be used to control the reentry trajectory of launcher upper stages, in order to lower the risks to the population or facilitate the retrieval of the stage. Several types of parachutes deployed at subsonic, supersonic and hypersonic speeds are analyzed, modeled as single and multistage systems. The performance of deceleration parachutes depends on their drag area and deployment conditions, while gliding parachutes are configured to achieve stable flight with a high glide ratio. Gliding parachutes can be autonomously guided to a low risk landing area. Sizing the canopy is shown to be an effective method to reduce parachute sensitivity to wind. The reentry trajectory of a launcher upper stage is simulated for each parachute system configuration and the results are compared to the nominal reentry case.

  10. The NxStage System One.

    Science.gov (United States)

    Clark, William R; Turk, Joseph E

    2004-01-01

    Given the results of recent randomized controlled trials as well as staffing and budget challenges that today face many institutions across North America, a novel therapeutic approach is likely necessary to enable improvements in clinical outcomes for renal failure patients. The NxStage System One was developed to address these challenges. The system is an innovative, flexible device that delivers hemodialysis, hemofiltration, and/or ultrafiltration therapies to patients with renal failure or fluid overload. The unique characteristics of this system include a highly automated system design with a drop-in cartridge to facilitate training and simple operation; portable size and independence from dedicated infrastructure to minimize practical barriers to where therapy may be administered; use of high-quality premixed treatment fluids to enable capture of the potential clinical benefits of fluid purity without the hassles of local water treatment; and wide operating ranges to allow clinician flexibility in patient therapy prescriptions. In both the chronic and acute care environments, the System One presents clinicians with a new platform for delivering patient therapy improvements within real-world constraints.

  11. Wind Solar Hybrid System Rectifier Stage Topology Simulation

    OpenAIRE

    Anup M. Gakare; Subhash Kamdi

    2014-01-01

    This paper presents power-control strategies of a grid-connected hybrid generation system with versatile power transfer. The hybrid system allows maximum utilization of freely available renewable sources like wind and photovoltaic energies. This paper presents a new system configuration of the multi input rectifier stage for a hybrid wind and photovoltaic energy system. This configuration allows the two sources to supply the load simultaneously depending on the availability of...

  12. Evaluation of the 8th AJCC staging system for pathologically versus clinically staged pancreatic adenocarcinoma: A time to revisit a dogma?

    Science.gov (United States)

    Abdel-Rahman, Omar

    2018-02-01

    The 8th edition of the American Joint Committee on Cancer (AJCC) staging system for pancreatic exocrine adenocarcinoma has been released. The current study seeks to assess the 7th and 8th editions among patients registered within the surveillance, epidemiology and end results (SEER) database. SEER database (2010-2013) has been accessed through SEER*Stat program and AJCC 8th edition stages were reconstructed utilizing the collaborative stage descriptions. Kaplan-Meier analysis of overall survival and pancreatic cancer-specific survival analyses (according to both 7th and 8th editions and according to whether pathological or clinical staging were conducted) has been performed. Multivariate analysis of factors affecting pancreatic cancer-specific survival was also conducted through a Cox proportional hazard model. A total of 18  948 patients with pancreatic adenocarcinoma were identified in the period from 2010-2013. Pancreatic cancer-specific survival among pathologically staged patients and according to the 8th edition showed significant differences for all pair wise comparisons among different stages (P < 0.0001) except for the comparison between stage IA and stage IB (P = 0.307) and the comparison between stage IB and stage IIA (P = 0.116). Moreover, P value for stage IA vs IIA was 0.014; while pancreatic cancer-specific survival according to the 7th edition among pathologically staged patients showed significant differences for all pair wise comparisons among different stages (P < 0.0001) except for the comparison between IA and IB (P = 0.072), the comparison between stage IIA and stage IIB (P = 0.065), the comparison between stage IIA and stage III (P = 0.059) and the comparison between IIB and III (P = 0.595). Among clinically staged patients (i.e. those who did not undergo initial radical surgery), the prognostic performance of both 7th and 8th stages for both overall survival and pancreatic cancer-specific survival was

  13. A Thermoelectric Generation System and Its Power Electronics Stage

    DEFF Research Database (Denmark)

    Gao, Junling; Sun, Kai; Ni, Longxian

    2012-01-01

    stage and signal-conditioning circuits of the load, including DC–DC conversion, the maximum power point tracking (MPPT) controller, and other power management controllers. In this paper, a survey of existing power electronics designs for TEG systems is presented first. Second, a flat, wall-like TEG...... system consisting of 32 modules is experimentally optimized, and the improved power parameters are tested. Power-conditioning circuitry based on an interleaved boost DC–DC converter is then developed for the TEG system in terms of the tested power specification. The power electronics design features...... a combined control scheme with an MPPT and a constant output voltage as well as the low-voltage and high-current output characteristics of the TEG system. The experimental results of the TEG system with the power electronics stage and with purely resistive loads are compared. The comparisons verify...

  14. Liver-inherent immune system: its role in blood-stage malaria.

    Science.gov (United States)

    Wunderlich, Frank; Al-Quraishy, Saleh; Dkhil, Mohamed A

    2014-01-01

    The liver is well known as that organ which is obligately required for the intrahepatocyte development of the pre-erythrocytic stages of the malaria-causative agent Plasmodium. However, largely neglected is the fact that the liver is also a central player of the host defense against the morbidity- and mortality-causing blood stages of the malaria parasites. Indeed, the liver is equipped with a unique immune system that acts locally, however, with systemic impact. Its main "antipodal" functions are to recognize and to generate effective immunoreactivity against pathogens on the one hand, and to generate tolerance to avoid immunoreactivity with "self" and harmless substances as dietary compounds on the other hand. This review provides an introductory survey of the liver-inherent immune system: its pathogen recognition receptors including Toll-like receptors (TLRs) and its major cell constituents with their different facilities to fight and eliminate pathogens. Then, evidence is presented that the liver is also an essential organ to overcome blood-stage malaria. Finally, we discuss effector responses of the liver-inherent immune system directed against blood-stage malaria: activation of TLRs, acute phase response, phagocytic activity, cytokine-mediated pro- and anti-inflammatory responses, generation of "protective" autoimmunity by extrathymic T cells and B-1 cells, and T cell-mediated repair of liver injuries mainly produced by malaria-induced overreactions of the liver-inherent immune system.

  15. Effectiveness of interim stage filter in the exhaust system of glove boxes

    International Nuclear Information System (INIS)

    Patre, D.K.; Vangara, H.; Thanamani, S.; Gopalakrishnan, R.K.; Mhatre, Amol M.

    2018-01-01

    All operations in radiochemical laboratories are carried out in containment systems like Glove boxes and Fume hoods. For controlling air contamination two separate air cleaning systems are incorporated. Laboratory has general ventilation system and glove boxes are provided with a negative pressure system (NPS). Glove box exhaust air is passed through three stage filtration systems: in situ, interim and final before discharging to the atmosphere. In addition to the individual HEPA filters of each glove box, there is an interim HEPA filter bank introduced at the laboratory end. This was introduced to reduce a load on main exhaust filter system. Finally the exhaust air is discharged through the final stage HEPA filter located in the filter house through the Stack. The interim HEPA filter bank provides additional protection for the release of particulate activity and reduces load on the final stage filters. In the present work efforts have been put to validate the interim stage filter, which has been introduced, to limit the environmental release

  16. The Subunit Principle in Scar Face Revision.

    Science.gov (United States)

    Elshahat, Ahmed; Lashin, Riham

    2017-06-01

    Facial scaring is considered one of the most difficult cosmetic problems for any plastic surgeon to solve. The condition is more difficult if the direction of the scar is not parallel to relaxed skin tension lines. Attempts to manage this difficult situation included revisions using geometric designs, Z plasties or W plasties to camouflage the straight line visible scaring. The use of long-lasting resorbable sutures was tried too. Recently, the use of botulinum toxin during revision improved the results. Fractional CO2 lasers, microfat grafts, and platelet-rich plasma were added to the armamentarium. The scar is least visible if placed in the junction between the facial subunits. The aim of this study is to investigate the use of the subunit principle to improve the results of scar revision. Four patients were included in this study. Tissue expansion of the intact part of the subunit allowed shifting the scar to the junction between the affected subunit and the adjacent one. Tissue expansion, delivery of the expanders, and advancement of the flaps were successful in all patients. The fact that this is a 2-stage procedure and sacrifices some of the intact skin from the affected facial subunit, makes this technique reserved to patients with ugly facial scars who are ambitious to improve their appearance.

  17. Revision Total Hip Arthoplasty: Factors Associated with Re-Revision Surgery

    OpenAIRE

    Khatod, M; Cafri, G; Inacio, MCS; Schepps, AL; Paxton, EW; Bini, SA

    2015-01-01

    The survivorship of implants after revision total hip arthroplasty and risk factors associated with re-revision are not well defined. We evaluated the re-revision rate with use of the institutional total joint replacement registry. The purpose of this study was to determine patient, implant, and surgeon factors associated with re-revision total hip arthroplasty.A retrospective cohort study was conducted. The total joint replacement registry was used to identify patients who had undergone revi...

  18. The revised WHO dengue case classification: does the system need to be modified?

    Science.gov (United States)

    Hadinegoro, Sri Rezeki S

    2012-05-01

    There has been considerable debate regarding the value of both the 1997 and 2009 World Health Organization (WHO) dengue case classification criteria for its diagnosis and management. Differentiation between classic dengue fever (DF) and dengue haemorrhagic fever (DHF) or severe dengue is a key aspect of dengue case classification. The geographic expansion of dengue and its increased incidence in older age groups have contributed to the limited applicability of the 1997 case definitions. Clinical experience of dengue suggests that the illness presents as a spectrum of disease instead of distinct phases. However, despite the rigid grouping of dengue into DF, DHF and dengue shock syndrome (DSS), overlap between the different manifestations has often been observed, which has affected clinical management and triage of patients. The findings of the DENCO study evaluating the 1997 case definitions formed the basis of the revised 2009 WHO case definitions, which classified the illness into dengue with and without warning signs and severe dengue. Although the revised scheme is more sensitive to the diagnosis of severe dengue, and beneficial to triage and case management, there remain issues with its applicability. It is considered by many to be too broad, requiring more specific definition of warning signs. Quantitative research into the predictive value of these warning signs on patient outcomes and the cost-effectiveness of the new classification system is required to ascertain whether the new classification system requires further modification, or whether elements of both classification systems can be combined.

  19. Alternatives generation and analysis for phase I intermediate waste feed staging system design requirements

    Energy Technology Data Exchange (ETDEWEB)

    Britton, M.D.

    1996-10-02

    This document provides; a decision analysis summary; problem statement; constraints, requirements, and assumptions; decision criteria; intermediate waste feed staging system options and alternatives generation and screening; intermediate waste feed staging system design concepts; intermediate waste feed staging system alternative evaluation and analysis; and open issues and actions.

  20. Writing a Book from Your Dissertation: Seven Stages

    Science.gov (United States)

    Pane, Debra M.

    2016-01-01

    The purpose of this Writer's Forum is to share seven stages for writing a book from your dissertation: relinquishing control of your dissertation; selecting and working with your publisher; defining and writing for your audience; revising and drafting your dissertation into a book; securing and using feedback; including front matter, back matter,…

  1. A Gas-Spring-Loaded X-Y-Z Stage System for X-ray Microdiffraction Sample Manipulation

    International Nuclear Information System (INIS)

    Shu Deming; Cai Zhonghou; Lai, Barry

    2007-01-01

    We have designed and constructed a gas-spring-loaded x-y-z stage system for x-ray microdiffraction sample manipulation at the Advanced Photon Source XOR 2-ID-D station. The stage system includes three DC-motor-driven linear stages and a gas-spring-based heavy preloading structure, which provides antigravity forces to ensure that the stage system keeps high-positioning performance under variable goniometer orientation. Microdiffraction experiments with this new stage system showed significant sample manipulation performance improvement

  2. A Three-Stage Optimal Approach for Power System Economic Dispatch Considering Microgrids

    Directory of Open Access Journals (Sweden)

    Wei-Tzer Huang

    2016-11-01

    Full Text Available The inclusion of microgrids (MGs in power systems, especially distribution-substation-level MGs, significantly affects power systems because of the large volumes of import and export power flows. Consequently, power dispatch has become complicated, and finding an optimal solution is difficult. In this study, a three-stage optimal power dispatch model is proposed to solve such dispatch problems. In the proposed model, the entire power system is divided into two parts, namely, the main power grid and MGs. The optimal power dispatch problem is resolved on the basis of multi-area concepts. In stage I, the main power system economic dispatch (ED problem is solved by sensitive factors. In stage II, the optimal power dispatches of the local MGs are addressed via an improved direct search method. In stage III, the incremental linear models for the entire power system can be established on the basis of the solutions of the previous two stages and can be subjected to linear programming to determine the optimal reschedules from the original dispatch solutions. The proposed method is coded using Matlab and tested by utilizing an IEEE 14-bus test system to verify its feasibility and accuracy. Results demonstrated that the proposed approach can be used for the ED of power systems with MGs as virtual power plants.

  3. Validation of revised Epstein's criteria for insignificant prostate cancer prediction in a Greek subpopulation.

    Science.gov (United States)

    Chondros, Κ; Karpathakis, Ν; Heretis, Ι; Mavromanolakis, Ε; Chondros, N; Sofras, F; Mamoulakis, C

    2015-01-01

    Different treatment options for patients with prostate cancer (PCa) are applicable after stratifying patients according to various classification criteria. The purpose of our study is to evaluate the revised Epstein's criteria for insignificant PCa prediction in a Greek subpopulation. During a 4-year-period, 172 Cretan patients were submitted to radical retropubic prostatectomy in our institution. 23 out of them met the revised Epstein's criteria for the presence of clinically insignificant PCa (clinical stage T1c, prostate specific antigen density < 0.15 ng/ml/g, absence of Gleason pattern 4-5, <3 positive biopsy cores, presence of <50% tumor per core) during pre-treatment evaluation and were retrospectively included in the study. Post-surgery outcomes were evaluated including pathological stage, surgical margins and Gleason score upgrade. Organ confined disease and insignificant PCa were predicted with a 74% and 31% accuracy, respectively. These figures are remarkably lower than those derived from similar studies worldwide. Due to the high variation in the revised Epstein's criteria prediction accuracy observed worldwide, the development and implementation of novel tools/nomograms with a greater predictive accuracy is still warranted. Hippokratia 2015, 19 (1): 30-33.

  4. Reassessing the NTCTCS Staging Systems for Differentiated Thyroid Cancer, Including Age at Diagnosis.

    Science.gov (United States)

    McLeod, Donald S A; Jonklaas, Jacqueline; Brierley, James D; Ain, Kenneth B; Cooper, David S; Fein, Henry G; Haugen, Bryan R; Ladenson, Paul W; Magner, James; Ross, Douglas S; Skarulis, Monica C; Steward, David L; Xing, Mingzhao; Litofsky, Danielle R; Maxon, Harry R; Sherman, Steven I

    2015-10-01

    Thyroid cancer is unique for having age as a staging variable. Recently, the commonly used age cut-point of 45 years has been questioned. This study assessed alternate staging systems on the outcome of overall survival, and compared these with current National Thyroid Cancer Treatment Cooperative Study (NTCTCS) staging systems for papillary and follicular thyroid cancer. A total of 4721 patients with differentiated thyroid cancer were assessed. Five potential alternate staging systems were generated at age cut-points in five-year increments from 35 to 70 years, and tested for model discrimination (Harrell's C-statistic) and calibration (R(2)). The best five models for papillary and follicular cancer were further tested with bootstrap resampling and significance testing for discrimination. The best five alternate papillary cancer systems had age cut-points of 45-50 years, with the highest scoring model using 50 years. No significant difference in C-statistic was found between the best alternate and current NTCTCS systems (p = 0.200). The best five alternate follicular cancer systems had age cut-points of 50-55 years, with the highest scoring model using 50 years. All five best alternate staging systems performed better compared with the current system (p = 0.003-0.035). There was no significant difference in discrimination between the best alternate system (cut-point age 50 years) and the best system of cut-point age 45 years (p = 0.197). No alternate papillary cancer systems assessed were significantly better than the current system. New alternate staging systems for follicular cancer appear to be better than the current NTCTCS system, although they require external validation.

  5. Reassessing the NTCTCS Staging Systems for Differentiated Thyroid Cancer, Including Age at Diagnosis

    Science.gov (United States)

    McLeod, Donald S.A.; Jonklaas, Jacqueline; Brierley, James D.; Ain, Kenneth B.; Cooper, David S.; Fein, Henry G.; Haugen, Bryan R.; Ladenson, Paul W.; Magner, James; Ross, Douglas S.; Skarulis, Monica C.; Steward, David L.; Xing, Mingzhao; Litofsky, Danielle R.; Maxon, Harry R.

    2015-01-01

    Background: Thyroid cancer is unique for having age as a staging variable. Recently, the commonly used age cut-point of 45 years has been questioned. Objective: This study assessed alternate staging systems on the outcome of overall survival, and compared these with current National Thyroid Cancer Treatment Cooperative Study (NTCTCS) staging systems for papillary and follicular thyroid cancer. Methods: A total of 4721 patients with differentiated thyroid cancer were assessed. Five potential alternate staging systems were generated at age cut-points in five-year increments from 35 to 70 years, and tested for model discrimination (Harrell's C-statistic) and calibration (R2). The best five models for papillary and follicular cancer were further tested with bootstrap resampling and significance testing for discrimination. Results: The best five alternate papillary cancer systems had age cut-points of 45–50 years, with the highest scoring model using 50 years. No significant difference in C-statistic was found between the best alternate and current NTCTCS systems (p = 0.200). The best five alternate follicular cancer systems had age cut-points of 50–55 years, with the highest scoring model using 50 years. All five best alternate staging systems performed better compared with the current system (p = 0.003–0.035). There was no significant difference in discrimination between the best alternate system (cut-point age 50 years) and the best system of cut-point age 45 years (p = 0.197). Conclusions: No alternate papillary cancer systems assessed were significantly better than the current system. New alternate staging systems for follicular cancer appear to be better than the current NTCTCS system, although they require external validation. PMID:26203804

  6. Description of the rates, trends and surgical burden associated with revision for prosthetic joint infection following primary and revision knee replacements in England and Wales: an analysis of the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man.

    Science.gov (United States)

    Lenguerrand, Erik; Whitehouse, Michael R; Beswick, Andrew D; Toms, Andrew D; Porter, Martyn L; Blom, Ashley W

    2017-07-10

    To describe the prevalence rates of revision surgery for the treatment of prosthetic joint infection (PJI) for patients undergoing knee replacement, their time trends, the cumulative incidence function of revision for PJI and estimate the burden of PJI at health service level. We analysed revision knee replacements performed due to a diagnosis of PJI and the linked index procedures recorded in the National Joint Registry from 2003 to 2014 for England and Wales. The cohort analysed consisted of 679 010 index primary knee replacements, 33 920 index revision knee replacements and 8247 revision total knee replacements performed due to a diagnosis of PJI. The prevalence rates, their time trends investigated by time from index surgery to revision for PJI, cumulative incidence functions and the burden of PJI (total procedures) were calculated. Overall linear trends were investigated with log-linear regression. The incidence of revision total knee replacement due to PJI at 2 years was 3.2/1000 following primary and 14.4/1000 following revision knee replacement, respectively. The prevalence of revision due to PJI in the 3 months following primary knee replacement has risen by 2.5-fold (95% CI 1.2 to 5.3) from 2005 to 2013 and 7.5-fold (95% CI 1.0 to 56.1) following revision knee replacement. Over 1000 procedures per year are performed as a consequence of knee PJI, an increase of 2.8 from 2005 to 2013. Overall, 75% of revisions were two-stage with an increase in use of single-stage from 7.9% in 2005 to 18.8% in 2014. Although the risk of revision due to PJI following knee replacement is low, it is rising, and coupled with the established and further predicted increased incidence of both primary and revision knee replacements, this represents an increasing and substantial treatment burden for orthopaedic service delivery in England and Wales. This has implications for future service design and the funding of individual and specialist centres. © Article author

  7. Revised

    DEFF Research Database (Denmark)

    Johannsen, Vivian Kvist; Nord-Larsen, Thomas; Riis-Nielsen, Torben

    This report is a revised analysis of the Danish data on CO2 emissions from forest, afforestation and deforestation for the period 1990 - 2008 and a prognosis for the period until 2020. Revision have included measurements from 2009 in the estimations. The report is funded by the Ministry of Climate...

  8. Design criteria tank farm storage and staging facility. Revision 1

    International Nuclear Information System (INIS)

    Lott, D.T.

    1994-01-01

    Tank Farms Operations must store/stage material and equipment until work packages are ready to work. Consumable materials are also required to be stored for routine and emergency work. Connex boxes and open storage is currently used for much of the storage because of the limited space at 272AW and 272WA. Safety issues based on poor housekeeping and material deteriorating due to weather damage has resulted from this inadequate storage space. It has been determined that a storage building in close proximity to the Tank Farm work force would be cost effective. Project W-402 and W-413 will provide a storage/staging area in 200 East and West Areas by the construction of two new storage facilities. The new facilities will be used by Operations, Maintenance and Materials groups to adequately store material and equipment. These projects will also furnish electrical services to the facilities for lighting and HVAC. Fire Protection shall be extended to the 200 East facility from 272AW if necessary

  9. Comparative study of nasopharyngeal carcinoma staging system between the chinese 2008 and '92 Fuzhou

    International Nuclear Information System (INIS)

    Zong Jingfeng; Lin Shaojun; Zhang Yu; Chen Yunbin; Guo Qiaojuan; Pan Jianji

    2010-01-01

    Objective: To carry out a comparative study between the Chinese 2008 and '92 staging system of nasopharyngeal carcinoma (NPC). Methods: A total of 777 patients presented with untreated non disseminated NPC who had received MRI scan of nasopharynx and neck were studied retrospectively. The clinical materials and information of imaging were collected. All patients were restaged according to the Chinese 2008 and 92 staging system of nasopharyngeal carcinoma. Distribution of T, N stage, survival and prognostic value were compared. 513 patients of the 777 cases were treated with conventional radiotherapy, 264 cases with intensity modulated radiation therapy. Results: The 3-year follow-up rate was 97.6%. The consistency of T stages was 95.0%. T, N and clinical stage distributions in two systems were similar ( Kappa = 0.93, P = 0.000; Kappa = 0.58, P = 0.000; Kappa = 0.74, P = 0.000). Local failure-free survival and disease specific survival were also similar. There was no difference of distant metastasis between N 0 and N 1 (χ 2 = 1.94, P=0. 164), and a marginal difference between N 1 and N 2 (χ 2 =3.83, P=0.051) in the Chinese '92 staging system. However, although there was also no difference of distant metastasis-free survival between N 0 and N 1a (χ 2 =0.07, P =0.797), ) the difference of overall survival among N 1b , N 2 , and N 3 were significant (χ 2 = 4.95, P = 0.026; χ 2 = 6.74, P = 0.009) in the Chinese 2008 staging system. Conventional radiotherapy or intensity modulated radiation therapy was not a prognostic factor for survival (χ 2 = 3.60, P =0.058). It is reasonable for the Chinese 2008 staging system integrated lymph node characteristics such as laterality, level and extra nodal neoplastic spread into the N staging criteria (χ 2 = 6.59, P = 0.010; χ 2 =4.78, P=0. 029; χ 2 =9.32, P=0.002). Conclusions: For the Chinese 2008 staging system, it was reasonable to simplify the previous T stage. The N stage showed a better predictive role of distant

  10. REVISION ANKLE SYNDESMOSIS FIXATION - FUNCTIONAL OUTCOME AFTER TIGHTROPE ® FIXATION

    Directory of Open Access Journals (Sweden)

    Sendhilvelan Rajagopalan

    2016-07-01

    Full Text Available BACKGROUND Syndesmotic disruptions are often seen in ankle fractures. Malreduction of these fractures can result in arthritis and instability. A proportion of these patients with malreduction require revision fixation. This study presents the results of revision fixation in such patients, using the Ankle TightRope ® (Arthrex system. METHODS Between January 2000 to December 2009, 124 patients who underwent ankle fracture fixations with syndesmotic stabilisation were analysed. Out of 124 patients, 8 patients were diagnosed with failure of primary stabilisation (based on radiological and clinical criteria and subjected to revision fixation using the Ankle TightRope ® (Arthrex system. Followup was done at periodic time intervals of 3, 6 and 12 months. Both clinical and radiological assessment was performed. Complications and duration of hospital stay was recorded. Functional evaluation was performed using the American Orthopaedic Foot and Ankle Society (AOFAS scoring system. RESULTS Five patients had good results, one satisfactory and two had poor outcomes. CONCLUSIONS Ankle TightRope ® fixation is an alternative method of stabilisation in patients who require revision syndesmosis fixation. Further studies are required to evaluate this method of revision stabilisation as compared to screws.

  11. Preliminary environmental assessment for the Satellite Power System (SPS). Revision 1. Volume 2. Detailed assessment

    Energy Technology Data Exchange (ETDEWEB)

    1980-01-01

    The Department of Energy (DOE) is considering several options for generating electrical power to meet future energy needs. The satellite power system (SPS), one of these options, would collect solar energy through a system of satellites in space and transfer this energy to earth. A reference system has been described that would convert the energy to microwaves and transmit the microwave energy via directive antennas to large receiving/rectifying antennas (rectennas) located on the earth. At the rectennas, the microwave energy would be converted into electricity. The potential environmental impacts of constructing and operating the satellite power system are being assessed as a part of the Department of Energy's SPS Concept Development and Evaluation Program. This report is Revision I of the Preliminary Environmental Assessment for the Satellite Power System published in October 1978. It refines and extends the 1978 assessment and provides a basis for a 1980 revision that will guide and support DOE recommendations regarding future SPS development. This is Volume 2 of two volumes. It contains the technical detail suitable for peer review and integrates information appearing in documents referenced herein. The key environmental issues associated with the SPS concern human health and safety, ecosystems, climate, and electromagnetic systems interactions. In order to address these issues in an organized manner, five tasks are reported: (I) microwave-radiation health and ecological effects; (II) nonmicrowave health and ecological effectss; (III) atmospheric effects; (IV) effects on communication systems due to ionospheric disturbance; and (V) electromagnetic compatibility. (WHK)

  12. Configuration of management accounting information system for multi-stage manufacturing

    Science.gov (United States)

    Mkrtychev, S. V.; Ochepovsky, A. V.; Enik, O. A.

    2018-05-01

    The article presents an approach to configuration of a management accounting information system (MAIS) that provides automated calculations and the registration of normative production losses in multi-stage manufacturing. The use of MAIS with the proposed configuration at the enterprises of textile and woodworking industries made it possible to increase the accuracy of calculations for normative production losses and to organize accounting thereof with the reference to individual stages of the technological process. Thus, high efficiency of multi-stage manufacturing control is achieved.

  13. Engineering work plan for container venting system drill press assembly troubleshooting. Revision 1

    International Nuclear Information System (INIS)

    Prather, M.C.

    1994-11-01

    This work plan is for troubleshooting the current CVS drill press to ensure that the drill bit assembly doesn't bind in the press plate. A drill press assembly has been fabricated for the Container Venting System (CVS). The drill bit assembly has bound in the press plate in previous revisions of this design. Initial troubleshooting of the drill press per Rev. 0 of this work plan was performed at the 200W Kaiser Machine Shop under Work Package 2H9401670F, Internal Work Order E20027. The drill press operated without jamming. Then, during the pre-operational test on 11/14/17 and the operational test on 11/17/94, two drum lids were drilled. Immediately after the test on 11/17/94, the drill was again operated, and it jammed. An inspection found shavings at the bottom of the drill bit assembly, between the drill bit sleeve and the press plate bore. This revised work plan provides direction for the machine shop to diagnose and correct this recent problem

  14. Two-stage model of development of heterogeneous uranium-lead systems in zircon

    International Nuclear Information System (INIS)

    Mel'nikov, N.N.; Zevchenkov, O.A.

    1985-01-01

    Behaviour of isotope systems of multiphase zircons at their two-stage distortion is considered. The results of calculations testify to the fact that linear correlations on the diagram with concordance can be explained including two-stage discovery of U-Pb systems of cogenetic zircons if zircon is considered physically heterogeneous and losing in its different part different ratios of accumulated radiogenic lead. ''Metamorphism ages'' obtained by these two-stage opening zircons are intermediate, and they not have geochronological significance while ''crystallization ages'' remain rather close to real ones. Two-stage opening zircons in some cases can be diagnosed by discordance of their crystal component

  15. [Retrospective analysis of 47 cases with hilar cholangiocarcinoma using T-staging system].

    Science.gov (United States)

    Peng, Cheng-hong; Zhao, Zhi-ming; Peng, Shu-you; Liu, Ying-bin; Wu, Yü-lian; Fang, He-qing; Jiang, Xian-chuan

    2005-01-01

    To evaluate the clinical value of T-staging system for hilar cholangiocarcinoma which was adopted in memorial Sloan-Kettering cancer center of New York. The image data of these 47 patients were analyzed retrospectively from December 1997 to December 2002 whose data were according with our demand, and they were staged into three-stage according to the criteria of the T-staging system. The difference of respectability, ratio of tumor-free resection margin and actuarial survival rate were analyzed for different T-staging. And the coincident ratio of three different kinds of imaging methods was also analyzed. Twenty patients had T(1) tumors, twenty three had T(2) tumors and four had T(3) tumors. The resectability of the three stage was 60%, 39% and 0% respectively, and the difference was significant (P = 0.013). The likelihood of achieving tumor-free margin decreased progressively with increasing T stage (P = 0.018). The cumulative 1-year survival rates of T(1), T(2) and T(3) patients were 60%, 39% and 0% respectively, and the cumulative 3-year survival rate was 35%, 9% and 0% respectively, the survival of different stage patients differed markedly (P = 0.0103). The coincident ratio of combined using MRCP and color Doppler-ultrasonography was higher than that of combined using MRCP and B-ultrasonography or combined using CT/SCT and color Doppler-ultrasonography (P = 0.007). The T-staging system has a better value for preoperative assessment, and can be used to judge resectability and survival of hilar cholangiocarcinoma. It will be helpful to use MRCP and color Doppler-Ultrasonography combined to verdict the coverage of the tumor and the T-staging preoperatively.

  16. Changes of endocrine and ultrasound markers as ovarian aging in modifying the Stages of Reproductive Aging Workshop (STRAW) staging system with subclassification of mid reproductive age stage.

    Science.gov (United States)

    Ding, Ting; Luo, Aiyue; Jiang, Jingjing; Du, Xiaofang; Yang, Shuhong; Lai, Zhiwen; Shen, Wei; Lu, Yunping; Ma, Ding; Wang, Shixuan

    2013-01-01

    To demonstrate the changes of ovarian aging markers across the Stages of Reproductive Aging Workshop (STRAW) stages and modify it with subclassification of mid reproductive age stage (MR). Healthy females were classified according to the STRAW system. Serum basal FSH, LH, E2, and anti-Müllerian hormone (AMH) were detected, FSH/LH ratio calculated, and antral follicle counts (AFCs) determined in follicular phase. Progression through the whole STRAW stages under MR stage subdivided is associated with elevations in FSH, LH, FSH/LH ratio and decreases in E2, AMH and AFCs (p age in MR stage. 0.982 ng/ml AMH and 3 antral follicles (low level of MR 25-30 years) were set as cutoffs to distinguish MR stage into early mid reproductive age (EMR) and late mid reproductive age (LMR) stages. The women in EMR stage compared with LMR could retrieve more oocytes in IVF treatment (p stage, demonstrating disparate reproductive aging period with reduced ovarian reserve in young age across the STRAW stages.

  17. Comparison of four staging systems of lymph node metastasis in gastric cancer.

    Science.gov (United States)

    Zhang, Ming; Zhu, Guanyu; Ma, Yan; Xue, Yingwei

    2009-11-01

    The classification of lymph node metastasis in patients with gastric cancer is still controversial. Our aim was to evaluate the relative merits of four staging systems of lymph node metastasis. In our study, the nodal status was classified according to the 5th edition of the tumor node metastasis (TNM) system, the Japanese Classification of Gastric Carcinoma (JCGC), the ratio of metastatic lymph nodes, and the size of the largest metastatic lymph node. Each staging system was scored as good (+2), fair (+1), or poor (0) with respect to the theoretical value (extent of the anatomical lymphatic tumor spread), convenience (simplicity), surgical applicability (extent of lymph node dissection), and prognostic value (ability to predict survival rate). In the multivariate analysis including the four staging systems and other potential prognostic factors, stepwise Cox regression revealed that the ratio of metastatic lymph nodes was the most independent prognostic factor. The TNM, ratio, and size systems were convenient because they had no consideration for the location of the tumor and lymph node. Although the JCGC system had advantages in theoretical value and surgical application, it was most optional due to the complexity of the system. Although all different staging systems are comparable, the metastatic lymph node ratio system is convenient, reproducible, and has the highest ability to predict survival.

  18. NRC revision to 10 CFR Part 20

    International Nuclear Information System (INIS)

    Baker, R.E.; Cool, W.S.; Mills, W.A.

    1983-01-01

    The Nuclear Regulatory Commission's pollution standards have been revised since publication in the late 1950s, but the basic approach has not changed. The revisions resulted in inaccuracies, conflicts, and ambiguities in requirements. The need for comprehensive updating including radiation-protection principles, risk, occupational exposure dose limits, standards for the public (including de minimis level), surveys and monitoring, disposal into sewerage systems, and records is discussed. 2 tables

  19. EPRI PWR primary water chemistry guidelines revision

    International Nuclear Information System (INIS)

    McElrath, Joel; Fruzzetti, Keith

    2014-01-01

    EPRI periodically updates the PWR Primary Water Chemistry Guidelines as new information becomes available and as required by NEI 97-06 (Steam Generator Program Guidelines) and NEI 03-08 (Guideline for the Management of Materials Issues). The last revision of the PWR water chemistry guidelines identified an optimum primary water chemistry program based on then-current understanding of research and field information. This new revision provides further details with regard to primary water stress corrosion cracking (PWSCC), fuel integrity, and shutdown dose rates. A committee of industry experts, including utility specialists, nuclear steam supply system (NSSS) and fuel vendor representatives, Institute of Nuclear Power Operations (INPO) representatives, consultants, and EPRI staff collaborated in reviewing the available data on primary water chemistry, reactor water coolant system materials issues, fuel integrity and performance issues, and radiation dose rate issues. From the data, the committee updated the water chemistry guidelines that all PWR nuclear plants should adopt. The committee revised guidance with regard to optimization to reflect industry experience gained since the publication of Revision 6. Among the changes, the technical information regarding the impact of zinc injection on PWSCC initiation and dose rate reduction has been updated to reflect the current level of knowledge within the industry. Similarly, industry experience with elevated lithium concentrations with regard to fuel performance and radiation dose rates has been updated to reflect data collected to date. Recognizing that each nuclear plant owner has a unique set of design, operating, and corporate concerns, the guidelines committee has retained a method for plant-specific optimization. Revision 7 of the Pressurized Water Reactor Primary Water Chemistry Guidelines provides guidance for PWR primary systems of all manufacture and design. The guidelines continue to emphasize plant

  20. Stages in the energetics of baroclinic systems

    Science.gov (United States)

    Orlanski, Isidoro; Sheldon, John P.

    1995-10-01

    The results from several idealized and case studies are drawn together to form a comprehensive picture of "downstream baroclinic evolution" using local energetics. This new viewpoint offers a complementary alternative to the more conventional descriptions of cyclone development. These additional insights are made possible largely because the local energetics approach permits one to define an energy flux vector which accurately describes the direction of energy dispersion and quantifies the role of neighboring systems in local development. In this view, the development of a system's energetics is divided into three stages. In Stage 1, a pre-existing disturbance well upstream of an incipient trough loses energy via ageostrophic geopotential fluxes directed downstream through the intervening ridge, generating a new energy center there. In Stage 2, this new energy center grows vigorously, at first due to the convergence of these fluxes, and later by baroclinic conversion as well. As the center matures, it begins to export energy via geopotential fluxes to the eastern side of the trough, initiating yet another energy center. In Stage 3, this new energy center continues to grow while that on the western side of the trough decays due to a dwinding supply of energy via fluxes from the older upstream system and also as a consequence of its own export of energy downstream. As the eastern energy center matures, it exports energy further downstream, and the sequence begins anew. The USA "Blizzard of'93" is used as a new case study to test the limits to which this conceptual sequence might apply, as well as to augment the current limited set of case studies. It is shown that, despite the extraordinary magnitude of the event, the evolution of the trough associated with the Blizzard fits the conceptual picture of downstream baroclinic evolution quite well, with geopotential fluxes playing a critical rôle in three respects. First, fluxes from an old, decaying system in the

  1. Revised hydrogeologic framework of the Floridan aquifer system in Florida and parts of Georgia, Alabama, and South Carolina

    Science.gov (United States)

    Williams, Lester J.; Kuniansky, Eve L.

    2015-04-08

    The hydrogeologic framework for the Floridan aquifer system has been revised throughout its extent in Florida and parts of Georgia, Alabama, and South Carolina. The updated framework generally conforms to the original framework established by the U.S. Geological Survey in the 1980s, except for adjustments made to the internal boundaries of the Upper and Lower Floridan aquifers and the individual higher and contrasting lower permeability zones within these aquifers. The system behaves as one aquifer over much of its extent; although subdivided vertically into two aquifer units, the Upper and Lower Floridan aquifers. In the previous framework, discontinuous numbered middle confining units (MCUI–VII) were used to subdivide the system. In areas where less-permeable rocks do not occur within the middle part of the system, the system was previously considered one aquifer and named the Upper Floridan aquifer. In intervening years, more detailed data have been collected in local areas, resulting in some of the same lithostratigraphic units in the Floridan aquifer system being assigned to the Upper or Lower Floridan aquifer in different parts of the State of Florida. Additionally, some of the numbered middle confining units are found to have hydraulic properties within the same order of magnitude as the aquifers. A new term “composite unit” is introduced for lithostratigraphic units that cannot be defined as either a confining or aquifer unit over their entire extent. This naming convention is a departure from the previous framework, in that stratigraphy is used to consistently subdivide the aquifer system into upper and lower aquifers across the State of Florida. This lithostratigraphic mapping approach does not change the concept of flow within the system. The revised boundaries of the Floridan aquifer system were mapped by considering results from local studies and regional correlations of lithostratigraphic and hydrogeologic units or zones. Additional zones within

  2. Application of individually performed acrylic cement spacers containing 5% of antibiotic in two-stage revision of hip and knee prosthesis due to infection.

    Science.gov (United States)

    Babiak, Ireneusz

    2012-07-03

    Deep infection of a joint endoprosthesis constitutes a threat to the stability of the implant and joint function. It requires a comprehensive and interdisciplinary approach, involving the joint revision and removal of the bacterial biofilm from all tissues, the endoprosthesis must be often removed and bone stock infection treated. The paper presents the author's experience with the use of acrylic cement spacers, custom-made during the surgery and containing low dose of an antibiotic supplemented with 5% of a selected, targeted antibiotic for the infection of hip and knee endoprostheses. 33 two-stage revisions of knee and hip joints with the use of a spacer were performed. They involved 24 knee joints and 9 hip joints. The infections were mostly caused by staphylococci MRSA (18) and MSSA (8), and in some cases Enterococci (4), Salmonella (1), Pseudomonas (1) and Acinetobacter (1). The infection was successfully treated in 31 out of 33 cases (93.93%), including 8 patients with the hip infection and 23 patients with the knee infection. The endoprosthesis was reimplanted in 30 cases: for 7 hips and 23 knees, in 3 remaining cases the endoprosthesis was not reimplanted. Mechanical complications due to the spacer occurred in 4 cases: 3 dislocations and 1 fracture (hip spacer). The patients with hip spacers were ambulatory with a partial weight bearing of the operated extremity and those with knee spacers were also ambulatory with a partial weight bearing, but the extremity was initially protected by an orthosis. The spacer enables to maintain a limb function, and making it by hand allows the addition of the specific bacteria targeted antibiotic thus increasing the likelihood of the effective antibacterial treatment.

  3. High-Level Waste Systems Plan. Revision 7 (U)

    International Nuclear Information System (INIS)

    Brooke, J.N.; Gregory, M.V.; Paul, P.; Taylor, G.; Wise, F.E.; Davis, N.R.; Wells, M.N.

    1996-10-01

    This revision of the High-Level Waste (HLW) System Plan aligns SRS HLW program planning with the DOE Savannah River (DOE-SR) Ten Year Plan (QC-96-0005, Draft 8/6), which was issued in July 1996. The objective of the Ten Year Plan is to complete cleanup at most nuclear sites within the next ten years. The two key principles of the Ten Year Plan are to accelerate the reduction of the most urgent risks to human health and the environment and to reduce mortgage costs. Accordingly, this System Plan describes the HLW program that will remove HLW from all 24 old-style tanks, and close 20 of those tanks, by 2006 with vitrification of all HLW by 2018. To achieve these goals, the DWPF canister production rate is projected to climb to 300 canisters per year starting in FY06, and remain at that rate through the end of the program in FY18, (Compare that to past System Plans, in which DWPF production peaked at 200 canisters per year, and the program did not complete until 2026.) An additional $247M (FY98 dollars) must be made available as requested over the ten year planning period, including a one-time $10M to enhance Late Wash attainment. If appropriate resources are made available, facility attainment issues are resolved and regulatory support is sufficient, then completion of the HLW program in 2018 would achieve a $3.3 billion cost savings to DOE, versus the cost of completing the program in 2026. Facility status information is current as of October 31, 1996

  4. Influence of dispatching rules on average production lead time for multi-stage production systems.

    Science.gov (United States)

    Hübl, Alexander; Jodlbauer, Herbert; Altendorfer, Klaus

    2013-08-01

    In this paper the influence of different dispatching rules on the average production lead time is investigated. Two theorems based on covariance between processing time and production lead time are formulated and proved theoretically. Theorem 1 links the average production lead time to the "processing time weighted production lead time" for the multi-stage production systems analytically. The influence of different dispatching rules on average lead time, which is well known from simulation and empirical studies, can be proved theoretically in Theorem 2 for a single stage production system. A simulation study is conducted to gain more insight into the influence of dispatching rules on average production lead time in a multi-stage production system. We find that the "processing time weighted average production lead time" for a multi-stage production system is not invariant of the applied dispatching rule and can be used as a dispatching rule independent indicator for single-stage production systems.

  5. LOX/LH2 propulsion system for launch vehicle upper stage, test results

    Science.gov (United States)

    Ikeda, T.; Imachi, U.; Yuzawa, Y.; Kondo, Y.; Miyoshi, K.; Higashino, K.

    1984-01-01

    The test results of small LOX/LH2 engines for two propulsion systems, a pump fed system and a pressure fed system are reported. The pump fed system has the advantages of higher performances and higher mass fraction. The pressure fed system has the advantages of higher reliability and relative simplicity. Adoption of these cryogenic propulsion systems for upper stage of launch vehicle increases the payload capability with low cost. The 1,000 kg thrust class engine was selected for this cryogenic stage. A thrust chamber assembly for the pressure fed propulsion system was tested. It is indicated that it has good performance to meet system requirements.

  6. 77 FR 24585 - List of Approved Spent Fuel Storage Casks: HI-STORM 100, Revision 8

    Science.gov (United States)

    2012-04-25

    ... Storage Casks: HI-STORM 100, Revision 8 AGENCY: Nuclear Regulatory Commission. ACTION: Direct final rule... revising the Holtec International HI-STORM 100 System listing within the ``List of Approved Spent Fuel...) 72.214, by revising the Holtec International HI-STORM 100 System listing within the ``List of...

  7. One-stage versus two-stage exchange arthroplasty for infected total knee arthroplasty: a systematic review.

    Science.gov (United States)

    Nagra, Navraj S; Hamilton, Thomas W; Ganatra, Sameer; Murray, David W; Pandit, Hemant

    2016-10-01

    Infection complicating total knee arthroplasty (TKA) has serious implications. Traditionally the debate on whether one- or two-stage exchange arthroplasty is the optimum management of infected TKA has favoured two-stage procedures; however, a paradigm shift in opinion is emerging. This study aimed to establish whether current evidence supports one-stage revision for managing infected TKA based on reinfection rates and functional outcomes post-surgery. MEDLINE/PubMed and CENTRAL databases were reviewed for studies that compared one- and two-stage exchange arthroplasty TKA in more than ten patients with a minimum 2-year follow-up. From an initial sample of 796, five cohort studies with a total of 231 patients (46 single-stage/185 two-stage; median patient age 66 years, range 61-71 years) met inclusion criteria. Overall, there were no significant differences in risk of reinfection following one- or two-stage exchange arthroplasty (OR -0.06, 95 % confidence interval -0.13, 0.01). Subgroup analysis revealed that in studies published since 2000, one-stage procedures have a significantly lower reinfection rate. One study investigated functional outcomes and reported that one-stage surgery was associated with superior functional outcomes. Scarcity of data, inconsistent study designs, surgical technique and antibiotic regime disparities limit recommendations that can be made. Recent studies suggest one-stage exchange arthroplasty may provide superior outcomes, including lower reinfection rates and superior function, in select patients. Clinically, for some patients, one-stage exchange arthroplasty may represent optimum treatment; however, patient selection criteria and key components of surgical and post-operative anti-microbial management remain to be defined. III.

  8. Revising legislative system for E-commerce activation and expansion of infrastructure

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dae Hee [Ministry of Infomatiion and Communications, Kwachon (Korea)

    2000-04-01

    Since the rapidly developing E-commerce in worldwide enables direct transactions between producers and consumers, it improves efficiency over whole economy with cutbacks of intermediate trade and growth of parcel service business. However, E-commerce is basically a trade without meeting each other and the side effects of E-commerce, such as a fraud and outflow of personal information, are emerging by abusing its feature that cannot be known a counterpart of trade. To be developed as an advanced country in E-commerce area by 2003, Korea should settle the revision of legislative system on E-commerce and the expansion of infrastructure first for a continuous development of such a new business.

  9. Microeconomics of introduction of a PET system based on the revised Japanese national insurance reimbursement system

    International Nuclear Information System (INIS)

    Abe, Katsumi; Kosuda, Shigeru; Kusano, Shoichi; Nagata, Masayoshi

    2003-01-01

    It is crucial to evaluate an annual balance beforehand when an institution installs a PET system because the revised Japanese national insurance reimbursement system set the cost of a FDG PET study as 75,000 yen. A break-even point was calculated in an 8-hour or a 24-hour operation of a PET system, based on the total costs reported. The break-even points were as follows: 13.4, 17.7, 22.1 studies per day for the 1 cyclotron-1 PET camera, 1 cyclotron-2 PET cameras, 1 cyclotron-3 PET cameras system, respectively, in an ordinary PET system operation of 8 hours. The break-even points were 19.9, 25.5, 31.2 studies per day for the 1 cyclotron-1 PET camera, 1 cyclotron-2 PET cameras, 1 cyclotron-3 PET cameras system, respectively, in a full PET system operation of 24 hours. The results indicate no profit would accrue in an ordinary PET system operation of 8 hours. The annual profit and break-even point for the total cost including the initial investment would be respectively 530 million yen and 2.8 years in a 24-hour operation with 1 cyclotron-3 PET cameras system. (author)

  10. [Microeconomics of introduction of a PET system based on the revised Japanese National Insurance reimbursement system].

    Science.gov (United States)

    Abe, Katsumi; Kosuda, Shigeru; Kusano, Shoichi; Nagata, Masayoshi

    2003-11-01

    It is crucial to evaluate an annual balance before-hand when an institution installs a PET system because the revised Japanese national insurance reimbursement system set the cost of a FDG PET study as 75,000 yen. A break-even point was calculated in an 8-hour or a 24-hour operation of a PET system, based on the total costs reported. The break-even points were as follows: 13.4, 17.7, 22.1 studies per day for the 1 cyclotron-1 PET camera, 1 cyclotron-2 PET cameras, 1 cyclotron-3 PET cameras system, respectively, in an ordinary PET system operation of 8 hours. The break-even points were 19.9, 25.5, 31.2 studies per day for the 1 cyclotron-1 PET camera, 1 cyclotron-2 PET cameras, 1 cyclotron-3 PET cameras system, respectively, in a full PET system operation of 24 hours. The results indicate no profit would accrue in an ordinary PET system operation of 8 hours. The annual profit and break-even point for the total cost including the initial investment would be respectively 530 million yen and 2.8 years in a 24-hour operation with 1 cyclotron-3 PET cameras system.

  11. Uterine cervical cancer. Preoperative staging with magnetic resonance imaging; Zervixkarzinom. Praeoperatives Staging mittels Magnetresonanztomographie

    Energy Technology Data Exchange (ETDEWEB)

    Collettini, F.; Hamm, B. [Charite-Universitaetsmedizin Berlin, Campus Charite Mitte, Klinik fuer Radiologie, Berlin (Germany)

    2011-07-15

    The treatment of uterine cervical carcinoma is largely dependent on the tumor stage. Despite significant inaccuracies in the clinical examination, uterine cervical cancer remains the only gynecological form of cancer still largely staged according to clinical findings. Although imaging is still not included in the staging the recently published revised FIGO (Federation International de Gynecologie et d'Obstetrique) system encourages the use of modern cross-sectional imaging (magnetic resonance imaging MRI and computed tomography CT). Due to its high soft tissue contrast MRI allows excellent non-invasive assessment of the cervix with direct tumor delineation as well as assessment of the prognosis based on morphological factors. Studies in the literature report an accuracy of 93% for MRI in the preoperative assessment of tumor size and in the differentiation of operable from advanced cervical cancer. Therefore MRI is considered to be the optimal modality for diagnostic evaluation starting from FIGO stage IB1, for radiation therapy planning, and for exclusion of recurrence in follow-up. In this paper we give an overview of the role of magnetic resonance imaging in preoperative staging of uterine cervical cancer. (orig.) [German] Die Therapieplanung beim Zervixkarzinom ist weitgehend von der Stadieneinteilung nach FIGO (Federation International de Gynecologie et d'Obstetrique) abhaengig, die trotz erheblicher Ungenauigkeiten bei der klinischen Stadieneinteilung weiterhin aufgrund klinischer Untersuchungsbefunde erfolgt. Obwohl bildgebende Verfahren nach wie vor fuer die Stadieneinteilung nicht vorgesehen sind, wird im kuerzlich erschienen revidierten Stagingsystem der FIGO zum ersten Mal die Verwendung moderner Schnittbilddiagnostik (MRT und CT) befuerwortet. Die MRT ermoeglicht dank ihres hohen Weichteilkontrasts ein ausgezeichnetes nichtinvasives Staging des Zervixkarzinoms mit direkter Tumordarstellung sowie einer Prognoseabschaetzung anhand

  12. NxStage dialysis system-associated thrombocytopenia: a report of two cases.

    Science.gov (United States)

    Sekkarie, Mohamed; Waldron, Michelle; Reynolds, Texas

    2016-01-01

    Thrombocytopenia in hemodialysis patients has recently been reported to be commonly caused by electron-beam sterilization of dialysis filters. We report the occurrence of thrombocytopenia in the first two patients of a newly established home hemodialysis program. The 2 patients switched from conventional hemodialysis using polysulfone electron-beam sterilized dialyzers to a NxStage system, which uses gamma sterilized polyehersulfone dialyzers incorporated into a drop-in cartridge. The thrombocytopenia resolved after return to conventional dialysis in both patients and recurred upon rechallenge in the patient who opted to retry NxStage. This is the first report of thrombocytopenia with the NxStage system according to the authors’ knowledge. Dialysis-associated thrombocytopenia pathophysiology and clinical significance are not well understood and warrant additional investigations.

  13. MR staging accuracy for endometrial cancer based on the new FIGO stage

    International Nuclear Information System (INIS)

    Shin, Kyung Eun; Park, Byung Kwan; Kim, Chan Kyo; Bae, Duk Soo; Song, Sang Yong; Kim, Bohyun

    2011-01-01

    Background: Magnetic resonance imaging (MRI) has been frequently used to determine a preoperative treatment plan for gynecologic cancers. However, the MR accuracy for staging an endometrial cancer is not satisfactory based on the old FIGO staging system. Purpose: To evaluate MR accuracy for staging endometrial cancer using the new FIGO staging system. Material and Methods: Between January 2005 and May 2009, 199 women underwent surgery due to endometrial cancer. In each patient, an endometrial cancer was staged using MR findings based on the old FIGO staging system and then repeated according to the new FIGO staging system for comparison. Histopathologic findings were used as a standard of reference. Results: The accuracy of MRI in the staging of endometrial carcinoma stage I, II, III, and IV using the old FIGO staging system were 80% (159/199), 89% (178/199), 90% (179/199), and 99% (198/199), respectively, compared to 87% (174/199), 97% (193/199), 90% (179/199), and 99% (198/199), respectively, when using the new FIGO staging criteria. The overall MR accuracy of the old and new staging systems were 51% (101/199) and 81% (161/199), respectively. Conclusion: MRI has become a more useful tool in the preoperative staging of endometrial cancers using the new FIGO staging system compared to the old one with increased accuracy

  14. Human-system interface design review guideline -- Review software and user's guide: Final report. Revision 1, Volume 3

    International Nuclear Information System (INIS)

    1996-06-01

    NUREG-0700, Revision 1, provides human factors engineering (HFE) guidance to the US Nuclear Regulatory Commission staff for its: (1) review of the human system interface (HSI) design submittals prepared by licensees or applications for a license or design certification of commercial nuclear power plants, and (2) performance of HSI reviews that could be undertaken as part of an inspection or other type of regulatory review involving HSI design or incidents involving human performance. The guidance consists of a review process and HFE guidelines. The document describes those aspects of the HSI design review process that are important to the identification and resolution of human engineering discrepancies that could adversely affect plant safety. Guidance is provided that could be used by the staff to review an applicant's HSI design review process or to guide the development of an HSI design review plan, e.g., as part of an inspection activity. The document also provides detailed HFE guidelines for the assessment of HSI design implementations. NUREG-0700, Revision 1, consists of three stand-alone volumes. Volume 3 contains an interactive software application of the NUREG-0700, Revision 1 guidance and a user's guide for this software. The software supports reviewers during review preparation, evaluation design using the human factors engineering guidelines, and in report preparation. The user's guide provides system requirements and installation instructions, detailed explanations of the software's functions and features, and a tutorial on using the software

  15. Vibration isolation and dual-stage actuation pointing system for space precision payloads

    Science.gov (United States)

    Kong, Yongfang; Huang, Hai

    2018-02-01

    Pointing and stability requirements for future space missions are becoming more and more stringent. This work follows the pointing control method which consists of a traditional spacecraft attitude control system and a payload active pointing loop, further proposing a vibration isolation and dual-stage actuation pointing system for space precision payloads based on a soft Stewart platform. Central to the concept is using the dual-stage actuator instead of the traditional voice coil motor single-stage actuator to improve the payload active pointing capability. Based on a specified payload, the corresponding platform was designed to be installed between the spacecraft bus and the payload. The performance of the proposed system is demonstrated by preliminary closed-loop control investigations in simulations. With the ordinary spacecraft bus, the line-of-sight pointing accuracy can be controlled to below a few milliarcseconds in tip and tilt. Meanwhile, utilizing the voice coil motor with the softening spring in parallel, which is a portion of the dual-stage actuator, the system effectively achieves low-frequency motion transmission and high-frequency vibration isolation along the other four degree-of-freedom directions.

  16. Information and Analysis System Stages of Family Welfare in District Balong

    Directory of Open Access Journals (Sweden)

    Eka Arynda Ayu

    2017-05-01

    Full Text Available Badan Kependudukan dan Keluarga Berencana Nasional (BKKBN is a family that formed due to legal marriage, is able to meet the needs of the spiritual and the material that is decent, devoted to God Almighty, have a relationship that is harmonious and balanced between members and between families with the community and the environment. Every year the government to collect data on the status of a prosperous family stage where the purpose of the data collection is in the framework of development and poverty alleviation programs. Data collection process in the District Balong is still done manually so that the risk of error in determining the status of a family stage could happen. Information and analysis system of status stages of family welfare is designed to make web-based officers in the input data and determine the status of a prosperous family stages based on selected indicators of the sheet R/1/KS. Sample of data from Bulukidul village and sub-district village of Balong Ngraket 2014. Results of the system in the form of data reports the results of process steps and the results can be viewed in graphical form. Comparison chart to show the status of the highest percentage of poor welfare families stages. Instead lowest percentage shows the stages of a prosperous family able or rich. 

  17. Rationale for one stage exchange of infected hip replacement using uncemented implants and antibiotic impregnated bone graft.

    Science.gov (United States)

    Winkler, Heinz

    2009-09-04

    Infection of a total hip replacement (THR) is considered a devastating complication, necessitating its complete removal and thorough debridement of the site. It is undoubted that one stage exchange, if successful, would provide the best benefit both for the patient and the society. Still the fear of re-infection dominates the surgeons decisions and in the majority of cases directs them to multiple stage protocols. However, there is no scientifically based argument for that practice. Successful eradication of infection with two stage procedures is reported to average 80% to 98%. On the other hand a literature review of Jackson and Schmalzried (CORR 2000) summarizing the results of 1,299 infected hip replacements treated with direct exchange (almost exclusively using antibiotic loaded cement), reports of 1,077 (83%) having been successful. The comparable results suggest, that the major factor for a successful outcome with traditional approaches may be found in the quality of surgical debridement and dead space management. Failures in all protocols seem to be caused by small fragments of bacterial colonies remaining after debridement, whereas neither systemic antibiotics nor antibiotic loaded bone cement (PMMA) have been able to improve the situation significantly. Reasons for failure may be found in the limited sensitivity of traditional bacterial culturing and reduced antibiotic susceptibility of involved pathogens, especially considering biofilm formation. Whenever a new prosthesis is implanted into a previously infected site the surgeon must be aware of increased risk of failure, both in single or two stage revisions. Eventual removal therefore should be easy with low risk of additional damage to the bony substance. On the other hand it should also have potential of a good long term result in case of success. Cemented revisions generally show inferior long term results compared to uncemented techniques; the addition of antibiotics to cement reduces its

  18. Revisions of the Learning Mastery Systems for the Harper and Row Grades One and Two and the Macmillan Bank Street Grade One Reading Series.

    Science.gov (United States)

    Maeder, Jacqueline; And Others

    The revisions on the Learning Mastery Systems (LMSs) for the Harper & Row grade-one and grade-two and the Macmillan Bank Street grade-one reading programs are outlined in this document. A rationale for the revisions is presented. An LMS is a set of materials and procedures prepared by the southwest Regional Laboratory (SWRL) as an…

  19. The optimum intermediate pressure of two-stages vapor compression refrigeration cycle for Air-Conditioning unit

    Science.gov (United States)

    Ambarita, H.; Sihombing, H. V.

    2018-03-01

    Vapor compression cycle is mainly employed as a refrigeration cycle in the Air-Conditioning (AC) unit. In order to save energy, the Coefficient of Performance (COP) of the need to be improved. One of the potential solutions is to modify the system into multi-stages vapor compression cycle. The suitable intermediate pressure between the high and low pressures is one of the design issues. The present work deals with the investigation of an optimum intermediate pressure of two-stages vapor compression refrigeration cycle. Typical vapor compression cycle that is used in AC unit is taken into consideration. The used refrigerants are R134a. The governing equations have been developed for the systems. An inhouse program has been developed to solve the problem. COP, mass flow rate of the refrigerant and compressor power as a function of intermediate pressure are plotted. It was shown that there exists an optimum intermediate pressure for maximum COP. For refrigerant R134a, the proposed correlations need to be revised.

  20. Application of the 2012 revised diagnostic definitions for paediatric multiple sclerosis and immune-mediated central nervous system demyelination disorders

    NARCIS (Netherlands)

    van Pelt, E. Danielle; Neuteboom, Rinze F.; Ketelslegers, Immy A.; Boon, Maartje; Catsman-Berrevoets, Coriene E.; Hintzen, Rogier Q.

    Background Recently, the International Paediatric Multiple Sclerosis Study Group (IPMSSG) definitions for the diagnosis of immune-mediated acquired demyelinating syndromes (ADS) of the central nervous system, including paediatric multiple sclerosis (MS), have been revised. Objective To evaluate the

  1. Influence of capacity- and time-constrained intermediate storage in two-stage food production systems

    DEFF Research Database (Denmark)

    Akkerman, Renzo; van Donk, Dirk Pieter; Gaalman, Gerard

    2007-01-01

    In food processing, two-stage production systems with a batch processor in the first stage and packaging lines in the second stage are common and mostly separated by capacity- and time-constrained intermediate storage. This combination of constraints is common in practice, but the literature hardly...... of systems like this. Contrary to the common sense in operations management, the LPT rule is able to maximize the total production volume per day. Furthermore, we show that adding one tank has considerable effects. Finally, we conclude that the optimal setup frequency for batches in the first stage...... pays any attention to this. In this paper, we show how various capacity and time constraints influence the performance of a specific two-stage system. We study the effects of several basic scheduling and sequencing rules in the presence of these constraints in order to learn the characteristics...

  2. Value of five-stage prognostic system in predicting short-term outcome of patients with liver cirrhosis

    Directory of Open Access Journals (Sweden)

    TIAN Yan

    2015-03-01

    Full Text Available ObjectiveTo evaluate the clinical value of five-stage prognostic system in predicting the short-term outcome of patients with liver cirrhosis, and to compare it with the Child-Turcotte-Pugh (CTP and Model of End-Stage Liver Disease (MELD scores. MethodsTwo hundred and one hospitalized patients with liver cirrhosis in the Department of Gastroenterology in the First Affiliated Hospital of Anhui Medical University from January 2011 to January 2014 were enrolled in the study and followed up for at least six months. Patients were classified accorded to the five-stage prognostic system, and the mortality rate in each stage was measured. The receiver operating characteristic (ROC curve and the area under the ROC curve (AUC were used to assess the accuracy of the five-stage prognostic system in predicting the short-term death risk of cirrhotic patients, which was then compared with the CTP and MELD scores. Categorical data were analyzed by chi-square test. Comparison of AUC was made by normal distribution Z test. Spearman′s correlation analysis was used to investigate the correlation of the five-stage prognostic system with the CTP and MELD scores. ResultsThe study used the admission time as the starting point and the death of patients or study termination time as the endpoint. Among the 201 patients, 50 (24.9% died within six months. Based on the five-stage prognostic system, the mortality rates for stages 1 to 5 were 0(0/11, 0(0/18, 4.2%(2/48, 16.3% (7/43, and 50.6%(41/81, respectively. In patients with decompensated cirrhosis (stages 3, 4, and 5, the mortality increased with stage, and the differences in mortality between patients in stages 3 and 4, 3 and 5, and 4 and 5 were all significant (χ2=3.89, 35.33, and 13.96, respectively; P=0.049, 0.000, and 0.049, respectively. The AUC for the five-stage prognostic system, five-stage prognostic system combined with CTP and MELD score, and CTP score were 0820, 0.915, 0.888, and 0

  3. Revised accident source terms for light-water reactors

    Energy Technology Data Exchange (ETDEWEB)

    Soffer, L. [Nuclear Regulatory Commission, Washington, DC (United States)

    1995-02-01

    This paper presents revised accident source terms for light-water reactors incorporating the severe accident research insights gained in this area over the last 15 years. Current LWR reactor accident source terms used for licensing date from 1962 and are contained in Regulatory Guides 1.3 and 1.4. These specify that 100% of the core inventory of noble gases and 25% of the iodine fission products are assumed to be instantaneously available for release from the containment. The chemical form of the iodine fission products is also assumed to be predominantly elemental iodine. These assumptions have strongly affected present nuclear air cleaning requirements by emphasizing rapid actuation of spray systems and filtration systems optimized to retain elemental iodine. A proposed revision of reactor accident source terms and some im implications for nuclear air cleaning requirements was presented at the 22nd DOE/NRC Nuclear Air Cleaning Conference. A draft report was issued by the NRC for comment in July 1992. Extensive comments were received, with the most significant comments involving (a) release fractions for both volatile and non-volatile species in the early in-vessel release phase, (b) gap release fractions of the noble gases, iodine and cesium, and (c) the timing and duration for the release phases. The final source term report is expected to be issued in late 1994. Although the revised source terms are intended primarily for future plants, current nuclear power plants may request use of revised accident source term insights as well in licensing. This paper emphasizes additional information obtained since the 22nd Conference, including studies on fission product removal mechanisms, results obtained from improved severe accident code calculations and resolution of major comments, and their impact upon the revised accident source terms. Revised accident source terms for both BWRS and PWRS are presented.

  4. Revising and editing for translators

    CERN Document Server

    Mossop, Brian

    2014-01-01

    Revising and Editing for Translators provides guidance and learning materials for translation students learning to edit texts written by others, and professional translators wishing to improve their self-revision ability or learning to revise the work of others. Editing is understood as making corrections and improvements to texts, with particular attention to tailoring them to the given readership. Revising is this same task applied to draft translations. The linguistic work of editors and revisers is related to the professional situations in which they work. Mossop offers in-depth coverage of a wide range of topics, including copyediting, style editing, structural editing, checking for consistency, revising procedures and principles, and translation quality assessment. This third edition provides extended coverage of computer aids for revisers, and of the different degrees of revision suited to different texts. The inclusion of suggested activities and exercises, numerous real-world examples, a proposed gra...

  5. Optimization of a Two Stage Pulse Tube Refrigerator for the Integrated Current Lead System

    Science.gov (United States)

    Maekawa, R.; Matsubara, Y.; Okada, A.; Takami, S.; Konno, M.; Tomioka, A.; Imayoshi, T.; Hayashi, H.; Mito, T.

    2008-03-01

    Implementation of a conventional current lead with a pulse tube refrigerator has been validated to be working as an Integrated Current Lead (ICL) system for the Superconducting Magnetic Energy Storage (SMES). Realization of the system is primarily accounted for the flexibility of a pulse tube refrigerator, which does not posses any mechanical piston and/or displacer. As for an ultimate version of the ICL system, a High Temperature Superconducting (HTS) lead links a superconducting coil with a conventional copper lead. To ensure the minimization of heat loads to the superconducting coil, a pulse tube refrigerator has been upgraded to have a second cooling stage. This arrangement reduces not only the heat loads to the superconducting coil but also the operating cost for a SMES system. A prototype two-stage pulse tube refrigerator, series connected arrangement, was designed and fabricated to satisfy the requirements for the ICL system. Operation of the first stage refrigerator is a four-valve mode, while the second stage utilizes a double inlet configuration to ensure its confined geometry. The paper discusses the optimization of second stage cooling to validate the conceptual design

  6. Multi-stage fuzzy PID power system automatic generation controller in deregulated environments

    International Nuclear Information System (INIS)

    Shayeghi, H.; Shayanfar, H.A.; Jalili, A.

    2006-01-01

    In this paper, a multi-stage fuzzy proportional integral derivative (PID) type controller is proposed to solve the automatic generation control (AGC) problem in a deregulated power system that operates under deregulation based on the bilateral policy scheme. In each control area, the effects of the possible contracts are treated as a set of new input signals in a modified traditional dynamical model. The multi-stage controller uses the fuzzy switch to blend a proportional derivative (PD) fuzzy logic controller with an integral fuzzy logic input. The proposed controller operates on fuzzy values passing the consequence of a prior stage on to the next stage as fact. The salient advantage of this strategy is its high insensitivity to large load changes and disturbances in the presence of plant parameter variations and system nonlinearities. This newly developed strategy leads to a flexible controller with simple structure that is easy to implement, and therefore, it can be useful for the real world power systems. The proposed method is tested on a three area power system with different contracted scenarios under various operating conditions. The results of the proposed controller are compared with those of the classical fuzzy PID type controller and classical PID controller through some performance indices to illustrate its robust performance

  7. Addenbrooke's Cognitive Examination-Revised for mild cognitive impairment in Parkinson's disease.

    Science.gov (United States)

    McColgan, Peter; Evans, Jonathan R; Breen, David P; Mason, Sarah L; Barker, Roger A; Williams-Gray, Caroline H

    2012-08-01

    Cognitive impairment is common in Parkinson's disease (PD), even in the early stages, and appropriate screening tools are needed. We investigated the utility of the Addenbrooke's Cognitive Examination-Revised for detecting mild cognitive impairment (MCI) in PD in an incident population-representative cohort (n = 132) and investigated the relationship between performance on this instrument and behavior and quality of life (n = 219). Twenty-two percent met criteria for MCI. Receiver operating curve analysis revealed an area under the curve of 0.81. A cutoff Cognitive Rating Scale, and there were significant correlations with the Cambridge Behavioral Inventory-Revised and Parkinson's Disease Questionnaire 39. This instrument is a useful screening tool for PD-MCI, and poor performance is significantly related to impaired behavior and quality of life. Copyright © 2012 Movement Disorder Society.

  8. [The Use of Jumbo Cups in Revision Total Hip Arthroplasty].

    Science.gov (United States)

    von Roth, Philipp; Wassilew, Georgi I

    2017-10-01

    Extra-large uncemented jumbo cups are among the most common methods of acetabular revision. Jumbo cups do not contribute to bone stock restoration, and in the case of a subsequent revision, an even larger bone defect is to be expected. Thus, understanding long-term survival is essential. The present article discusses the literature relevant to this topic and addresses technical and implant-specific characteristics of jumbo cups. In summary, jumbo cups show an acceptable long-term survival rate, with aseptic loosening as the most common reason for revision and dislocation being the most common complication. Through the development of alternative revision systems, jumbo cups have lost their importance in today's practice. However, they can serve as a benchmark for studies of newer technologies in revision total hip arthroplasty. Georg Thieme Verlag KG Stuttgart · New York.

  9. The 2016 revision of the WHO Classification of Central Nervous System Tumours: retrospective application to a cohort of diffuse gliomas.

    Science.gov (United States)

    Rogers, Te Whiti; Toor, Gurvinder; Drummond, Katharine; Love, Craig; Field, Kathryn; Asher, Rebecca; Tsui, Alpha; Buckland, Michael; Gonzales, Michael

    2018-03-01

    The classification of central nervous system tumours has more recently been shaped by a focus on molecular pathology rather than histopathology. We re-classified 82 glial tumours according to the molecular-genetic criteria of the 2016 revision of the World Health Organization (WHO) Classification of Tumours of the Central Nervous System. Initial diagnoses and grading were based on the morphological criteria of the 2007 WHO scheme. Because of the impression of an oligodendroglial component on initial histological assessment, each tumour was tested for co-deletion of chromosomes 1p and 19q and mutations of isocitrate dehydrogenase (IDH-1 and 2) genes. Additionally, expression of proteins encoded by alpha-thalassemia X-linked mental retardation (ATRX) and TP53 genes was assessed by immunohistochemistry. We found that all but two tumours could be assigned to a specific category in the 2016 revision. The most common change in diagnosis was from oligoastrocytoma to specifically astrocytoma or oligodendroglioma. Analysis of progression free survival (PFS) for WHO grade II and III tumours showed that the objective criteria of the 2016 revision separated diffuse gliomas into three distinct molecular categories: chromosome 1p/19q co-deleted/IDH mutant, intact 1p/19q/IDH mutant and IDH wild type. No significant difference in PFS was found when comparing IDH mutant grade II and III tumours suggesting that IDH status is more informative than tumour grade. The segregation into distinct molecular sub-types that is achieved by the 2016 revision provides an objective evidence base for managing patients with grade II and III diffuse gliomas based on prognosis.

  10. EPRI BWR Water Chemistry Guidelines Revision

    International Nuclear Information System (INIS)

    Garcia, Susan E.; Giannelli, Joseph F.

    2014-01-01

    BWRVIP-190: BWR Water Chemistry Guidelines – 2008 Revision has been revised. The revision committee consisted of U.S. and non-U.S. utilities (members of the BWR Vessel and Internals Protection (BWRVIP) Mitigation Committee), reactor system manufacturers, fuel suppliers, and EPRI and industry experts. The revised document, BWRVIP-190 Revision 1, was completely reformatted into two volumes, with a simplified presentation of water chemistry control, diagnostic and good practice parameters in Volume 1 and the technical bases in Volume 2, to facilitate use. The revision was developed in parallel and in coordination with preparation of the Fuel Reliability Guidelines Revision 1: BWR Fuel Cladding Crud and Corrosion. Guidance is included for plants operating under normal water chemistry (NWC), moderate hydrogen water chemistry (HWC-M), and noble metal application (GE-Hitachi NobleChem™) plus hydrogen injection. Volume 1 includes significant changes to BWR feedwater and reactor water chemistry control parameters to provide increased assurance of intergranular stress corrosion cracking (IGSCC) mitigation of reactor materials and fuel reliability during all plant conditions, including cold shutdown (≤200°F (93°C)), startup/hot standby (>200°F (93°C) and ≤ 10%) and power operation (>10% power). Action Level values for chloride and sulfate have been tightened to minimize environmentally assisted cracking (EAC) of all wetted surfaces, including those not protected by hydrogen injection, with or without noble metals. Chemistry control guidance has been enhanced to minimize shutdown radiation fields by clarifying targets for depleted zinc oxide (DZO) injection while meeting requirements for fuel reliability. Improved tabular presentations of parameter values explicitly indicate levels at which actions are to be taken and required sampling frequencies. Volume 2 provides the technical bases for BWR water chemistry control for control of EAC, flow accelerated corrosion

  11. Computer simulation of a staging system for a theta-pinch reactor (RTPR)

    International Nuclear Information System (INIS)

    Crnkovich, P.G.

    1976-02-01

    To reduce excessive energy requirements for the implosion heating system of a theta-pinch reactor, two staging methods, the brute force and bucking field options, were proposed. A Marshall coil and a segmented coil were also considered. Calculations involved in coding these coil designs and staging options into a PL/I subprogram are described. A marked savings in the energy required for the IH system is realized with the bucking option and others

  12. Loosening After Acetabular Revision

    DEFF Research Database (Denmark)

    Beckmann, Nicholas A.; Weiss, Stefan; Klotz, Matthias C.M.

    2014-01-01

    The best method of revision acetabular arthroplasty remains unclear. Consequently, we reviewed the literature on the treatment of revision acetabular arthroplasty using revision rings (1541 cases; mean follow-up (FU) 5.7 years) and Trabecular Metal, or TM, implants (1959 cases; mean FU 3.7 years...

  13. Maximally efficient two-stage screening: Determining intellectual disability in Taiwanese military conscripts

    Directory of Open Access Journals (Sweden)

    Chia-Chang Chien

    2009-01-01

    Full Text Available Chia-Chang Chien1, Shu-Fen Huang1,2,3,4, For-Wey Lung1,2,3,41Department of Psychiatry, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan; 2Graduate Institute of Behavioral Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan; 4Calo Psychiatric Center, Pingtung County, TaiwanObjective: The purpose of this study was to apply a two-stage screening method for the large-scale intelligence screening of military conscripts.Methods: We collected 99 conscripted soldiers whose educational levels were senior high school level or lower to be the participants. Every participant was required to take the Wisconsin Card Sorting Test (WCST and the Wechsler Adult Intelligence Scale-Revised (WAIS-R assessments.Results: Logistic regression analysis showed the conceptual level responses (CLR index of the WCST was the most significant index for determining intellectual disability (ID; FIQ ≤ 84. We used the receiver operating characteristic curve to determine the optimum cut-off point of CLR. The optimum one cut-off point of CLR was 66; the two cut-off points were 49 and 66. Comparing the two-stage window screening with the two-stage positive screening, the area under the curve and the positive predictive value increased. Moreover, the cost of the two-stage window screening decreased by 59%.Conclusion: The two-stage window screening is more accurate and economical than the two-stage positive screening. Our results provide an example for the use of two-stage screening and the possibility of the WCST to replace WAIS-R in large-scale screenings for ID in the future.Keywords: intellectual disability, intelligence screening, two-stage positive screening, Wisconsin Card Sorting Test, Wechsler Adult Intelligence Scale-Revised

  14. Fill Rates of Single-Stage and Multistage Supply Systems

    OpenAIRE

    Matthew J. Sobel

    2004-01-01

    A supply system's fill rate is the fraction of demand that is met from on-hand inventory. This paper presents formulas for the fill rate of periodic review supply systems that use base-stock-level policies. The first part of the paper contains fill-rate formulas for a single-stage system and general distributions of demand. When demand is normally distributed, an exact expression uses only the standard normal distribution and density functions, and a good approximation uses only the standard ...

  15. Development and testing of a de novo clinical staging system for podoconiosis (endemic non-filarial elephantiasis).

    Science.gov (United States)

    Tekola, Fasil; Ayele, Zewdu; Mariam, Dereje Haile; Fuller, Claire; Davey, Gail

    2008-10-01

    To develop and test a robust clinical staging system for podoconiosis, a geochemical disease in individuals exposed to red clay soil. We adapted the Dreyer system for staging filarial lymphoedema and tested it in four re-iterative field tests conducted in an area of high-podoconiosis prevalence in Southern Ethiopia. The system has five stages according to proximal spread of disease and presence of dermal nodules, ridges and bands. We measured the 1-week repeatability and the inter-observer agreement of the final staging system. The five-stage system is readily understood by community workers with little health training. Kappa for 1-week repeatability was 0.88 (95% CI 0.80-0.96), for agreement between health professionals was 0.71 (95% CI 0.60-0.82), while that between health professionals and community podoconiosis agents without formal health training averaged 0.64 (95% CI 0.52-0.78). This simple staging system with good inter-observer agreement and repeatability can assist in the management and further study of podoconiosis.

  16. A two-stage stochastic programming approach for operating multi-energy systems

    DEFF Research Database (Denmark)

    Zeng, Qing; Fang, Jiakun; Chen, Zhe

    2017-01-01

    This paper provides a two-stage stochastic programming approach for joint operating multi-energy systems under uncertainty. Simulation is carried out in a test system to demonstrate the feasibility and efficiency of the proposed approach. The test energy system includes a gas subsystem with a gas...

  17. [Revision of the drinking water regulations].

    Science.gov (United States)

    Hauswirth, S

    2011-11-01

    The revision the Drinking Water Regulations will come into effect on 01.11.2011. Surveillance authorities and owners of drinking water supply systems had hoped for simplifications and reductions because of the new arrangements. According to the official statement for the revision the legislature intended to create more clarity, consider new scientific findings, to change regulations that have not been proved to close regulatory gaps, to deregulate and to increase the high quality standards. A detailed examination of the regulation text, however, raises doubts. The new classification of water supply systems requires different modalities of registration, water analyses and official observation, which will complicate the work of the authorities. In particular, the implementation of requirements of registration and examination for the owners of commercial and publicly-operated large hot-water systems in accordance with DVGW Worksheet W 551 requires more effort. According to the estimated 30 000 cases of legionellosis in Germany the need for a check of such systems for Legionella, however, is not called into question. Furthermore, the development of sampling plans and the monitoring of mobile water supply systems requires more work for the health authorities. © Georg Thieme Verlag KG Stuttgart · New York.

  18. The experimental study of a two-stage photovoltaic thermal system based on solar trough concentration

    International Nuclear Information System (INIS)

    Tan, Lijun; Ji, Xu; Li, Ming; Leng, Congbin; Luo, Xi; Li, Haili

    2014-01-01

    Highlights: • A two-stage photovoltaic thermal system based on solar trough concentration. • Maximum cell efficiency of 5.21% with the mirror opening width of 57 cm. • With single cycle, maximum temperatures rise in the heating stage is 12.06 °C. • With 30 min multiple cycles, working medium temperature 62.8 °C, increased 28.7 °C. - Abstract: A two-stage photovoltaic thermal system based on solar trough concentration is proposed, in which the metal cavity heating stage is added on the basis of the PV/T stage, and thermal energy with higher temperature is output while electric energy is output. With the 1.8 m 2 mirror PV/T system, the characteristic parameters of the space solar cell under non-concentrating solar radiation and concentrating solar radiation are respectively tested experimentally, and the solar cell output characteristics at different opening widths of concentrating mirror of the PV/T stage under condensation are also tested experimentally. When the mirror opening width was 57 cm, the solar cell efficiency reached maximum value of 5.21%. The experimental platform of the two-stage photovoltaic thermal system was established, with a 1.8 m 2 mirror PV/T stage and a 15 m 2 mirror heating stage, or a 1.8 m 2 mirror PV/T stage and a 30 m 2 mirror heating stage. The results showed that with single cycle, the long metal cavity heating stage would bring lower thermal efficiency, but temperature rise of the working medium is higher, up to 12.06 °C with only single cycle. With 30 min closed multiple cycles, the temperature of the working medium in the water tank was 62.8 °C, with an increase of 28.7 °C, and thermal energy with higher temperature could be output

  19. The nuclear liability conventions revised

    International Nuclear Information System (INIS)

    Reyners, P.

    2004-01-01

    The signature on 12 February 2004 of the Protocols amending respectively the 1960 Paris Convention and the 1963 Brussels Supplementary Convention was the second step of the process of modernisation of the international nuclear liability regime after the adoption in September 1997 of a Protocol revising the 1963 Vienna Convention and of a new Convention on Supplementary Compensation for Nuclear Damage. The common objective of the new instruments is to provide more funds to compensate a larger number of potential victims in respect of a broader range of damage. Another goal of the revision exercise was to maintain the compatibility between the Paris and Vienna based systems, a commitment enshrined in the 1988 Joint Protocol, as well as to ascertain that Paris/Brussels countries could also become a Party to the Convention on Supplementary Compensation. However, while generally consistent vis a vis the Joint Protocol, the provisions of the Paris and Vienna Conventions, as revised, differ on some significant aspects. Another remaining issue is whether the improved international nuclear liability regime will succeed in attracting in the future a larger number of countries, particularly outside Europe, and will so become truly universal. Therefore, the need for international co-operation to address these issues, to facilitate the adoption of new implementing legislation and to ensure that this special regime keeps abreast of economic and technological developments, is in no way diminished after the revision of the Conventions.(author)

  20. Performance assessment and transient optimization of air precooling in multi-stage solid desiccant air conditioning systems

    International Nuclear Information System (INIS)

    Gadalla, Mohamed; Saghafifar, Mohammad

    2016-01-01

    Highlights: • Studying three two-stage solid desiccant cooling systems using Maisotsenko cooler. • Proposing precooling to improve two-stage desiccant systems’ COP for humid climates. • Performing transient analysis for a two-stage solid desiccant cooler in UAE. • Optimizing daily performance of a two-stage solid desiccant cooler for UAE. - Abstract: Renewable energy is one of the most promising solutions to both energy and global warming crisis. Energy consumption can be minimized considerably by utilizing solar energy in air conditioning systems operation. One of the popular solar air conditioning technologies is desiccant air conditioning. Nonetheless, conventional desiccant air conditioning systems have a relatively low coefficient of performance (COP). In consequence, two-stage desiccant air-conditioning systems are proposed to improve desiccant air conditioning systems’ COP. Moreover, a recently commercialized cooling method named Maisotsenko cooling cycle which is capable of cooling air near to its dew point temperature is considered to be integrated within the proposed multi-stage desiccant cooling systems. In this paper, three new two-stage desiccant air conditioning systems incorporating Maisotsenko cooling cycle are proposed and investigated in details for hot and humid climates such as UAE. Furthermore, air precooling is considered to improve two stage desiccant air conditioning systems’ COP. Moreover, full transient analysis and optimization are carried out in UAE within June–October. The proposed system can minimize the required solar heating during noon time as the ambient air dry bulb temperature rises. Average COP of the system during electricity load peak hours (10:00–14:00) for all five considered and combined months is 1.77. Average rate of heat input required to operate the system and average building cooling load are determined to be 100.3 kW and 46.2 kW, respectively. Therefore, system average COP is computed to be 0.46.

  1. A two-stage stochastic programming model for the optimal design of distributed energy systems

    International Nuclear Information System (INIS)

    Zhou, Zhe; Zhang, Jianyun; Liu, Pei; Li, Zheng; Georgiadis, Michael C.; Pistikopoulos, Efstratios N.

    2013-01-01

    Highlights: ► The optimal design of distributed energy systems under uncertainty is studied. ► A stochastic model is developed using genetic algorithm and Monte Carlo method. ► The proposed system possesses inherent robustness under uncertainty. ► The inherent robustness is due to energy storage facilities and grid connection. -- Abstract: A distributed energy system is a multi-input and multi-output energy system with substantial energy, economic and environmental benefits. The optimal design of such a complex system under energy demand and supply uncertainty poses significant challenges in terms of both modelling and corresponding solution strategies. This paper proposes a two-stage stochastic programming model for the optimal design of distributed energy systems. A two-stage decomposition based solution strategy is used to solve the optimization problem with genetic algorithm performing the search on the first stage variables and a Monte Carlo method dealing with uncertainty in the second stage. The model is applied to the planning of a distributed energy system in a hotel. Detailed computational results are presented and compared with those generated by a deterministic model. The impacts of demand and supply uncertainty on the optimal design of distributed energy systems are systematically investigated using proposed modelling framework and solution approach.

  2. Comparison of single-stage and temperature-phased two-stage anaerobic digestion of oily food waste

    International Nuclear Information System (INIS)

    Wu, Li-Jie; Kobayashi, Takuro; Li, Yu-You; Xu, Kai-Qin

    2015-01-01

    Highlights: • A single-stage and two two-stage anaerobic systems were synchronously operated. • Similar methane production 0.44 L/g VS_a_d_d_e_d from oily food waste was achieved. • The first stage of the two-stage process became inefficient due to serious pH drop. • Recycle favored the hythan production in the two-stage digestion. • The conversion of unsaturated fatty acids was enhanced by recycle introduction. - Abstract: Anaerobic digestion is an effective technology to recover energy from oily food waste. A single-stage system and temperature-phased two-stage systems with and without recycle for anaerobic digestion of oily food waste were constructed to compare the operation performances. The synchronous operation indicated the similar ability to produce methane in the three systems, with a methane yield of 0.44 L/g VS_a_d_d_e_d. The pH drop to less than 4.0 in the first stage of two-stage system without recycle resulted in poor hydrolysis, and methane or hydrogen was not produced in this stage. Alkalinity supplement from the second stage of two-stage system with recycle improved pH in the first stage to 5.4. Consequently, 35.3% of the particulate COD in the influent was reduced in the first stage of two-stage system with recycle according to a COD mass balance, and hydrogen was produced with a percentage of 31.7%, accordingly. Similar solids and organic matter were removed in the single-stage system and two-stage system without recycle. More lipid degradation and the conversion of long-chain fatty acids were achieved in the single-stage system. Recycling was proved to be effective in promoting the conversion of unsaturated long-chain fatty acids into saturated fatty acids in the two-stage system.

  3. Current Epidemiology of Revision Total Knee Arthroplasty in the United States.

    Science.gov (United States)

    Delanois, Ronald E; Mistry, Jaydev B; Gwam, Chukwuweike U; Mohamed, Nequesha S; Choksi, Ujval S; Mont, Michael A

    2017-09-01

    Revision surgery for failed total knee arthroplasty (TKA) continues to pose a substantial burden for the United States healthcare system. The predominant etiology of TKA failure has changed over time and may vary between studies. This report aims to update the current literature on this topic by using a large national database. Specifically, we analyzed: (1) etiologies for revision TKA; (2) frequencies of revision TKA procedures; (3) various demographics including payer type and region; and (4) the length of stay (LOS) and total charges based on type of revision TKA procedure. The Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) database was used to identify all revision TKA procedures performed between 2009 and 2013. Clinical, economic, and demographic data were collected and analyzed for 337,597 procedures. Patients were stratified according to etiology of failure, age, sex, race, US census region, and primary payor class. The mean LOS and total charges were also calculated. Infection was the most common etiology for revision TKA (20.4%), closely followed by mechanical loosening (20.3%). The most common revision TKA procedure performed was all component revision (31.3%). Medicare was the primary payor for the greatest proportion of revisions (57.7%). The South census region performed the most revision TKAs (33.2%). The overall mean LOS was 4.5 days, with arthrotomy for removal of prosthesis without replacement procedures accounting for the longest stays (7.8 days). The mean total charge for revision TKAs was $75,028.07. Without appropriate measures in place, the burden of revision TKAs may become overwhelming and pose a strain on providers and institutions. Continued insight into the etiology and epidemiology of revision TKAs may be the principle step towards improving outcomes and mitigating the need for future revisions. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. MAR Assessments Of The High Level Waste System Plan Revision 16

    International Nuclear Information System (INIS)

    Peeler, D.; Edwards, T.

    2011-01-01

    which a glass system (i.e., a projected sludge composition with a candidate frit) is predicted to be acceptable can be defined (i.e., the projected operating window) which will provide insight into the ability to meet future contractual WL obligations. In this study, future contractual WL obligations are assumed to be 40%, which is the goal after all flowsheet enhancements have been implemented to support DWPF operations. For a system to be considered acceptable, candidate frits must be identified that provide access to at least 40% WL while accounting for potential variation in the sludge resulting from differences in batch-to-batch transfers into the Sludge Receipt and Adjustment Tank (SRAT) and/or analytical uncertainties. In more general terms, this study will assess whether or not the current glass formulation strategy (based on the use of the Nominal and Variation Stage assessments) and current PCCS models will allow access to compositional regions required to targeted higher WLs for future operations. Some of the key questions to be considered in this study include: (1) If higher WLs are attainable with current process control models, are the models valid in these compositional regions? If the higher WL glass regions are outside current model development or validation ranges, is there existing data that could be used to demonstrate model applicability (or lack thereof)? If not, experimental data may be required to revise current models or serve as validation data with the existing models. (2) Are there compositional trends in frit space that are required by the PCCS models to obtain access to these higher WLs? If so, are there potential issues with the compositions of the associated frits (e.g., limitations on the B 2 O 3 and/or Li 2 O concentrations) as they are compared to model development/validation ranges or to the term 'borosilicate' glass? If limitations on the frit compositional range are realized, what is the impact of these restrictions on other glass

  5. 78 FR 61329 - Revision of the Land Management Plan for the Nantahala and Pisgah National Forests

    Science.gov (United States)

    2013-10-03

    .... Individuals who use telecommunication devices for the deaf (TDD) may call the Federal Information Relay.... More information on the planning process can also be found on the Nantahala and Pisgah Plan Revision... Forest Planning Rule (36 CFR Part 219), the planning process encompases three-stages: Assessment, plan...

  6. Milgrom's revision of Newton's laws: Dynamical and cosmological consequences

    International Nuclear Information System (INIS)

    Felten, J.E.; and University of Maryland, College Park)

    1984-01-01

    Milgrom's recent revision of Newtonian dynamics was introduced to eliminate the inference that large quantities of invisible mass exist in galaxies. I show by simple examples that a Milgrom acceleration, in the form presented so far, implies other far-reaching changes in dynamics. The momentum of an isolated system is not conserved, and the usual theorem for center-of-mass motion of any system does not hold. Naive applications require extreme caution. The model fails to provide a complete description of particle dynamics and should be thought of as a revision of Kepler's laws rather than Newton's

  7. A Two-stage DC-DC Converter for the Fuel Cell-Supercapacitor Hybrid System

    DEFF Research Database (Denmark)

    Zhang, Zhe; Thomsen, Ole Cornelius; Andersen, Michael A. E.

    2009-01-01

    A wide input range multi-stage converter is proposed with the fuel cells and supercapacitors as a hybrid system. The front-end two-phase boost converter is used to optimize the output power and to reduce the current ripple of fuel cells. The supercapacitor power module is connected by push...... and designed. A 1kW prototype controlled by TMS320F2808 DSP is built in the lab. Simulation and experimental results confirm the feasibility of the proposed two stage dc-dc converter system.......-pull-forward half bridge (PPFHB) converter with coupled inductors in the second stage to handle the slow transient response of the fuel cells and realize the bidirectional power flow control. Moreover, this cascaded structure simplifies the power management. The control strategy for the whole system is analyzed...

  8. Two-stage energy storage equalization system for lithium-ion battery pack

    Science.gov (United States)

    Chen, W.; Yang, Z. X.; Dong, G. Q.; Li, Y. B.; He, Q. Y.

    2017-11-01

    How to raise the efficiency of energy storage and maximize storage capacity is a core problem in current energy storage management. For that, two-stage energy storage equalization system which contains two-stage equalization topology and control strategy based on a symmetric multi-winding transformer and DC-DC (direct current-direct current) converter is proposed with bidirectional active equalization theory, in order to realize the objectives of consistent lithium-ion battery packs voltages and cells voltages inside packs by using a method of the Range. Modeling analysis demonstrates that the voltage dispersion of lithium-ion battery packs and cells inside packs can be kept within 2 percent during charging and discharging. Equalization time was 0.5 ms, which shortened equalization time of 33.3 percent compared with DC-DC converter. Therefore, the proposed two-stage lithium-ion battery equalization system can achieve maximum storage capacity between lithium-ion battery packs and cells inside packs, meanwhile efficiency of energy storage is significantly improved.

  9. Revising an Engineering Design Rubric: A Case Study Illustrating Principles and Practices to Ensure Technical Quality of Rubrics

    Directory of Open Access Journals (Sweden)

    Gail Lynn Goldberg

    2014-08-01

    Full Text Available This article provides a detailed account of a rubric revision process to address seven common problems to which rubrics are prone: lack of consistency and parallelism; the presence of - orphan- and - widow- words and phrases; redundancy in descriptors; inconsistency in the focus of qualifiers; limited routes to partial credit; unevenness in incremental levels of performance; and inconsistencies across suites or sets of related rubrics. The author uses examples from both the draft stage precursor and the first revised (pilot version of the Engineering Design Process Portfolio Scoring Rubric (EDPPSR, to illustrate the application of broadly relevant guidelines that can inform the creation of a new-'or revision of an existing-'rubric to achieve technical quality while preserving content integrity

  10. Target tracking system based on preliminary and precise two-stage compound cameras

    Science.gov (United States)

    Shen, Yiyan; Hu, Ruolan; She, Jun; Luo, Yiming; Zhou, Jie

    2018-02-01

    Early detection of goals and high-precision of target tracking is two important performance indicators which need to be balanced in actual target search tracking system. This paper proposed a target tracking system with preliminary and precise two - stage compound. This system using a large field of view to achieve the target search. After the target was searched and confirmed, switch into a small field of view for two field of view target tracking. In this system, an appropriate filed switching strategy is the key to achieve tracking. At the same time, two groups PID parameters are add into the system to reduce tracking error. This combination way with preliminary and precise two-stage compound can extend the scope of the target and improve the target tracking accuracy and this method has practical value.

  11. Staging Lung Cancer: Metastasis.

    Science.gov (United States)

    Shroff, Girish S; Viswanathan, Chitra; Carter, Brett W; Benveniste, Marcelo F; Truong, Mylene T; Sabloff, Bradley S

    2018-05-01

    The updated eighth edition of the tumor, node, metastasis (TNM) classification for lung cancer includes revisions to T and M descriptors. In terms of the M descriptor, the classification of intrathoracic metastatic disease as M1a is unchanged from TNM-7. Extrathoracic metastatic disease, which was classified as M1b in TNM-7, is now subdivided into M1b (single metastasis, single organ) and M1c (multiple metastases in one or multiple organs) descriptors. In this article, the rationale for changes in the M descriptors, the utility of preoperative staging with PET/computed tomography, and the treatment options available for patients with oligometastatic disease are discussed. Copyright © 2018 Elsevier Inc. All rights reserved.

  12. The Epidemiology of Revision Anterior Cruciate Ligament Reconstruction in Adults from Ontario, Canada

    Science.gov (United States)

    Leroux, Timothy; Wasserstein, David; Dwyer, Tim; Ogilvie-Harris, Darrell; Marks, Paul H.; Bach, Bernard R.; Townley, John; Mahomed, Nizar; Chahal, Jaskarndip

    2015-01-01

    Objectives: The morbidity associated with revision anterior cruciate ligament reconstruction (ACLR) is largely unknown. The objective of this study was to determine the rate of and risk factors for re-revision, re-operation, and re-admission following revision ACLR in the general population. Methods: All patients who underwent first revision ACLR in Ontario, Canada from January 2004 to December 2010 were identified and followed to December 2012. Exclusions included age (<16 years), previous osteotomy, or multi-ligament knee reconstruction. The main outcome was re-revision ACLR. Secondary outcomes included re-operation [irrigation and debridement (I&D), meniscectomy, manipulation under anesthesia (MUA), contralateral ACLR, and total knee arthroplasty (TKA)], and re-admission within 90 days of surgery. Survival to re-revision was determined using the Kaplan-Meier (KM) approach. A Cox proportional hazards model or logistic regression were used to determine the influence of patient factors (age, sex, neighborhood income quintile, and comorbidity), surgical factors (graft choice, concurrent meniscal procedure, and fixation method), and provider factors (surgeon volume, surgeon years in practice, and hospital status) on outcomes. A post-hoc analysis was performed to determine the influence of the aforementioned factors on overall post-operative infection risk, including both operative and non-operative cases. Results: Overall, 827 patients were included (median age: 30 years; 58.8% males). Single stage revisions comprised 92.9% of cases, and a meniscal procedure (repair or debridement) was performed in 45.3% of cases. The re-revision rate at a mean follow-up of 4.8±2.2 years was 4.4%, and the five-year survival rate was 95.4% (Figure 1). The rates of I&D, meniscectomy, contralateral ACLR, and re-admission were 0.8%, 3.1%, 3.4%, and 4.1%, respectively. MUA and TKA were rare. Young age significantly increased contralateral ACLR risk (risk decreased by 5.1% with each year

  13. Coupling effect and control strategies of the maglev dual-stage inertially stabilization system based on frequency-domain analysis.

    Science.gov (United States)

    Lin, Zhuchong; Liu, Kun; Zhang, Li; Zeng, Delin

    2016-09-01

    Maglev dual-stage inertially stabilization (MDIS) system is a newly proposed system which combines a conventional two-axis gimbal assembly and a 5-DOF (degree of freedom) magnetic bearing with vernier tilting capacity to perform dual-stage stabilization for the LOS of the suspended optical instrument. Compared with traditional dual-stage system, maglev dual-stage system exhibits different characteristics due to the negative position stiffness of the magnetic forces, which introduces additional coupling in the dual stage control system. In this paper, the coupling effect on the system performance is addressed based on frequency-domain analysis, including disturbance rejection, fine stage saturation and coarse stage structural resonance suppression. The difference between various control strategies is also discussed, including pile-up(PU), stabilize-follow (SF) and stabilize-compensate (SC). A number of principles for the design of a maglev dual stage system are proposed. A general process is also suggested, which leads to a cost-effective design striking a balance between high performance and complexity. At last, a simulation example is presented to illustrate the arguments in the paper. Copyright © 2016 ISA. Published by Elsevier Ltd. All rights reserved.

  14. Production system and harvesting stage influence on nitrate content and quality of butterhead lettuce

    Directory of Open Access Journals (Sweden)

    Siti Fairuz Yosoff

    2015-01-01

    Full Text Available Leafy vegetables such as lettuce grown under different production systems may accumulate different concentrations of nitrate which may reach to the levels potentially toxic to humans. Moreover, nitrate accumulation varies in various plant parts and physiological age of the plant. Therefore, to determine the effect of production system and harvesting stage on nitrate accumulation and quality of butterhead lettuce, a study was conducted considering two lettuce production systems namely hydroponic and organic, and four different harvesting stages such as 35, 38, 41 and 44 days after transplanting (DAT. The experimental design was complete randomized design (CRD with four replications. Hydroponic and organic systems performed similar in terms of yield, quality and nitrate content of butterhead lettuce. Delaying harvesting can not only increase yield but also can minimize nitrate accumulation and health hazard risk as well. Delay in harvesting stage may result in quality deterioration of lettuce and increased production cost. Thus, a compromise is necessary to consider 41 DAT as the optimum stage to harvest butterhead lettuce with significantly higher reduction of nitrate content in both outer adult leaf blades and young leaves of hydroponic lettuce. Fresh weight, firmness and color of butterhead lettuce at this stage were still acceptable.

  15. Proposal for a new staging system for osteoradionecrosis of the mandible

    NARCIS (Netherlands)

    Karagozoglu, K.H.; Dekker, H.A.; Rietveld, D.; de Bree, R.; Schulten, E.A.J.M.; Kantola, S.; Forouzanfar, T.; van der Waal, I.

    2014-01-01

    A new staging system for osteoradionecrosis of the mandible has been retrospectively applied to a group of 31 patients. In this system clinicoradiographic signs and symptoms are incorporated in a simplified manner. For imaging purposes the use of plain radiographs such as periapical films and

  16. Embryonic staging using a 3D virtual reality system

    NARCIS (Netherlands)

    C.M. Verwoerd-Dikkeboom (Christine); A.H.J. Koning (Anton); P.J. van der Spek (Peter); N. Exalto (Niek); R.P.M. Steegers-Theunissen (Régine)

    2008-01-01

    textabstractBACKGROUND: The aim of this study was to demonstrate that Carnegie Stages could be assigned to embryos visualized with a 3D virtual reality system. METHODS: We analysed 48 3D ultrasound scans of 19 IVF/ICSI pregnancies at 7-10 weeks' gestation. These datasets were visualized as 3D

  17. Two-stage commercial evaluation of engineering systems production projects for high-rise buildings

    Science.gov (United States)

    Bril, Aleksander; Kalinina, Olga; Levina, Anastasia

    2018-03-01

    The paper is devoted to the current and debatable problem of methodology of choosing the effective innovative enterprises for venture financing. A two-stage system of commercial innovation evaluation based on the UNIDO methodology is proposed. Engineering systems account for 25 to 40% of the cost of high-rise residential buildings. This proportion increases with the use of new construction technologies. Analysis of the construction market in Russia showed that the production of internal engineering systems elements based on innovative technologies has a growth trend. The production of simple elements is organized in small enterprises on the basis of new technologies. The most attractive for development is the use of venture financing of small innovative business. To improve the efficiency of these operations, the paper proposes a methodology for a two-stage evaluation of small business development projects. A two-stage system of commercial evaluation of innovative projects allows creating an information base for informed and coordinated decision-making on venture financing of enterprises that produce engineering systems elements for the construction business.

  18. Two-stage commercial evaluation of engineering systems production projects for high-rise buildings

    Directory of Open Access Journals (Sweden)

    Bril Aleksander

    2018-01-01

    Full Text Available The paper is devoted to the current and debatable problem of methodology of choosing the effective innovative enterprises for venture financing. A two-stage system of commercial innovation evaluation based on the UNIDO methodology is proposed. Engineering systems account for 25 to 40% of the cost of high-rise residential buildings. This proportion increases with the use of new construction technologies. Analysis of the construction market in Russia showed that the production of internal engineering systems elements based on innovative technologies has a growth trend. The production of simple elements is organized in small enterprises on the basis of new technologies. The most attractive for development is the use of venture financing of small innovative business. To improve the efficiency of these operations, the paper proposes a methodology for a two-stage evaluation of small business development projects. A two-stage system of commercial evaluation of innovative projects allows creating an information base for informed and coordinated decision-making on venture financing of enterprises that produce engineering systems elements for the construction business.

  19. Failure of aseptic revision total knee arthroplasties.

    Science.gov (United States)

    Leta, Tesfaye H; Lygre, Stein Håkon L; Skredderstuen, Arne; Hallan, Geir; Furnes, Ove

    2015-02-01

    In Norway, the proportion of revision knee arthroplasties increased from 6.9% in 1994 to 8.5% in 2011. However, there is limited information on the epidemiology and causes of subsequent failure of revision knee arthroplasty. We therefore studied survival rate and determined the modes of failure of aseptic revision total knee arthroplasties. This study was based on 1,016 aseptic revision total knee arthroplasties reported to the Norwegian Arthroplasty Register between 1994 and 2011. Revisions done for infections were not included. Kaplan-Meier and Cox regression analyses were used to assess the survival rate and the relative risk of re-revision with all causes of re-revision as endpoint. 145 knees failed after revision total knee arthroplasty. Deep infection was the most frequent cause of re-revision (28%), followed by instability (26%), loose tibial component (17%), and pain (10%). The cumulative survival rate for revision total knee arthroplasties was 85% at 5 years, 78% at 10 years, and 71% at 15 years. Revision total knee arthroplasties with exchange of the femoral or tibial component exclusively had a higher risk of re-revision (RR = 1.7) than those with exchange of the whole prosthesis. The risk of re-revision was higher for men (RR = 2.0) and for patients aged less than 60 years (RR = 1.6). In terms of implant survival, revision of the whole implant was better than revision of 1 component only. Young age and male sex were risk factors for re-revision. Deep infection was the most frequent cause of failure of revision of aseptic total knee arthroplasties.

  20. Preoperative ultrasound staging of the axilla make's peroperative examination of the sentinel node redundant in breast cancer: saving tissue, time and money.

    Science.gov (United States)

    Van Berckelaer, Christophe; Huizing, Manon; Van Goethem, Mireille; Vervaecke, Andrew; Papadimitriou, Konstantinos; Verslegers, Inge; Trinh, Bich X; Van Dam, Peter; Altintas, Sevilay; Van den Wyngaert, Tim; Huyghe, Ivan; Siozopoulou, Vasiliki; Tjalma, Wiebren A A

    2016-11-01

    To evaluate the role of preoperative axillary staging with ultrasound (US) and fine needle aspiration cytology (FNAC). Can we avoid intraoperative sentinel lymph node (SLN) examination, with an acceptable revision rate by preoperative staging? This study is based on the retrospective data of 336 patients that underwent US evaluation of the axilla as part of their staging. A FNAC biopsy was performed when abnormal lymph nodes were visualized. Patients with normal appearing nodes on US or a benign diagnostic biopsy had removal of the SLNs without intraoperative pathological examination. We calculated the sensitivity, specificity and accuracy of US/FNAC in predicting the necessity of an axillary lymphadenectomy. Subsequently we looked at the total cost and the operating time of 3 models. Model A is our study protocol. Model B is a theoretical protocol based on the findings of the Z0011 trial with only clinical preoperative staging and in Model C preoperative staging and intraoperative pathological examination were both theoretically done. sentinel node, staging, ultrasound, preoperative axillary staging, FNAC, axilla RESULTS: The sensitivity, specificity and accuracy are respectively 0.75 (0.66-0.82), 1.00 (0.99-1.00) and 0.92 (0.88-0.94). Only 26 out of 317 (8.2%) patients that successfully underwent staging needed a revision. The total cost of Model A was 1.58% cheaper than Model C and resulted in a decrease in operation time by 9,46%. The benefits compared with Model B were much smaller. Preoperative US/FNAC staging of the axillary lymph nodes can avoid intraoperative examination of the sentinel node with an acceptable revision rate. It saves tissue, reduces operating time and decreases healthcare costs in general. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  1. Closed cooling water chemistry guidelines revision

    International Nuclear Information System (INIS)

    McElrath, Joel; Breckenridge, Richard

    2014-01-01

    This second revision of the Closed Cooling Water Chemistry Guideline addresses the use of chemicals and monitoring methods to mitigate corrosion, fouling, and microbiological growth in the closed cooling-water (CCW) systems of nuclear and fossil-fueled power plants. This revision has been endorsed by the utility chemistry community and represents another step in developing a more proactive chemistry program to limit or control closed cooling system degradation with increased consideration of corporate resources and plant-specific design and operating concerns. These guidelines were developed using laboratory data, operating experience, and input from organizations and utilities within and outside of the United States of America. It is the intent of the Revision Committee that these guidelines are applicable to all nuclear and fossil-fueled generating stations around the world. A committee of industry experts—including utility specialists, Institute of Nuclear Power Operations representatives, water-treatment service-company representatives, consultants, a primary contractor, and EPRI staff—collaborated in reviewing available data on closed cooling-water system corrosion and microbiological issues. Recognizing that each plant owner has a unique set of design, operating, and corporate concerns, the Guidelines Committee developed a methodology for plant-specific optimization. The guideline provides the technical basis for a reasonable but conservative set of chemical treatment and monitoring programs. The use of operating ranges for the various treatment chemicals discussed in this guideline will allow a power plant to limit corrosion, fouling, and microbiological growth in CCW systems to acceptable levels. The guideline now includes closed cooling chemistry regimes proven successful in use in the international community. The guideline provides chemistry constraints for the use of phosphates control, as well as pure water with pH control. (author)

  2. Biomechanical evaluation of tibial bone adaptation after revision total knee arthroplasty: A comparison of different implant systems.

    Directory of Open Access Journals (Sweden)

    María Paz Quilez

    Full Text Available The best methods to manage tibial bone defects following total knee arthroplasty remain under debate. Different fixation systems exist to help surgeons reconstruct knee osseous bone loss (such as tantalum cones, cement, modular metal augments, autografts, allografts and porous metaphyseal sleeves However, the effects of the various solutions on the long-term outcome remain unknown. In the present work, a bone remodeling mathematical model was used to predict bone remodeling after total knee arthroplasty (TKA revision. Five different types of prostheses were analyzed: one with a straight stem; two with offset stems, with and without supplements; and two with sleeves, with and without stems. Alterations in tibia bone density distribution and implant Von Mises stresses were quantified. In all cases, the bone density decreased in the proximal epiphysis and medullary channels, and an increase in bone density was predicted in the diaphysis and around stem tips. The highest bone resorption was predicted for the offset prosthesis without the supplement, and the highest bone formation was computed for the straight stem. The highest Von Mises stress was obtained for the straight tibial stem, and the lowest was observed for the stemless metaphyseal sleeves prosthesis. The computational model predicted different behaviors among the five systems. We were able to demonstrate the importance of choosing an adequate revision system and that in silico models may help surgeons choose patient-specific treatments.

  3. Validation of the Mayo Clinic Staging System in Determining Prognoses of Patients With Perihilar Cholangiocarcinoma

    NARCIS (Netherlands)

    Coelen, Robert J. S.; Gaspersz, Marcia P.; Labeur, Tim A.; van Vugt, Jeroen L. A.; van Dieren, Susan; Willemssen, François E. J. A.; Nio, Chung Y.; Ijzermans, Jan N. M.; Klümpen, Heinz-Josef; Groot Koerkamp, Bas; van Gulik, Thomas M.

    2017-01-01

    BACKGROUND & AIMS: Most systems for staging perihilar cholangiocarcinoma (PHC) have been developed for the minority of patients with resectable disease. The recently developed Mayo Clinic system for staging PHC requires only clinical and radiologic variables, but has not yet been validated. We

  4. 75 FR 44144 - Washington: Final Authorization of State Hazardous Waste Management Program Revisions

    Science.gov (United States)

    2010-07-28

    ...)(c)(ix)(K), 400(3)(c)(ix)(L), 400(3)(c)(x), 400(3)(c)(xi)(A), 400(3)(c)(xii)(B), 400(3)(a)(xiii), 400.... definition--Upda ted to match Federal rule. 040 Staging Pile 260.10. definition--Upda ted to match Federal... test methods to latest revision date. 110(3)(g)(x) Duplicate deleted 260.11(15). [see 110(3)(g)(vii...

  5. 77 FR 9515 - List of Approved Spent Fuel Storage Casks: HI-STORM 100, Revision 8

    Science.gov (United States)

    2012-02-17

    ... Storage Casks: HI-STORM 100, Revision 8 AGENCY: Nuclear Regulatory Commission. ACTION: Direct final rule... regulations by revising the Holtec International HI-STORM 100 dry cask storage system listing within the... and safety will be adequately protected. This direct final rule revises the HI-STORM 100 listing in 10...

  6. Staging for vulvar cancer.

    Science.gov (United States)

    Hacker, Neville F; Barlow, Ellen L

    2015-08-01

    Vulvar cancer has been staged by the International Federation of Gynaecology and Obstetrics (FIGO) since 1969, and the original staging system was based on clinical findings only. This system provided a very good spread of prognostic groupings. Because vulvar cancer is virtually always treated surgically, the status of the lymph nodes is the most important prognostic factor and this can only be determined with certainty by histological examination of resected lymph nodes, FIGO introduced a surgical staging system in 1988. This was modified in 1994 to include a category of microinvasive vulvar cancer (stage IA), because such patients have virtually no risk of lymph node metastases. This system did not give a reasonably even spread of prognostic groupings. In addition, patients with stage III disease were shown to be a heterogeneous group prognostically, and the number of positive nodes and the morphology of those nodes were not taken into account. A new surgical staging system for vulvar cancer was introduced by FIGO in 2009. Initial retrospective analyses have suggested that this new staging system has overcome the major deficiencies in the 1994 system. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  7. Development and applications of a two-dimensional tip-tilting stage system with nanoradian-level positioning resolution

    Energy Technology Data Exchange (ETDEWEB)

    Shu Deming, E-mail: shu@aps.anl.gov [Advanced Photon Source, Argonne National Laboratory, Argonne, IL 60439 (United States); Lee, Wah-Keat; Liu, Wenjun [Advanced Photon Source, Argonne National Laboratory, Argonne, IL 60439 (United States); Ice, Gene E. [MST Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831-6132 (United States); Shvyd' ko, Yuri; Kim, Kwang-Je [Advanced Photon Source, Argonne National Laboratory, Argonne, IL 60439 (United States)

    2011-09-01

    In this paper, designs of a novel rotary weak-link stage for a vertical rotation axis and a two-dimensional tip-tilting system are presented. Applications of these new stage systems include: an advanced X-ray stereo imaging instrument for particle tracking velocimetry, an alignment stage system for hard X-ray nano-focusing Montel mirror optics, and an ultra-precision crystal manipulator for cryo-cooling optical cavities of an X-ray free-electron-laser oscillator (XFELO).

  8. Application of two-stage biofilter system for the removal of odorous compounds.

    Science.gov (United States)

    Jeong, Gwi-Taek; Park, Don-Hee; Lee, Gwang-Yeon; Cha, Jin-Myeong

    2006-01-01

    Biofiltration is a biological process which is considered to be one of the more successful examples of biotechnological applications to environmental engineering, and is most commonly used in the removal of odoriferous compounds. In this study, we have attempted to assess the efficiency with which both single and complex odoriferous compounds could be removed, using one- or two-stage biofiltration systems. The tested single odor gases, limonene, alpha-pinene, and iso-butyl alcohol, were separately evaluated in the biofilters. Both limonene and alpha-pinene were removed by 90% or more EC (elimination capacity), 364 g/m3/h and 321 g/m3/h, respectively, at an input concentration of 50 ppm and a retention time of 30 s. The iso-butyl alcohol was maintained with an effective removal yield of more than 90% (EC 375 g/m3/h) at an input concentration of 100 ppm. The complex gas removal scheme was applied with a 200 ppm inlet concentration of ethanol, 70 ppm of acetaldehyde, and 70 ppm of toluene with residence time of 45 s in a one- or two-stage biofiltration system. The removal yield of toluene was determined to be lower than that of the other gases in the one-stage biofilter. Otherwise, the complex gases were sufficiently eliminated by the two-stage biofiltration system.

  9. {sup 18}F-FDG-PET/CT for systemic staging of newly diagnosed triple-negative breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ulaner, Gary A.; Castillo, Raychel; Riedl, Christopher C.; Jochelson, Maxine S. [Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY (United States); Weill Cornell Medical College, Department of Radiology, New York, NY (United States); Goldman, Debra A.; Goenen, Mithat [Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, New York, NY (United States); Wills, Jonathan [Memorial Sloan Kettering Cancer Center, Department of Information Systems, New York, NY (United States); Pinker-Domenig, Katja [Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY (United States)

    2016-10-15

    National Comprehensive Cancer Network guidelines recommend {sup 18}F-FDG-PET/CT, in addition to standard staging procedures, for systemic staging of newly diagnosed stage III breast cancer patients. However, factors in addition to stage may influence PET/CT utility. As breast cancers that are negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor (triple-negative breast cancer, or TNBC) are more aggressive and metastasize earlier than other breast cancers, we hypothesized that receptor expression may be one such factor. This study assesses {sup 18}F-FDG-PET/CT for systemic staging of newly diagnosed TNBC. In this Institutional Review Board-approved retrospective study, our Healthcare Information System was screened for patients with TNBC who underwent {sup 18}F-FDG-PET/CT in 2007-2013 prior to systemic or radiation therapy. Initial stage was determined from mammography, ultrasound, magnetic resonance imaging, and/or surgery, if performed prior to {sup 18}F-FDG-PET/CT. {sup 18}F-FDG-PET/CT was evaluated to identify unsuspected extra-axillary regional nodal and distant metastases, as well as unsuspected synchronous malignancies. Kaplan Meier survival estimates were calculated for initial stage IIB patients stratified by whether or not stage 4 disease was detected by {sup 18}F-FDG-PET/CT. A total of 232 patients with TNBC met inclusion criteria. {sup 18}F-FDG-PET/CT revealed unsuspected distant metastases in 30 (13 %): 0/23 initial stage I, 4/82 (5 %) stage IIA, 13/87 (15 %) stage IIB, 4/23 (17 %) stage IIIA, 8/14 (57 %) stage IIIB, and 1/3 (33 %) stage IIIC. Twenty-six of 30 patients upstaged to IV by {sup 18}F-FDG-PET/CT were confirmed by pathology, with the remaining four patients confirmed by follow-up imaging. In addition, seven unsuspected synchronous malignancies were identified in six patients. Initial stage 2B patients who were upstaged to 4 by {sup 18}F-FDG-PET/CT had significantly shorter survival compared to

  10. Mixed adenosquamous histology is associated with poorer survival of cervical cancer stage 1b

    DEFF Research Database (Denmark)

    Lauszus, Finn; Tjessem, Ingvild; Al-Far, Hanine M

    2016-01-01

    Background: Evaluation of histopathological factors for women with radical hysterectomy a.m. Okabayashi for cervical cancer in stage 1bwith similar pre- and postoperative treatment Methods: Data on 141 women with cervical cancer stage 1b were revised. The local patient registry, data charts...... and adenomatous type (pmixed versus pure type). Five year’s survival rate was 40 % (2-78 %) for mixed type and 92 % (87-97 %) for pure type. The mixed type was associated with glandular metastasis (p

  11. Method and system for dual resolution translation stage

    Science.gov (United States)

    Halpin, John Michael

    2014-04-22

    A dual resolution translation stage includes a stage assembly operable to receive an optical element and a low resolution adjustment device mechanically coupled to the stage assembly. The dual resolution stage also includes an adjustable pivot block mechanically coupled to the stage assembly. The adjustable pivot block includes a pivot shaft. The dual resolution stage further includes a lever arm mechanically coupled to the adjustable pivot block. The lever arm is operable to pivot about the pivot shaft. The dual resolution stage additionally includes a high resolution adjustment device mechanically coupled to the lever arm and the stage assembly.

  12. Bibliocable. Revised Edition.

    Science.gov (United States)

    Cable Television Information Center, Washington, DC.

    This selective, annotated bibliography is a revision of the original published in 1972 (ED 071 402). Some 104 books, articles, and reports included here deal with access, applications, franchising, regulation, technology, and other aspects of cable television. The listings are of two types in each category. First are revisions of the original…

  13. Draft revision of human factors guideline HF-010

    International Nuclear Information System (INIS)

    Lee, Hyun Chul; Lee, Yong Hee; Oh, In Seok; Lee, Jung Woon; Cha, Woo Chang; Lee, Dhong Ha

    2003-05-01

    The Application of Human Factors to the design of Man-Machine Interfaces System(MMIS) in the nuclear power plant is essential to the safety and productivity of the nuclear power plants, human factors standards and guidelines as well as human factors analysis methods and experiments are weightily used to the design application. A Korean engineering company has developed a human factors engineering guideline, so-call HF-010, and has used it for human factors design, however the revision of HF-010 is necessary owing to lack of the contents related to the advanced MMI(Man-Machine Interfaces). As the results of the reviews of HF-010, it is found out that the revision of Section 9. Computer Displays of HF-010 is urgent, thus the revision was drafted on the basis of integrated human factors design guidelines for VDT, human factors design guidelines for PMAS SPADES display, human factors design guidelines for PMAS alarm display, and human factors design guidelines for electronic displays developed by the surveillance and operation support project of KOICS. The draft revision of HF-010 Section 9 proposed in this report can be utilized for the human factors design of the advanced MMI, and the high practical usability of the draft can be kept up through the continuous revision according to the advancement of digital technology

  14. The Birth Satisfaction Scale-Revised Indicator (BSS-RI).

    Science.gov (United States)

    Martin, Colin R; Hollins Martin, Caroline; Redshaw, Maggie

    2017-08-29

    The current study sought to develop a short birth satisfaction indicator utilising items from the Birth Satisfaction Scale-Revised (BSS-R) for use as a brief measure of birth satisfaction and as a possible key performance indicator for perinatal service delivery evaluation. Building on the recently developed BSS-R, the study aimed to develop a simplified version of the instrument to assess birth satisfaction easily that could work as a short evaluative measure of clinical service delivery for labour and birth that is consistent with policy documents, placing women at the centre of the birth experience. The six item Birth Satisfaction Scale-Revised Indicator (BSS-RI) was embedded within the 2014 National Maternity Survey for England. A random selection of mothers who had given birth in a two week period in England were surveyed three months after the birth. Using a two-stage design and split-half dataset, exploratory factor analysis, confirmatory factor analysis, internal consistency, convergent, divergent and known-groups discriminant validity evaluation were conducted in a secondary analysis of the survey data. Using this large population based survey of recent mothers the short revised measure was found to comprise two distinct domains of birth satisfaction, 'stress and emotional response to labour and birth' and 'quality of care'. The psychometric qualities of the tool were robust as were the indices of validity and reliability evaluated. The BSS-RI represents a short easily administered and scored measure of women's satisfaction with care and the experience of labour and birth. The instrument is potentially useful for researchers, service evaluation and policy makers.

  15. Performance study of a heat pump driven and hollow fiber membrane-based two-stage liquid desiccant air dehumidification system

    International Nuclear Information System (INIS)

    Zhang, Ning; Yin, Shao-You; Zhang, Li-Zhi

    2016-01-01

    Graphical abstract: A heat pump driven, hollow fiber membrane-based two-stage liquid desiccant air dehumidification system. - Highlights: • A two-stage hollow fiber membrane based air dehumidification is proposed. • It is heat pump driven liquid desiccant system. • Performance is improved 20% upon single stage system. • The optimal first to second stage dehumidification area ratio is 1.4. - Abstract: A novel compression heat pump driven and hollow fiber membrane-based two-stage liquid desiccant air dehumidification system is presented. The liquid desiccant droplets are prevented from crossing over into the process air by the semi-permeable membranes. The isoenthalpic processes are changed to quasi-isothermal processes by the two-stage dehumidification processes. The system is set up and a model is proposed for simulation. Heat and mass capacities in the system, including the membrane modules, the condenser, the evaporator and the heat exchangers are modeled in detail. The model is also validated experimentally. Compared with a single-stage dehumidification system, the two-stage system has a lower solution concentration exiting from the dehumidifier and a lower condensing temperature. Thus, a better thermodynamic system performance is realized and the COP can be increased by about 20% under the typical hot and humid conditions in Southern China. The allocations of heat and mass transfer areas in the system are also investigated. It is found that the optimal regeneration to dehumidification area ratio is 1.33. The optimal first to second stage dehumidification area ratio is 1.4; and the optimal first to second stage regeneration area ratio is 1.286.

  16. Nitrogen removal and microbial communities in a three-stage system simulating a riparian environment.

    Science.gov (United States)

    Wang, Ziyuan; Wang, Zhixin; Pei, Yuansheng

    2014-06-01

    The riparian zone is an active interface for nitrogen removal, in which nitrogen transformations by microorganisms have not been valued. In this study, a three-stage system was constructed to simulate the riparian zone environments, and nitrogen removal as well as the microbial community was investigated in this 'engineered riparian system'. The results demonstrated that stage 1 of this system accounted for 41-51 % of total nitrogen removal. Initial ammonium loading and redox potential significantly impacted the nitrogen removal performances. Stages 1 and 2 were both composed of an anoxic/oxic (A/O) zone and an anaerobic column. The A/O zone removed most of the ammonium load (6.8 g/m(2)/day), while the anaerobic column showed a significant nitrate removal rate (11.1 g/m(2)/day). Molecular biological analysis demonstrated that bacterial diversity was high in the A/O zones, where ammonium-oxidizing bacteria and nitrite-oxidizing bacteria accounted for 8.42 and 3.32 % of the bacterial population, respectively. The denitrifying bacteria Acidovorax sp. and the nitrifying bacteria Nitrosospira/Nitrosomonas were the predominant microorganisms in this engineered riparian system. This three-stage system was established to achieve favorable nitrogen removal and the microbial community in the system was also retained. This investigation should deepen our understanding of biological nitrogen removal in engineered riparian zones.

  17. STAGES : a system for generating strategic alternatives for forest management

    NARCIS (Netherlands)

    Bos, J.

    1994-01-01

    Strategic planning is important in forest management. However, it has never been described clearly in literature. In this study a framework for strategic planning was developed and based on this a STrategic Alternatives Generating System (STAGES) to support decision making in strategic

  18. Review of revised Japanese seismic guidelines for Nuclear Power Plant design

    International Nuclear Information System (INIS)

    Kato, M.

    1987-01-01

    Development of aseismic design for nuclear power plants in Japan has evolved roughly in three stages. The first phase, which continued by 1978, was a period progressive development when design for each siteplant has referred to designs of predecessor plants and have added the latest knowledge and experience in that time. The second phase from issuance of 'Regulatory Guide for Aseismic Design of Nuclear Power Reactor Facilities' (1978, revised in 1981), or 1978 to 1986, was a period when the application of customary conservative design method was continued, while standardization of the aseismic design technology have been proceded. It is in this phase when new knowledge was accumulated by aseismic proof studies. The third phase represents a transient period to rational design when the conservative aseismic design technology has been reviewed due to the new knowledge and revision of the above JEAG guideline has progressed for incorporation in design, and ont the other hand by-laws of the Ministry of International Trade and Industry are being provided. In this report a review is given of aseismic design and its guideline after the second phase onward and an overview of the revised JEAG - Recent Aseismic Design Method - and the by-laws including rationalization of aseismic design technology

  19. Human respiratory tract model for radiological protection: A revision of the ICRP Dosimetric Model for the Respiratory System

    International Nuclear Information System (INIS)

    Bair, W.J.

    1989-01-01

    In 1984, the International Commission on Radiological Protection (ICRP) appointed a task group of Committee 2 to review and revise, as necessary, the ICRP Dosimetric Model for the Respiratory System. The model was originally published in 1966, modified slightly in Publication No. 19, and again in Publication No. 30 (in 1979). The task group concluded that research during the past 20 y suggested certain deficiencies in the ICRP Dosimetric Model for the Respiratory System. Research has also provided sufficient information for a revision of the model. The task group's approach has been to review, in depth, morphology and physiology of the respiratory tract; deposition of inhaled particles in the respiratory tract; clearance of deposited materials; and the nature and specific sites of damage to the respiratory tract caused by inhaled radioactive substances. This review has led to a redefinition of the regions of the respiratory tract for dosimetric purposes. The redefinition has a morphologic and physiological basis and is consistent with observed deposition and clearance of particles and with resultant pathology. Regions, as revised, are the extrathoracic (E-T) region, comprising the nasal and oral regions, the pharynx, larynx, and upper part of the trachea; the fast-clearing thoracic region (T[f]), comprising the remainder of the trachea and bronchi; and the slow-clearing thoracic region (T[s]), comprising the bronchioles, alveoli, and thoracic lymph nodes. A task group report will include models for calculating radiation doses to these regions of the respiratory tract following inhalation of representative alpha-, beta-, and gamma-emitting particulate and gaseous radionuclides. The models may be implemented as a package of computer codes available to a wide range of users

  20. Polarized proton Target-III operators manual, revision A

    International Nuclear Information System (INIS)

    Hill, D.; Moretti, A.; Onesto, F.; Rynes, P.

    1976-04-01

    A revision is given of a manual containing standard operating procedures for the vacuum, cryogenic, and electronic systems of a polarized proton target. The discussion includes the target cryostat, the 3 He and 4 He pumping systems, remote monitors and controls, the microwave system, the magnet and power supply, the computerized polarization monitor, the 4 He liquifier and gas recovery system, and miscellaneous auxiliary equipment

  1. The development and revision of the Federal Radiological Emergency Response Plan

    International Nuclear Information System (INIS)

    Gant, K.S.; Adler, M.V.; Wolff, W.F.

    1989-01-01

    Since 1985, federal agencies have been using the Federal Radiological Emergency Response Plan (FRERP) in exercises and real events. This experience and the development of other emergency response guidance (e.g., National System for Emergency Coordination) are fueling current efforts to review and revise the FRERP to reflect what the agencies have learned since the FRERP was published. Revision efforts are concentrating on clarifying the plan and addressing deficiencies. No major changes are expected in the general structure of the federal response nor should states need to revise their plans because of these modifications. 5 refs

  2. Scout fourth stage attitude and velocity control (AVC) system feasibility study

    Science.gov (United States)

    Byars, L. B.

    1975-01-01

    The feasibility of incorporating a guidance system in the Scout fourth stage to achieve a significant improvement in expected payload delivery accuracy is studied. The technical investigations included the determination of the AVC equipment performance requirements, establishment of qualification and acceptance test levels, generation of layouts illustrating design approaches for the upper D and payload transition sections to incorporate the hardware, and the preparation of a vendor bid package. Correction concepts, utilizing inertial velocity and attitude, were identified and evaluated. Fourth stage attitude adjustments as determined from inertial velocity variation through the first three stages and a final velocity correction based upon the measured in-plane component errors at injection were employed. Results show radical reductions in apogee-perigee deviations.

  3. A comparative study on assessment procedures and metric properties of two scoring systems of the Coma Recovery Scale-Revised items: standard and modified scores.

    Science.gov (United States)

    Sattin, Davide; Lovaglio, Piergiorgio; Brenna, Greta; Covelli, Venusia; Rossi Sebastiano, Davide; Duran, Dunja; Minati, Ludovico; Giovannetti, Ambra Mara; Rosazza, Cristina; Bersano, Anna; Nigri, Anna; Ferraro, Stefania; Leonardi, Matilde

    2017-09-01

    The study compared the metric characteristics (discriminant capacity and factorial structure) of two different methods for scoring the items of the Coma Recovery Scale-Revised and it analysed scale scores collected using the standard assessment procedure and a new proposed method. Cross sectional design/methodological study. Inpatient, neurological unit. A total of 153 patients with disorders of consciousness were consecutively enrolled between 2011 and 2013. All patients were assessed with the Coma Recovery Scale-Revised using standard (rater 1) and inverted (rater 2) procedures. Coma Recovery Scale-Revised score, number of cognitive and reflex behaviours and diagnosis. Regarding patient assessment, rater 1 using standard and rater 2 using inverted procedures obtained the same best scores for each subscale of the Coma Recovery Scale-Revised for all patients, so no clinical (and statistical) difference was found between the two procedures. In 11 patients (7.7%), rater 2 noted that some Coma Recovery Scale-Revised codified behavioural responses were not found during assessment, although higher response categories were present. A total of 51 (36%) patients presented the same Coma Recovery Scale-Revised scores of 7 or 8 using a standard score, whereas no overlap was found using the modified score. Unidimensionality was confirmed for both score systems. The Coma Recovery Scale Modified Score showed a higher discriminant capacity than the standard score and a monofactorial structure was also supported. The inverted assessment procedure could be a useful evaluation method for the assessment of patients with disorder of consciousness diagnosis.

  4. Pre-defined and optional staging for the deployment of enterprise systems: a case study and a framework

    Science.gov (United States)

    Lichtenstein, Yossi; Cucuy, Shy; Fink, Lior

    2017-03-01

    The effective deployment of enterprise systems has been a major challenge for many organisations. Customising the new system, changing business processes, and integrating multiple information sources are all difficult tasks. As such, they are typically done in carefully planned stages in a process known as phased implementation. Using ideas from Option Theory, this article critiques aspects of phased implementation. One customer relationship management (CRM) project and its phased implementation are described in detail and ten other enterprise system deployments are summarised as a basis for the observation that almost all deployment stages are pre-defined operational steps rather than decision points. However, Option Theory suggests that optional stages, to be used only when risk materialises, should be integral parts of project plans. Although such optional stages are often more valuable than pre-defined stages, the evidence presented in this article shows that they are only rarely utilised. Therefore, a simple framework is presented; it first identifies risks related to the deployment of enterprise systems, then identifies optional stages that can mitigate these risks, and finally compares the costs and benefits of both pre-defined and optional stages.

  5. Evolution of International Space Station GN&C System Across ISS Assembly Stages

    Science.gov (United States)

    Lee, Roscoe; Frank, K. D. (Technical Monitor)

    1999-01-01

    The Guidance Navigation and Control (GN&C) system for the International Space Station is initially implemented by the Functional Cargo Block (FGB) which was built by the Khrunichev Space Center under direct contract to Boeing. This element (Stage 1A/R) was launched on 20 November 1998 and is currently operating on-orbit. The components and capabilities of the FGB Motion Control System (MCS) are described. The next ISS element, which has GN&C functionality will be the Service Module (SM) built by Rocket Space Corporation-Energia. This module is scheduled for launch (Stage 1R) in early 2000. Following activation of the SM GN&C system, the FGB MCS is deactivated and no longer used. The components and capabilities of the SM GN&C system are described. When a Progress vehicle is attached to the ISS it can be used for reboost operations, based on commands provided by the Mission Control Center-Moscow. When a data connection is implemented between the SM and the Progress, the SM can command the Progress thrusters for attitude control and reboosts. On Stage 5A, the U.S. GN&C system will become activated when the U.S. Laboratory is de loyed and installed (launch schedule is currently TBD). The U.S. GN&C system provides non-propulsive control capabilities to support micro-gravity operations and minimize the use of propellant for attitude control, and an independent capability for determining the ISS state vector, attitude, attitude rate. and time.. The components and capabilities of the U.S. GN&C system are described and the interactions between the U.S. and Russian Segment GN&C systems are also described.

  6. Buccal mucosal urethroplasty for balanitis xerotica obliterans related urethral strictures: the outcome of 1 and 2-stage techniques.

    Science.gov (United States)

    Dubey, Deepak; Sehgal, Anand; Srivastava, Aneesh; Mandhani, Anil; Kapoor, Rakesh; Kumar, Anant

    2005-02-01

    Balanitis xerotica obliterans (BXO) related strictures are complex and generally managed by 2-staged urethroplasty. We present our results with 1-stage dorsal onlay and 2-stage buccal mucosal urethroplasty for such strictures. Between January 2000 and April 2004, 39 patients underwent buccal mucosal urethroplasty for BXO related anterior urethral strictures. The 25 patients with a salvageable urethral plate (group 1) were treated with 1-stage dorsal onlay urethroplasty using a cosmetic incision. The 14 patients with a severely scarred urethral plate, focally dense segments or active infection (group 2) underwent 2-stage urethroplasty. Outcomes in terms of cosmetic appearance, stricture recurrence and complications in the 2 groups were assessed. At a mean followup of 32.5 months (range 3 to 52) 3 patients (12%) in group 1 had recurrent stricture, of which 2 and 1 were treated with optical urethrotomy and urethral dilation, respectively. All patients had a normal slit-like meatus and none had chordee or erectile dysfunction. Four group 2 patients (28.6%) required stomal revision and 2 had glans cleft narrowing after stage 1 urethroplasty. Following stage 2, 3 patients had recurrent stricture, of whom 2 were treated with optical urethrotomy and 1 underwent repeat urethroplasty. In BXO related strictures with a viable urethral plate 1-stage dorsal onlay buccal mucosal urethroplasty provides excellent intermediate term results. The cosmetic incision described provides a normal, wide caliber, slit-like glans. Two-stage procedures provide satisfactory outcomes but they are associated with a higher revision rate.

  7. Guidance document for revision of DOE Order 5820.2A, Radioactive Waste Technical Support Program. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Kudera, D.E.; McMurtrey, C.D.; Meagher, B.G.

    1993-04-01

    This document provides guidance for the revision of DOE Order 5820.2A, ``Radioactive Waste Management.`` Technical Working Groups have been established and are responsible for writing the revised order. The Technical Working Groups will use this document as a reference for polices and procedures that have been established for the revision process. The overall intent of this guidance is to outline how the order will be revised and how the revision process will be managed. In addition, this document outlines technical issues considered for inclusion by a Department of Energy Steering Committee.

  8. System-level Reliability Assessment of Power Stage in Fuel Cell Application

    DEFF Research Database (Denmark)

    Zhou, Dao; Wang, Huai; Blaabjerg, Frede

    2016-01-01

    reliability. In a case study of a 5 kW fuel cell power stage, the parameter variations of the lifetime model prove that the exponential factor of the junction temperature fluctuation is the most sensitive parameter. Besides, if a 5-out-of-6 redundancy is used, it is concluded both the B10 and the B1 system......High efficient and less pollutant fuel cell stacks are emerging and strong candidates of the power solution used for mobile base stations. In the application of the backup power, the availability and reliability hold the highest priority. This paper considers the reliability metrics from...... the component-level to the system-level for the power stage used in a fuel cell application. It starts with an estimation of the annual accumulated damage for the key power electronic components according to the real mission profile of the fuel cell system. Then, considering the parameter variations in both...

  9. Dynamic multi-stage dispatch of isolated wind–diesel power systems

    DEFF Research Database (Denmark)

    Hu, Yu; Morales González, Juan Miguel; Pineda, Salvador

    2015-01-01

    -stage decision-making model is proposed to determine the diesel power output that minimizes the cost of running and maintaining the wind–diesel power system. Optimized operational decisions for each time period are generated dynamically considering the path-dependent nature of the optimal dispatch policy, given......An optimal dispatch strategy is crucial for an isolated wind–diesel power system to save diesel fuel and maintain the system stability. The uncertainty associated with the stochastic character of the wind is, though, a challenging problem for this optimization. In this paper, a dynamic multi...

  10. Comparing Cultural Differences in Two Quality Measures in Chinese Kindergartens: The Early Childhood Environment Rating Scale-Revised and the Kindergarten Quality Rating System

    Science.gov (United States)

    Hu, Bi Ying

    2015-01-01

    This study examined the degrees of congruence between two early childhood evaluation systems on various quality concepts: the Early Childhood Environment Rating Scale-Revised (ECERS-R) and Zhejiang's Kindergarten Quality Rating System (KQRS). Analysis of variance and post hoc least significant difference tests were employed to show the extent to…

  11. New J-STAGE system accelerates digitization and distribution of academic journals from Japan

    Science.gov (United States)

    Sato, Ryuichi; Kubota, Soichi; Aoyama, Kota; Tsuchiya, Eri; Miyagawa, Yoshiyuki

    13 years have passed since J-STAGE was launched. At present no one could deny that its user interface and functions were already out of date comparing to foreign established e-journals. So JST has developed a new system called “J-STAGE3” in order to offer better usability and give powerful dissemination of academic papers from Japan. As the result of it, they will be able to enjoy the following things: 1) integration of two databases, Journal@rchive and J-STAGE, 2) new design/interface, 3) introduction of international standard XML format, 4) advanced subscription management, 5) saving cost of publishers, and 6) improving J-STAGE online submission and review system. At the end of March 2011, we conducted a market research on current status of digitization on Japanese society journals. The report told us that digitization ratio of those was 62% in total but it was 34% in humanities/social sciences. Or it was 92% in English journals and 55% in Japanese ones. It means that we need further promotion of digitization. In this paper, we discuss functions and direction of J-STAGE3 as well as our role in promotion of digitization of Japanese society journals.

  12. Cancer of the Esophagus and Esophagogastric Junction: An Eighth Edition Staging Primer

    Science.gov (United States)

    Rice, Thomas W.; Ishwaran, Hemant; Ferguson, Mark K.; Blackstone, Eugene H.; Goldstraw, Peter

    2017-01-01

    This primer for eighth edition staging of esophageal and esophagogastric epithelial cancers presents separate classifications for the clinical (cTNM), pathologic (pTNM), and postneoadjuvant pathologic (ypTNM) stage groups, which are no longer shared. For pTNM, pT1 has been subcategorized as pT1a and pT1b for the subgrouping pStage I adenocarcinoma and squamous cell carcinoma. A new, simplified esophagus-specific regional lymph node map has been introduced. Undifferentiated histologic grade (G4) has been eliminated; additional analysis is required to expose histopathologic cell type. Location has been removed as a category for pT2N0M0 squamous cell cancer. The definition of the esophagogastric junction has been revised. ypTNM stage groups are identical for both histopathologic cell types, unlike those for cTNM and pTNM. PMID:27810391

  13. Adaptive kanban control mechanism for a single-stage hybrid system

    Science.gov (United States)

    Korugan, Aybek; Gupta, Surendra M.

    2002-02-01

    In this paper, we consider a hybrid manufacturing system with two discrete production lines. Here the output of either production line can satisfy the demand for the same type of product without any penalties. The interarrival times for demand occurrences and service completions are exponentially distributed i.i.d. variables. In order to control this type of manufacturing system we suggest a single stage pull type control mechanism with adaptive kanbans and state independent routing of the production information.

  14. Statistical Methods and Tools for Hanford Staged Feed Tank Sampling

    Energy Technology Data Exchange (ETDEWEB)

    Fountain, Matthew S. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Brigantic, Robert T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Peterson, Reid A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2013-10-01

    This report summarizes work conducted by Pacific Northwest National Laboratory to technically evaluate the current approach to staged feed sampling of high-level waste (HLW) sludge to meet waste acceptance criteria (WAC) for transfer from tank farms to the Hanford Waste Treatment and Immobilization Plant (WTP). The current sampling and analysis approach is detailed in the document titled Initial Data Quality Objectives for WTP Feed Acceptance Criteria, 24590-WTP-RPT-MGT-11-014, Revision 0 (Arakali et al. 2011). The goal of this current work is to evaluate and provide recommendations to support a defensible, technical and statistical basis for the staged feed sampling approach that meets WAC data quality objectives (DQOs).

  15. A Sensorless Power Reserve Control Strategy for Two-Stage Grid-Connected PV Systems

    DEFF Research Database (Denmark)

    Sangwongwanich, Ariya; Yang, Yongheng; Blaabjerg, Frede

    2017-01-01

    Due to the still increasing penetration of grid-connected Photovoltaic (PV) systems, advanced active power control functionalities have been introduced in grid regulations. A power reserve control, where namely the active power from the PV panels is reserved during operation, is required for grid...... support. In this paper, a cost-effective solution to realize the power reserve for two-stage grid-connected PV systems is proposed. The proposed solution routinely employs a Maximum Power Point Tracking (MPPT) control to estimate the available PV power and a Constant Power Generation (CPG) control...... performed on a 3-kW two-stage single-phase grid-connected PV system, where the power reserve control is achieved upon demands....

  16. New current control based MPPT technique for single stage grid connected PV systems

    International Nuclear Information System (INIS)

    Jain, Sachin; Agarwal, Vivek

    2007-01-01

    This paper presents a new maximum power point tracking algorithm based on current control for a single stage grid connected photovoltaic system. The main advantage of this algorithm comes from its ability to predict the approximate amplitude of the reference current waveform or power that can be derived from the PV array with the help of an intermediate variable β. A variable step size for the change in reference amplitude during initial tracking helps in fast tracking. It is observed that if the reference current amplitude is greater than the array capacity, the system gets unstable (i.e. moves into the positive slope region of the p-v characteristics of the array). The proposed algorithm prevents the PV system from entering the positive slope region of the p-v characteristics. It is also capable of restoring stability if the system goes unstable due to a sudden environmental change. The proposed algorithm has been tested on a new single stage grid connected PV configuration recently developed by the authors to feed sinusoidal current into the grid. The system is operated in a continuous conduction mode to realize advantages such as low device current stress, high efficiency and low EMI. A fast MPPT tracker with single stage inverter topology operating in CCM makes the overall system highly efficient. Specific cases of the system, operating in just discontinuous current mode and discontinuous current mode and their relative merits and demerits are also discussed

  17. Optimisation of Refrigeration System with Two-Stage and Intercooler Using Fuzzy Logic and Genetic Algorithm

    Directory of Open Access Journals (Sweden)

    Bayram Kılıç

    2017-04-01

    Full Text Available Two-stage compression operation prevents excessive compressor outlet pressure and temperature and this operation provides more efficient working condition in low-temperature refrigeration applications. Vapor compression refrigeration system with two-stage and intercooler is very good solution for low-temperature refrigeration applications. In this study, refrigeration system with two-stage and intercooler were optimized using fuzzy logic and genetic algorithm. The necessary thermodynamic characteristics for optimization were estimated with Fuzzy Logic and liquid phase enthalpy, vapour phase enthalpy, liquid phase entropy, vapour phase entropy values were compared with actual values. As a result, optimum working condition of system was estimated by the Genetic Algorithm as -6.0449 oC for evaporator temperature, 25.0115 oC for condenser temperature and 5.9666 for COP. Morever, irreversibility values of the refrigeration system are calculated.

  18. Selection of a computer code for Hanford low-level waste engineered-system performance assessment. Revision 1

    International Nuclear Information System (INIS)

    McGrail, B.P.; Bacon, D.H.

    1998-02-01

    Planned performance assessments for the proposed disposal of low-activity waste (LAW) glass produced from remediation of wastes stored in underground tanks at Hanford, Washington will require calculations of radionuclide release rates from the subsurface disposal facility. These calculations will be done with the aid of computer codes. The available computer codes with suitable capabilities at the time Revision 0 of this document was prepared were ranked in terms of the feature sets implemented in the code that match a set of physical, chemical, numerical, and functional capabilities needed to assess release rates from the engineered system. The needed capabilities were identified from an analysis of the important physical and chemical processes expected to affect LAW glass corrosion and the mobility of radionuclides. This analysis was repeated in this report but updated to include additional processes that have been found to be important since Revision 0 was issued and to include additional codes that have been released. The highest ranked computer code was found to be the STORM code developed at PNNL for the US Department of Energy for evaluation of arid land disposal sites

  19. 42 CFR 412.517 - Revision of LTC-DRG group classifications and weighting factors.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Revision of LTC-DRG group classifications and... the LTC-DRG classifications and recalibration of the weighting factors described in paragraph (a) of... SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.517 Revision of LTC-DRG group...

  20. The United States Revised Uniform Anatomical Gift Act (2006: New challenges to balancing patient rights and physician responsibilities

    Directory of Open Access Journals (Sweden)

    McGregor Joan L

    2007-09-01

    Full Text Available Abstract Advance health care directives and informed consent remain the cornerstones of patients' right to self-determination regarding medical care and preferences at the end-of-life. However, the effectiveness and clinical applicability of advance health care directives to decision-making on the use of life support systems at the end-of-life is questionable. The Uniform Anatomical Gift Act (UAGA has been revised in 2006 to permit the use of life support systems at or near death for the purpose of maximizing procurement opportunities of organs medically suitable for transplantation. Some states have enacted the Revised UAGA (2006 and a few of those have included amendments while attempting to preserve the uniformity of the revised Act. Other states have introduced the Revised UAGA (2006 for legislation and remaining states are likely to follow soon. The Revised UAGA (2006 poses challenges to the Patient Self Determination Act (PSDA embodied in advance health care directives and individual expression about the use of life support systems at the end-of-life. The challenges are predicated on the UAGA revising the default choice to presumption of donation intent and the use of life support systems to ensure medical suitability of organs for transplantation. The default choice trumps the expressed intent in an individual's advance health care directive to withhold and/or withdraw life support systems at the end-of-life. The Revised UAGA (2006 overrides advance directives on utilitarian grounds, which is a serious ethical challenge to society. The subtle progression of the Revised UAGA (2006 towards the presumption about how to dispose of one's organs at death can pave the way for an affirmative "duty to donate". There are at least two steps required to resolve these challenges. First, physicians and hospitals must fulfill their responsibilities to educate patients on the new legislations and document their preferences about the use of life support

  1. 48 CFR 15.307 - Proposal revisions.

    Science.gov (United States)

    2010-10-01

    ... AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Source Selection 15.307 Proposal revisions. (a) If an... allow proposal revisions to clarify and document understandings reached during negotiations. At the... submit a final proposal revision. The contracting officer is required to establish a common cut-off date...

  2. Use of CT in the management of anterior cruciate ligament revision surgery

    International Nuclear Information System (INIS)

    Groves, C.; Chandramohan, M.; Chew, C.; Subedi, N.

    2013-01-01

    Anterior cruciate ligament (ACL) injuries occur most commonly in individuals between 18 and 29 years of age and are strongly correlated with sporting activity, with female athletes being at higher risk of ACL rupture than their male counterparts. ACL reconstruction is one of the most frequently performed procedures in orthopaedic surgery, having a reported incidence of 85 per 100,000 head of population in the at-risk age group. Subsequent graft failure is most commonly caused by recurrent trauma, followed by tunnel malpositioning, although the choice of graft type does not appear to affect outcome. The Danish ACL registry reported that ACL revisions accounted for 7.5% of all ACL reconstruction surgery performed between 2005 and 2008. Revision of ACL reconstruction is recognized to carry a worse outcome than primary reconstruction. Preoperative imaging has become a crucial part of surgical planning in these patients, with great reliance placed on computed tomography (CT). The radiologist should be able to recognize the types of primary repair and must be able to assess for the complications of primary surgery, such as tunnel malpositioning, tunnel widening, and fixation device failure. Revision is commonly a two-stage procedure with bone grafting of the tunnels prior to the definitive ligament repair. The radiologist should be able to asses for adequate bone graft incorporation. The purpose of this article is to present a review of the use of CT in the management of ACL revision surgery with examples of commonly used fixation devices; complications, such as tunnel widening and tunnel malpositioning; and bone graft incorporation

  3. 7 CFR 3015.115 - Budget revisions.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Budget revisions. 3015.115 Section 3015.115..., DEPARTMENT OF AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Programmatic Changes and Budget Revisions § 3015.115 Budget revisions. (a) Nonconstruction projects. (1) Except as provided in paragraph (a)(2) of...

  4. Problem solving stages in the five square problem.

    Science.gov (United States)

    Fedor, Anna; Szathmáry, Eörs; Öllinger, Michael

    2015-01-01

    According to the restructuring hypothesis, insight problem solving typically progresses through consecutive stages of search, impasse, insight, and search again for someone, who solves the task. The order of these stages was determined through self-reports of problem solvers and has never been verified behaviorally. We asked whether individual analysis of problem solving attempts of participants revealed the same order of problem solving stages as defined by the theory and whether their subjective feelings corresponded to the problem solving stages they were in. Our participants tried to solve the Five-Square problem in an online task, while we recorded the time and trajectory of their stick movements. After the task they were asked about their feelings related to insight and some of them also had the possibility of reporting impasse while working on the task. We found that the majority of participants did not follow the classic four-stage model of insight, but had more complex sequences of problem solving stages, with search and impasse recurring several times. This means that the classic four-stage model is not sufficient to describe variability on the individual level. We revised the classic model and we provide a new model that can generate all sequences found. Solvers reported insight more often than non-solvers and non-solvers reported impasse more often than solvers, as expected; but participants did not report impasse more often during behaviorally defined impasse stages than during other stages. This shows that impasse reports might be unreliable indicators of impasse. Our study highlights the importance of individual analysis of problem solving behavior to verify insight theory.

  5. A study on scar revision

    Directory of Open Access Journals (Sweden)

    Ashutosh Talwar

    2016-04-01

    Full Text Available Introduction: Scars are psychologically distressing for the patients and have an impact on the quality of life and self esteem of the patients. Scar revision is an aesthetic skill which is mastered by plastic surgeons and encroached now by dermatosurgeons. Scars on the face are aesthetically unacceptable and various techniques have been improvised for making a scar aesthetically acceptable. Various types of techniques are used for scar revision like W plasty, Z plasty and VY plasty. Aims: To see the efficacy of various scar revision techniques including Z plasty, VY plasty and W plasty in 30 patients with disfiguring scars. Methods: We selected twenty patients of disfiguring scars for the study. The scars from various causes including trauma and burns were included in our study. Various techniques of scar revision include Z plasty, W plasty and VY plasty were performed according to the type and site of scar. Results: Male: female was 1.5: 1. The scar revision surgery yielded excellent results with minimal complications including haematoma formation, secondary infection and delayed healing seen in 5% patients each. Regarding the efficacy of scar revision, excellent improvement was seen in 60% patients, moderate improvement was seen in 30% patients and mild improvement was seen in 10% patients. Conclusions: Dermatologists can employ a number of surgical scar revision techniques. While some are better suited to treat specific types of scars, they can be used in combination with each other or with adjunctive therapies to achieve optimal results.

  6. 75 FR 36126 - Office of New Reactors; Proposed Revision to Standard Review Plan Section 13.6.1, Revision 1 on...

    Science.gov (United States)

    2010-06-24

    ... Standard Review Plan Section 13.6.1, Revision 1 on Physical Security--Combined License and Operating...), Section 13.6.1 on ``Physical Security--Combined License and Operating Reactors,'' (Agencywide Documents Access and Management System (ADAMS) Accession No. ML100350158). The Office of Nuclear Security and...

  7. Ages and Stages Questionnaire used to measure cognitive deficit in children born extremely preterm

    DEFF Research Database (Denmark)

    Klamer, Anja; Lando, Ane; Pinborg, Anja

    2005-01-01

    AIM: To validate the Ages and Stages Questionnaire (ASQ) and to measure average cognitive deficit in children born extremely preterm. METHODS: Parents of 30 term children aged 36-42 mo completed the ASQ and the children underwent the Wechsler Preschool and Primary Scales of Intelligence--Revised.......AIM: To validate the Ages and Stages Questionnaire (ASQ) and to measure average cognitive deficit in children born extremely preterm. METHODS: Parents of 30 term children aged 36-42 mo completed the ASQ and the children underwent the Wechsler Preschool and Primary Scales of Intelligence...

  8. Mechanisms important to later stages of streamer system development

    Science.gov (United States)

    Lehtinen, N. G.; Carlson, B.; Kochkin, P.; Østgaard, N.

    2017-12-01

    Typical streamer modeling focuses on the propagation of the streamer head and thus neglects processes such as electron detachment, electron energy relaxation, and thermalization of the electron energy distribution. These mechanisms, however, may become important at later stages of streamer system development, in particular following streamer collisions. We present a model of a later-stage streamer system development which includes these processes. A linear analysis suggests that these processes under some conditions can lead to new effects, such as excitation of waves similar to striations in the positive column of a glow discharge. Such instabilities do not occur if these mechanisms are neglected under the same conditions, although previous modeling suggested existence of wave-like phenomena during the streamer propagation [Luque et al, 2016, doi:10.1002/2015JA022234]. In the sea-level pressure air, the obtained striation-like waves may manifest as very high frequency range (>10 MHz) oscillations in plasma parameters and may have been detected in the electrode current and electromagnetic radiation measurements during laboratory spark experiments. We discuss whether the longitudinal electric field in such waves can efficiently transfer energy to charged particles, because such a process may play a role in production of x-rays.

  9. Performance assessment and microbial diversity of two pilot scale multi-stage sub-surface flow constructed wetland systems.

    Science.gov (United States)

    Babatunde, A O; Miranda-CasoLuengo, Raul; Imtiaz, Mehreen; Zhao, Y Q; Meijer, Wim G

    2016-08-01

    This study assessed the performance and diversity of microbial communities in multi-stage sub-surface flow constructed wetland systems (CWs). Our aim was to assess the impact of configuration on treatment performance and microbial diversity in the systems. Results indicate that at loading rates up to 100gBOD5/(m(2)·day), similar treatment performances can be achieved using either a 3 or 4 stage configuration. In the case of phosphorus (P), the impact of configuration was less obvious and a minimum of 80% P removal can be expected for loadings up to 10gP/(m(2)·day) based on the performance results obtained within the first 16months of operation. Microbial analysis showed an increased bacterial diversity in stage four compared to the first stage. These results indicate that the design and configuration of multi-stage constructed wetland systems may have an impact on the treatment performance and the composition of the microbial community in the systems, and such knowledge can be used to improve their design and performance. Copyright © 2016. Published by Elsevier B.V.

  10. Adjuvant chemoradiotherapy instead of revision radical resection after local excision for high-risk early rectal cancer.

    Science.gov (United States)

    Jeong, Jae-Uk; Nam, Taek-Keun; Kim, Hyeong-Rok; Shim, Hyun-Jeong; Kim, Yong-Hyub; Yoon, Mee Sun; Song, Ju-Young; Ahn, Sung-Ja; Chung, Woong-Ki

    2016-09-05

    After local excision of early rectal cancer, revision radical resection is recommended for patients with high-risk pathologic stage T1 (pT1) or pT2 cancer, but the revision procedure has high morbidity rates. We evaluated the efficacy of adjuvant concurrent chemoradiotherapy (CCRT) for reducing recurrence after local excision in these patients. Eighty-three patients with high-risk pT1 or pT2 rectal cancer underwent postoperative adjuvant CCRT after local excision. We defined high-risk features as pT1 having tumor size ≤3 cm, and/or resection margin (RM) ≤3 mm, and/or lymphovascular invasion (LVI), and/or non-full thickness excision such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), or unknown records regarding those features, or pT2 cancer. Radiotherapy was administered with a median dose of 50.4 Gy in 1.8 Gy fraction size over 5-7 weeks. Concurrent 5-fluorouracil and leucovorin were administered for 4 days in the first and fifth weeks of radiotherapy. The median interval between local excision and radiotherapy was 34 (range, 11-104) days. Fifteen patients (18.1 %) had stage pT2 tumors, 22 (26.5 %) had RM of ≥3 mm, and 21 (25.3 %) had tumors of ≥3 cm in size. Thirteen patients (15.7 %) had LVI. Transanal excision was performed in 58 patients (69.9 %) and 25 patients (30.1 %) underwent EMR or ESD. The median follow-up was 61 months. The 5-year overall survival (OS), locoregional relapse-free survival (LRFS), and disease-free survival (DFS) rates for all patients were 94.9, 91.0, and 89.8 %, respectively. Multivariate analysis did not identify any significant factors for OS or LRFS, but the only significant factor affecting DFS was the pT stage (p = 0.027). In patients with high-risk pT1 rectal cancer, adjuvant CCRT after local excision could be an effective alternative treatment instead of revision radical resection. However, patients with pT2 stage showed inferior DFS compared to pT1.

  11. Prognosis of patients with hepatocellular carcinoma. Validation and ranking of established staging-systems in a large western HCC-cohort.

    Directory of Open Access Journals (Sweden)

    Mark op den Winkel

    Full Text Available HCC is diagnosed in approximately half a million people per year, worldwide. Staging is a more complex issue than in most other cancer entities and, mainly due to unique geographic characteristics of the disease, no universally accepted staging system exists to date. Focusing on survival rates we analyzed demographic, etiological, clinical, laboratory and tumor characteristics of HCC-patients in our institution and applied the common staging systems. Furthermore we aimed at identifying the most suitable of the current staging systems for predicting survival.Overall, 405 patients with HCC were identified from an electronic medical record database. The following seven staging systems were applied and ranked according to their ability to predict survival by using the Akaike information criterion (AIC and the concordance-index (c-index: BCLC, CLIP, GETCH, JIS, Okuda, TNM and Child-Pugh. Separately, every single variable of each staging system was tested for prognostic meaning in uni- and multivariate analysis. Alcoholic cirrhosis (44.4% was the leading etiological factor followed by viral hepatitis C (18.8%. Median survival was 18.1 months (95%-CI: 15.2-22.2. Ascites, bilirubin, alkaline phosphatase, AFP, number of tumor nodes and the BCLC tumor extension remained independent prognostic factors in multivariate analysis. Overall, all of the tested staging systems showed a reasonable discriminatory ability. CLIP (closely followed by JIS was the top-ranked score in terms of prognostic capability with the best values of the AIC and c-index (AIC 2286, c-index 0.71, surpassing other established staging systems like BCLC (AIC 2343, c-index 0.66. The unidimensional scores TNM (AIC 2342, c-index 0.64 and Child-Pugh (AIC 2369, c-index 0.63 performed in an inferior fashion.Compared with six other staging systems, the CLIP-score was identified as the most suitable staging system for predicting prognosis in a large German cohort of predominantly non-surgical HCC-patients.

  12. 75 FR 35510 - License Renewal Interim Staff Guidance Process, Revision 2 Notice of Availability

    Science.gov (United States)

    2010-06-22

    ... Related Regulatory Functions.'' An electronic copy of the revised LR-ISG process is available in the NRC's Agencywide Documents Access and Management System (ADAMS) under Accession No. ML100920158. The revised LR-ISG... interim changes to certain NRC license renewal guidance documents. These guidance documents facilitate the...

  13. 78 FR 10269 - National Primary Drinking Water Regulations: Revisions to the Total Coliform Rule

    Science.gov (United States)

    2013-02-13

    ... Illness CWS--Community Water System DBP--Disinfection Byproduct DWC--Drinking Water Committee EA--Economic... 141 and 142 National Primary Drinking Water Regulations: Revisions to the Total Coliform Rule; Final...-9684-8] RIN 2040-AD94 National Primary Drinking Water Regulations: Revisions to the Total Coliform Rule...

  14. Design of a Scalable Modular Production System for a Two-stage Food Service Franchise System

    OpenAIRE

    Matt,; T., D.; Rauch,; E.,

    2012-01-01

    The geographically distributed production of fresh food poses unique challenges to the production system design because of their stringent industry and logistics requirements. The purpose of this research is to examine the case of a European fresh food manufacturer’s approach to introduce a scalable modular production concept for an international two‐stage gastronomy franchise system in order to identify best practice guidelines and to derive a framework for the design of distributed producti...

  15. Inquiry, A Project of the Wisconsin Bar Foundation. Vols. 1 and 2, Revised.

    Science.gov (United States)

    Scheurich, G. Michael, Ed.

    This new, revised edition of the Inquiry instructional materials is designed for use in teaching high school students about the U. S. laws and legal systems. The revised outlines, designed for instructors who have had legal training, are less technical and more informal, include new concepts and many current relevant topics, and de-emphasize…

  16. Multi-Stage Admission Control for Load Balancing in Next Generation Systems

    DEFF Research Database (Denmark)

    Mihovska, Albena D.; Anggorojati, Bayu; Luo, Jijun

    2008-01-01

    This paper describes a load-dependent multi-stage admission control suitable for next generation systems. The concept uses decision polling in entities located at different levels of the architecture hierarchy and based on the load to activate a sequence of actions related to the admission...

  17. Three-stage enzymatic digestive system for a gut-on-a-chip

    NARCIS (Netherlands)

    de Haan, Pim; Ianovska, Margaryta A.; Mathwig, Klaus; Bouwmeester, Hans; Verpoorte, Elisabeth

    2017-01-01

    In this work, we present the development of a three-stage microfluidic system as a cell-free model for digestion in the human gastrointestinal (GI) tract. Larger-scale digestion models are currently being used for pharmacological, toxicological and nutritional studies to determine the possible

  18. A clinical staging system and treatment guidelines for maxillary osteoradionecrosis in irradiated nasopharyngeal carcinoma patients

    International Nuclear Information System (INIS)

    Cheng, S.-J.; Lee, J.-J.; Ting, L.-L.; Tseng, I.-Y.; Chang, H.-H.; Chen, H.-M.; Kuo, Y.-S.; Hahn, L.-J.; Kok, S.-H.

    2006-01-01

    Purpose: To develop a clinical staging system for maxillary osteoradionecrosis (ORN) in irradiated nasopharyngeal carcinoma (NPC) patients. Methods and Materials: The data of maxillary ORN cases among 1,758 irradiated NPC patients were analyzed. A staging system based on the degrees of bone exposure (E), infection (I), and bleeding (B) was developed. Correlations between various clinical parameters and stages of maxillary ORN and relationships between treatment modalities and outcomes at each stage were evaluated. Cumulative success of treatment and risk factors that affect treatment outcomes were analyzed. Results: The incidence of maxillary ORN was 2.7% (48/1,758). TNM stage of NPC (p < 0.001), radiation dose (p = 0.029), and tooth extraction (p < 0.001) appeared to have significant influences on disease severity. Success rates between conservative therapy and surgical treatment were not significantly different for Stage I ORN but differed significantly for Stage II (p = 0.013) and Stage III (p = 0.008) lesions. Grade 3 infection and bleeding significantly jeopardized treatment success (p = 0.043 and 0.015, respectively). The risk ratios of treatment failure for Grade 3 infection and bleeding were 2.523 (p = 0.034) and 3.141 (p = 0.027), respectively. Conclusions: More serious maxillary ORN tended to occur in cases with more advanced NPC, higher radiation dose, and history of tooth extraction. Surgical treatment was usually required in Stage II and III ORN. The grades of infection and bleeding are important factors in guidance of treatment and prediction of outcomes

  19. Waterhammer modeling for the Ares I Upper Stage Reaction Control System cold flow development test article

    Science.gov (United States)

    Williams, Jonathan Hunter

    The Upper Stage Reaction Control System provides in-flight three-axis attitude control for the Ares I Upper Stage. The system design must accommodate rapid thruster firing to maintain proper launch trajectory and thus allow for the possibility to pulse multiple thrusters simultaneously. Rapid thruster valve closure creates an increase in static pressure, known as waterhammer, which propagates throughout the propellant system at pressures exceeding nominal design values. A series of development tests conducted at Marshall Space Flight Center in 2009 were performed using a water-flow test article to better understand fluid characteristics of the Upper Stage Reaction Control System. A subset of the tests examined the waterhammer pressure and frequency response in the flight-representative system and provided data to anchor numerical models. This thesis presents a comparison of waterhammer test results with numerical model and analytical results. An overview of the flight system, test article, modeling and analysis are also provided.

  20. Waterhammer Modeling for the Ares I Upper Stage Reaction Control System Cold Flow Development Test Article

    Science.gov (United States)

    Williams, Jonathan H.

    2010-01-01

    The Upper Stage Reaction Control System provides three-axis attitude control for the Ares I launch vehicle during active Upper Stage flight. The system design must accommodate rapid thruster firing to maintain the proper launch trajectory and thus allow for the possibility to pulse multiple thrusters simultaneously. Rapid thruster valve closure creates an increase in static pressure, known as waterhammer, which propagates throughout the propellant system at pressures exceeding nominal design values. A series of development tests conducted in the fall of 2009 at Marshall Space Flight Center were performed using a water-flow test article to better understand fluid performance characteristics of the Upper Stage Reaction Control System. A subset of the tests examined waterhammer along with the subsequent pressure and frequency response in the flight-representative system and provided data to anchor numerical models. This thesis presents a comparison of waterhammer test results with numerical model and analytical results. An overview of the flight system, test article, modeling and analysis are also provided.

  1. Performance evaluation of a once-through multi-stage flash distillation system: Impact of brine heater fouling

    International Nuclear Information System (INIS)

    Baig, Hasan; Antar, Mohamed A.; Zubair, Syed M.

    2011-01-01

    Multi-stage flash distillation (MSF) system modeling involves a number of process variables. An estimation of all these process variables requires both analytical solutions and experimental/field analysis. However, the accurate estimate of variables related to the brine heater operation in a MSF system is very important for a reliable operation of the system. For example, steam operating conditions as well as the brine properties including fouling of the brine heater tubes have a significant effect on the heat transfer characteristics of the brine heater, which in turn influence the distillate output from the system. In this study, the effect of various design as well as operating conditions on the performance ratio (PR), brine temperature and salinity as it leaves the last flash stage are investigated in a once-through system. Increasing the number of stages from 24 to 32 has a significant effect on the PR, it ranges between 79% (for ΔT = 1.5) and 327% (for ΔT = 2.3) for a top-brine temperature of 106 o C. This value increase as the top-brine temperature increases. Increasing the stage-to-stage temperature difference increases the water salinity as it leaves the final stage and reduces its temperature that would imply better energy utilization within the plant. Results show that brine side heat exchanger fouling has a significant effect in decreasing the overall heat transfer coefficient, which reduces the production rate as the fouling increases with time. A sensitivity analysis to identify the key parameters, which can have a significant influence on the desalination plant performance, is carried out in an attempt to contribute a better understanding and operation of MSF desalination processes.

  2. Cochlear implant revision surgeries in children.

    Science.gov (United States)

    Amaral, Maria Stella Arantes do; Reis, Ana Cláudia Mirândola B; Massuda, Eduardo T; Hyppolito, Miguel Angelo

    2018-02-16

    The surgery during which the cochlear implant internal device is implanted is not entirely free of risks and may produce problems that will require revision surgeries. To verify the indications for cochlear implantation revision surgery for the cochlear implant internal device, its effectiveness and its correlation with certain variables related to language and hearing. A retrospective study of patients under 18 years submitted to cochlear implant Surgery from 2004 to 2015 in a public hospital in Brazil. Data collected were: age at the time of implantation, gender, etiology of the hearing loss, audiological and oral language characteristics of each patient before and after Cochlear Implant surgery and any need for surgical revision and the reason for it. Two hundred and sixty-five surgeries were performed in 236 patients. Eight patients received a bilateral cochlear implant and 10 patients required revision surgery. Thirty-two surgeries were necessary for these 10 children (1 bilateral cochlear implant), of which 21 were revision surgeries. In 2 children, cochlear implant removal was necessary, without reimplantation, one with cochlear malformation due to incomplete partition type I and another due to trauma. With respect to the cause for revision surgery, of the 8 children who were successfully reimplanted, four had cochlear calcification following meningitis, one followed trauma, one exhibited a facial nerve malformation, one experienced a failure of the cochlear implant internal device and one revision surgery was necessary because the electrode was twisted. The incidence of the cochlear implant revision surgery was 4.23%. The period following the revision surgeries revealed an improvement in the subject's hearing and language performance, indicating that these surgeries are valid in most cases. Copyright © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  3. Short-term results of the reverse Total Evolutive Shoulder System (TESS) in cuff tear arthropathy and revision arthroplasty cases.

    Science.gov (United States)

    von Engelhardt, Lars Victor; Manzke, Michael; Filler, Timm J; Jerosch, Joerg

    2015-07-01

    The aim of this study was to evaluate the clinical and radiological outcome of the Total Evolutive Shoulder System (TESS) in patients with cuff tear arthropathy and patients in need of a revision arthroplasty. In this sequential study, 67 patients (56 non-stemmed, 11 stemmed) were evaluated after a mean follow-up of 17.5 months. The relative Constant and DASH scores, radiological joint geometry changes, complications and postoperative problems, which are not likely to affect the outcome, were evaluated. A significant increase was noticed for the relative Constant (11.3 vs. 78.8 %) and DASH scores (73.7 vs. 31.8) without significant differences between both etiology groups. Complication rates were similar to previous studies. An aseptic loosening of the non-stemmed humeral component was not noticed in the cuff tear arthropathy group, whereas one case with a loosening was noticed in the revision arthroplasty group. With nine cases (13.4 %), scapular notching rates were very low. On average, the acromiohumeral distance increased by 17 mm and the humeral offset by 13.9 mm; the height of the center of rotation decreased by 4.6 mm and the lateral glenohumeral offset by 6.1 mm, p TESS system provided adequate distalization and medialization of the humerus and the center of rotation. This corresponds to a good clinical outcome. The use of the surgical opportunity to implant the prosthesis with a relatively low neck-shaft angle might explain the low rates of scapular notching in our series. Regarding the case with a loosening of the humeral component, the surgeon should carefully indicate a stemless version for metaphyseal press-fit fixation in patients with revision arthroplasty.

  4. Analysis of stage and clinical/prognostic factors for colon and rectal cancer from SEER registries: AJCC and collaborative stage data collection system.

    Science.gov (United States)

    Chen, Vivien W; Hsieh, Mei-Chin; Charlton, Mary E; Ruiz, Bernardo A; Karlitz, Jordan; Altekruse, Sean F; Ries, Lynn A G; Jessup, J Milburn

    2014-12-01

    The Collaborative Stage (CS) Data Collection System enables multiple cancer registration programs to document anatomic and molecular pathology features that contribute to the Tumor (T), Node (N), Metastasis (M) - TNM - system of the American Joint Committee on Cancer (AJCC). This article highlights changes in CS for colon and rectal carcinomas as TNM moved from the AJCC 6th to the 7th editions. Data from 18 Surveillance, Epidemiology, and End Results (SEER) population-based registries were analyzed for the years 2004-2010, which included 191,361colon and 73,341 rectal carcinomas. Overall, the incidence of colon and rectal cancers declined, with the greatest decrease in stage 0. The AJCC's 7th edition introduction of changes in the subcategorization of T4, N1, and N2 caused shifting within stage groups in 25,577 colon and 10,150 rectal cancers diagnosed in 2010. Several site-specific factors (SSFs) introduced in the 7th edition had interesting findings: 1) approximately 10% of colon and rectal cancers had tumor deposits - about 30%-40% occurred without lymph node metastases, which resulted in 2.5% of colon and 3.3% of rectal cases becoming N1c (stage III A/B) in the AJCC 7th edition; 2) 10% of colon and 12% of rectal cases had circumferential radial margins Cancer Society.

  5. [Home Daily Hemodialysis with NxStage System One: monocentric italian casistic results].

    Science.gov (United States)

    Brunati, Chiara; Cassaro, Franca; Cretti, Laura; Izzo, Michela; Pegoraro, Marisa; Negri, Daniela; Gervasi, Francesca; Colussi, Giacomo

    2017-09-28

    NxStage System One is a new dialytic technology based on easy setup, simplicity of use and reduced dimensions, which is increasingly in use worldwide for home hemodialysis treatments. The system utilizes a low amount of dialysate, usually 15-30 liters according to anthropometric patients' values. The dialysate is supplied at very low flux, generally about 1/3 of blood flow, in order to obtain an elevated saturation of dialysate for solutes. In these conditions the clearance of urea will be almost equal to dialysate flow rate. In order to achieve an obptimal weekly clearance evaluated by Std Kt/V the dialysis sessions are repeated six times a week. In this way a good control of blood voleme can be reached. In this paper we report our experience of treatment with NxStage System One in 12 patients from May 2011 to Dicember 2016. Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.

  6. Human-system interface design review guideline -- Reviewer`s checklist: Final report. Revision 1, Volume 2

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-06-01

    NUREG-0700, Revision 1, provides human factors engineering (HFE) guidance to the US Nuclear Regulatory Commission staff for its: (1) review of the human system interface (HSI) design submittals prepared by licensees or applications for a license or design certification of commercial nuclear power plants, and (2) performance of HSI reviews that could be undertaken as part of an inspection or other type of regulatory review involving HSI design or incidents involving human performance. The guidance consists of a review process and HFE guidelines. The document describes those aspects of the HSI design review process that are important to the identification and resolution of human engineering discrepancies that could adversely affect plant safety. Guidance is provided that could be used by the staff to review an applicant`s HSI design review process or to guide the development of an HSI design review plan, e.g., as part of an inspection activity. The document also provides detailed HFE guidelines for the assessment of HSI design implementations. NUREG-0700, Revision 1, consists of three stand-alone volumes. Volume 2 is a complete set of the guidelines contained in Volume 1, Part 2, but in a checklist format that can be used by reviewers to assemble sets of individual guidelines for use in specific design reviews. The checklist provides space for reviewers to enter guidelines evaluations and comments.

  7. Human-system interface design review guideline -- Process and guidelines: Final report. Revision 1, Volume 1

    International Nuclear Information System (INIS)

    1996-06-01

    NUREG-0700, Revision 1, provides human factors engineering (HFE) guidance to the US Nuclear Regulatory Commission staff for its: (1) review of the human system interface (HSI) design submittals prepared by licensees or applications for a license or design certification of commercial nuclear power plants, and (2) performance of HSI reviews that could be undertaken as part of an inspection or other type of regulatory review involving HSI design or incidents involving human performance. The guidance consists of a review process and HFE guidelines. The document describes those aspects of the HSI design review process that are important to the identification and resolution of human engineering discrepancies that could adversely affect plant safety. Guidance is provided that could be used by the staff to review an applicant's HSI design review process or to guide the development of an HSI design review plan, e.g., as part of an inspection activity. The document also provides detailed HFE guidelines for the assessment of HSI design implementations. NUREG-0700, Revision 1, consists of three stand-alone volumes. Volume 1 consists of two major parts. Part 1 describes those aspects of the review process of the HSI design that are important to identifying and resolving human engineering discrepancies. Part 2 contains detailed guidelines for a human factors engineering review which identify criteria for assessing the implementation of an applicant's or licensee's HSI design

  8. 24 CFR 968.225 - Budget revisions.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Budget revisions. 968.225 Section... Fewer Than 250 Units) § 968.225 Budget revisions. (a) A PHA shall not incur any modernization cost in excess of the total HUD-approved CIAP budget. A PHA shall submit a budget revision, in a form prescribed...

  9. A two-stage optimal planning and design method for combined cooling, heat and power microgrid system

    International Nuclear Information System (INIS)

    Guo, Li; Liu, Wenjian; Cai, Jiejin; Hong, Bowen; Wang, Chengshan

    2013-01-01

    Highlights: • A two-stage optimal method is presented for CCHP microgrid system. • Economic and environmental performance are considered as assessment indicators. • Application case demonstrates its good economic and environmental performance. - Abstract: In this paper, a two-stage optimal planning and design method for combined cooling, heat and power (CCHP) microgrid system was presented. The optimal objective was to simultaneously minimize the total net present cost and carbon dioxide emission in life circle. On the first stage, multi-objective genetic algorithm based on non-dominated sorting genetic algorithm-II (NSGA-II) was applied to solve the optimal design problem including the optimization of equipment type and capacity. On the second stage, mixed-integer linear programming (MILP) algorithm was used to solve the optimal dispatch problem. The approach was applied to a typical CCHP microgrid system in a hospital as a case study, and the effectiveness of the proposed method was verified

  10. Single stage three level grid interactive MPPT inverter for PV systems

    International Nuclear Information System (INIS)

    Ozdemir, Saban; Altin, Necmi; Sefa, Ibrahim

    2014-01-01

    Highlights: • A three phase three-level NPC inverter for grid interactive PV systems is proposed. • A novel MPPT algorithm is introduced for single stage systems. • The proposed algorithm is robust with respect to parameter variations of PV system. • THD level is measured as 3.45% and it meets the international standards (<5%). • Total system efficiency is measured as 93.08%. - Abstract: In this study, three-phase, single stage neutral point clamped grid interactive inverter is designed and implemented. The reference current of the voltage source inverter is determined by maximum power point tracking sub-program in order to obtain maximum power from photovoltaic modules instantaneously. Proposed control is realized via TMS320F28335 32-bit floating point processor. The modified incremental conductance method is applied for maximum power point tracking; the PI regulator is used to control the inverter output current shape and level. Galvanic isolation is provided by a line frequency transformer that matches inverter output voltage to the grid voltage level and prevents DC current injection into the grid. Experimental results show that the designed inverter imports energy to the grid with unity power factor, total harmonic distortion level is 3.45% and this value is in the limits of the international standards. In addition, the total efficiency of the system is measured as 93.08%. The proposed system gets the maximum power from photovoltaic module and dispatches into the grid without using additional DC/DC converter

  11. Structural integration of separation and reaction systems: I. Integration of stage-wise processes

    Directory of Open Access Journals (Sweden)

    Mitrović Milan

    2002-01-01

    Full Text Available The structural integration of separation processes, using multifunctional equipment, has been studied on four stage-wise liquid-liquid separations extraction, absorption, distillation, adsorption and on some combinations of these processes. It was shown for stage - wise processes that the ultimate aim of equipment integration is 3-way integration (by components by steps and by stages and that membrane multiphase contactors present concerning the equipment optimal solutions in many cases. First, by using partially integrated equipment and, later by developing fully integrated systems it was experimentally confirmed that structural 3-way integration produces much higher degrees of component separations and component enrichments in compact and safe equipment.

  12. Dilemmas in Lung Cancer Staging.

    Science.gov (United States)

    Vlahos, Ioannis

    2018-05-01

    The advent of the 8th edition of the lung cancer staging system reflects a further meticulous evidence-based advance in the stratification of the survival of patients with lung cancer. Although addressing many limitations of earlier staging systems, several limitations in staging remain. This article reviews from a radiological perspective the limitations of the current staging system, highlighting the process of TNM restructuring, the residual issues with regards to the assignment of T, N, M descriptors, and their associated stage groupings and how these dilemmas impact guidance of multidisciplinary teams taking care of patients with lung cancer. Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.

  13. Nitrogen and phosphorus removed from a subsurface flow multi-stage filtration system purifying agricultural runoff.

    Science.gov (United States)

    Zhao, Yaqi; Huang, Lei; Chen, Yucheng

    2018-07-01

    Agricultural nonpoint source pollution has been increasingly serious in China since the 1990s. The main causes were excessive inputs of nitrogen fertilizer and pesticides. A multi-stage filtration system was built to test the purification efficiencies and removal characteristics of nitrogen and phosphorus when treating agricultural runoff. Simulated runoff pollution was prepared by using river water as source water based on the monitoring of local agricultural runoff. Experimental study had been performed from September to November 2013, adopting 12 h for flooding and 12 h for drying. The results showed that the system was made adaptive to variation of inflow quality and quantity, and had good removal for dissolved total nitrogen, total nitrogen, dissolved total phosphorus (DTP), and total phosphorus, and the average removal rate was 27%, 36%, 32%, and 48%, respectively. Except nitrate ([Formula: see text]), other forms of nitrogen and phosphorus all decreased with the increase of stages. Nitrogen was removed mainly in particle form the first stage, and mostly removed in dissolved form the second and third stage. Phosphorus was removed mainly in particulate during the first two stages, but the removal of particulate phosphorus and DTP were almost the same in the last stage. An approximate logarithmic relationship between removal loading and influent loading to nitrogen and phosphorus was noted in the experimental system, and the correlation coefficient was 0.78-0.94. [Formula: see text]: ammonium; [Formula: see text]: nitrite; [Formula: see text]: nitrate; DTN: dissolved total nitrogen; TN: total nitrogen; DTP: dissolved total phosphorus; TP: total phosphorus; PN: particulate nitrogen; PP: particulate phosphorus.

  14. 76 FR 77025 - Office of New Reactors; Notice of Availability of the Final Staff Guidance Section 1.0, Revision...

    Science.gov (United States)

    2011-12-09

    ... the Final Staff Guidance Section 1.0, Revision 2 on Introduction and Interfaces AGENCY: Nuclear... Plants: LWR Edition,'' Section 1.0, Revision 2 on ``Introduction and Interfaces'' (Agencywide Documents Access and Management System (ADAMS) Accession No. ML112730393). The NRC staff issues revisions to SRP...

  15. Evaluation of high step-up power electronics stages in thermoelectric generator systems

    DEFF Research Database (Denmark)

    Sun, Kai; Ni, Longxian; Chen, Min

    2013-01-01

    To develop practical thermoelectric generator (TEG) systems, especially radioisotope thermoelectric power supplies for deep-space exploration, a power conditioning stage with high step-up gain is indispensable. This stage is used to step up the low output voltage of thermoelectric generators...... to the required high level. Furthermore, maximum power point tracking control for TEG modules needs to be implemented into the power electronics stages. In this paper, the temperature-dependent electrical characteristics of a thermoelectric generator are analyzed in depth. Three typical high step-up power...... converters suitable for TEG applications are discussed: an interleaved boost converter, a boost converter with a coupled inductor and an interleaved boost converter with an auxiliary transformer. A general comparison of the three high step-up converters is conducted to study the step-up gain, conversion...

  16. Mortality prediction in chronic obstructive pulmonary disease comparing the GOLD 2007 and 2011 staging systems

    DEFF Research Database (Denmark)

    Soriano, Joan B; Lamprecht, Bernd; Ramírez, Ana S

    2015-01-01

    BACKGROUND: There is no universal consensus on the best staging system for chronic obstructive pulmonary disease (COPD). Although documents (eg, the Global Initiative for Chronic Obstructive Lung Disease [GOLD] 2007) have traditionally used forced expiratory volume in 1 s (FEV1) for staging, clin...

  17. Revise of the law concerning prevention from radiation hazards due to radioisotopes, etc

    International Nuclear Information System (INIS)

    Sakamoto, Yoshiaki; Sendo, Muneaki

    2004-01-01

    The Law Concerning Prevention from Radiation Hazards due to Radioisotopes, etc. was revised in 2004. The regulation about disposal of RI waste was fixed at this revise of the law. Regulation of an application about the disposal of the RI waste was added to former radioactive waste control business. And regulation of confirmation of waste disposal by a regulation body was added. By this law revision, a necessary system for the RI waste disposal is ready. Furthermore, the Basic Safety Standard (BSS) and the following rationalization of related to regulation were introduced into the Law Concerning Prevention from Radiation Hazards due to Radioisotopes, etc. by this law revision. The regulation for a handling of radionuclides will be changed a lot due to the introduction of the BSS. (author)

  18. Revision Total Hip Arthroplasty Using a Modular Tapered Stem With Distal Fixation Good Short-Term Results in 125 Revisions

    DEFF Research Database (Denmark)

    Ovesen, Ole; Emmeluth, Claus; Hofbauer, Christian

    2009-01-01

    After 2 to 7 years we reviewed 125 prosthetic hip arthroplasty stem revisions using a modular tapered stem with distal fixation. Median age of these patients was 68 (33-92) years. Baseline and follow-up data were registered prospectively according to the Danish Hip Arthroplasty Registry. Survival...... system is very versatile, can be used in most femoral revision cases, and allows rapid bone remodeling. We did not find an increased number of complications compared to the literature. Further long-term follow-up, however, is essential......., free of any rerevision, was 94%. Harris Hip Score improved from average 44 to 85. Bony regeneration was an early and significant finding in most cases. Complications included 4 (3%) fractures intraoperatively and 8 (6%) dislocations, 4 (3%) deep infections, and 1 (1%) stem fracture. This modular taper...

  19. Can Good Infection Control Be Obtained in One-stage Exchange of the Infected TKA to a Rotating Hinge Design? 10-year Results.

    Science.gov (United States)

    Zahar, Akos; Kendoff, Daniel O; Klatte, Till O; Gehrke, Thorsten A

    2016-01-01

    Prosthetic joint infection (PJI) occurs in 1% to 2% of total knee arthroplasties (TKAs). Although two-stage exchange is the preferred management method of patients with chronic PJI in TKA in North America, one-stage exchange is an alternative treatment method, but long-term studies of this approach have not been conducted. We reviewed our minimum 9-year results of 70 patients who underwent one-stage exchange arthroplasty with a rotating hinge design to determine: (1) What was the proportion of patients free of infection? (2) What was the patient rate of survival free of any reoperation? (3) What were the clinical outcomes as measured by Hospital for Special Surgery scores? (4) What proportion of patients developed radiographic evidence of loosening? All one-stage revision TKAs for infection between January 1 and December 31, 2002, with a minimum 9-year followup (mean, 10 years; range, 9-11 years), in which patients had been seen within the last 1 year, were included in this retrospective review. During that period, 11 patients with infected TKAs were treated with other approaches (including two-stage approaches in eight); the general indication for one-stage revision was the diagnosis of PJI with a known causative organism. Exclusion criteria were culture-negative preoperative aspiration, known allergy to local antibiotics or bone cement, or cases in which radical débridement was impossible as a result of the involvement of important anatomical structures. Eighty-one patients with PJI were seen during this period; 70 underwent one-stage exchange using our strict protocol and were reimplanted with a rotating hinge TKA. Eleven patients (15.7%) were lost to followup. Hospital for Special Surgery scores were recorded and all radiographs were evaluated for prosthetic loosening. Failure was defined as revision surgery for infection or any other cause. Our 10-year infection-free survival was 93% (mean, 4.1; 95% confidence interval [CI], 89%-96%; p exchange techniques for

  20. ∑∆ Modulator System-Level Considerations for Hearing-Aid Audio Class-D Output Stage Application

    DEFF Research Database (Denmark)

    Pracný, Peter; Bruun, Erik

    2012-01-01

    This paper deals with a system-level design of a digital sigma-delta (∑∆) modulator for hearing-aid audio Class D output stage application. The aim of this paper is to provide a thorough discussion on various possibilities and tradeoffs of ∑∆ modulator system-level design parameter combinations...... - order, oversampling ratio (OSR) and number of bits in the quantizer - including their impact on interpolation filter design as well. The system is kept in digital domain up to the input of the Class D power stage including the digital pulse width modulation (DPWM) block. Notes on the impact of the DPWM...

  1. Describing Peripancreatic Collections According to the Revised Atlanta Classification of Acute Pancreatitis: An International Interobserver Agreement Study.

    Science.gov (United States)

    Bouwense, Stefan A; van Brunschot, Sandra; van Santvoort, Hjalmar C; Besselink, Marc G; Bollen, Thomas L; Bakker, Olaf J; Banks, Peter A; Boermeester, Marja A; Cappendijk, Vincent C; Carter, Ross; Charnley, Richard; van Eijck, Casper H; Freeny, Patrick C; Hermans, John J; Hough, David M; Johnson, Colin D; Laméris, Johan S; Lerch, Markus M; Mayerle, Julia; Mortele, Koenraad J; Sarr, Michael G; Stedman, Brian; Vege, Santhi Swaroop; Werner, Jens; Dijkgraaf, Marcel G; Gooszen, Hein G; Horvath, Karen D

    2017-08-01

    Severe acute pancreatitis is associated with peripancreatic morphologic changes as seen on imaging. Uniform communication regarding these morphologic findings is crucial for accurate diagnosis and treatment. For the original 1992 Atlanta classification, interobserver agreement is poor. We hypothesized that for the revised Atlanta classification, interobserver agreement will be better. An international, interobserver agreement study was performed among expert and nonexpert radiologists (n = 14), surgeons (n = 15), and gastroenterologists (n = 8). Representative computed tomographies of all stages of acute pancreatitis were selected from 55 patients and were assessed according to the revised Atlanta classification. The interobserver agreement was calculated among all reviewers and subgroups, that is, expert and nonexpert reviewers; interobserver agreement was defined as poor (≤0.20), fair (0.21-0.40), moderate (0.41-0.60), good (0.61-0.80), or very good (0.81-1.00). Interobserver agreement among all reviewers was good (0.75 [standard deviation, 0.21]) for describing the type of acute pancreatitis and good (0.62 [standard deviation, 0.19]) for the type of peripancreatic collection. Expert radiologists showed the best and nonexpert clinicians the lowest interobserver agreement. Interobserver agreement was good for the revised Atlanta classification, supporting the importance for widespread adaption of this revised classification for clinical and research communications.

  2. Juvenile nasopharyngeal angiofibroma staging: An overview.

    Science.gov (United States)

    Alshaikh, Nada Ali; Eleftheriadou, Anna

    2015-06-01

    Staging of tumors is very important in treatment and surgical decision making, as well as in predicting disease recurrence and prognosis. This review focuses on the different available classifications of juvenile nasopharyngeal angiofibroma (JNA) and their impact on the evaluation, management, and prognosis of JNA. The literature was reviewed, and publications on JNA staging were examined. Our MEDLINE search of the entire English-language literature found no review article on the current available staging systems for JNA. In this article, we review the common JNA classification systems that have been published, and we discuss some of their advantages and disadvantages. The most commonly used staging systems for JNA are the Radkowski and the Andrews-Fisch staging systems. However, some newer staging systems that are based on advances in technology and surgical approaches-the Onerci, INCan, and UPMC systems-have shown promising utility, and they will probably gain popularity in the future.

  3. System and method for single-phase, single-stage grid-interactive inverter

    Science.gov (United States)

    Liu, Liming; Li, Hui

    2015-09-01

    The present invention provides for the integration of distributed renewable energy sources/storages utilizing a cascaded DC-AC inverter, thereby eliminating the need for a DC-DC converter. The ability to segment the energy sources and energy storages improves the maintenance capability and system reliability of the distributed generation system, as well as achieve wide range reactive power compensation. In the absence of a DC-DC converter, single stage energy conversion can be achieved to enhance energy conversion efficiency.

  4. Microcomputers and the Improvement of Revision Skills.

    Science.gov (United States)

    Balajthy, Ernest; And Others

    1987-01-01

    Discusses use of word processing software as an effective tool in writing and revision instruction, and describes the role of the teacher. Examples of exercises that encourage revision and of software designed to teach effective revision skills are reviewed. (MBR)

  5. Individual questions of financial control and revision

    Directory of Open Access Journals (Sweden)

    В. М. Глібко

    2015-05-01

    Full Text Available Problem setting. In modern conditions at investigation and gathering of proofs in criminal proceedings according to item 93 CPC of Ukraine collecting of proofs which is carried out by the criminal proceedings parties, victim is important, the representative of the legal person, in which relation carries out manufacture, including a way истребования and receptions from public authorities, local governments, the enterprises, establishments and organisations, official and physical persons of things, documents, data, conclusions of experts, conclusions of revisions and certificates of checks. Recent research and publications analisis. In scientific sources questions of carrying out of revisions S. B.Zhivko, V.V.Akimov, G.Demjanchuk, J.Buzdugan is considered. Paper objective. Article purpose is studying and definition of a place of revision among forms of inspection of the state control and use of results of revision in criminal proceedings. Paper main body. Off-schedule exit revision that is revision which is not provided in plans of work of body of the state financial control is considered and is spent at presence at least one of the circumstances listed in item 11 of the Law of Ukraine «About main principles of realisation of the state financial control in Ukraine». If revision is carried out on request of investigating bodies it is spent on the basis of the petition of the inspector and accepted by the results of consideration of this petition of the decision of the investigatory judge. The primary goal of revision on request of investigating bodies or on the basis of court definition is reception of proofs on business. Therefore the revision certificate admits the written proof as on the basis of its conclusion of the inspector, the public prosecutor receives the information on a perfect crime, abusing, and also on the persons who have committed a crime, on the period of commission of crime and an amount of damage. In criminal

  6. Revised and enlarged edition: editorial production as an artistic and a literary genre

    Directory of Open Access Journals (Sweden)

    Sofia Gonçalves

    2016-07-01

    Full Text Available The appropriation of the expression «revised and enlarged edition», from the traditional publishing jargon, is presented in this article as a hypotheses to characterize contemporary publishing practices. It consid- ers the publication, in all its stages, as a writing space and as a process that never resigns creativity and criticism.These practices are «revised» (revisited because they imply the problematization of practice, through an exploratory attitude or critic, leading to processes and discourses prepared for a permanent review. And «en- larged» because they expand the operations of each editorial production phase, they iden- tify alternative formats and models, they blur traditional roles (author/editor/designer/ reader and question editing as a mere me- diation for the creation, circulation, reception or reading processes. In this article, we will identify some of the principles and emerging phenomena that help us understand editorial production as an artistic or a literary genre.

  7. Are Bundled Payments a Viable Reimbursement Model for Revision Total Joint Arthroplasty?

    Science.gov (United States)

    Courtney, P Maxwell; Ashley, Blair S; Hume, Eric L; Kamath, Atul F

    2016-12-01

    Alternative payment models, such as the Centers for Medicare & Medicaid Services (CMS) Bundled Payment for Care Improvement (BPCI) initiative, aim to decrease overall costs for hip and knee arthroplasties. We asked: (1) Is there any difference in the CMS episode-of-care costs, hospital length of stay, and readmission rate from before and after implementation of our bundled-payment program? (2) Is there any difference in reimbursements and resource utilization between revision THA and TKA at our institution? (3) Are there any independent risk factors for patients with high costs who may not be appropriate for a bundled-payment system for revision total joint arthroplasty (TJA)? Between October 2013 and March 2015, 218 patients underwent revision TKA or THA in one health system. Two hundred seventeen patients were reviewed as part of this study, and one patient with hemophilia was excluded from the analysis as an outlier. Our institution began a BPCI program for revision TJA during this study period. Patients' procedures done before January 1, 2014 at one hospital and January 1, 2015 at another hospital were not included in the bundled-care arrangement (70 revision TKAs and 56 revision THAs), whereas 50 revision TKAs and 41 revision THAs were performed under the BPCI initiative. Patient demographics, medical comorbidities, episode-of-care reimbursement data derived directly from CMS, length of stay, and readmission proportions were compared between the bundled and nonbundled groups. Length of stay in the group that underwent surgery before the bundled-care arrangement was longer than for patients whose procedures were done under the BPCI (mean 4.02 [SD, 3.0 days] versus mean 5.27 days [SD, 3.6 days]; p = 0.001). Index hospitalization reimbursement for the bundled group was less than for the nonbundled group (mean USD 17,754 [SD, USD 2741] versus mean USD 18,316 [SD, USD 4732]; p = 0.030). There was no difference, with the numbers available, in total episode

  8. Outcome, revision rate and indication for revision following resurfacing hemiarthroplasty for osteoarthritis of the shoulder

    DEFF Research Database (Denmark)

    Rasmussen, J V; Polk, A; Sorensen, A K

    2014-01-01

    In this study, we evaluated patient-reported outcomes, the rate of revision and the indications for revision following resurfacing hemiarthroplasty of the shoulder in patients with osteoarthritis. All patients with osteoarthritis who underwent primary resurfacing hemiarthroplasty and reported...... to the Danish Shoulder Arthroplasty Registry (DSR), between January 2006 and December 2010 were included. There were 772 patients (837 arthroplasties) in the study. The Western Ontario Osteoarthritis of the Shoulder (WOOS) index was used to evaluate patient-reported outcome 12 months (10 to 14) post......-operatively. The rates of revision were calculated from the revisions reported to the DSR up to December 2011 and by checking deaths with the Danish National Register of Persons. A complete questionnaire was returned by 688 patients (82.2%). The mean WOOS was 67 (0 to 100). A total of 63 hemiarthroplasties (7...

  9. Experimental study on an innovative multifunction heat pipe type heat recovery two-stage sorption refrigeration system

    International Nuclear Information System (INIS)

    Li, T.X.; Wang, R.Z.; Wang, L.W.; Lu, Z.S.

    2008-01-01

    An innovative multifunction heat pipe type sorption refrigeration system is designed, in which a two-stage sorption thermodynamic cycle based on two heat recovery processes was employed to reduce the driving heat source temperature, and the composite sorbent of CaCl 2 and activated carbon was used to improve the mass and heat transfer performances. For this test unit, the heating, cooling and heat recovery processes between two reactive beds are performed by multifunction heat pipes. The aim of this paper is to investigate the cycled characteristics of two-stage sorption refrigeration system with heat recovery processes. The two sub-cycles of a two-stage cycle have different sorption platforms though the adsorption and desorption temperatures are equivalent. The experimental results showed that the pressure evolutions of two beds are nearly equivalent during the first stage, and desorption pressure during the second stage is large higher than that in the first stage while the desorption temperatures are same during the two operation stages. In comparison with conventional two-stage cycle, the two-stage cycle with heat recovery processes can reduce the heating load for desorber and cooling load for adsorber, the coefficient of performance (COP) has been improved more than 23% when both cycles have the same regeneration temperature of 103 deg. C and the cooling water temperature of 30 deg. C. The advanced two-stage cycle provides an effective method for application of sorption refrigeration technology under the condition of low-grade temperature heat source or utilization of renewable energy

  10. Expedited technology demonstration project (Revised mixed waste management facility project) Project baseline revision 4.0 and FY98 plan

    International Nuclear Information System (INIS)

    Adamson, M. G.

    1997-01-01

    The re-baseline of the Expedited Technology Demonstration Project (Revised Mixed Waste Facility Project) is designated as Project Baseline Revision 4.0. The last approved baseline was identified as Project Baseline Revision 3.0 and was issued in October 1996. Project Baseline Revision 4.0 does not depart from the formal DOE guidance followed by, and contained in, Revision 3.0. This revised baseline document describes the MSO and Final Forms testing activities that will occur during FY98, the final year of the ETD Project. The cost estimate for work during FY98 continues to be $2.OM as published in Revision 3.0. However, the funds will be all CENRTC rather than the OPEX/CENTRC split previously anticipated. LLNL has waived overhead charges on ETD Project CENRTC funds since the beginning of project activities. By requesting the $2.OM as all CENTRC a more aggressive approach to staffing and testing can be taken. Due to a cost under- run condition during FY97 procurements were made and work was accomplished, with the knowledge of DOE, in the Feed Preparation and Final Forms areas that were not in the scope of Revision 3.0. Feed preparation activities for FY98 have been expanded to include the drum opening station/enclosure previously deleted

  11. Novel clinical staging for patients with end-stage gastrointestinal carcinoma.

    Science.gov (United States)

    Yasuda, Naokuni; Nakashima, Osamu; Ohnaka, Toru; Kamisaka, Koji; Tsunoda, Akira; Kusano, Mitsuo

    2006-01-01

    We created a new clinical staging system for end-stage gastrointestinal (GI) carcinoma to clarify the therapeutic goals for these patients. Data were obtained from a retrospective review of medical charts. Based on daily clinical observation of 144 patients with end-stage GI carcinoma, we classified the terminal stages as A, B, C, and D. The mean durations of terminal stages A, B, C, and D were 19, 16.6, 6.6, and 1.8 days, respectively, in patients with end-stage gastric cancer and 28.5, 9.1, 5.4, and 1.9 days, respectively, in patients with colorectal cancer. Moreover, 88.0% of patients with gastric carcinoma and 82.6% of patients with colorectal carcinoma passed through terminal stages A, B, C, and D sequentially. The patients in terminal stage B experienced temporary relief of symptoms, but those in terminal stage C did not (P terminal stages can easily be judged by clinical observation and may be an effective new tool with which to manage patients with end-stage GI carcinoma and their families.

  12. Stage separation study of Nike-Black Brant V Sounding Rocket System

    Science.gov (United States)

    Ferragut, N. J.

    1976-01-01

    A new Sounding Rocket System has been developed. It consists of a Nike Booster and a Black Brant V Sustainer with slanted fins which extend beyond its nozzle exit plane. A cursory look was taken at different factors which must be considered when studying a passive separation system. That is, one separation system without mechanical constraints in the axial direction and which will allow separation due to drag differential accelerations between the Booster and the Sustainer. The equations of motion were derived for rigid body motions and exact solutions were obtained. The analysis developed could be applied to any other staging problem of a Sounding Rocket System.

  13. Circumcision revision in male children

    Directory of Open Access Journals (Sweden)

    Mohammed A. Al-Ghazo

    2006-08-01

    Full Text Available OBJECTIVE: To determine indications for circumcision revision and to identify the specialty of the person who performed unsatisfactory primary circumcision. MATERIALS AND METHODS: The authors reviewed medical records of 52 cases that underwent circumcision revision over a 6-year period (1998 to 2004. Sleeve surgical technique was used for revision in patients with redundant foreskin or concealed penis, penoplasty for partial or complete degloving of the penis and meatotomy for external meatal stenosis. The mean age of children was 32 months (range 6 months to 9 years. RESULTS: Most of unsatisfactory primary circumcisions (86.7% were performed by laymen. All patients who underwent circumcision revision had good to excellent cosmetic results. CONCLUSION: Primary circumcision performed by laymen carry a high complication rate and serious complications may occur. A period of training and direct supervision by physicians is required before allowing laymen to perform circumcision independently.

  14. Effect of ammoniacal nitrogen on one-stage and two-stage anaerobic digestion of food waste

    International Nuclear Information System (INIS)

    Ariunbaatar, Javkhlan; Scotto Di Perta, Ester; Panico, Antonio; Frunzo, Luigi; Esposito, Giovanni; Lens, Piet N.L.; Pirozzi, Francesco

    2015-01-01

    Highlights: • Almost 100% of the biomethane potential of food waste was recovered during AD in a two-stage CSTR. • Recirculation of the liquid fraction of the digestate provided the necessary buffer in the AD reactors. • A higher OLR (0.9 gVS/L·d) led to higher accumulation of TAN, which caused more toxicity. • A two-stage reactor is more sensitive to elevated concentrations of ammonia. • The IC 50 of TAN for the AD of food waste amounts to 3.8 g/L. - Abstract: This research compares the operation of one-stage and two-stage anaerobic continuously stirred tank reactor (CSTR) systems fed semi-continuously with food waste. The main purpose was to investigate the effects of ammoniacal nitrogen on the anaerobic digestion process. The two-stage system gave more reliable operation compared to one-stage due to: (i) a better pH self-adjusting capacity; (ii) a higher resistance to organic loading shocks; and (iii) a higher conversion rate of organic substrate to biomethane. Also a small amount of biohydrogen was detected from the first stage of the two-stage reactor making this system attractive for biohythane production. As the digestate contains ammoniacal nitrogen, re-circulating it provided the necessary alkalinity in the systems, thus preventing an eventual failure by volatile fatty acids (VFA) accumulation. However, re-circulation also resulted in an ammonium accumulation, yielding a lower biomethane production. Based on the batch experimental results the 50% inhibitory concentration of total ammoniacal nitrogen on the methanogenic activities was calculated as 3.8 g/L, corresponding to 146 mg/L free ammonia for the inoculum used for this research. The two-stage system was affected by the inhibition more than the one-stage system, as it requires less alkalinity and the physically separated methanogens are more sensitive to inhibitory factors, such as ammonium and propionic acid

  15. 77 FR 64920 - Revisions to Reliability Standard for Transmission Vegetation Management

    Science.gov (United States)

    2012-10-24

    ... reliability of the Bulk Electric System.'' NERC defines ``System Operating Limit'' as ``[t]he value (such as... values or gives reason to revisit the Reliability Standard. Accordingly, consistent with the activity...] Revisions to Reliability Standard for Transmission Vegetation Management AGENCY: Federal Energy Regulatory...

  16. Analysis of fatigue reliability for high temperature and high pressure multi-stage decompression control valve

    Science.gov (United States)

    Yu, Long; Xu, Juanjuan; Zhang, Lifang; Xu, Xiaogang

    2018-03-01

    Based on stress-strength interference theory to establish the reliability mathematical model for high temperature and high pressure multi-stage decompression control valve (HMDCV), and introduced to the temperature correction coefficient for revising material fatigue limit at high temperature. Reliability of key dangerous components and fatigue sensitivity curve of each component are calculated and analyzed by the means, which are analyzed the fatigue life of control valve and combined with reliability theory of control valve model. The impact proportion of each component on the control valve system fatigue failure was obtained. The results is shown that temperature correction factor makes the theoretical calculations of reliability more accurate, prediction life expectancy of main pressure parts accords with the technical requirements, and valve body and the sleeve have obvious influence on control system reliability, the stress concentration in key part of control valve can be reduced in the design process by improving structure.

  17. Treatment of natural rubber processing wastewater using a combination system of a two-stage up-flow anaerobic sludge blanket and down-flow hanging sponge system.

    Science.gov (United States)

    Tanikawa, D; Syutsubo, K; Hatamoto, M; Fukuda, M; Takahashi, M; Choeisai, P K; Yamaguchi, T

    2016-01-01

    A pilot-scale experiment of natural rubber processing wastewater treatment was conducted using a combination system consisting of a two-stage up-flow anaerobic sludge blanket (UASB) and a down-flow hanging sponge (DHS) reactor for more than 10 months. The system achieved a chemical oxygen demand (COD) removal efficiency of 95.7% ± 1.3% at an organic loading rate of 0.8 kg COD/(m(3).d). Bacterial activity measurement of retained sludge from the UASB showed that sulfate-reducing bacteria (SRB), especially hydrogen-utilizing SRB, possessed high activity compared with methane-producing bacteria (MPB). Conversely, the acetate-utilizing activity of MPB was superior to SRB in the second stage of the reactor. The two-stage UASB-DHS system can reduce power consumption by 95% and excess sludge by 98%. In addition, it is possible to prevent emissions of greenhouse gases (GHG), such as methane, using this system. Furthermore, recovered methane from the two-stage UASB can completely cover the electricity needs for the operation of the two-stage UASB-DHS system, accounting for approximately 15% of the electricity used in the natural rubber manufacturing process.

  18. A study on the revision of nuclear safety act to build the foundation of nuclear export and import control system in Korea

    International Nuclear Information System (INIS)

    Yang, Seung Hyo; Choi, Sun Do

    2012-01-01

    Nuclear related items require export and import control beyond the multilateral export control system according to Safeguard Agreement, Additional Protocol and bilateral agreements. Besides Korea as a nuclear supplier is needed to actively cope with its export control system, which is being reinforced internationally. In regard to this trend, this study drew the revision plan of present Nuclear Safety Act to found the nuclear export and import control system in Korea by examining the related legislations and analyzing the implementation status of nuclear export and import control

  19. A study on the revision of nuclear safety act to build the foundation of nuclear export and import control system in Korea

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Seung Hyo; Choi, Sun Do [Korea Institute of Nuclear Nonproliferation and Control, Daejeon (Korea, Republic of)

    2012-10-15

    Nuclear related items require export and import control beyond the multilateral export control system according to Safeguard Agreement, Additional Protocol and bilateral agreements. Besides Korea as a nuclear supplier is needed to actively cope with its export control system, which is being reinforced internationally. In regard to this trend, this study drew the revision plan of present Nuclear Safety Act to found the nuclear export and import control system in Korea by examining the related legislations and analyzing the implementation status of nuclear export and import control.

  20. Grid Integration of Single Stage Solar PV System using Three-level Voltage Source Converter

    Science.gov (United States)

    Hussain, Ikhlaq; Kandpal, Maulik; Singh, Bhim

    2016-08-01

    This paper presents a single stage solar PV (photovoltaic) grid integrated power generating system using a three level voltage source converter (VSC) operating at low switching frequency of 900 Hz with robust synchronizing phase locked loop (RS-PLL) based control algorithm. To track the maximum power from solar PV array, an incremental conductance algorithm is used and this maximum power is fed to the grid via three-level VSC. The use of single stage system with three level VSC offers the advantage of low switching losses and the operation at high voltages and high power which results in enhancement of power quality in the proposed system. Simulated results validate the design and control algorithm under steady state and dynamic conditions.

  1. Low cryogen inventory, forced flow Ne cooling system with room temperature compression stage and heat recuperation

    CERN Document Server

    Shornikov, A; Wolf, A

    2014-01-01

    We present design and commissioning results of a forced flow cooling system utilizing neon at 30 K. The cryogen is pumped through the system by a room-temperature compression stage. To decouple the cold zone from the compression stage a recuperating counterflow tube-in-tube heat exchanger is used. Commissioning demonstrated successful condensation of neon and transfer of up to 30 W cooling power to the load at 30 K using only 30 g of the cryogen circulating in the system at pressures below 170 kPa.

  2. Two-stage simplified swarm optimization for the redundancy allocation problem in a multi-state bridge system

    International Nuclear Information System (INIS)

    Lai, Chyh-Ming; Yeh, Wei-Chang

    2016-01-01

    The redundancy allocation problem involves configuring an optimal system structure with high reliability and low cost, either by alternating the elements with more reliable elements and/or by forming them redundantly. The multi-state bridge system is a special redundancy allocation problem and is commonly used in various engineering systems for load balancing and control. Traditional methods for redundancy allocation problem cannot solve multi-state bridge systems efficiently because it is impossible to transfer and reduce a multi-state bridge system to series and parallel combinations. Hence, a swarm-based approach called two-stage simplified swarm optimization is proposed in this work to effectively and efficiently solve the redundancy allocation problem in a multi-state bridge system. For validating the proposed method, two experiments are implemented. The computational results indicate the advantages of the proposed method in terms of solution quality and computational efficiency. - Highlights: • Propose two-stage SSO (SSO_T_S) to deal with RAP in multi-state bridge system. • Dynamic upper bound enhances the efficiency of searching near-optimal solution. • Vector-update stages reduces the problem dimensions. • Statistical results indicate SSO_T_S is robust both in solution quality and runtime.

  3. How to Revise, and Revise Really Well, for Premier Academic Journals

    DEFF Research Database (Denmark)

    LaPlaca, Peter J.; Lindgreen, Adam; Vanhamme, Joelle

    2018-01-01

    Most of the premier academic journals in all fields routinely have rejection rates of 80%, 95%, or higher. All journals prefer articles that make significant contributions to the field. Revising a manuscript and responding properly to the comments of reviewers and editors often is challenging....... This article discusses how to revise effectively a manuscript according to the (minor or major) comments of reviewers and editors for premier academic journals. We provide a series of tips for helping the authors in their endeavor, making the process less arduous and improving the possibility of a positive...

  4. A taxonomic revision of the genus Podocarpus

    NARCIS (Netherlands)

    Laubenfels, de D.J.

    1985-01-01

    In connection with the forthcoming revision of the Coniferae for the Flora Malesiana, the author thought it necessary to revise the genus Podocarpus. Although this genus has a substantial representation in Malesia (30 species), the revision is too involved to be appropriate with the Flora Malesiana

  5. Nevada Test Site Radiological Control Manual. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    2010-02-09

    This document supersedes DOE/NV/25946--801, “Nevada Test Site Radiological Control Manual,” Revision 0 issued in October 2009. Brief Description of Revision: A minor revision to correct oversights made during revision to incorporate the 10 CFR 835 Update; and for use as a reference document for Tenant Organization Radiological Protection Programs.

  6. Revision of ISO 15859 Aerospace Fluid Standards

    Science.gov (United States)

    Greene, Benjamin; McClure, Mark B.

    2012-01-01

    A detailed review of ISO 15859 "Space Systems - Fluid Characteristics, Sampling and Test Methods" was performed An approach to revising Parts 1-9 and 11-13 was developed and concurred by the NASA Technical Standards Program Office. The approach was to align them with the highest level source documents, and not to program-specific requirements. The updated documents were prepared and presented.

  7. Maximally efficient two-stage screening: Determining intellectual disability in Taiwanese military conscripts.

    Science.gov (United States)

    Chien, Chia-Chang; Huang, Shu-Fen; Lung, For-Wey

    2009-01-27

    The purpose of this study was to apply a two-stage screening method for the large-scale intelligence screening of military conscripts. We collected 99 conscripted soldiers whose educational levels were senior high school level or lower to be the participants. Every participant was required to take the Wisconsin Card Sorting Test (WCST) and the Wechsler Adult Intelligence Scale-Revised (WAIS-R) assessments. Logistic regression analysis showed the conceptual level responses (CLR) index of the WCST was the most significant index for determining intellectual disability (ID; FIQ ≤ 84). We used the receiver operating characteristic curve to determine the optimum cut-off point of CLR. The optimum one cut-off point of CLR was 66; the two cut-off points were 49 and 66. Comparing the two-stage window screening with the two-stage positive screening, the area under the curve and the positive predictive value increased. Moreover, the cost of the two-stage window screening decreased by 59%. The two-stage window screening is more accurate and economical than the two-stage positive screening. Our results provide an example for the use of two-stage screening and the possibility of the WCST to replace WAIS-R in large-scale screenings for ID in the future.

  8. Human-system interface design review guideline -- Process and guidelines: Final report. Revision 1, Volume 1

    Energy Technology Data Exchange (ETDEWEB)

    None

    1996-06-01

    NUREG-0700, Revision 1, provides human factors engineering (HFE) guidance to the US Nuclear Regulatory Commission staff for its: (1) review of the human system interface (HSI) design submittals prepared by licensees or applications for a license or design certification of commercial nuclear power plants, and (2) performance of HSI reviews that could be undertaken as part of an inspection or other type of regulatory review involving HSI design or incidents involving human performance. The guidance consists of a review process and HFE guidelines. The document describes those aspects of the HSI design review process that are important to the identification and resolution of human engineering discrepancies that could adversely affect plant safety. Guidance is provided that could be used by the staff to review an applicant`s HSI design review process or to guide the development of an HSI design review plan, e.g., as part of an inspection activity. The document also provides detailed HFE guidelines for the assessment of HSI design implementations. NUREG-0700, Revision 1, consists of three stand-alone volumes. Volume 1 consists of two major parts. Part 1 describes those aspects of the review process of the HSI design that are important to identifying and resolving human engineering discrepancies. Part 2 contains detailed guidelines for a human factors engineering review which identify criteria for assessing the implementation of an applicant`s or licensee`s HSI design.

  9. Magnetic Resonance Imaging Features of the Nigrostriatal System: Biomarkers of Parkinson’s Disease Stages?

    Science.gov (United States)

    Hopes, Lucie; Grolez, Guillaume; Moreau, Caroline; Lopes, Renaud; Ryckewaert, Gilles; Carrière, Nicolas; Auger, Florent; Laloux, Charlotte; Petrault, Maud; Devedjian, Jean-Christophe; Bordet, Regis; Defebvre, Luc; Jissendi, Patrice; Delmaire, Christine; Devos, David

    2016-01-01

    Introduction Magnetic resonance imaging (MRI) can be used to identify biomarkers in Parkinson’s disease (PD); R2* values reflect iron content related to high levels of oxidative stress, whereas volume and/or shape changes reflect neuronal death. We sought to assess iron overload in the nigrostriatal system and characterize its relationship with focal and overall atrophy of the striatum in the pivotal stages of PD. Methods Twenty controls and 70 PD patients at different disease stages (untreated de novo patients, treated early-stage patients and advanced-stage patients with L-dopa-related motor complications) were included in the study. We determined the R2* values in the substantia nigra, putamen and caudate nucleus, together with striatal volume and shape analysis. We also measured R2* in an acute MPTP mouse model and in a longitudinal follow-up two years later in the early-stage PD patients. Results The R2* values in the substantia nigra, putamen and caudate nucleus were significantly higher in de novo PD patients than in controls. Early-stage patients displayed significantly higher R2* values in the substantia nigra (with changes in striatal shape), relative to de novo patients. Measurements after a two-year follow-up in early-stage patients and characterization of the acute MPTP mouse model confirmed that R2* changed rapidly with disease progression. Advanced-stage patients displayed significant atrophy of striatum, relative to earlier disease stages. Conclusion Each pivotal stage in PD appears to be characterized by putative nigrostriatal MRI biomarkers: iron overload at the de novo stage, striatal shape changes at early-stage disease and generalized striatal atrophy at advanced disease. PMID:27035571

  10. Preoperative diagnostic for periprosthetic joint infection prior to total knee revision arthroplasty

    Directory of Open Access Journals (Sweden)

    Leif Claassen

    2014-08-01

    Full Text Available Periprosthetic joint infection (PJI after total knee arthroplasty remains a challenging problem. The aim of this study was to evaluate the accuracy of diagnostic knee aspiration and serum inflammatory markers in diagnostic of a PJI after total knee arthroplasty. Within 2011 and 2012, 46 patients received a one- or two-stage revision arthroplasty of the knee joint. These patients received a total number of 77 operations. A preoperative aspiration was performed in each case. We analyzed the microbiological and histological examinations of the samples from the aspiration and from the revision operation and additionally estimated serum inflammatory markers. The diagnostic aspiration had a specificity of 0.87, a sensitivity of 0.39, a positive predictive value of 0.67 and a negative predictive value of 0.68. For C-reactive protein the specificity was 0.61 and the sensitivity was 0.48, the serum white blood cell count had a specificity of 0.98 and a sensitivity of 0.23. Our data queries whether diagnostic joint aspiration or serum inflammatory markers are sufficient to verify or exclude a PJI.

  11. Thermal properties Forsmark. Modelling stage 2.3 Complementary analysis and verification of the thermal bedrock model, stage 2.

    Energy Technology Data Exchange (ETDEWEB)

    Sundberg, Jan; Wrafter, John; Laendell, Maerta (Geo Innova AB (Sweden)); Back, Paer-Erik; Rosen, Lars (Sweco AB (Sweden))

    2008-11-15

    This report present the results of thermal modelling work for the Forsmark area carried out during modelling stage 2.3. The work complements the main modelling efforts carried out during modelling stage 2.2. A revised spatial statistical description of the rock mass thermal conductivity for rock domain RFM045 is the main result of this work. Thermal modelling of domain RFM045 in Forsmark model stage 2.2 gave lower tail percentiles of thermal conductivity that were considered to be conservatively low due to the way amphibolite, the rock type with the lowest thermal conductivity, was modelled. New and previously available borehole data are used as the basis for revised stochastic geological simulations of domain RFM045. By defining two distinct thermal subdomains, these simulations have succeeded in capturing more of the lithological heterogeneity present. The resulting thermal model for rock domain RFM045 is, therefore, considered to be more realistic and reliable than that presented in model stage 2.2. The main conclusions of modelling efforts in model stage 2.3 are: - Thermal modelling indicates a mean thermal conductivity for domain RFM045 at the 5 m scale of 3.56 W/(mK). This is slightly higher than the value of 3.49 W/(mK) derived in model stage 2.2. - The variance decreases and the lower tail percentiles increase as the scale of observation increases from 1 to 5 m. Best estimates of the 0.1 percentile of thermal conductivity for domain RFM045 are 2.24 W/(mK) for the 1 m scale and 2.36 W/(mK) for the 5 m scale. This can be compared with corresponding values for domain RFM029 of 2.30 W/(mK) for the 1 m scale and 2.87 W/(mK)for the 5 m scale. - The reason for the pronounced lower tail in the thermal conductivity distribution for domain RFM045 is the presence of large bodies of the low-conductive amphibolite. - The modelling results for domain RFM029 presented in model stage 2.2 are still applicable. - As temperature increases, the thermal conductivity decreases

  12. Space Launch System, Core Stage, Structural Test Design and Implementation

    Science.gov (United States)

    Shaughnessy, Ray

    2017-01-01

    As part of the National Aeronautics and Space Administration's (NASA) Space Launch System (SLS) Program, engineers at NASA's Marshall Space Flight Center (MSFC) in Huntsville, Alabama are working to design, develop and implement the SLS Core Stage structural testing. The SLS will have the capability to return humans to the Moon and beyond and its first launch is scheduled for December of 2017. The SLS Core Stage consist of five major elements; Forward Skirt, Liquid Oxygen (LOX) tank, Intertank (IT), Liquid Hydrogen (LH2) tank and the Engine Section (ES). Structural Test Articles (STA) for each of these elements are being designed and produced by Boeing at Michoud Assembly Facility located in New Orleans, La. The structural test for the Core Stage STAs (LH2, LOX, IT and ES) are to be conducted by the MSFC Test Laboratory. Additionally, the MSFC Test Laboratory manages the Structural Test Equipment (STE) design and development to support the STAs. It was decided early (April 2012) in the project life that the LH2 and LOX tank STAs would require new test stands and the Engine Section and Intertank would be tested in existing facilities. This decision impacted schedules immediately because the new facilities would require Construction of Facilities (C of F) funds that require congressional approval and long lead times. The Engine Section and Intertank structural test are to be conducted in existing facilities which will limit lead times required to support the first launch of SLS. With a SLS launch date of December, 2017 Boeing had a need date for testing to be complete by September of 2017 to support flight certification requirements. The test facilities were required to be ready by October of 2016 to support test article delivery. The race was on to get the stands ready before Test Article delivery and meet the test complete date of September 2017. This paper documents the past and current design and development phases and the supporting processes, tools, and

  13. Effects of the Original Versus Revised Bloom's Taxonomy on Lesson Planning Skills: A Turkish Study Among Pre-Service Teachers

    Science.gov (United States)

    Bümen, Nilay T.

    2007-07-01

    The original taxonomy of educational objectives, developed by Benjamin S.␣Bloom and his associates in the 1950s, was revised several decades later by a group of educationists and cognitive psychologists, who developed a revised taxonomy (RT). This article describes a Turkish study carried out among a group of pre-service teachers in order to compare the influence of the two systems on lesson planning skills. The results confirmed other studies that have indicated a number of advantages of the revised system over the earlier one.

  14. Validation of the Hong Kong Liver Cancer Staging System in Determining Prognosis of the North American Patients Following Intra-arterial Therapy

    Science.gov (United States)

    Sohn, Jae Ho; Duran, Rafael; Zhao, Yan; Fleckenstein, Florian; Chapiro, Julius; Sahu, Sonia P.; Schernthaner, Rüdiger E.; Qian, Tianchen; Lee, Howard; Zhao, Li; Hamilton, James; Frangakis, Constantine; Lin, MingDe; Salem, Riad; Geschwind, Jean-Francois

    2018-01-01

    Background & Aims There is debate over the best way to stage hepatocellular carcinoma (HCC). We attempted to validate the prognostic and clinical utility of the recently developed Hong Kong Liver Cancer (HKLC) staging system, a hepatitis B-based model, and compared data with that from the Barcelona Clinic Liver Cancer (BCLC) staging system in a North American population who underwent intra-arterial therapy (IAT). Methods We performed a retrospective analysis of data from 1009 patients with HCC who underwent intra-arterial therapy from 2000 through 2014. Most patients had hepatitis C or unresectable tumors; all patients underwent IAT, with or without resection, transplantation, and/or systemic chemotherapy. We calculated HCC stage for each patient using 5-stage HKLC (HKLC-5) and 9-stage HKLC (HKLC-9) system classifications, as well as the BCLC system. Survival information was collected up until end of 2014 at which point living or unconfirmed patients were censored. We compared performance of the BCLC, HKLC-5, and HKLC-9 systems in predicting patient outcomes using Kaplan-Meier estimates, calibration plots, c-statistic, Akaike information criterion, and the likelihood ratio test. Results Median overall survival time, calculated from first IAT until date of death or censorship, for the entire cohort (all stages) was 9.8 months. The BCLC and HKLC staging systems predicted patient survival times with significance (P<.001). HKLC-5 and HKLC-9 each demonstrated good calibration. The HKLC-5 system outperformed the BCLC system in predicting patient survival times (HKLC c=0.71, Akaike information criterion=6242; BCLC c=0.64, Akaike information criterion=6320), reducing error in predicting survival time (HKLC reduced error by 14%, BCLC reduced error by 12%), and homogeneity (HKLC χ2=201; P<.001; BCLC χ2=119; P<.001) and monotonicity (HKLC linear trend χ2=193; P<.001; BCLC linear trend χ2=111; P<.001). Small proportions of patients with HCC of stages IV or V, according to

  15. [An overview on the collation and revision of medical books by the Bureau for Revising Medical Books in the Northern Song Dynasty].

    Science.gov (United States)

    Meng, Yongliang; Liang, Yongxuan

    2014-07-01

    The Bureau for Revising Medical Books was a temporary agency established by the government of the Northern Song Dynasty in 1057, the 2nd year of Jiayou of Emperor Renzong, exclusively for the edition, revision and publishing of ancient medical books. 11 medical books were revised and edited by 13 Bureau members in a period of 12 years until 1069, the 2nd year of Xining of Emperor ShenZong, which eventually became the final versions until today. 8 medical books were initially planned for the revision, but 11 were actually completed in the end. The time for completing a revision varied from over 10 years at most to less than 1 year at least. Instead of working in the office, the officers of the Bureau for Revising Medical Books did their works at home. The members of the said Bureau came from the Tiju officer of the Bureau for Revising Medical Books and the officials of revising medical books, consisting of both Confucian ministers and medical officers. Confucian ministers played an important role in revising medical books. The Bureau had a strict workflow in electing revising officials, making the project, and the determination of the principles and arrangements of the tasks of editing and proofreading.

  16. Application of preference selection index method for decision making over the design stage of production system life cycle

    Directory of Open Access Journals (Sweden)

    Rajesh Attri

    2015-07-01

    Full Text Available The life cycle of production system shows the progress of production system from the inception to the termination of the system. During each stage, mainly in the design stage, certain strategic decisions have to be taken. These decisions are more complex as the decision makers have to assess a wide range of alternatives based on a set of conflicting criteria. As the decision making process is found to be unstructured, characterized by domain dependent knowledge, there is a need to apply an efficient multi-criteria decision making (MCDM tool to help the decision makers in making correct decisions. This paper explores the application of a novel MCDM method i.e. Preference selection index (PSI method to solve various decision-making problems that are generally encountered in the design stage of production system life cycle. To prove the potentiality, applicability and accuracy of PSI method in solving decision making problem during the design stage of production system life cycle, five examples are cited from the literature and are compared with the results obtained by the past researchers.

  17. An adaptive three-stage extended Kalman filter for nonlinear discrete-time system in presence of unknown inputs.

    Science.gov (United States)

    Xiao, Mengli; Zhang, Yongbo; Wang, Zhihua; Fu, Huimin

    2018-04-01

    Considering the performances of conventional Kalman filter may seriously degrade when it suffers stochastic faults and unknown input, which is very common in engineering problems, a new type of adaptive three-stage extended Kalman filter (AThSEKF) is proposed to solve state and fault estimation in nonlinear discrete-time system under these conditions. The three-stage UV transformation and adaptive forgetting factor are introduced for derivation, and by comparing with the adaptive augmented state extended Kalman filter, it is proven to be uniformly asymptotically stable. Furthermore, the adaptive three-stage extended Kalman filter is applied to a two-dimensional radar tracking scenario to illustrate the effect, and the performance is compared with that of conventional three stage extended Kalman filter (ThSEKF) and the adaptive two-stage extended Kalman filter (ATEKF). The results show that the adaptive three-stage extended Kalman filter is more effective than these two filters when facing the nonlinear discrete-time systems with information of unknown inputs not perfectly known. Copyright © 2018 ISA. Published by Elsevier Ltd. All rights reserved.

  18. Revised definition of neuropathic pain and its grading system: an open case series illustrating its use in clinical practice.

    Science.gov (United States)

    Geber, Christian; Baumgärtner, Ulf; Schwab, Rainer; Müller, Harald; Stoeter, Peter; Dieterich, Marianne; Sommer, Clemens; Birklein, Frank; Treede, Rolf-Detlef

    2009-10-01

    The definition of neuropathic pain has recently been revised by an expert committee of the Neuropathic Pain Special Interest Group of the International Association for the Study of Pain (NeuPSIG) as "pain arising as direct consequence of a lesion or disease affecting the somatosensory system," and a grading system of "definite," "probable," and "possible" neuropathic pain has been introduced. This open case series of 5 outpatients (3 men, 2 women; mean age 48 +/- 12 years) demonstrates how the grading system can be applied, in combination with appropriate confirmatory testing, to diagnosis neuropathic conditions in clinical practice. The proposed grading system includes a dynamic algorithm that enhances the physician's ability to determine with a greater level of certainty whether a pain condition is neuropathic. Its clinical use should be further validated in prospective studies.

  19. Emotion Processes in Knowledge Revision

    Science.gov (United States)

    Trevors, Gregory J.; Kendeou, Panayiota; Butterfuss, Reese

    2017-01-01

    In recent years, a number of insights have been gained into the cognitive processes that explain how individuals overcome misconceptions and revise their previously acquired incorrect knowledge. The current study complements this line of research by investigating the moment-by-moment emotion processes that occur during knowledge revision using a…

  20. Health system delay and its effect on clinical stage of breast cancer: Multicenter study.

    Science.gov (United States)

    Unger-Saldaña, Karla; Miranda, Alfonso; Zarco-Espinosa, Gelasio; Mainero-Ratchelous, Fernando; Bargalló-Rocha, Enrique; Miguel Lázaro-León, Jesús

    2015-07-01

    The objective of this study was to determine the correlation between health system delay and clinical disease stage in patients with breast cancer. This was a cross-sectional study of 886 patients who were referred to 4 of the largest public cancer hospitals in Mexico City for the evaluation of a probable breast cancer. Data on time intervals, sociodemographic factors, and clinical stage at diagnosis were retrieved. A logistic regression model was used to estimate the average marginal effects of delay on the probability of being diagnosed with advanced breast cancer (stages III and IV). The median time between problem identification and the beginning of treatment was 7 months. The subinterval with the largest delay was that between the first medical consultation and diagnosis (median, 4 months). Only 15% of the patients who had cancer were diagnosed with stage 0 and I disease, and 48% were diagnosed with stage III and IV disease. Multivariate analyses confirmed independent correlations for the means of problem identification, patient delay, health system delay, and age with a higher probability that patients would begin cancer treatment in an advanced stage. In the sample studied, the majority of patients with breast cancer began treatment after a delay. Both patient delays and provider delays were associated with advanced disease. Research aimed at identifying specific access barriers to medical services is much needed to guide the design of tailored health policies that go beyond the promotion of breast care awareness and screening participation to include improvements in health services that facilitate access to timely diagnosis and treatment. © 2015 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

  1. 75 FR 57597 - Revised Proposal for Revisions to the Schedules of Civil Penalties for a Violation of a Federal...

    Science.gov (United States)

    2010-09-21

    ... Revisions to the Schedules of Civil Penalties for a Violation of a Federal Railroad Safety Law or Federal... railroad safety laws and regulations are necessary because many of FRA's civil penalties have not been..., et al. Revised Proposal for Revisions to the Schedules of Civil Penalties for a Violation of a...

  2. Two-Stage orders sequencing system for mixed-model assembly

    Science.gov (United States)

    Zemczak, M.; Skolud, B.; Krenczyk, D.

    2015-11-01

    In the paper, the authors focus on the NP-hard problem of orders sequencing, formulated similarly to Car Sequencing Problem (CSP). The object of the research is the assembly line in an automotive industry company, on which few different models of products, each in a certain number of versions, are assembled on the shared resources, set in a line. Such production type is usually determined as a mixed-model production, and arose from the necessity of manufacturing customized products on the basis of very specific orders from single clients. The producers are nowadays obliged to provide each client the possibility to determine a huge amount of the features of the product they are willing to buy, as the competition in the automotive market is large. Due to the previously mentioned nature of the problem (NP-hard), in the given time period only satisfactory solutions are sought, as the optimal solution method has not yet been found. Most of the researchers that implemented inaccurate methods (e.g. evolutionary algorithms) to solving sequencing problems dropped the research after testing phase, as they were not able to obtain reproducible results, and met problems while determining the quality of the received solutions. Therefore a new approach to solving the problem, presented in this paper as a sequencing system is being developed. The sequencing system consists of a set of determined rules, implemented into computer environment. The system itself works in two stages. First of them is connected with the determination of a place in the storage buffer to which certain production orders should be sent. In the second stage of functioning, precise sets of sequences are determined and evaluated for certain parts of the storage buffer under certain criteria.

  3. Optics of two-stage photovoltaic concentrators with dielectric second stages

    Science.gov (United States)

    Ning, Xiaohui; O'Gallagher, Joseph; Winston, Roland

    1987-04-01

    Two-stage photovoltaic concentrators with Fresnel lenses as primaries and dielectric totally internally reflecting nonimaging concentrators as secondaries are discussed. The general design principles of such two-stage systems are given. Their optical properties are studied and analyzed in detail using computer ray trace procedures. It is found that the two-stage concentrator offers not only a higher concentration or increased acceptance angle, but also a more uniform flux distribution on the photovoltaic cell than the point focusing Fresnel lens alone. Experimental measurements with a two-stage prototype module are presented and compared to the analytical predictions.

  4. Optics of two-stage photovoltaic concentrators with dielectric second stages.

    Science.gov (United States)

    Ning, X; O'Gallagher, J; Winston, R

    1987-04-01

    Two-stage photovoltaic concentrators with Fresnel lenses as primaries and dielectric totally internally reflecting nonimaging concentrators as secondaries are discussed. The general design principles of such two-stage systems are given. Their optical properties are studied and analyzed in detail using computer ray trace procedures. It is found that the two-stage concentrator offers not only a higher concentration or increased acceptance angle, but also a more uniform flux distribution on the photovoltaic cell than the point focusing Fresnel lens alone. Experimental measurements with a two-stage prototype module are presented and compared to the analytical predictions.

  5. Effect of ammoniacal nitrogen on one-stage and two-stage anaerobic digestion of food waste

    Energy Technology Data Exchange (ETDEWEB)

    Ariunbaatar, Javkhlan, E-mail: jaka@unicas.it [Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Via Di Biasio 43, 03043 Cassino, FR (Italy); UNESCO-IHE Institute for Water Education, Westvest 7, 2611 AX Delft (Netherlands); Scotto Di Perta, Ester [Department of Civil, Architectural and Environmental Engineering, University of Naples Federico II, Via Claudio 21, 80125 Naples (Italy); Panico, Antonio [Telematic University PEGASO, Piazza Trieste e Trento, 48, 80132 Naples (Italy); Frunzo, Luigi [Department of Mathematics and Applications Renato Caccioppoli, University of Naples Federico II, Via Claudio, 21, 80125 Naples (Italy); Esposito, Giovanni [Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Via Di Biasio 43, 03043 Cassino, FR (Italy); Lens, Piet N.L. [UNESCO-IHE Institute for Water Education, Westvest 7, 2611 AX Delft (Netherlands); Pirozzi, Francesco [Department of Civil, Architectural and Environmental Engineering, University of Naples Federico II, Via Claudio 21, 80125 Naples (Italy)

    2015-04-15

    Highlights: • Almost 100% of the biomethane potential of food waste was recovered during AD in a two-stage CSTR. • Recirculation of the liquid fraction of the digestate provided the necessary buffer in the AD reactors. • A higher OLR (0.9 gVS/L·d) led to higher accumulation of TAN, which caused more toxicity. • A two-stage reactor is more sensitive to elevated concentrations of ammonia. • The IC{sub 50} of TAN for the AD of food waste amounts to 3.8 g/L. - Abstract: This research compares the operation of one-stage and two-stage anaerobic continuously stirred tank reactor (CSTR) systems fed semi-continuously with food waste. The main purpose was to investigate the effects of ammoniacal nitrogen on the anaerobic digestion process. The two-stage system gave more reliable operation compared to one-stage due to: (i) a better pH self-adjusting capacity; (ii) a higher resistance to organic loading shocks; and (iii) a higher conversion rate of organic substrate to biomethane. Also a small amount of biohydrogen was detected from the first stage of the two-stage reactor making this system attractive for biohythane production. As the digestate contains ammoniacal nitrogen, re-circulating it provided the necessary alkalinity in the systems, thus preventing an eventual failure by volatile fatty acids (VFA) accumulation. However, re-circulation also resulted in an ammonium accumulation, yielding a lower biomethane production. Based on the batch experimental results the 50% inhibitory concentration of total ammoniacal nitrogen on the methanogenic activities was calculated as 3.8 g/L, corresponding to 146 mg/L free ammonia for the inoculum used for this research. The two-stage system was affected by the inhibition more than the one-stage system, as it requires less alkalinity and the physically separated methanogens are more sensitive to inhibitory factors, such as ammonium and propionic acid.

  6. Proposed Lymph Node Staging System Using the International Consensus Guidelines for Lymph Node Levels Is Predictive for Nasopharyngeal Carcinoma Patients From Endemic Areas Treated With Intensity Modulated Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Li, Wen-Fei; Sun, Ying; Mao, Yan-Ping; Chen, Lei; Chen, Yuan-Yuan; Chen, Mo [Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou (China); Liu, Li-Zhi [Imaging Diagnosis and Interventional Center, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou (China); Lin, Ai-Hua [Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou (China); Li, Li [Imaging Diagnosis and Interventional Center, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou (China); Ma, Jun, E-mail: majun2@mail.sysu.edu.cn [Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou (China)

    2013-06-01

    Purpose: To propose a lymph node (N) staging system for nasopharyngeal carcinoma (NPC) based on the International Consensus Guidelines for lymph node (LN) levels and MRI-determined nodal variables. Methods and Materials: The MRI scans and medical records of 749 NPC patients receiving intensity modulated radiation therapy with or without chemotherapy were retrospectively reviewed. The prognostic significance of nodal level, laterality, maximal axial diameter, extracapsular spread, necrosis, and Union for International Cancer Control/American Joint Committee on Cancer (UICC/AJCC) size criteria were analyzed. Results: Nodal level and laterality were the only independent prognostic factors for distant failure and disease failure in multivariate analysis. Compared with unilateral levels Ib, II, III, and/or Va involvement (hazard ratio [HR] 1), retropharyngeal lymph node involvement alone had a similar prognostic value (HR 0.71; 95% confidence interval [CI] 0.43-1.17; P=.17), whereas bilateral levels Ib, II, III, and/or Va involvement (HR 1.65; 95% CI 1.06-2.58; P=.03) and levels IV, Vb, and/or supraclavicular fossa involvement (HR 3.47; 95% CI 1.92-6.29; P<.01) both significantly increased the HR for distant failure. Thus we propose that the N category criteria could be revised as follows: N0, no regional LN metastasis; N1, retropharyngeal lymph node involvement, and/or unilateral levels Ib, II, III, and/or Va involvement; N2, bilateral levels Ib, II, III, and/or Va involvement; N3, levels IV, Vb, and/or supraclavicular fossa involvement. Compared with the 7th edition of the UICC/AJCC criteria, the proposed N staging system provides a more satisfactory distinction between the HRs for regional failure, distant failure, and disease failure in each N category. Conclusions: The proposed N staging system defined by the International Consensus Guidelines and laterality is predictive and practical. However, because of no measurements of the maximal nodal diameter on MRI slices

  7. Organic semiconductor wastewater treatment using a four-stage Bardenpho with membrane system.

    Science.gov (United States)

    Chung, Jinwook; Fleege, Daniel; Ong, Say Kee; Lee, Yong-Woo

    2014-01-01

    Electronic wastewater from a semiconductor plant was treated with a pilot-scale four-stage Bardenpho process with membrane system. The system was operated over a 14-month period with an overall hydraulic retention time (HRT) ranging from 9.5 to 30 h. With a few exceptions, the pilot plant consistently treated the electronic wastewater with an average removal efficiency of chemical oxygen demand (COD) and total nitrogen of 97% and 93%, respectively, and achieving effluent quality of COD<15 mg/L, turbidity<1, and silt density index<1. Based on removal efficiencies of the pilot plant, it is possible to lower the HRT to less than 9.5 h to achieve comparable removal efficiencies. An energy-saving configuration where an internal recycle line was omitted and the biomass recycle was rerouted to the pre-anoxic tank, can reduce energy consumption by 8.6% and gave removal efficiencies that were similar to the Bardenpho process. The system achieved pre-anoxic and post-anoxic specific denitrification rate values with a 95% confidence interval of 0.091 ± 0.011 g NO₃-N/g MLVSS d and 0.087 ± 0.016 g NO₃-N/g MLVSS d, respectively. The effluent from the four-stage Bardenpho with membrane system can be paired with a reverse osmosis system to provide further treatment for reuse purposes.

  8. Aqueous Transport Code Revisions Using Geographic Information Systems

    International Nuclear Information System (INIS)

    Chen, K.F.

    2003-01-01

    STREAM II, developed at the Savannah River Site (SRS) for execution on a personal computer, is an emergency response code that predicts downstream pollutant concentrations for releases from the SRS area to the Savannah River for emergency response management decision making. The STREAM II code consists of pre-processor, calculation, and post-processor modules. The pre-processor module provides a graphical user interface (GUI) for inputting the initial release data. The GUI passes the user specified data to the calculation module that calculates the pollutant concentrations at downstream locations and the transport times. The calculation module of the STREAM II adopts the transport module of the WASP5 code. WASP5 is a US Environmental Protection Agency water quality analysis program that simulates pollutant transport and fate through surface water using a finite difference method to solve the transport equation. The calculated downstream pollutant concentrations and travel times a re passed to the post-processor for display on the computer screen in graphical and tabular forms. To minimize the user's effort in the emergency situation, the required input parameters are limited to the time and date of release, type of release, location of release, amount and duration of release, and the calculation units. The user, however, could only select one of the seventeen predetermined locations. Hence, STREAM II could not be used for situations in which release locations differ from the seventeen predetermined locations. To eliminate this limitation, STREAM II has been revised to allow users to select the release location anywhere along the specified SRS main streams or the Savannah River by mouse-selection from a map displayed on the computer monitor. The required modifications to STREAM II using geographic information systems (GIS) software is discussed in this paper

  9. Belief revision and delusions: how do patients with schizophrenia take advice?

    Science.gov (United States)

    Kaliuzhna, Mariia; Chambon, Valérian; Franck, Nicolas; Testud, Bérangère; Van der Henst, Jean-Baptiste

    2012-01-01

    The dominant cognitive model that accounts for the persistence of delusional beliefs in schizophrenia postulates that patients suffer from a general deficit in belief revision. It is generally assumed that this deficit is a consequence of impaired reasoning skills. However, the possibility that such inflexibility affects the entire system of a patient's beliefs has rarely been empirically tested. Using delusion-neutral material in a well-documented advice-taking task, the present study reports that patients with schizophrenia: 1) revise their beliefs, 2) take into account socially provided information to do so, 3) are not overconfident about their judgments, and 4) show less egocentric advice-discounting than controls. This study thus shows that delusional patients' difficulty in revising beliefs is more selective than had been previously assumed. The specificities of the task and the implications for a theory of delusion formation are discussed.

  10. DEPTH-CHARGE static and time-dependent perturbation/sensitivity system for nuclear reactor core analysis. Revision I

    International Nuclear Information System (INIS)

    White, J.R.

    1985-04-01

    This report provides the background theory, user input, and sample problems required for the efficient application of the DEPTH-CHARGE system - a code black for both static and time-dependent perturbation theory and data sensitivity analyses. The DEPTH-CHARGE system is of modular construction and has been implemented within the VENTURE-BURNER computational system at Oak Ridge National Laboratory. The DEPTH module (coupled with VENTURE) solves for the three adjoint functions of Depletion Perturbation Theory and calculates the desired time-dependent derivatives of the response with respect to the nuclide concentrations and nuclear data utilized in the reference model. The CHARGE code is a collection of utility routines for general data manipulation and input preparation and considerably extends the usefulness of the system through the automatic generation of adjoint sources, estimated perturbed responses, and relative data sensitivity coefficients. Combined, the DEPTH-CHARGE system provides, for the first time, a complete generalized first-order perturbation/sensitivity theory capability for both static and time-dependent analyses of realistic multidimensional reactor models. This current documentation incorporates minor revisions to the original DEPTH-CHARGE documentation (ORNL/CSD-78) to reflect some new capabilities within the individual codes

  11. Two-stage open-loop velocity compensating method applied to multi-mass elastic transmission system

    Directory of Open Access Journals (Sweden)

    Zhang Deli

    2014-02-01

    Full Text Available In this paper, a novel vibration-suppression open-loop control method for multi-mass system is proposed, which uses two-stage velocity compensating algorithm and fuzzy I + P controller. This compensating method is based on model-based control theory in order to provide a damping effect on the system mechanical part. The mathematical model of multi-mass system is built and reduced to estimate the velocities of masses. The velocity difference between adjacent masses is calculated dynamically. A 3-mass system is regarded as the composition of two 2-mass systems in order to realize the two-stage compensating algorithm. Instead of using a typical PI controller in the velocity compensating loop, a fuzzy I + P controller is designed and its input variables are decided according to their impact on the system, which is different from the conventional fuzzy PID controller designing rules. Simulations and experimental results show that the proposed velocity compensating method is effective in suppressing vibration on a 3-mass system and it has a better performance when the designed fuzzy I + P controller is utilized in the control system.

  12. Two-stage dental implants inserted in a one-stage procedure : a prospective comparative clinical study

    NARCIS (Netherlands)

    Heijdenrijk, Kees

    2002-01-01

    The results of this study indicate that dental implants designed for a submerged implantation procedure can be used in a single-stage procedure and may be as predictable as one-stage implants. Although one-stage implant systems and two-stage.

  13. SCALE: A modular code system for performing standardized computer analyses for licensing evaluation. Miscellaneous -- Volume 3, Revision 4

    Energy Technology Data Exchange (ETDEWEB)

    Petrie, L.M.; Jordon, W.C. [Oak Ridge National Lab., TN (United States); Edwards, A.L. [Oak Ridge National Lab., TN (United States)]|[Lawrence Livermore National Lab., CA (United States)] [and others

    1995-04-01

    SCALE--a modular code system for Standardized Computer Analyses Licensing Evaluation--has been developed by Oak Ridge National Laboratory at the request of the US Nuclear Regulatory Commission. The SCALE system utilizes well-established computer codes and methods within standard analysis sequences that (1) allow an input format designed for the occasional user and/or novice; (2) automate the data processing and coupling between modules, and (3) provide accurate and reliable results. System developments has been directed at problem-dependent cross-section processing and analysis of criticality safety, shielding, heat transfer, and depletion/decay problems. Since the initial release of SCALE in 1980, the code system has been heavily used for evaluation of nuclear fuel facility and package designs. This revision documents Version 4.2 of the system. This manual is divided into three volumes: Volume 1--for the control module documentation, Volume 2--for the functional module documentation, and Volume 3--for the data libraries and subroutine libraries.

  14. SCALE: A modular code system for performing standardized computer analyses for licensing evaluation. Miscellaneous -- Volume 3, Revision 4

    International Nuclear Information System (INIS)

    Petrie, L.M.; Jordon, W.C.; Edwards, A.L.

    1995-04-01

    SCALE--a modular code system for Standardized Computer Analyses Licensing Evaluation--has been developed by Oak Ridge National Laboratory at the request of the US Nuclear Regulatory Commission. The SCALE system utilizes well-established computer codes and methods within standard analysis sequences that (1) allow an input format designed for the occasional user and/or novice; (2) automate the data processing and coupling between modules, and (3) provide accurate and reliable results. System developments has been directed at problem-dependent cross-section processing and analysis of criticality safety, shielding, heat transfer, and depletion/decay problems. Since the initial release of SCALE in 1980, the code system has been heavily used for evaluation of nuclear fuel facility and package designs. This revision documents Version 4.2 of the system. This manual is divided into three volumes: Volume 1--for the control module documentation, Volume 2--for the functional module documentation, and Volume 3--for the data libraries and subroutine libraries

  15. Computerized breast cancer analysis system using three stage semi-supervised learning method.

    Science.gov (United States)

    Sun, Wenqing; Tseng, Tzu-Liang Bill; Zhang, Jianying; Qian, Wei

    2016-10-01

    A large number of labeled medical image data is usually a requirement to train a well-performed computer-aided detection (CAD) system. But the process of data labeling is time consuming, and potential ethical and logistical problems may also present complications. As a result, incorporating unlabeled data into CAD system can be a feasible way to combat these obstacles. In this study we developed a three stage semi-supervised learning (SSL) scheme that combines a small amount of labeled data and larger amount of unlabeled data. The scheme was modified on our existing CAD system using the following three stages: data weighing, feature selection, and newly proposed dividing co-training data labeling algorithm. Global density asymmetry features were incorporated to the feature pool to reduce the false positive rate. Area under the curve (AUC) and accuracy were computed using 10 fold cross validation method to evaluate the performance of our CAD system. The image dataset includes mammograms from 400 women who underwent routine screening examinations, and each pair contains either two cranio-caudal (CC) or two mediolateral-oblique (MLO) view mammograms from the right and the left breasts. From these mammograms 512 regions were extracted and used in this study, and among them 90 regions were treated as labeled while the rest were treated as unlabeled. Using our proposed scheme, the highest AUC observed in our research was 0.841, which included the 90 labeled data and all the unlabeled data. It was 7.4% higher than using labeled data only. With the increasing amount of labeled data, AUC difference between using mixed data and using labeled data only reached its peak when the amount of labeled data was around 60. This study demonstrated that our proposed three stage semi-supervised learning can improve the CAD performance by incorporating unlabeled data. Using unlabeled data is promising in computerized cancer research and may have a significant impact for future CAD system

  16. Student-initiated revision in child health.

    Science.gov (United States)

    Alfaham, M; Gray, O P; Davies, D P

    1994-03-01

    Most teaching of child health in Cardiff takes place in block attachments of 8 weeks. There is an introductory seminar of 2 days followed by a 6-week clinical attachment in a district general hospital in Wales, and then a revision period of one week designed to help students formalize and structure their basic knowledge and to clarify aspects of child health which they may have had difficulty in understanding. The revision programme has to take into account: the short time available, the small number of teaching staff, the most relevant basic knowledge and active participation by the student. This paper describes how this week has been improved through the use of student-initiated revision (SIR). The students' appraisal of this revision and in particular SIR is presented.

  17. Revised hypothesis and future perspectives

    DEFF Research Database (Denmark)

    Norsk, P; Drummer, C; Christensen, N J

    2001-01-01

    Results from space have been unexpected and not predictable from the results of ground-based simulations. Therefore, the concept of how weightlessness and gravity modulates the regulation of body fluids must be revised and a new simulation model developed. The main questions to ask in the future...... are the following: Does weightlessness induce a diuresis and natriuresis during the initial hours of space flight leading to an extracellular and intravascular fluid volume deficit? Can sodium in excess be stored in a hitherto unknown way, particularly during space flight? Why are fluid and sodium retaining systems...

  18. 78 FR 9047 - Public Water System Supervision Program Revision for the State of Texas

    Science.gov (United States)

    2013-02-07

    ... Water System Supervision Program. Texas has adopted three EPA drinking water rules, namely the: (1) Long Term 2 Enhanced Surface Water Treatment Rule (LT2), (2) the Stage 2 Disinfectants and Disinfection... Drinking Water Section (MC-155), Building F, 12100 Park 35 Circle, Austin, TX 78753; and United States...

  19. Contact activation: a revision.

    Science.gov (United States)

    Schmaier, A H

    1997-07-01

    In conclusion, a revised view of the contact system has been presented. This system has little to do with the initiation of hemostasis. Like lupus anticoagulants, deficiencies of contact proteins give prolonged APTTs but may be risk factors for thrombosis. BK from kininogens is a potent modulator of vascular biology inducing vasodilation, tissue plasminogen activator release, and prostacyclin liberation. Kininogens, themselves, are selective inhibitors of alpha-thrombin-induced platelet activation preventing alpha-thrombin from cleaving the cloned thrombin receptor after arginine41. Kininogens' alpha-thrombin inhibitory activity exists in intact kininogens, BK, and all of BK's breakdown products. HK also is the pivotal protein for contact protein assembly on endothelium. It is the receptor for prekallikrein which when bound to HK becomes activated to kallikrein by an endothelial cell enzyme system independent of activated forms of plasma factor XII. Prekallikrein activation on endothelial cells results in kinetically favorable single chain urokinase and plasminogen activation. Thus the "physiologic, negatively charged surface" for contact system activation is really the assembly of these proteins on cell membranes and activation by membrane-associated enzymes.

  20. Total hip arthroplasty revision due to infection: a cost analysis approach.

    Science.gov (United States)

    Klouche, S; Sariali, E; Mamoudy, P

    2010-04-01

    The treatment of total hip arthroplasty (THA) infections is long and costly. However,the number of studies in the literature analysing the real cost of THA revision in relation to their etiology, including infection, is limited. The aim of this retrospective study was to determine the cost of revision of infected THA and to compare these costs to those of primary THA and revision of non-infected THA. We performed a retrospective cost analysis for the year 2006 using an identical analytic accounting system in each hospital department (according to internal criteria) based on allotment of direct costs and receipts for each department. From January to December 2006, 424 primary THA, 57 non-infected THA revisions and 40 THA revisions due to infection were performed. The different cost areas of the patient's treatment were identified.This included preoperative medical work-up, medicosurgical management during hospital stay,a second stay in an orthopedic rehabilitation hospital (ORH) and post-hospitalisation antibiotic therapy after revision due to infection, as well as home-based hospitalisation (HH) costs, if this was the selected alternative option. We used the national health insurance fee schedule found in the "Common classification of medical procedures" and the "General nomenclature of professional procedures" applicable in France since September 1, 2005. Hospital costs included direct costs (hospital overhead costs) and indirect costs, (medical, surgical, technical settings and net general service expenses). The calculation of HH costs and ORH costs were based on the average daily charge of these departments. The cost of primary THA was used as the reference.We then compared our surgical costs with those found for the corresponding comparable hospital stay groups (Groupes homogènes de séjour). The average hospital stay (AHS) was 7.5 +/- 1.8 days for primary THA, 8.9 +/- 2.2 days for non-infected revisions and 30.6 +/- 14.9 days for revisions due to infection

  1. Clinical and Economic Burden of Revision Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Mohit Bhandari

    2012-01-01

    Full Text Available Surgery is indicated for symptomatic knee osteoarthritis (OA when conservative measures are unsuccessful. High tibial osteotomy (HTO, unicompartmental knee arthroplasty (UKA, and total knee arthroplasty (TKA are surgical options intended to relieve knee OA pain and dysfunction. The choice of surgical intervention is dependent on several factors such as disease location, patient age, comorbidities, and activity levels. Regardless of surgical treatment, complications such as infection, loosening or lysis, periprosthetic fracture, and postoperative pain are known risks and are indications for revision surgery. The clinical and economic implications for revision surgery are underappreciated. Over 55,000 revision surgeries were performed in 2010 in the US, with 48% of these revisions in patients under 65 years. Total costs associated with each revision TKA surgery have been estimated to be in excess of $49,000. The current annual economic burden of revision knee OA surgery is $2.7 billion for hospital charges alone. By 2030, assuming a 5-fold increase in the number of revision procedures, this economic burden will exceed $13 billion annually. It is appealing to envision a therapy that could delay or obviate the need for arthroplasty. From an actuarial standpoint, this would have the theoretical downstream effect of substantially reducing the number of revision procedures. Although no known therapies currently meet these criteria, such a breakthrough would have a tremendous impact in lessening the clinical and economic burden of knee OA revision surgery.

  2. Strengthening power generation efficiency utilizing liquefied natural gas cold energy by a novel two-stage condensation Rankine cycle (TCRC) system

    International Nuclear Information System (INIS)

    Bao, Junjiang; Lin, Yan; Zhang, Ruixiang; Zhang, Ning; He, Gaohong

    2017-01-01

    Highlights: • A two-stage condensation Rankine cycle (TCRC) system is proposed. • Net power output and thermal efficiency increases by 45.27% and 42.91%. • The effects of the condensation temperatures are analyzed. • 14 working fluids (such as propane, butane etc.) are compared. - Abstract: For the low efficiency of the traditional power generation system with liquefied natural gas (LNG) cold energy utilization, by improving the heat transfer characteristic between the working fluid and LNG, this paper has proposed a two-stage condensation Rankine cycle (TCRC) system. Using propane as working fluid, compared with the combined cycle in the conventional LNG cold energy power generation method, the net power output, thermal efficiency and exergy efficiency of the TCRC system are respectively increased by 45.27%, 42.91% and 52.31%. Meanwhile, the effects of the first-stage and second-stage condensation temperature and LNG vaporization pressure on the performance and cost index of the TCRC system (net power output, thermal efficiency, exergy efficiency and UA) are analyzed. Finally, using the net power output as the objective function, with 14 organic fluids (such as propane, butane etc.) as working fluids, the first-stage and second-stage condensation temperature at different LNG vaporization pressures are optimized. The results show that there exists a first-stage and second-stage condensation temperature making the performance of the TCRC system optimal. When LNG vaporization pressure is supercritical pressure, R116 has the best economy among all the investigated working fluids, and while R150 and R23 are better when the vaporization pressure of LNG is subcritical.

  3. Performance evaluation of a piezoactuator-based single-stage valve system subjected to high temperature

    Science.gov (United States)

    Jeon, Juncheol; Han, Chulhee; Chung, Jye Ung; Choi, Seung-Bok

    2015-01-01

    In this paper, a novel single-stage valve system activated by a piezostack actuator is proposed and experimentally evaluated at both room temperature (20 °C) and high temperature (100 °C) conditions. A hinge-lever displacement amplifier is adopted in the valve system to magnify the displacement generated from the piezostack actuator. After explaining the operating principle of the proposed piezostack-driven single-stage valve system, the geometric dimensions and mechanical properties of the valve components are discussed in details. An experimental apparatus is then manufactured to evaluate the performances of the valve system such as flow rate. The experimental apparatus consists of a heat chamber, which can regulate the temperature of the valve system and oil, pneumatic-hydraulic cylinders, a hydraulic circuit, a pneumatic circuit, electronic devices, an interface card, and a high voltage amplifier. The pneumatic-hydraulic cylinder transforms the pneumatic pressure into hydraulic pressure. The performances of the valve system regarding spool response, pressure drop, and flow rate are evaluated and presented. In addition, the performance of the valve system under high temperature condition is compared with that under room temperature condition. The experimental results are plotted in both frequency and time domains.

  4. Performance evaluation of a piezoactuator-based single-stage valve system subjected to high temperature

    International Nuclear Information System (INIS)

    Jeon, Juncheol; Han, Chulhee; Ung Chung, Jye; Choi, Seung-Bok

    2015-01-01

    In this paper, a novel single-stage valve system activated by a piezostack actuator is proposed and experimentally evaluated at both room temperature (20 °C) and high temperature (100 °C) conditions. A hinge-lever displacement amplifier is adopted in the valve system to magnify the displacement generated from the piezostack actuator. After explaining the operating principle of the proposed piezostack-driven single-stage valve system, the geometric dimensions and mechanical properties of the valve components are discussed in details. An experimental apparatus is then manufactured to evaluate the performances of the valve system such as flow rate. The experimental apparatus consists of a heat chamber, which can regulate the temperature of the valve system and oil, pneumatic-hydraulic cylinders, a hydraulic circuit, a pneumatic circuit, electronic devices, an interface card, and a high voltage amplifier. The pneumatic-hydraulic cylinder transforms the pneumatic pressure into hydraulic pressure. The performances of the valve system regarding spool response, pressure drop, and flow rate are evaluated and presented. In addition, the performance of the valve system under high temperature condition is compared with that under room temperature condition. The experimental results are plotted in both frequency and time domains. (paper)

  5. Humeral windows in revision total elbow arthroplasty.

    Science.gov (United States)

    Peach, Chris A; Salama, Amir; Stanley, David

    2016-04-01

    The use of cortical windows for revision elbow arthroplasty has not previously been widely reported. Their use aids safe revision of a well fixed humeral prosthesis and can be used in the setting of dislocation, periprosthetic fracture or aseptic loosening of the ulnar component. We describe our technique and results of cortical windows in the distal humerus for revision elbow arthroplasty surgery.

  6. Two-Stage Battery Energy Storage System (BESS in AC Microgrids with Balanced State-of-Charge and Guaranteed Small-Signal Stability

    Directory of Open Access Journals (Sweden)

    Bing Xie

    2018-02-01

    Full Text Available In this paper, a two-stage battery energy storage system (BESS is implemented to enhance the operation condition of conventional battery storage systems in a microgrid. Particularly, the designed BESS is composed of two stages, i.e., Stage I: integration of dispersed energy storage units (ESUs using parallel DC/DC converters, and Stage II: aggregated ESUs in grid-connected operation. Different from a conventional BESS consisting of a battery management system (BMS and power conditioning system (PCS, the developed two-stage architecture enables additional operation and control flexibility in balancing the state-of-charge (SoC of each ESU and ensures the guaranteed small-signal stability, especially in extremely weak grid conditions. The above benefits are achieved by separating the control functions between the two stages. In Stage I, a localized power sharing scheme based on the SoC of each particular ESU is developed to manage the SoC and avoid over-charge or over-discharge issues; on the other hand, in Stage II, an additional virtual impedance loop is implemented in the grid-interactive DC/AC inverters to enhance the stability margin with multiple parallel-connected inverters integrating at the point of common coupling (PCC simultaneously. A simulation model based on MATLAB/Simulink is established, and simulation results verify the effectiveness of the proposed BESS architecture and the corresponding control diagram.

  7. Dynamic solar-powered multi-stage direct contact membrane distillation system: Concept design, modeling and simulation

    KAUST Repository

    Lee, Jung Gil; Kim, Woo-Seung; Choi, June-Seok; Ghaffour, NorEddine; Kim, Young-Deuk

    2017-01-01

    This paper presents a theoretical analysis of the monthly average daily and hourly performances of a solar-powered multi-stage direct contact membrane distillation (SMDCMD) system with an energy recovery scheme and dynamic operating system. Mid

  8. Diet History Questionnaire: Database Revision History

    Science.gov (United States)

    The following details all additions and revisions made to the DHQ nutrient and food database. This revision history is provided as a reference for investigators who may have performed analyses with a previous release of the database.

  9. Revision surgery for failed thermal capsulorrhaphy.

    Science.gov (United States)

    Park, Hyung Bin; Yokota, Atsushi; Gill, Harpreet S; El Rassi, George; McFarland, Edward G

    2005-09-01

    With the failure of thermal capsulorrhaphy for shoulder instability, there have been concerns with capsular thinning and capsular necrosis affecting revision surgery. To report the findings at revision surgery for failed thermal capsulorrhaphy and to evaluate the technical effects on subsequent revision capsular plication. Case series; Level of evidence, 4. Fourteen patients underwent arthroscopic evaluation and open reconstruction for a failed thermal capsulorrhaphy. The cause of the failure, the quality of the capsule, and the ability to suture the capsule were recorded. The patients were evaluated at follow-up for failure, which was defined as recurrent subluxations or dislocations. The origin of the instability was traumatic (n = 6) or atraumatic (n = 8). At revision surgery in the traumatic group, 4 patients sustained failure of the Bankart repair with capsular laxity, and the others experienced capsular laxity alone. In the atraumatic group, all patients experienced capsular laxity as the cause of failure. Of the 14 patients, the capsule quality was judged to be thin in 5 patients and ablated in 1 patient. A glenoid-based capsular shift could be accomplished in all 14 patients. At follow-up (mean, 35.4 months; range, 22 to 48 months), 1 patient underwent revision surgery and 1 patient had a subluxation, resulting in a failure rate of 14%. Recurrent capsular laxity after failed thermal capsular shrinkage is common and frequently associated with capsular thinning. In most instances, the capsule quality does not appear to technically affect the revision procedure.

  10. Development of Bottom Oil Recovery Systems. Revised

    Science.gov (United States)

    2014-02-01

    ahead of the filtration process. Stage 6 Disposal: Collection of oil , oiled debris, and decontaminated sand/sediments. 7 NET ENVIRONMENTAL BENEFIT......Sea HFO / 10.7 X 1983 T/V Hanon Jade Yosu, South Korea Heavy Arabian Crude Oil X (salt) ( burn residue) 1984 T/V Alvenus Louisiana Merey

  11. On the Role of Design Activities in the Development of Complex Industrial Systems

    DEFF Research Database (Denmark)

    Englyst, Linda

    when focus may be shifted from design for authorization to design for operation, which have been identified as separate stages with different characteristics. The research is based on a case study of developing downstream logistics systems from the point of view of a divisionalised manufacturing....... Existing theory indicates that a sense of dissatisfaction or even crisis might provoke a revision of beliefs and drive action, but empirically, it appears that if dissatisfaction should function as a driver, it must be used quickly. Furthermore, it appears that an alternative to establishing...... manifestation of already mature beliefs maintained by a dominant coalition in the organisation. It is argued that dominant beliefs should be re-vised through the management of ideas, cultivation and evaluation of competing ideas. The research has indicated that systems development is likely to be realised...

  12. A revised inoceramid biozonation for the Upper Cretaceous based on high-resolution carbon isotope stratigraphy in northwestern Hokkaido, Japan

    Science.gov (United States)

    Hayakawa, Tatsuya; Hirano, Hiromichi

    2013-06-01

    Hayakawa, T., Hirano, H. 2013. A revised inoceramid biozonation for the Upper Cretaceous based on high-resolution carbon isotope stratigraphy in northwestern Hokkaido, Japan. Acta Geologica Polonica, 63 (2), 239-263. Warszawa. Biostratigraphic correlations of inoceramid bivalves between the North Pacific and Euramerican provinces have been difficult because the inoceramid biostratigraphy of the Japanese strata has been based on endemic species of the northwest Pacific. In this study, carbon stable isotope fluctuations of terrestrial organic matter are assembled for the Upper Cretaceous Yezo Group in the Haboro and Obira areas, Hokkaido, Japan, in order to revise the chronology of the inoceramid biozonation in Japan. The carbon isotope curves are correlated with those of marine carbonates in English and German sections with the aid of age-diagnostic taxa. According to the correlations of the carbon isotope curves, 11 isotope events are recognised in the sections studied. As a result of these correlations, the chronology of the inoceramid biozones of the Northwest Pacific has been considerably revised. The revised inoceramid biozones suggest that the timing of the origination and extinction of the inoceramids in the North Pacific biotic province is different from the stage/substage boundaries defined by inoceramids, as used in Europe and North America.

  13. Seasonal thermal energy storage in shallow geothermal systems: thermal equilibrium stage

    Directory of Open Access Journals (Sweden)

    Nowamooz Hossein

    2016-01-01

    Full Text Available This paper is dedicated to the study of seasonal heat storage in shallow geothermal installations in unsaturated soils for which hydrothermal properties such as degree of saturation and thermal conductivity vary with time throughout the profile. In the model, a semi-analytical model which estimates time-spatial thermal conductivity is coupled with a 2D cylindrical heat transfer modeling using finite difference method. The variation of temperature was obtained after 3 heating and cooling cycles for the different types of loads with maximum thermal load of qmax = 15 W.m−1 with variable angular frequency (8 months of heating and 4 months of cooling.and constant angular frequency (6 months of heating and 6 months of cooling to estimate the necessary number of cycles to reach the thermal equilibrium stage. The results show that we approach a thermal equilibrium stage where the same variation of temperature can be observed in soils after several heating and cooling cycles. Based on these simulations, the necessary number of cycles can be related to the total applied energy on the system and the minimum number of cycles is for a system with the total applied energy of 1.9qmax.

  14. Belief revision and delusions: how do patients with schizophrenia take advice?

    Directory of Open Access Journals (Sweden)

    Mariia Kaliuzhna

    Full Text Available The dominant cognitive model that accounts for the persistence of delusional beliefs in schizophrenia postulates that patients suffer from a general deficit in belief revision. It is generally assumed that this deficit is a consequence of impaired reasoning skills. However, the possibility that such inflexibility affects the entire system of a patient's beliefs has rarely been empirically tested. Using delusion-neutral material in a well-documented advice-taking task, the present study reports that patients with schizophrenia: 1 revise their beliefs, 2 take into account socially provided information to do so, 3 are not overconfident about their judgments, and 4 show less egocentric advice-discounting than controls. This study thus shows that delusional patients' difficulty in revising beliefs is more selective than had been previously assumed. The specificities of the task and the implications for a theory of delusion formation are discussed.

  15. Introductory Business Textbook Revision Cycles: Are They Getting Shorter?

    Science.gov (United States)

    Zinser, Brian; Brunswick, Gary

    2010-01-01

    The rate of textbook revision cycles is examined in light of the recent trend towards more rapid revisions (and adoptions of textbooks). The authors conduct background research to better understand the context for textbook revision cycles and the environmental forces that have been influencing what appears to be more rapid textbook revisions. A…

  16. Revised Rules for Concrete Bridges

    DEFF Research Database (Denmark)

    Thoft-Christensen, Palle; Jensen, F. M.; Middleton, C.

    This paper is based on research performed for the Highway Agency, London, UK under the project DPU/9/44 "Revision of Bridge Assessment Rules Based on Whole Life Performance: Concrete Bridges" It contains details of a methodology which can be used to generate Whole Life (WL) reliability profiles....... These WL reliability profiles may be used to establish revised rules for Concrete Bridges....

  17. Inferential revision in narrative texts: An ERP study.

    Science.gov (United States)

    Pérez, Ana; Cain, Kate; Castellanos, María C; Bajo, Teresa

    2015-11-01

    We evaluated the process of inferential revision during text comprehension in adults. Participants with high or low working memory read short texts, in which the introduction supported two plausible concepts (e.g., 'guitar/violin'), although one was more probable ('guitar'). There were three possible continuations: a neutral sentence, which did not refer back to either concept; a no-revise sentence, which referred to a general property consistent with either concept (e.g., '…beautiful curved body'); and a revise sentence, which referred to a property that was consistent with only the less likely concept (e.g., '…matching bow'). Readers took longer to read the sentence in the revise condition, indicating that they were able to evaluate their comprehension and detect a mismatch. In a final sentence, a target noun referred to the alternative concept supported in the revise condition (e.g., 'violin'). ERPs indicated that both working memory groups were able to evaluate their comprehension of the text (P3a), but only high working memory readers were able to revise their initial incorrect interpretation (P3b) and integrate the new information (N400) when reading the revise sentence. Low working memory readers had difficulties inhibiting the no-longer-relevant interpretation and thus failed to revise their situation model, and they experienced problems integrating semantically related information into an accurate memory representation.

  18. ABC transporters and xenobiotic defense systems in early life stages of rainbow trout (Oncorhynchus mykiss).

    Science.gov (United States)

    Kropf, Christian; Segner, Helmut; Fent, Karl

    2016-01-01

    Embryos of oviparous fish, in contrast to (ovo) viviparous species, develop in the aquatic environment, and therefore need solute transport systems at their body surfaces for maintaining internal homeostasis and defending against potentially harmful substances. We hypothesized that solute transporters undergo changes in tissue distribution from the embryo to the larval stage. We therefore studied the mRNA profiles of eight ABC transporters (abcb1a, abcb1b, abcc1, abcc2, abcc3, abcc4, abcc5, abcg2) and three solute carriers (oatp1d, putative oatp2 putative, mate1) in different body regions (head, yolk sac epithelium, abdominal viscera, skin/muscles) of developing rainbow trout. Additionally, we investigated mRNA levels of phase I (cyp1a, cyp3a) and phase II (gstp, putative ugt1, putative ugt2) biotransformation enzymes. The study covered the developmental period from the eleuthero-embryo stage to the first-feeding larval stage (1-20days post-hatch, dph). At 1dph, transcripts of abcc2, abcc4, abcg2, cyp3a, gstp, putative mate1, and putative oatp2 occurred primarily in the yolk sac epithelium, whereas at later stages expression of these genes was predominantly observed in the abdominal viscera. The functional activity of ABC transporters in fish early life stages was assessed by rhodamine B accumulation assays. Finally, we investigated the potential impact of xenobiotics (clotrimazole, clofibric acid) on the ABC and biotransformation systems of trout early life stages. While clofibric acid had no effect, clotrimazole lead to an increased rhodamine B accumulation. The results provide evidence that the transition from the eleuthero-embryo to the larval stage is accompanied by a major alteration in tissue expression of ABC transporters. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Programme for the Environmental Control at the Swedish Nuclear Facilities, Revision; Omgivningskontrollprogram foer de kaerntekniska anlaeggningarna, revision

    Energy Technology Data Exchange (ETDEWEB)

    Linden, Ann-Marie

    2004-12-01

    This report contains a revised version of the Environmental Monitoring Programme for the Swedish Nuclear Facilities. The revision is based on earlier experiences and evaluations. Some samples have been excluded. Some have been added, for example spruce cone and the food products apple and currant. The sediment samples of 2 cm length have been completed with samples of 10 cm length every fourth year to follow the migration of radio nuclides down the sediment layers over time. The revised Environmental Monitoring Programme is valid from the 1st of January 2005.

  20. Revising Nabokov Revising”

    Directory of Open Access Journals (Sweden)

    Marie Bouchet

    2010-10-01

    Full Text Available Nabokov revised his works as he translated them and, on another plane, canon revisionism has been having its backlash and provoked other refracting waves. The purpose of the conference was to advance Nabokov studies through the discussion of how our view of Nabokov’s standing and his works today should be revised, especially after the publication of The Original of Laura. However the conference was not confined to just this theme, since “revising” is a word rich with implications. To borrow s...

  1. Adaptive fuzzy trajectory control for biaxial motion stage system

    Directory of Open Access Journals (Sweden)

    Wei-Lung Mao

    2016-04-01

    Full Text Available Motion control is an essential part of industrial machinery and manufacturing systems. In this article, the adaptive fuzzy controller is proposed for precision trajectory tracking control in biaxial X-Y motion stage system. The theoretical analyses of direct fuzzy control which is insensitive to parameter uncertainties and external load disturbances are derived to demonstrate the feasibility to track the reference trajectories. The Lyapunov stability theorem has been used to testify the asymptotic stability of the whole system, and all the signals are bounded in the closed-loop system. The intelligent position controller combines the merits of the adaptive fuzzy control with robust characteristics and learning ability for periodic command tracking of a servo drive mechanism. The simulation and experimental results on square, triangle, star, and circle reference contours are presented to show that the proposed controller indeed accomplishes the better tracking performances with regard to model uncertainties. It is observed that the convergence of parameters and tracking errors can be faster and smaller compared with the conventional adaptive fuzzy control in terms of average tracking error and tracking error standard deviation.

  2. Plasma gasification of refuse derived fuel in a single-stage system using different gasifying agents.

    Science.gov (United States)

    Agon, N; Hrabovský, M; Chumak, O; Hlína, M; Kopecký, V; Masláni, A; Bosmans, A; Helsen, L; Skoblja, S; Van Oost, G; Vierendeels, J

    2016-01-01

    The renewable evolution in the energy industry and the depletion of natural resources are putting pressure on the waste industry to shift towards flexible treatment technologies with efficient materials and/or energy recovery. In this context, a thermochemical conversion method of recent interest is plasma gasification, which is capable of producing syngas from a wide variety of waste streams. The produced syngas can be valorized for both energetic (heat and/or electricity) and chemical (ammonia, hydrogen or liquid hydrocarbons) end-purposes. This paper evaluates the performance of experiments on a single-stage plasma gasification system for the treatment of refuse-derived fuel (RDF) from excavated waste. A comparative analysis of the syngas characteristics and process yields was done for seven cases with different types of gasifying agents (CO2+O2, H2O, CO2+H2O and O2+H2O). The syngas compositions were compared to the thermodynamic equilibrium compositions and the performance of the single-stage plasma gasification of RDF was compared to that of similar experiments with biomass and to the performance of a two-stage plasma gasification process with RDF. The temperature range of the experiment was from 1400 to 1600 K and for all cases, a medium calorific value syngas was produced with lower heating values up to 10.9 MJ/Nm(3), low levels of tar, high levels of CO and H2 and which composition was in good agreement to the equilibrium composition. The carbon conversion efficiency ranged from 80% to 100% and maximum cold gas efficiency and mechanical gasification efficiency of respectively 56% and 95%, were registered. Overall, the treatment of RDF proved to be less performant than that of biomass in the same system. Compared to a two-stage plasma gasification system, the produced syngas from the single-stage reactor showed more favourable characteristics, while the recovery of the solid residue as a vitrified slag is an advantage of the two-stage set-up. Copyright

  3. 309 Building fire protection analysis and justification for deactivation of sprinkler system. Revision 1

    International Nuclear Information System (INIS)

    Conner, R.P.

    1997-01-01

    Provide a 'graded approach' fire evaluation in preparation for turnover to Environmental Restoration Contractor for D and D. Scope includes revising 309 Building book value and evaluating fire hazards, radiological and toxicological releases, and life safety issues

  4. System-Level Optimization of a DAC for Hearing-Aid Audio Class D Output Stage

    DEFF Research Database (Denmark)

    Pracný, Peter; Jørgensen, Ivan Harald Holger; Bruun, Erik

    2013-01-01

    This paper deals with system-level optimization of a digital-to-analog converter (DAC) for hearing-aid audio Class D output stage. We discuss the ΣΔ modulator system-level design parameters – the order, the oversampling ratio (OSR) and the number of bits in the quantizer. We show that combining...... by comparing two ΣΔ modulator designs. The proposed optimization has impact on the whole hearing-aid audio back-end system including less hardware in the interpolation filter and half the switching rate in the digital-pulse-width-modulation (DPWM) block and Class D output stage...... a reduction of the OSR with an increase of the order results in considerable power savings while the audio quality is kept. For further savings in the ΣΔ modulator, overdesign and subsequent coarse coefficient quantization are used. A figure of merit (FOM) is introduced to confirm this optimization approach...

  5. SARP-II: Safeguards Accounting and Reports Program, Revised

    International Nuclear Information System (INIS)

    Kempf, C.R.

    1994-01-01

    A computer code, SARP (Safeguards Accounting and Reports Program) which will generate and maintain at-facility safeguards accounting records, and generate IAEA safeguards reports based on accounting data input by the user, was completed in 1990 by the Safeguards, Safety, and Nonproliferation Division (formerly the Technical Support Organization) at Brookhaven National Laboratory as a task under the US Program of Technical Support to IAEA safeguards. The code was based on a State System of Accounting for and Control of Nuclear Material (SSAC) for off-load refueled power reactor facilities, with model facility and safeguards accounting regime as described in IAEA Safeguards Publication STR-165. Since 1990, improvements in computing capabilities and comments and suggestions from users engendered revision of the original code. The result is an updated, revised version called SARP-II which is discussed in this report

  6. The revision of the safety standards for protection against ionizing radiation

    International Nuclear Information System (INIS)

    Wei Li Chen; Hsiao Ping Wang; Chia Chun Liao; Chin Shiun Yeh

    1994-01-01

    The Chinese Safety Standards for Protection Against Ionizing Radiation was issued on July 29, 1970, and has been used for more than thirteen years. In 1983, the Atomic Energy Council (AEC) decided to revise it accordingly to the recommendations of the International Commission on Radiological Protection and the experiences of regulation enforcement in Taiwan and other countries. The AEC assembled a task group of eight members from academic institutions, licensees, government agency, and senior health physics to be in charge of the revision. In this presentation the major changes of the Safety Standards are summarized. They refer to the adoption of the system of dose limitation recommended by ICRP publication 26 and 30, the use of the units of the International System as the primary units with the old units being noted in parentheses, the adoption of the minimums levels recommended by the International Atomic Energy Agency and the setting up of an executive regulatory system for the implementation of the ALARA concept. 6 refs

  7. Revised action plan of the Maintenance division for 1965, Annex 4

    International Nuclear Information System (INIS)

    Nikolic, M.

    1965-01-01

    The action plan presented in this annex is a revised version of the plan adopted in January 1965. It includes tasks of the mechanics, electrical and electronic equipment services. It includes a detailed list of planned and preventive maintenance actions related to the heavy water system, technical water system, helium system, reactor core, transportation equipment, hot cells, heating and ventilation systems in the reactor building, power supply system, auxiliary systems in the RA reactor building [sr

  8. Dynamic multi-stage dispatch of isolated wind–diesel power systems

    International Nuclear Information System (INIS)

    Hu, Yu; Morales, Juan M.; Pineda, Salvador; Sánchez, María Jesús; Solana, Pablo

    2015-01-01

    Highlights: • Optimal decision-making model for isolated hybrid wind–diesel power system is proposed. • Wind power uncertainty and conditional operating cost are considered. • Battery wear cost of the energy storage system is included in the model. • The results are compared with deterministic dispatch strategies. - Abstract: An optimal dispatch strategy is crucial for an isolated wind–diesel power system to save diesel fuel and maintain the system stability. The uncertainty associated with the stochastic character of the wind is, though, a challenging problem for this optimization. In this paper, a dynamic multi-stage decision-making model is proposed to determine the diesel power output that minimizes the cost of running and maintaining the wind–diesel power system. Optimized operational decisions for each time period are generated dynamically considering the path-dependent nature of the optimal dispatch policy, given the plausible future realizations of the wind power production. A numerical case study is analyzed and it is demonstrated that the proposed stochastic dynamic optimization model significantly outperforms the traditional deterministic dispatch strategies

  9. A new measurement for the revised reinforcement sensitivity theory: psychometric criteria and genetic validation

    Directory of Open Access Journals (Sweden)

    Martin eReuter

    2015-03-01

    Full Text Available Jeffrey Gray’s Reinforcement Sensitivity Theory (RST represents one of the most influential biologically-based personality theories describing individual differences in approach and avoidance tendencies. The most prominent self-report inventory to measure individual differences in approach and avoidance behavior to date is the BIS/BAS scale by Carver & White (1994. As Gray & McNaughton (2000 revised the RST after its initial formulation in the 1970/80s, and given the Carver & White measure is based on the initial conceptualization of RST, there is a growing need for self-report inventories measuring individual differences in the revised behavioral inhibition system (BIS, behavioral activation system (BAS and the fight, flight, freezing system (FFFS. Therefore, in this paper we present a new questionnaire measuring individual differences in the revised constructs of the BIS, BAS and FFFS in N = 1814 participants (German sample. An English translated version of the new measure is also presented and tested in N = 299 English language participants. A large number of German participants (N = 1090 also filled in the BIS/BAS scales by Carver & White (1994 and the correlations between these measures are presented. Finally, this same subgroup of participants provided buccal swaps for the investigation of the arginine vasopressin receptor 1a (AVPR1a gene. Here, a functional genetic polymorphism (rs11174811 on the AVPR1a gene was shown to be associated with individual differences in both the revised BIS and classic BIS dimensions.

  10. Revision of the DELFIC Particle Activity Module

    Energy Technology Data Exchange (ETDEWEB)

    Hooper, David A [ORNL; Jodoin, Vincent J [ORNL

    2010-09-01

    The Defense Land Fallout Interpretive Code (DELFIC) was originally released in 1968 as a tool for modeling fallout patterns and for predicting exposure rates. Despite the continual advancement of knowledge of fission yields, decay behavior of fission products, and biological dosimetry, the decay data and logic of DELFIC have remained mostly unchanged since inception. Additionally, previous code revisions caused a loss of conservation of radioactive nuclides. In this report, a new revision of the decay database and the Particle Activity Module is introduced and explained. The database upgrades discussed are replacement of the fission yields with ENDF/B-VII data as formatted in the Oak Ridge Isotope Generation (ORIGEN) code, revised decay constants, revised exposure rate multipliers, revised decay modes and branching ratios, and revised boiling point data. Included decay logic upgrades represent a correction of a flaw in the treatment of the fission yields, extension of the logic to include more complex decay modes, conservation of nuclides (including stable nuclides) at all times, and conversion of key variables to double precision for nuclide conservation. Finally, recommended future work is discussed with an emphasis on completion of the overall radiation physics upgrade, particularly for dosimetry, induced activity, decay of the actinides, and fractionation.

  11. A translating stage system for µ-PIV measurements surrounding the tip of a migrating semi-infinite bubble.

    Science.gov (United States)

    Smith, B J; Yamaguchi, E; Gaver, D P

    2010-01-01

    We have designed, fabricated and evaluated a novel translating stage system (TSS) that augments a conventional micro particle image velocimetry (µ-PIV) system. The TSS has been used to enhance the ability to measure flow fields surrounding the tip of a migrating semi-infinite bubble in a glass capillary tube under both steady and pulsatile reopening conditions. With conventional µ-PIV systems, observations near the bubble tip are challenging because the forward progress of the bubble rapidly sweeps the air-liquid interface across the microscopic field of view. The translating stage mechanically cancels the mean bubble tip velocity, keeping the interface within the microscope field of view and providing a tenfold increase in data collection efficiency compared to fixed-stage techniques. This dramatic improvement allows nearly continuous observation of the flow field over long propagation distances. A large (136-frame) ensemble-averaged velocity field recorded with the TSS near the tip of a steadily migrating bubble is shown to compare well with fixed-stage results under identical flow conditions. Use of the TSS allows the ensemble-averaged measurement of pulsatile bubble propagation flow fields, which would be practically impossible using conventional fixed-stage techniques. We demonstrate our ability to analyze these time-dependent two-phase flows using the ensemble-averaged flow field at four points in the oscillatory cycle.

  12. Integrating Relational Reasoning and Knowledge Revision during Reading

    Science.gov (United States)

    Kendeou, Panayiota; Butterfuss, Reese; Van Boekel, Martin; O'Brien, Edward J.

    2017-01-01

    Our goal in this theoretical contribution is to connect research on knowledge revision and relational reasoning. To achieve this goal, first, we review the "knowledge revision components framework" (KReC) that provides an account of knowledge revision processes, specifically as they unfold during reading of texts. Second, we review a…

  13. Quantitative Resilience Assessment under a Tri-Stage Framework for Power Systems

    Directory of Open Access Journals (Sweden)

    Han Zhang

    2018-06-01

    Full Text Available The frequent occurrence of natural disasters and malicious attacks has exerted unprecedented disturbances on power systems, accounting for the extensive attention paid to power system resilience. Combined with the evolving nature of general disasters, this paper proposes resilience assessment approaches for power systems under a tri-stage framework. The pre-disaster toughness is proposed to quantify the robustness of power systems against potential disasters, where the thinking of area division and partitioned multi-objective risk method (PMRM is introduced. In the case of information deficiency caused by disasters, the during-disaster resistance to disturbance is calculated to reflect the real-time system running state by state estimation (SE. The post-disaster restoration ability consists of response ability, restoration efficiency and restoration economy, which is evaluated by Sequential Monte-Carlo Simulation to simulate the system restoration process. Further, a synthetic metric system is presented to quantify the resilience performance of power systems from the above three aspects. The proposed approaches and framework are validated on the IEEE RTS 79 system, and helpful conclusions are drawn from extensive case studies.

  14. SCALE: A modular code system for performing standardized computer analyses for licensing evaluation. Control modules -- Volume 1, Revision 4

    Energy Technology Data Exchange (ETDEWEB)

    Landers, N.F.; Petrie, L.M.; Knight, J.R. [Oak Ridge National Lab., TN (United States)] [and others

    1995-04-01

    SCALE--a modular code system for Standardized Computer Analyses Licensing Evaluation--has been developed by Oak Ridge National Laboratory at the request of the US Nuclear Regulatory Commission. The SCALE system utilizes well-established computer codes and methods within standard analysis sequences that (1) allow an input format designed for the occasional user and/or novice, (2) automate the data processing and coupling between modules, and (3) provide accurate and reliable results. System development has been directed at problem-dependent cross-section processing and analysis of criticality safety, shielding, heat transfer, and depletion/decay problems. Since the initial release of SCALE in 1980, the code system has been heavily used for evaluation of nuclear fuel facility and package designs. This revision documents Version 4.2 of the system. This manual is divided into three volumes: Volume 1--for the control module documentation, Volume 2--for the functional module documentation, and Volume 3 for the documentation of the data libraries and subroutine libraries.

  15. SCALE: A modular code system for performing standardized computer analyses for licensing evaluation. Control modules -- Volume 1, Revision 4

    International Nuclear Information System (INIS)

    Landers, N.F.; Petrie, L.M.; Knight, J.R.

    1995-04-01

    SCALE--a modular code system for Standardized Computer Analyses Licensing Evaluation--has been developed by Oak Ridge National Laboratory at the request of the US Nuclear Regulatory Commission. The SCALE system utilizes well-established computer codes and methods within standard analysis sequences that (1) allow an input format designed for the occasional user and/or novice, (2) automate the data processing and coupling between modules, and (3) provide accurate and reliable results. System development has been directed at problem-dependent cross-section processing and analysis of criticality safety, shielding, heat transfer, and depletion/decay problems. Since the initial release of SCALE in 1980, the code system has been heavily used for evaluation of nuclear fuel facility and package designs. This revision documents Version 4.2 of the system. This manual is divided into three volumes: Volume 1--for the control module documentation, Volume 2--for the functional module documentation, and Volume 3 for the documentation of the data libraries and subroutine libraries

  16. Evaluation of the AJCC 8th Edition Staging System for Pathologically Versus Clinically Staged Intrahepatic Cholangiocarcinoma (iCCA): a Time to Revisit a Dogma? A Surveillance, Epidemiology, and End Results (SEER) Analysis.

    Science.gov (United States)

    Kamarajah, Sivesh K

    2018-03-07

    Recently, the AJCC has released its 8th edition changes to the staging system for intrahepatic cholangiocarcinoma (iCCA). This study sought to validate the proposed changes to the 8th edition of AJCC system for T and N classification of iCCA using a population-based data set. Using the Surveillance, Epidemiology, and End Results (SEER) database (1998-2013), patients undergoing resection or non-surgical management for non-metastatic iCCA were identified. Overall survival was estimated using the Kaplan-Meier method and compared using log-rank tests. Concordance indices (c-indices) calculated from Cox proportional hazards models were calculated to evaluate discriminatory power. The study included 2630 patients resected (37%) or non-surgically managed (63%) for iCCA. Nodal staging was performed in 56%, of whom 31% had positive nodes. For all patients with iCCA, the median 5-year survival by AJCC T classification for T1a, T1b, T2, T3, and T4 was 32, 21, 14, 10, and 10 months, respectively (p < 0.001). The concordance index for the staging system was 0.57 for all patients, 0.62 for those who underwent resection, and 0.54 for patients who did not undergo resection. In summary, the new AJCC 8th edition staging system is comparable to the 7th edition and valid in stratifying patients with iCCA. However, the performance of the staging system is better in patients undergoing surgical resection than those undergoing non-surgical management. These findings further highlight the need for improved accuracy of radiological imaging in clinically staging patients to guide prognosis.

  17. 40 CFR 60.4124 - Hg budget permit revisions.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 6 2010-07-01 2010-07-01 false Hg budget permit revisions. 60.4124... Coal-Fired Electric Steam Generating Units Permits § 60.4124 Hg budget permit revisions. Except as provided in § 60.4123(b), the permitting authority will revise the Hg Budget permit, as necessary, in...

  18. 76 FR 18930 - Medicare Programs: Changes to the End-Stage Renal Disease Prospective Payment System Transition...

    Science.gov (United States)

    2011-04-06

    ... Payment System Transition Budget-Neutrality Adjustment AGENCY: Centers for Medicare & Medicaid Services... in the CY 2011 ESRD Prospective Payment System (PPS) final rule for renal dialysis services provided...-Stage Renal Disease Prospective Payment System'', hereinafter, referred to as the CY 2011 ESRD PPS final...

  19. Overpowering posterior lumbar instrumentation and fusion with hyperlordotic anterior lumbar interbody cages followed by posterior revision: a preliminary feasibility study.

    Science.gov (United States)

    Kadam, Abhijeet; Wigner, Nathan; Saville, Philip; Arlet, Vincent

    2017-12-01

    OBJECTIVE The authors' aim in this study was to evaluate whether sagittal plane correction can be obtained from the front by overpowering previous posterior instrumentation and/or fusion with hyperlordotic anterior lumbar interbody fusion (ALIF) cages in patients undergoing revision surgery for degenerative spinal conditions and/or spinal deformities. METHODS The authors report their experience with the application of hyperlordotic cages at 36 lumbar levels for ALIFs in a series of 20 patients who underwent revision spinal surgery at a single institution. Included patients underwent staged front-back procedures: ALIFs with hyperlordotic cages (12°, 20°, and 30°) followed by removal of posterior instrumentation and reinstrumentation from the back. Patients were divided into the following 2 groups depending on the extent of posterior instrumentation and fusion during the second stage: long constructs (≥ 6 levels with extension into thoracic spine and/or pelvis) and short constructs (lumbar lordosis increased from 44.3° to 59.8° (p lumbar levels that have pseudarthrosis from the previous posterior spinal fusion. Meticulous selection of levels for ALIF is crucial for safely and effectively performing this technique.

  20. Milgrom's revision of cosmic dynamics: Amending Newton's laws or Keplers

    International Nuclear Information System (INIS)

    Felten, J.E.

    1983-12-01

    Milgrom's recent revision of Newtonian dynamics was introduced to eliminate the inference that large quantities of invisible mass exist in galaxies. Simple examples show that a Milgrom acceleration, in the form presented so far, imply other far-reaching changes in dynamics. The momentum of an isolated system is not conserved, and the usual theorem for center-of-mass motion of any system does not hold. Naive applications require extreme caution. The model fails to provide a complete description of particle dynamics and should be thought of as a revision of Kepler's laws rather than Newton's. The Milgrom acceleration also implies fundamental changes in cosmology. A quasi-Newtonian calculation adapted from Newtonian cosmology suggests that a Milgrom universe will recollapse even if the classical closure parameter theta is less than 1. The solution, however, fails to satisfy the cosmological principle. Reasons for the breakdown of this calculation are examined. A theory of gravitation needed before the behavior of a Milgrom universe can be predicted

  1. Milgrom's revision of cosmic dynamics: Amending Newton's laws or Keplers?

    Science.gov (United States)

    Felten, J. E.

    1983-01-01

    Milgrom's recent revision of Newtonian dynamics was introduced to eliminate the inference that large quantities of invisible mass exist in galaxies. Simple examples show that a Milgrom acceleration, in the form presented so far, imply other far-reaching changes in dynamics. The momentum of an isolated system is not conserved, and the usual theorem for center-of-mass motion of any system does not hold. Naive applications require extreme caution. The model fails to provide a complete description of particle dynamics and should be thought of as a revision of Kepler's laws rather than Newton's. The Milgrom acceleration also implies fundamental changes in cosmology. A quasi-Newtonian calculation adapted from Newtonian cosmology suggests that a Milgrom universe will recollapse even if the classical closure parameter theta is less than 1. The solution, however, fails to satisfy the cosmological principle. Reasons for the breakdown of this calculation are examined. A theory of gravitation needed before the behavior of a Milgrom universe can be predicted.

  2. Milgrom's revision of Newton's laws - Dynamical and cosmological consequences

    Science.gov (United States)

    Felten, J. E.

    1984-01-01

    Milgrom's (1983) recent revision of Newtonian dynamics was introduced to eliminate the inference that large quantities of invisible mass exist in galaxies. It is shown by simple examples that a Milgrom acceleration, in the form presented so far, implies other far-reaching changes in dynamics. The momentum of an isolated system is not conserved, and the usual theorem for center-of-mass motion of any system does not hold. Naive applications require extreme caution. The model fails to provide a complete description of particle dynamics and should be thought of as a revision of Kepler's laws rather than Newton's. The Milgrom acceleration also implies fundamental changes in cosmology. A quasi-Newtonian calculation adapted from Newtonian cosmology suggests that a 'Milgrom universe' will recollapse even if the classical closure parameter Omega is much less than unity. The solution, however, fails to satisfy the cosmological principle. Reasons for the breakdown of this calculation are examined. A new theory of gravitation will be needed before the behavior of a Milgrom universe can be predicted.

  3. 3D Printing Aids Acetabular Reconstruction in Complex Revision Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Andrew J. Hughes

    2017-01-01

    Full Text Available Revision hip arthroplasty requires comprehensive appreciation of abnormal bony anatomy. Advances in radiology and manufacturing technology have made three-dimensional (3D representation of osseous anatomy obtainable, which provide visual and tactile feedback. Such life-size 3D models were manufactured from computed tomography scans of three hip joints in two patients. The first patient had undergone multiple previous hip arthroplasties for bilateral hip infections, resulting in right-sided pelvic discontinuity and a severe left-sided posterosuperior acetabular deficiency. The second patient had a first-stage revision for infection and recurrent dislocations. Specific metal reduction protocols were used to reduce artefact. The images were imported into Materialise MIMICS 14.12®. The models were manufactured using selective laser sintering. Accurate templating was performed preoperatively. Acetabular cup, augment, buttress, and cage sizes were trialled using the models, before being adjusted, and resterilised, enhancing the preoperative decision-making process. Screw trajectory simulation was carried out, reducing the risk of neurovascular injury. With 3D printing technology, complex pelvic deformities were better evaluated and treated with improved precision. Life-size models allowed accurate surgical simulation, thus improving anatomical appreciation and preoperative planning. The accuracy and cost-effectiveness of the technique should prove invaluable as a tool to aid clinical practice.

  4. Validation of the CPS+EG and Neo-Bioscore staging systems after preoperative systemic therapy for breast cancer in a single center in China.

    Science.gov (United States)

    Xu, Ling; Duan, Xuening; Zhou, Bin; Liu, Yinhua; Ye, Jingming; Liu, Zhaorui; Ma, Chao; Zhang, Hong; Zhang, Shuang; Zhang, Lanbo; Zhao, Jianxin; Cheng, Yuanjia

    2018-04-17

    Prognostic assessment after preoperative systemic therapy (PST) plays a vital role in determining treatment in breast cancer patients. Many researchers have sought to develop a system to quantitate residual tumor and its correlation with prognosis after PST. This retrospective study validated the CPS + EG staging system and Neo-Bioscore in a single center in China. Data from patients with non-metastatic primary breast cancer who were treated with PST and surgery from Jan. 2008 to Dec. 2014 at the Breast Disease Center of Peking University First Hospital, China, were reviewed. DFS, DSS and OS were calculated using the K-M curve and AUC. Multivariate analysis was used for a Cox proportional hazards model. All calculations were performed with SAS 9.4. A total of 403 patients were enrolled in this study. The median follow-up period was 45 (range 11-107) months. The five-year DFS, DSS and OS rates were 86.4%, 91.2% and 90.5%, respectively. The CS, PS, CPS + EG staging system and Neo-Bioscore stratified patients according to DFS, DSS, and OS after PST, with all P values < 0.0001. The CPS + EG staging system and Neo-Bioscore stratified prognosis after PST better than CS. HER2-positive patients without trastuzumab treatment had obviously worse DFS and OS than other subgroups with different HER2 statuses that scored a 3 in the Neo-Bioscore system. The CPS + EG staging system and Neo-Bioscore can improve prognostic prediction in non-pCR breast cancer patients after PST and, provided unfavorable prognostic factors such as insufficient treatment are incorporated, will have broader clinical applicability. Copyright © 2018 Elsevier Ltd. All rights reserved.

  5. 77 FR 22387 - Pipeline Safety: Information Collection Activities, Revision to Gas Transmission and Gathering...

    Science.gov (United States)

    2012-04-13

    ... DEPARTMENT OF TRANSPORTATION Pipeline and Hazardous Materials Safety Administration [Docket No. PHMSA-2012-0024] Pipeline Safety: Information Collection Activities, Revision to Gas Transmission and Gathering Pipeline Systems Annual Report, Gas Transmission and Gathering Pipeline Systems Incident Report...

  6. 77 FR 58616 - Pipeline Safety: Information Collection Activities, Revision to Gas Transmission and Gathering...

    Science.gov (United States)

    2012-09-21

    ... DEPARTMENT OF TRANSPORTATION Pipeline and Hazardous Materials Safety Administration [Docket No. PHMSA-2012-0024] Pipeline Safety: Information Collection Activities, Revision to Gas Transmission and Gathering Pipeline Systems Annual Report, Gas Transmission and Gathering Pipeline Systems Incident Report...

  7. Edmonton obesity staging system among pediatric patients: a validation and obesogenic risk factor analysis.

    Science.gov (United States)

    Grammatikopoulou, M G; Chourdakis, M; Gkiouras, K; Roumeli, P; Poulimeneas, D; Apostolidou, E; Chountalas, I; Tirodimos, I; Filippou, O; Papadakou-Lagogianni, S; Dardavessis, T

    2018-01-08

    The Edmonton Obesity Staging System for Pediatrics (EOSS-P) is a useful tool, delineating different obesity severity tiers associated with distinct treatment barriers. The aim of the study was to apply the EOSS-P on a Greek pediatric cohort and assess risk factors associated with each stage, compared to normal weight controls. A total of 361 children (2-14 years old), outpatients of an Athenian hospital, participated in this case-control study by forming two groups: the obese (n = 203) and the normoweight controls (n = 158). Anthropometry, blood pressure, blood and biochemical markers, comorbidities and obesogenic lifestyle parameters were recorded and the EOSS-P was applied. Validation of EOSS-P stages was conducted by juxtaposing them with IOTF-defined weight status. Obesogenic risk factors' analysis was conducted by constructing gender-and-age-adjusted (GA) and multivariate logistic models. The majority of obese children were stratified at stage 1 (46.0%), 17.0% were on stage 0, and 37.0% on stage 2. The validation analysis revealed that EOSS-P stages greater than 0 were associated with diastolic blood pressure and levels of glucose, cholesterol, LDL and ALT. Reduced obesity odds were observed among children playing outdoors and increased odds for every screen time hour, both in the GA and in the multivariate analyses (all P  2 times/week was associated with reduced obesity odds in the GA analysis (OR = 0.57, 95% CI = 0.33-0.98, P linear = 0.047), it lost its significance in the multivariate analysis (P linear = 0.145). Analogous results were recorded in the analyses of the abovementioned physical activity risk factors for the EOSS-P stages. Linear relationships were observed for fast-food consumption and IOTF-defined obesity and higher than 0 EOSS-P stages. Parental obesity status was associated with all EOSS-P stages and IOTF-defined obesity status. Few outpatients were healthy obese (stage 0), while the majority exhibited several comorbidities

  8. A taxonomic revision of the genus Podocarpus

    OpenAIRE

    Laubenfels, de, D.J.

    1985-01-01

    In connection with the forthcoming revision of the Coniferae for the Flora Malesiana, the author thought it necessary to revise the genus Podocarpus. Although this genus has a substantial representation in Malesia (30 species), the revision is too involved to be appropriate with the Flora Malesiana per se. One new subgenus and 17 new sections are described, and 94 species are enumerated, of which 11 species and 1 variety are described as new, and 3 varieties have been raised to specific rank....

  9. 75 FR 14097 - Revision to Electric Reliability Organization Definition of Bulk Electric System

    Science.gov (United States)

    2010-03-24

    ... electrical failure of a 138 kV motor operated switch on a 138 kV-13 kV transformer located in the ReliabilityFirst region resulted in the tripping of two transformers, one due to the electrical failure and the... Commission 18 CFR Part 40 [Docket No. RM09-18-000; 130 FERC ] 61,204] Revision to Electric Reliability...

  10. Revised Human Health Risk Assessment on Chlorpyrifos

    Science.gov (United States)

    We have revised our human health risk assessment and drinking water exposure assessment for chlorpyrifos that supported our October 2015 proposal to revoke all food residue tolerances for chlorpyrifos. Learn about the revised analysis.

  11. REVISION PERMISSIABILITY IN CIVIL PROCEDURE IN REPUBLIC OF MACEDONIA

    Directory of Open Access Journals (Sweden)

    Marina Gligorova

    2015-04-01

    Full Text Available The revision as an extraordinary legal remedy is one more legal instrument for litigant in the effort to achieve protection of the rights or to defend against ungrounded claims of the other party. Litigants may declare revision of the litigation process due to substantive violations of the provisions of Civil Procedure and incorrect application of substantive law. Declaring revision because of a substantive violation of the provisions of Civil Procedure is limited. The purpose of this research paper is to investigate the most common reasons for filing revision of the litigation process in the period from June 2011 to June in 2012. The research includes what kind of reasons are often repeated, and the volume, or the number of reviews submitted to the Supreme Court of the Republic of Macedonia. As general hypothesis is that most of the adopted revisions are due to substantial violations of the provisions of civil procedure. Two-thirds of the stated revisions in front of the Supreme Court of Republic of Macedonia were rejected as unfounded and only one third of the submitted revisions from June 2011 to June 2012 were grounded. Since accepted revisions 59% due to incorrect application of substantive law, and 41% due to substantial violations of the provisions of Civil Procedure.

  12. Grating exchange system of independent mirror supported by floating rotary stage

    Science.gov (United States)

    Zhang, Jianhuan; Tao, Jin; Liu, Yan; Nan, Yan

    2015-10-01

    The performance of The Grating Exchange System can satisfy the Thirty Meter Telescope - TMT for astronomical observation WFOS index requirements and satisfy the requirement of accuracy in the grating exchange. It is used to install in the MOBIE and a key device of MOBIE. The Wide Field Optical Spectrograph (WFOS) is one of the three first-light observing capabilities selected by the TMT Science Advisory Committee. The Multi-Object Broadband Imaging Echellette (MOBIE) instrument design concept has been developed to address the WFOS requirements as described in the TMT Science-Based Requirements Document (SRD). The Grating Exchange System uses a new type of separate movement way of three grating devices and a mirror device. Three grating devices with a mirror are able to achieve independence movement. This kind of grating exchange system can effectively solve the problem that the volume of the grating change system is too large and that the installed space of MOBIE instruments is too limit. This system adopts the good stability, high precision of rotary stage - a kind of using air bearing (Air bearing is famous for its ultra-high precision, and can meet the optical accuracy requirement) and rotation positioning feedback gauge turntable to support grating device. And with a kind of device which can carry greater weight bracket fixed on the MOBIE instrument, with two sets of servo motor control rotary stage and the mirror device respectively. And we use the control program to realize the need of exercising of the grating device and the mirror device. Using the stress strain analysis software--SolidWorks for stress and strain analysis of this structure. And then checking the structure of the rationality and feasibility. And prove that this system can realize the positioning precision under different working conditions can meet the requirements of imaging optical grating diffraction efficiency and error by the calculation and optical performance analysis.

  13. Design of decoupled dual servo stage with voice coil motor and linear motor for XY long stroke ultra-precision scanning system

    Science.gov (United States)

    Kim, Ki-Hyun; Choi, Young-Man; Gweon, Dae-Gab; Hong, Dong-Pyo; Kim, Koung-Suk; Lee, Suk-Won; Lee, Moon-Gu

    2005-12-01

    A decoupled dual servo (DDS) stage for ultra-precision scanning system is introduced in this paper. The proposed DDS consists of a 3 axis fine stage for handling and carrying workpieces and a XY coarse stage. Especially, the DDS uses three voice coil motors (VCM) as a planar actuation system of the fine stage to reduce the disturbances due to any mechanical connections with its coarse stage. VCMs are governed by Lorentz law. According to the law and its structure, there are no mechanical connections between coils and magnetic circuits. Moreover, the VCM doesn't have force ripples due to imperfections of commutation components of linear motor systems - currents and flux densities. However, due to the VCM's mechanical constraints the working range of the fine is about 5mm2. To break that hurdle, the coarse stage with linear motors is used for the fine stage to move about 200mm2. Because of the above reasons, the proposed DDS can achieve higher precision scanning than other stages with only one servo. Using MATLAB's Sequential Quadratic Programming (SQP), the VCMs are optimally designed for the highest force under conditions and constraints such as thermal dissipations due to its coil, its size, and so on. For linear motors, Halbach magnet linear motor is proposed and optimally designed in this paper. In addition, for their smooth movements without any frictions, guide systems of the DDS are composed of air bearings. And then, precisely to get their positions, linear scales with 0.1um resolution are used for the coarse's XY motions and plane mirror laser interferometers with 20nm for the fine's XYθz. On scanning, the two stages have same trajectories and are controlled. The control algorithm is Parallel method. The embodied ultra-precision scanning system has about 100nm tracking error and in-positioning stability.

  14. Test-Retest Reliability of the Parent Behavior Importance Questionnaire-Revised and the Parent Behavior Frequency Questionnaire-Revised

    Science.gov (United States)

    Mowder, Barbara A.; Shamah, Renee

    2011-01-01

    This study evaluated the test-retest reliability of two parenting measures: the Parent Behavior Importance Questionnaire-Revised (PBIQ-R) and Parent Behavior Frequency Questionnaire-Revised (PBFQ-R). These self-report parenting behavior assessment measures may be utilized as pre- and post-parent education program measures, with parents as well as…

  15. A new system for assessment of growth using mandibular canine calcification stages and its correlation with modified MP3 stages.

    Science.gov (United States)

    Hegde, Gautham; Hegde, Nanditha; Kumar, Anil; Keshavaraj

    2014-07-01

    Orthodontic diagnosis and treatment planning for growing children must involve growth prediction, especially in the treatment of skeletal problems. Studies have shown that a strong association exists between skeletal maturity and dental calcification stages. The present study was therefore taken up to provide a simple and practical method for assessing skeletal maturity using a dental periapical film and standard dental X-ray machine, to compare the developmental stages of the mandibular canine with that of developmental stages of modified MP3 and to find out if any correlation exists, to determine if the developmental stages of the mandibular canine alone can be used as a reliable indicator for assessment of skeletal maturity. A total of 160 periapical radiographs, of the mandibular right canine and the MP3 region was taken and assessed according to the Dermirjian's stages of dental calcification and the modified MP3 stages. The correlation coefficient between MP3 stages and developmental stages of mandibular canine was found to be significant in both male and female groups. When the canine calcification stages were compared with the MP3 stages it was found that with the exception of the D stage of canine calcification the remaining stages showed a very high correlation with the modified MP3 stages. The correlation between the mandibular canine calcification stages, and the MP3 stages was found to be significant. The canine calcification could be used as a sole indicator for assessment of skeletal maturity.

  16. Stage measurement at gaging stations

    Science.gov (United States)

    Sauer, Vernon B.; Turnipseed, D. Phil

    2010-01-01

    Stream and reservoir stage are critical parameters in the computation of stream discharge and reservoir volume, respectively. In addition, a record of stream stage is useful in the design of structures that may be affected by stream elevation, as well as for the planning for various uses of flood plains. This report describes equipment and methodology for the observation, sensing, and recording of stage in streams and reservoirs. Although the U.S. Geological Survey (USGS) still uses the traditional, basic stilling-well float system as a predominant gaging station, modern electronic stage sensors and water-level recorders are now commonly used. Bubble gages coupled with nonsubmersible pressure transducers eliminate the need for stilling wells. Submersible pressure transducers have become common in use for the measurement of stage in both rivers and lakes. Furthermore, noncontact methods, such as radar, acoustic, and laser methods of sensing water levels, are being developed and tested, and in the case of radar, are commonly used for the measurement of stage. This report describes commonly used gaging-station structures, as well as the design and operation of gaging stations. Almost all of the equipment and instruments described in this report will meet the accuracy standard set by the USGS Office of Surface Water (OSW) for the measurement of stage for most applications, which is ±0.01 foot (ft) or 0.2 percent of the effective stage. Several telemetry systems are used to transmit stage data from the gaging station to the office, although satellite telemetry has become the standard. These telemetry systems provide near real-time stage data, as well as other information that alerts the hydrographer to extreme or abnormal events, and instrument malfunctions.

  17. Vibration characteristics of two-stage planetary transmission system with thin-walled ring gear on elastic supports

    Science.gov (United States)

    Li, JianYing; Hu, QingChun; Zong, ChangFu; Zhu, TianJun; Zhang, ZeXing

    2018-03-01

    A dual-clutch and dual-speed planetary gears mechanism of a hybrid car coupled-system is taken as research subject, in which the ring gear of planet set II is a thin-walled structure and the clutch friction plates of planet set II are used as its elastic supports. Based on the lumped parameter-rigid elastic coupled dynamic model of two-stage planetary transmission system with thin-walled ring gear on elastic supports, the motion differential equations are established and the dynamic responses are solved by the Runge-Kutta method considering each stage internal and external time-varying mesh stiffness. The vibration displacements of each stage ring gear have been affected differently in time-domain, the translational vibration displacement of the ring gear of planet set I are obviously more than the torsional vibration displacement, but it is opposite for the ring gear of planet set II; The translational and torsional vibration responses of each stage ring gear arrive the peak in low-frequency. The analysis results of this paper can enrich the theoretical research of multistage planetary transmission and provide guidance for dynamic design.

  18. A new system for assessment of growth using mandibular canine calcification stages and its correlation with modified MP3 stages

    Directory of Open Access Journals (Sweden)

    Gautham Hegde

    2014-01-01

    Full Text Available Objective: Orthodontic diagnosis and treatment planning for growing children must involve growth prediction, especially in the treatment of skeletal problems. Studies have shown that a strong association exists between skeletal maturity and dental calcification stages. The present study was therefore taken up to provide a simple and practical method for assessing skeletal maturity using a dental periapical film and standard dental X-ray machine, to compare the developmental stages of the mandibular canine with that of developmental stages of modified MP3 and to find out if any correlation exists, to determine if the developmental stages of the mandibular canine alone can be used as a reliable indicator for assessment of skeletal maturity. Materials and Methods: A total of 160 periapical radiographs, of the mandibular right canine and the MP3 region was taken and assessed according to the Dermirjian′s stages of dental calcification and the modified MP3 stages. Results and Discussion: The correlation coefficient between MP3 stages and developmental stages of mandibular canine was found to be significant in both male and female groups. When the canine calcification stages were compared with the MP3 stages it was found that with the exception of the D stage of canine calcification the remaining stages showed a very high correlation with the modified MP3 stages. Conclusion: The correlation between the mandibular canine calcification stages, and the MP3 stages was found to be significant. The canine calcification could be used as a sole indicator for assessment of skeletal maturity.

  19. A two-stage approach for multi-objective decision making with applications to system reliability optimization

    International Nuclear Information System (INIS)

    Li Zhaojun; Liao Haitao; Coit, David W.

    2009-01-01

    This paper proposes a two-stage approach for solving multi-objective system reliability optimization problems. In this approach, a Pareto optimal solution set is initially identified at the first stage by applying a multiple objective evolutionary algorithm (MOEA). Quite often there are a large number of Pareto optimal solutions, and it is difficult, if not impossible, to effectively choose the representative solutions for the overall problem. To overcome this challenge, an integrated multiple objective selection optimization (MOSO) method is utilized at the second stage. Specifically, a self-organizing map (SOM), with the capability of preserving the topology of the data, is applied first to classify those Pareto optimal solutions into several clusters with similar properties. Then, within each cluster, the data envelopment analysis (DEA) is performed, by comparing the relative efficiency of those solutions, to determine the final representative solutions for the overall problem. Through this sequential solution identification and pruning process, the final recommended solutions to the multi-objective system reliability optimization problem can be easily determined in a more systematic and meaningful way.

  20. Design and modelling of an innovative three-stage thermal storage system for direct steam generation CSP plants

    Science.gov (United States)

    Garcia, Pierre; Vuillerme, Valéry; Olcese, Marco; El Mourchid, Nadim

    2016-05-01

    Thermal Energy Storage systems (TES) for a Direct Steam Generation (DSG) solar plant feature preferably three stages in series including a latent heat storage module so that steam can be recovered with a limited temperature loss. The storage system designed within the Alsolen Sup project is characterized by an innovative combination of sensible and latent modules. A dynamic model of this three-stage storage has been developed and applied to size the storage system of the Alsolen Sup® plant demonstrator at CEA Cadarache. Results of this simulation show that this promising concept is an efficient way to store heat in DSG solar plants.

  1. Maximum surgical blood ordering schedules for revision lower limb arthroplasty.

    Science.gov (United States)

    Mahadevan, Devendra; Challand, Christopher; Clarke, Andrew; Keenan, Jonathan

    2011-05-01

    Effective utilisation of blood products is fundamental. The introduction of maximum surgical blood ordering schedules (MSBOS) for operations has been shown to improve transfusion services. A retrospective analysis was undertaken to establish an evidence-based MSBOS for revision total hip replacement (THR) and total knee revision (TKR). The impact of this schedule on blood conservation was analysed. A retrospective analysis was undertaken on 397 patients who underwent revision THR and TKR over a 4-year period. The cross-match-to-transfusion ratio (CTR) and transfusion index (TI) were calculated. A MSBOS protocol was created based on the TIs and its' impact on transfusion services was assessed prospectively on 125 patients by comparing CTRs. In revision THR, TI was 1.19 for elective cases, 1.55 for emergency cases and 2.35 for infected cases. There was no difference in TI for revisions of cemented and uncemented components. Single component THR revision required less transfusion. In revision TKR, TI was 0.31 for elective cases, 2.0 for emergency cases and 1.23 for cases with infection. The introduction of the MSBOS protocol had resulted in a considerable improvement in blood ordering. Reductions in the CTR were seen for all types of revision surgery, but most evident in elective revision THR (3.24-2.18) and elective revision TKR (7.95-1.2). Analysis confirmed that excessive cross-matching occurred for revision lower limb arthroplasty. The introduction of our MSBOS protocol promoted blood conservation and compliance with established national guidelines.

  2. Risk factors for total hip arthroplasty aseptic revision.

    Science.gov (United States)

    Khatod, Monti; Cafri, Guy; Namba, Robert S; Inacio, Maria C S; Paxton, Elizabeth W

    2014-07-01

    The purpose of this study was to evaluate patient, operative, implant, surgeon, and hospital factors associated with aseptic revision after primary THA in patients registered in a large US Total Joint Replacement Registry. A total of 35,960 THAs registered from 4/2001-12/2010 were evaluated. The 8-year survival rate was 96.7% (95% CI 96.4%-97.0%). Females had a higher risk of aseptic revision than males. Hispanic and Asian patients had a lower risk of revision than white patients. Ceramic-on-ceramic, ceramic-on-conventional polyethylene, and metal-on-conventional polyethylene bearing surfaces had a higher risk of revision than metal-on-highly cross-linked polyethylene. Body mass index, health status, diabetes, diagnosis, fixation, approach, bilateral procedures, head size, surgeon fellowship training, surgeon and hospital volume were not revision risk factors. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. DNA repair systems and the pathogenesis of Mycobacterium tuberculosis: varying activities at different stages of infection.

    Science.gov (United States)

    Gorna, Alina E; Bowater, Richard P; Dziadek, Jaroslaw

    2010-05-25

    Mycobacteria, including most of all MTB (Mycobacterium tuberculosis), cause pathogenic infections in humans and, during the infectious process, are exposed to a range of environmental insults, including the host's immune response. From the moment MTB is exhaled by infected individuals, through an active and latent phase in the body of the new host, until the time they reach the reactivation stage, MTB is exposed to many types of DNA-damaging agents. Like all cellular organisms, MTB has efficient DNA repair systems, and these are believed to play essential roles in mycobacterial pathogenesis. As different stages of infection have great variation in the conditions in which mycobacteria reside, it is possible that different repair systems are essential for progression to specific phases of infection. MTB possesses homologues of DNA repair systems that are found widely in other species of bacteria, such as nucleotide excision repair, base excision repair and repair by homologous recombination. MTB also possesses a system for non-homologous end-joining of DNA breaks, which appears to be widespread in prokaryotes, although its presence is sporadic within different species within a genus. However, MTB does not possess homologues of the typical mismatch repair system that is found in most bacteria. Recent studies have demonstrated that DNA repair genes are expressed differentially at each stage of infection. In the present review, we focus on different DNA repair systems from mycobacteria and identify questions that remain in our understanding of how these systems have an impact upon the infection processes of these important pathogens.

  4. Two-Stage Series-Resonant Inverter

    Science.gov (United States)

    Stuart, Thomas A.

    1994-01-01

    Two-stage inverter includes variable-frequency, voltage-regulating first stage and fixed-frequency second stage. Lightweight circuit provides regulated power and is invulnerable to output short circuits. Does not require large capacitor across ac bus, like parallel resonant designs. Particularly suitable for use in ac-power-distribution system of aircraft.

  5. Revision of nuclear power plants safety systems' routine testing assigned periodicity during the design extension period

    International Nuclear Information System (INIS)

    Skalozubov, V.I.; Kozlov, Yi.L.; Chulkyin, O.O.

    2017-01-01

    When nuclear power plants safety systems thermal equipment operation extending, a necessary requirement shall rely on revising the scheduled equipment tests frequency to optimize those tests schedule taking into account the equipment remained lifespan. On the one hand, there exists a need for tests frequency increase to detect ''hidden'' failures, and on the another, frequent tests cause a premature wear of the equipment. Proposed is an original method for optimizing the frequency of NPPs safety systems thermal engineering equipment testing. Essential in the proposed method is the optimization criterion chosen: index of security system failure probability non-exceedance during the beyond-design operating period as referred to the failure probability expected considering the equipment residual resource during the design operating period. The developed method implementation when applied to NPPs safety systems operated beyond the design service life at nuclear power plants with WWER-1000 series reactors, allowed to establish that the optimal tests frequency makes half the designed one when the equipment service life is extended by five years and three times less that the designed frequency when subject lifespan extended by 10 years.

  6. A Sensorless Power Reserve Control Strategy for Two-Stage Grid-Connected PV Systems

    OpenAIRE

    Sangwongwanich, Ariya; Yang, Yongheng; Blaabjerg, Frede

    2017-01-01

    Due to the still increasing penetration of grid-connected Photovoltaic (PV) systems, advanced active power control functionalities have been introduced in grid regulations. A power reserve control, where namely the active power from the PV panels is reserved during operation, is required for grid support. In this paper, a cost-effective solution to realize the power reserve for two-stage grid-connected PV systems is proposed. The proposed solution routinely employs a Maximum Power Point Track...

  7. Language Practice with Multimedia Supported Web-Based Grammar Revision Material

    Science.gov (United States)

    Baturay, Meltem Huri; Daloglu, Aysegul; Yildirim, Soner

    2010-01-01

    The aim of this study was to investigate the perceptions of elementary-level English language learners towards web-based, multimedia-annotated grammar learning. WEBGRAM, a system designed to provide supplementary web-based grammar revision material, uses audio-visual aids to enrich the contextual presentation of grammar and allows learners to…

  8. Is it time to incorporate 'depth of infiltration' in the T staging of oral tongue and floor of mouth cancer?

    Science.gov (United States)

    Piazza, Cesare; Montalto, Nausica; Paderno, Alberto; Taglietti, Valentina; Nicolai, Piero

    2014-04-01

    To summarize recent acquisitions in three-dimensional tongue and floor of mouth anatomy that can help in better evaluation of the pathways of cancer progression within these oral subsites, thus giving some hints for refining of the current TNM staging system. The Visual Human Project is an initiative aimed at establishing a three-dimensional dataset of anatomy of two cadavers made available free to the scientific community. Visual human data have been analyzed by specific software thus improving our three-dimensional understanding of the tongue myostructure. It is already known that there is limited prognostic utility in using the two-dimensional surface diameter alone as criterion for T1-T3 definition. Recently, also the T4a categorization for the infiltration of 'deep' or extrinsic tongue muscles has been criticized. This is largely because the descriptor 'deep' does not take into account the fact that considerable portions of these muscles lie in a very superficial plane. Different prognosticators have been proposed for inclusion into the TNM staging system of oral cancer but 'depth of tumor infiltration' seems to be the most robust, universally recognized, and reproducible in the preoperative, intraoperative, and postoperative settings. Oral tongue and floor of mouth cancer needs to be classified according to a revised TNM staging system in which 'depth of infiltration' should be taken into account. An 'ideal cut off' for distinguishing 'low' (T1-T2) from 'high-risk' (T3-T4) categories has been proposed based on the literature review, but needs retrospective as well as large prospective trials before its validation.

  9. Morphogenesis of the rhea (Rhea americana respiratory system in different embryonic and foetal stages

    Directory of Open Access Journals (Sweden)

    Renata P. Sousa

    Full Text Available ABSTRACT: The rhea (Rhea americana is an important wild species that has been highlighted in national and international livestock. This research aims to analyse embryo-foetal development in different phases of the respiratory system of rheas. Twenty-three embryos and foetuses were euthanized, fixed and dissected. Fragments of the respiratory system, including the nasal cavity, larynx, trachea, syrinx, bronchi and lungs, were collected and processed for studies using light and scanning electron microscopy. The nasal cavity presented cubic epithelium in the early stages of development. The larynx exhibited typical respiratory epithelium between 27 and 31 days. The trachea showed early formation of hyaline cartilage after 15 days. Syrinx in the mucous membrane of 18-day foetuses consisted of ciliated epithelium in the bronchial region. The main bronchi had ciliated epithelium with goblet cells in the syringeal region. In the lung, the parabronchial stage presented numerous parabronchi between 15 and 21 days. This study allowed the identification of normal events that occur during the development of the rhea respiratory system, an important model that has not previously been described. The information generated here will be useful for the diagnosis of pathologies that affect this organic system, aimed at improving captive production systems.

  10. THE EVALUATION SYSTEM OF DESIGN SOLUTIONS FOR RESIDENTIAL PROPERTY ON THE PRE-INVESTMENT STAGE THROUGH NEURAL NETWORK TECHNOLOGY

    Directory of Open Access Journals (Sweden)

    G. D. Kostsikava

    2016-01-01

    Full Text Available Ever since the Soviet Union design solutions were evaluated according to different criteria and indicators. At the present stage of evaluation systems of design solutions stands systemengineering doctrine is allocated. It is complemented by the theory of efficiency and financial sustainability investment project in view of the general market concept. Also great attention is paid to the virtual object modeling. It is urgent to include the behavior prediction of an investment construction project model at each stage of its life cycle. The high cost of all phases of this life cycle makes it necessary to calculate the feasibility of the investment. Very urgent to do it as accurately as possible and before we start of design works on the stage of the investment plan evaluation. Belarus has legislated pre-investment stage of construction project development. To evaluate the design solution at this stage is necessary to develop an investment justification, a project management plan and a business plan. They will evaluate and will compare several options for future objects by the complex. This requires not only time, but considerable financial costs. In order to optimize the process to develop an evaluation system design solutions based on existing projects. It allows the customer (investor choose design solutions to build the object without developing of pre-design documentations for several options. This system it is advisable to try out the example of apartment house building with the assistance of the national fund of project documentation and objects-analogues data bank. The developed evaluation system of design solutions for residential real estate objects in the pre-investment stage is supposed to use the theory of neural networks and neyroprogramming. This system bases on the input parameters projects. The hidden layer neurons are trained to choose suitable projects of apartment houses with their classification. The projects will be classified

  11. Frequent hemodialysis with NxStage system in pediatric patients receiving maintenance hemodialysis.

    Science.gov (United States)

    Goldstein, Stuart L; Silverstein, Douglas M; Leung, Jocelyn C; Feig, Daniel I; Soletsky, Beth; Knight, Cathy; Warady, Bradley A

    2008-01-01

    Recent evidence from adult hemodialysis (HD) patient studies reveal improved biochemical control and reported health-related quality of life after transition from conventional thrice weekly to daily home maintenance HD treatment. Published pediatric frequent dialysis experiences demonstrate similar improvement but all used conventional HD machines, which employ a treated municipal water supply, thereby frequently exposing patients to proinflammatory components. We report our pediatric experience with six-times-weekly HD using the NxStage system, which uses sterile dialysis fluid to provide dialysis in the home or center setting. Four patients (weight range 38-61.4 kg) completed the 16-week study. Patients exhibited progressive reductions in casual pretreatment systolic and diastolic blood pressures, discontinuation of antihypertensive medications, and decreased blood pressure load by ambulatory blood pressure monitoring. Mean serum phosphorus improved without change in phosphorus binder medication, and all three patients with a normalized protein catabolic rate 1.1 g/kg per day. Patients reported no adverse effects. Variable changes in proinflammatory cytokine levels were observed. We suggest that frequent HD with the NxStage system be considered for children who would benefit from home-based maintenance dialysis.

  12. 75 FR 60485 - NRC Enforcement Policy Revision

    Science.gov (United States)

    2010-09-30

    ... NUCLEAR REGULATORY COMMISSION [NRC-2008-0497] NRC Enforcement Policy Revision AGENCY: Nuclear Regulatory Commission. ACTION: Policy statement. SUMMARY: The Nuclear Regulatory Commission (NRC or Commission) is publishing a major revision to its Enforcement Policy (Enforcement Policy or Policy) to...

  13. [Revised practice guideline 'Anaemia in midwifery practice'

    NARCIS (Netherlands)

    Beentjes, M.; Jans, S.M.P.J.

    2012-01-01

    The practice guideline of the Royal Dutch Organization of Midwives 'Anaemia in primary care midwifery practice' published in 2000, has recently been revised. The revised guideline takes physiological haemodilution during pregnancy into consideration and provides gestation specific reference values

  14. Low Voltage Ride-Through Capability of a Single-Stage Single-Phase Photovoltaic System Connected to the Low-Voltage Grid

    DEFF Research Database (Denmark)

    Yang, Yongheng; Blaabjerg, Frede

    2013-01-01

    The progressively growing of single-phase photovoltaic (PV) systems makes the Distribution System Operators (DSO) to update or revise the existing grid codes in order to guarantee the availability, quality and reliability of the electrical system. It is expected that the future PV systems connected...... to the low-voltage grid will be more active with functionalities of low voltage ride-through (LVRT) and the grid support capability, which is not the case today. In this paper, the operation principle is demonstrated for a single-phase grid-connected PV system in low voltage ride through operation in order...... to map future challenges. The system is verified by simulations and experiments. Test results show that the proposed power control method is effective and the single-phase PV inverters connected to low-voltage networks are ready to provide grid support and ride-through voltage fault capability...

  15. Analysis of NRC Regulatory Guide 1.21 Revision 2

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sung Il; Yook, Dae Sik; Lee, Byung Soo [KINS, Daejeon (Korea, Republic of)

    2015-05-15

    It is essential to have a degree of uniformity in the methods used for measuring, evaluating, recording, and reporting data on radioactive material in effluents and solid wastes. For this purpose, the U.S. Nuclear Regulatory Commission (NRC) released a revised version of the Regulatory Guide 1.21 'Measuring, evaluating, and reporting radioactive material in liquid and gaseous effluents and solid waste' (revision 2) in 2009, updating the revision 1 version released in 1974. This study compares the previous revision 1 (1974) version with the revision 2 (2009) version to elaborate on the application of the guidelines to Korea. This study consists of an analysis of the 2009 Revision 2 version of the U.S. NRC Regulatory Guidelines 1.21 and an exposition of methods for its application in the domestic environment. Major revisions were made to allow for the adoption of a risk informed approach. Radionuclides with lower than 1% contribution to emission or radiation levels can be selected as principal radionuclides. Requirements for analysis of leaks and spills have been reinforced, with additional groundwater monitoring and hydrological data analysis becoming necessary.

  16. 77 FR 38043 - TRICARE; Revised Guideline for Determining the Outpatient Prospective Payment System (OPPS...

    Science.gov (United States)

    2012-06-26

    ... within these private pay norms was chosen as a method to more equitably meet DoD's objectives in making...) Amount AGENCY: Department of Defense (DoD). ACTION: Notice of revised guideline for determining TRICARE's... the methodology to calculate TRICARE's OPPS General TMCPA amount for qualifying hospitals. DATES: The...

  17. The DSM revision process: needing to keep an eye on the empirical ball.

    Science.gov (United States)

    First, M B

    2017-01-01

    From DSM-III onward, successive DSM editions have strived to ground the diagnostic definitions in empirical evidence. DSM-IV established a three-stage process of empirical review, consisting of comprehensive and systematic literature reviews, secondary analyses of datasets, and field trials to provide reliability and validity data for the most substantial or controversial proposals. DSM-IV Work Group members were required to review the empirical literature to document explicitly the evidence supporting the text and criteria published in DSM-IV. As noted by Kendler and Solomon (2016), in contrast to the emphasis on systematic reviews in medicine which is a manifestation of the evidence-based medicine movement, such systematic evidence-based reviews have not been consistently integrated into the development of DSM-5, raising questions about empirical rigor underlying the DSM-5 revision. It is likely that this regression in terms of anchoring the revision process in a comprehensive review of empirical data stemmed from the emphasis during the DSM-5 revision process on trying to move DSM-5 from its categorical descriptive approach towards a more etiological dimensional approach. Although such a shift ultimately did not occur, the effort spent on trying to achieve a paradigm shift likely came at the expense of the hard work of conducting systematic empirical reviews. For the DSM to continue to remain credible in the current era of evidence-based medicine, it is essential that the developers of future editions of the DSM avoid taking their eye off the empirical ball and insure that the manual remains grounded in solid empirical evidence.

  18. Transuranic waste baseline inventory report. Revision No. 3

    International Nuclear Information System (INIS)

    1996-06-01

    The Transuranic Waste Baseline Inventory Report (TWBIR) establishes a methodology for grouping wastes of similar physical and chemical properties from across the U.S. Department of Energy (DOE) transuranic (TRU) waste system into a series of open-quotes waste profilesclose quotes that can be used as the basis for waste form discussions with regulatory agencies. The purpose of Revisions 0 and 1 of this report was to provide data to be included in the Sandia National Laboratories/New Mexico (SNL/NM) performance assessment (PA) processes for the Waste Isolation Pilot Plant (WIPP). Revision 2 of the document expanded the original purpose and was also intended to support the WIPP Land Withdrawal Act (LWA) requirement for providing the total DOE TRU waste inventory. The document included a chapter and an appendix that discussed the total DOE TRU waste inventory, including nondefense, commercial, polychlorinated biphenyls (PCB)-contaminated, and buried (predominately pre-1970) TRU wastes that are not planned to be disposed of at WIPP

  19. Calculation code revised MIXSET for Purex process

    International Nuclear Information System (INIS)

    Gonda, Kozo; Oka, Koichiro; Fukuda, Shoji.

    1979-02-01

    Revised MIXSET is a FORTRAN IV calculation code developed to simulate steady and transient behaviors of the Purex extraction process and calculate the optimum operating condition of the process. Revised MIXSET includes all the functions of MIXSET code as shown below. a) Maximum chemical system of eight components can be handled with or without mutual dependence of the distribution of components. b) The flowrate and concentration of feed can be renewed successively at any state, transient or steady, for searching optimum operating conditions. c) Optimum inputs of feed concentrations and flowrates can be calculated to satisfy both of specification and recovery rate of a product. d) Radioactive decay reactions can be handled on each component. Besides these functions, the following chemical reactions concerned in Purex process are newly-included in Revised MIXSET code and the quantitative changes of components such as H + , U(IV), U(VI), Pu(III), Pu(IV), NH 2 OH, N 2 H 4 can be simulated. 1st Gr. (i) reduction of Pu(IV); U 4+ + 2Pu 4+ + 2H 2 O → UO 2 2+ + 2Pu 3+ + 4H + . (ii) oxidation of Pu(III); 2Pu 3+ + 3H + + NO 3 - → 2Pu 4+ + HNO 2 + H 2 O. (iii) oxidation of U(IV); U 4+ + NO 3 - + H 2 O → UO 2 2+ + H + + HNO 2 2U 4+ + O 2 + 2H 2 O → 2UO 2 2+ + 4H + . (iv) decomposition of HNO 2 ; HNO 2 + N 2 H 5 + → HN 3 + 2H 2 O + H + . (author)

  20. Use of massive structural allograft in revision septic hip arthroplasty

    International Nuclear Information System (INIS)

    Imran Ilyas; Morgan, F.; David, A.

    1999-01-01

    The reconstruction of failed septic hip arthroplasty with the use of massive osseous allograft segments is reported in ten patients. All of these patients had a two-stage procedure with an interval Girdlestone arthroplasty separating the initial demolition from the subsequent reconstruction. The mean follow-up was 58 months (range 36 to 98 months) and the most common pathogen isolated was Staphylococcus epidermidis. The mean preoperative modified Harris hip score was 27 points (range 9 to 58) and the mean postoperative score was 73 points (range 53 to 92). There was one patient who required an additional procedure not related to allograft use. There has been no case of recurrence of infection. We conclude that the revision of septic hip arthroplasty in the use of massive allografts do not have to be mutually exclusive events

  1. The role of stages in designing English syllabus development for the students of electrical engineering study program

    Science.gov (United States)

    Imron, Aly

    2017-09-01

    Developing syllabus is badly needed to anticipate the quick progress of the educational era and revision of the existing one when it is considered not to meet a demand of clearness, efficiency, and pedagogic view. Polytechnic education product goes professional worker`s candidate in the workplace. Therefore, the subject given is designed as proper as possible which is closely and in line with the job place. The research problem is stated with: what is the suitable English syllabus for the technical student by using communicative approach. The method used consists of some stages, namely: 1. Doing the needs survey; 2. Deciding the purpose of the course; 3. Choosing the syllabus type; 4. Writing the proto syllabus; 5. Writing syllabus product for the technical students; 6. Expect validation and revising; and 7. Implementation of class procedure and revising the final product. The research uses the questionnaire and interview for collecting the data. The result shows that the syllabus developed are appropriate based on the input from students, teachers, subject specialist, and reviewer.

  2. The dynamics of patients' life quality indices under the conditions of two-stage knee joint replacement

    Directory of Open Access Journals (Sweden)

    Shpinyak S.P.

    2017-09-01

    Full Text Available  The aim: to analyze the changes in the life quality indices of the patients with deep periprosthetic joint infection of the knee under the two-stage surgical treatment. Material and Methods. 57 patients who underwent two-stage revision-ary treatment in Research Institute of Traumatology, Orthopedics and Neurosurgery were interviewed with life quality questionnaire Short Form Medical Outcomes Study (SF 36 v.1. Interview results were compared with standardized population indices of SF-36 scales for males and females. Results. In all groups regardless of sex there was a general tendency for an increase in physical and psychological health component up to mean population values after the first stage of surgery and further growth after the second stage. Rehabilitation potential of psychomotor health was higher in women than in men. The ability to handle stress was lower in direct ratio with the patients' age. Conclusion. Two-stage reendoprosthetic treatment with articulating antimicrobial spacer implantation having high grade of fixation is an effective treatment method for deep periprosthetic infection which increases physical health and improves social functioning of patients.

  3. Lot-sizing for a single-stage single-product production system with rework of perishable production defectives

    NARCIS (Netherlands)

    Teunter, R.; Flapper, S.D.P.

    2003-01-01

    We consider a single-stage single-product production system. Produced units may be non-defective, reworkable defective, or non-reworkable defective. The system switches between production and rework. After producing a fixed number (N) of units, all reworkable defective units are reworked. Reworkable

  4. Influence of Shaft Torsional Stiffness on Dynamic Response of Four-Stage Main Transmission System

    Directory of Open Access Journals (Sweden)

    Yuan Chen

    2018-01-01

    Full Text Available Dynamic response analysis has potential for increasing fatigue life of the components in the transmission of a multistage main transmission system. The calculated data can demonstrate the influence of shaft torsional stiffness on dynamic characteristics of the system. Detecting key shafts of the system and analyzing their sensitivity are important for the design of four-stage helicopter gear box. Lumped mass method is applied for dynamic modeling and Fourier method is used to solve differential equation of the system. Results of the analysis indicate that key shafts can be designed carefully to improve the performance of the transmission system.

  5. All-inside, anatomical lateral ankle stabilization for revision and complex primary lateral ankle stabilization: a technique guide.

    Science.gov (United States)

    Prissel, Mark A; Roukis, Thomas S

    2014-12-01

    Lateral ankle instability is a common mechanical problem that often requires surgical management when conservative efforts fail. Historically, myriad open surgical approaches have been proposed. Recently, consideration for arthroscopic management of lateral ankle instability has become popular, with promising results. Unfortunately, recurrent inversion ankle injury following lateral ankle stabilization can occur and require revision surgery. To date, arthroscopic management for revision lateral ankle stabilization has not been described. We present a novel arthroscopic technique combining an arthroscopic lateral ankle stabilization kit with a suture anchor ligament augmentation system for revision as well as complex primary lateral ankle stabilization. © 2014 The Author(s).

  6. Two-stage single-phase grid-connected photovoltaic system with reduced complexity

    Science.gov (United States)

    da Silva, Cintia S.; Motta, Filipe R.; Tofoli, Fernando L.

    2011-06-01

    This article presents a grid-connected photovoltaic (PV) system using the classical DC-DC buck converter, which is responsible for stepping down the resulting voltage from several series-connected panels. Besides, the structure provides high power factor operation by injecting a quasi-sinusoidal current into the grid, with near no displacement in relation to the line voltage at the point of common coupling among the PV system and the loads. A CSI employing thyristors is cascaded with the DC-DC stage so that AC voltage results. The inverter output voltage level is adjusted by using a low-frequency transformer, which also provides galvanic isolation. The proposed system is described as mathematical approach and design guidelines are presented, providing an overview of the topology. An experimental prototype is also implemented, and relevant results to validate the proposal are discussed.

  7. Method for simulating predictive control of building systems operation in the early stages of building design

    DEFF Research Database (Denmark)

    Petersen, Steffen; Svendsen, Svend

    2011-01-01

    A method for simulating predictive control of building systems operation in the early stages of building design is presented. The method uses building simulation based on weather forecasts to predict whether there is a future heating or cooling requirement. This information enables the thermal...... control systems of the building to respond proactively to keep the operational temperature within the thermal comfort range with the minimum use of energy. The method is implemented in an existing building simulation tool designed to inform decisions in the early stages of building design through...... parametric analysis. This enables building designers to predict the performance of the method and include it as a part of the solution space. The method furthermore facilitates the task of configuring appropriate building systems control schemes in the tool, and it eliminates time consuming manual...

  8. Predicting prognosis in hepatocellular carcinoma; comparison of staging system in pakistani cohort

    International Nuclear Information System (INIS)

    Sarwar, S.; Khan, A.A.

    2015-01-01

    To determine the clinical, biochemical and radiological prognostic indicators and to compare the performance of six staging systems in patients of hepatocellular carcinoma (HCC). Study Design:Descriptive study. Place and Duration of Study: Department of Gastroenterology, Doctors Hospital, Lahore, from October 2007 to December 2013. Methodology:Patients with HCC were included. Baseline clinical, hematological and radiological variables were noted. Patients were followed for 5 years or till death. Survival predictors were identified using Cox proportional hazard analysis and 6 prognostic staging systems were evaluated by determining homogeneity, discriminatory ability and monotonicity. Results: Of the 228 patients included, male to female ratio was 2.6/1 (165/63) and mean age was 56.5 ± 10.4 years. Majority of patients 189 (82.9%) were anti-HCV positive. Solitary HCC lesion was seen in 121 (53.1%) patients, 16 (7%) had 2 lesions while 73 (32%) had 3 or more lesions. Only 36 (15.8%) patients had palliative therapy for HCC. Survival rate was 45.2%, 25%, 12.3%, 7%, 2.2% and 1% for 6 months, 1, 2, 3, 4 and 5 years respectively. Male gender, portal vein thrombosis, serum albumin < 3.5 g/dl, tumor size =6 cm and alpha fetoprotein (AFP) =147 U/ml were bad prognostic indicators. OKUDA, GRETCH and early stages of CLIP had better homogeneity while CLIP showed superior discriminatory ability and monotonicity for predicting survival. Conclusion: Male gender, presence of portal vein thrombosis, low serum albumin, large tumor size and high AFP level are poor prognostic indicators in patients of HCC. CLIP has better performance in predicting mortality. (author)

  9. BWR Water Chemistry Guidelines: 1993 Revision, Normal and hydrogen water chemistry

    International Nuclear Information System (INIS)

    Karlberg, G.; Goddard, C.; Fitzpatrick, S.

    1994-02-01

    The goal of water chemistry control is to extend the operating life of the reactor and rector coolant system, balance-of-plant components, and turbines while simultaneously controlling costs to safeguard the continued economic viability of the nuclear power generation investment. To further this goal an industry committee of chemistry personnel prepared guidelines to identify the benefits, risks, and costs associated with water chemistry in BWRs and to provide a template for an optimized water chemistry program. This document replaces the BWR Normal Water Chemistry Guidelines - 1986 Revision and the BWR Hydrogen Water Chemistry Guidelines -- 1987 Revision. It expands on the previous guidelines documents by covering the economic implications of BWR water chemistry control

  10. Planned revision to DOE Order 5820.2A, Radioactive Waste Management

    Energy Technology Data Exchange (ETDEWEB)

    Duggan, G.J. [Dept. of Energy, Washington, DC (United States); Williams, R.E.; Kudera, D.E. [EG and G Idaho, Inc., Idaho Falls, ID (United States). Idaho National Engineering Lab.; Bailey, D.E. [NJG, Inc. (United States)

    1993-03-01

    US Department of Energy Headquarters initiated efforts to revise DOE Order 5820.2A, ``Radioactive Waste Management``. The purpose of the revision is to enhance DOE waste management requirements, reflect new DOE organizational responsibilities, and consolidate requirements for management of all waste, under the responsibility of Environmental Restoration and Waste Management, into a single order. This paper discusses the revision philosophy, objectives of the revision, and strategy for the revision. Issues being considered for inclusion in the revision and recommended methods of resolving each issue are also discussed.

  11. Experimental investigation of two-stage thermoelectric generator system integrated with phase change materials

    DEFF Research Database (Denmark)

    Ahmadi Atouei, Saeed; Ranjbar, Ali Akbar; Rezaniakolaei, Alireza

    2017-01-01

    this amount of voltage just for 2100 s. Therefore, the proposed design makes TEG systems more suitable for wireless sensor applications when the heat source does not provide steady thermal energy. In this study, four different patterns of thermal power applied to the TTEG system are considered. These patterns...... experimentally. In the first stage, a TEG module installed between a phase change material (PCM) heat sink, as cooling system, and an electrical heater, as the heat source. Because of the inherent characteristics of PCMs to save the thermal energy as latent heat, the PCM heat sink is used as the heat source...

  12. A non-linear dynamical approach to belief revision in cognitive behavioral therapy

    Science.gov (United States)

    Kronemyer, David; Bystritsky, Alexander

    2014-01-01

    Belief revision is the key change mechanism underlying the psychological intervention known as cognitive behavioral therapy (CBT). It both motivates and reinforces new behavior. In this review we analyze and apply a novel approach to this process based on AGM theory of belief revision, named after its proponents, Carlos Alchourrón, Peter Gärdenfors and David Makinson. AGM is a set-theoretical model. We reconceptualize it as describing a non-linear, dynamical system that occurs within a semantic space, which can be represented as a phase plane comprising all of the brain's attentional, cognitive, affective and physiological resources. Triggering events, such as anxiety-producing or depressing situations in the real world, or their imaginal equivalents, mobilize these assets so they converge on an equilibrium point. A preference function then evaluates and integrates evidentiary data associated with individual beliefs, selecting some of them and comprising them into a belief set, which is a metastable state. Belief sets evolve in time from one metastable state to another. In the phase space, this evolution creates a heteroclinic channel. AGM regulates this process and characterizes the outcome at each equilibrium point. Its objective is to define the necessary and sufficient conditions for belief revision by simultaneously minimizing the set of new beliefs that have to be adopted, and the set of old beliefs that have to be discarded or reformulated. Using AGM, belief revision can be modeled using three (and only three) fundamental syntactical operations performed on belief sets, which are expansion; revision; and contraction. Expansion is like adding a new belief without changing any old ones. Revision is like adding a new belief and changing old, inconsistent ones. Contraction is like changing an old belief without adding any new ones. We provide operationalized examples of this process in action. PMID:24860491

  13. Descriptor revision belief change through direct choice

    CERN Document Server

    Hansson, Sven Ove

    2017-01-01

    This book provides a critical examination of how the choice of what to believe is represented in the standard model of belief change. In particular the use of possible worlds and infinite remainders as objects of choice is critically examined. Descriptors are introduced as a versatile tool for expressing the success conditions of belief change, addressing both local and global descriptor revision. The book presents dynamic descriptors such as Ramsey descriptors that convey how an agent’s beliefs tend to be changed in response to different inputs. It also explores sentential revision and demonstrates how local and global operations of revision by a sentence can be derived as a special case of descriptor revision. Lastly, the book examines revocation, a generalization of contraction in which a specified sentence is removed in a process that may possibly also involve the addition of some new information to the belief set.

  14. Stage-by-Stage and Parallel Flow Path Compressor Modeling for a Variable Cycle Engine

    Science.gov (United States)

    Kopasakis, George; Connolly, Joseph W.; Cheng, Larry

    2015-01-01

    This paper covers the development of stage-by-stage and parallel flow path compressor modeling approaches for a Variable Cycle Engine. The stage-by-stage compressor modeling approach is an extension of a technique for lumped volume dynamics and performance characteristic modeling. It was developed to improve the accuracy of axial compressor dynamics over lumped volume dynamics modeling. The stage-by-stage compressor model presented here is formulated into a parallel flow path model that includes both axial and rotational dynamics. This is done to enable the study of compressor and propulsion system dynamic performance under flow distortion conditions. The approaches utilized here are generic and should be applicable for the modeling of any axial flow compressor design.

  15. A Two-Stage Queue Model to Optimize Layout of Urban Drainage System considering Extreme Rainstorms

    OpenAIRE

    He, Xinhua; Hu, Wenfa

    2017-01-01

    Extreme rainstorm is a main factor to cause urban floods when urban drainage system cannot discharge stormwater successfully. This paper investigates distribution feature of rainstorms and draining process of urban drainage systems and uses a two-stage single-counter queue method M/M/1→M/D/1 to model urban drainage system. The model emphasizes randomness of extreme rainstorms, fuzziness of draining process, and construction and operation cost of drainage system. Its two objectives are total c...

  16. Bioremediation of storage tank bottom sludge by using a two-stage composting system: Effect of mixing ratio and nutrients addition.

    Science.gov (United States)

    Koolivand, Ali; Rajaei, Mohammad Sadegh; Ghanadzadeh, Mohammad Javad; Saeedi, Reza; Abtahi, Hamid; Godini, Kazem

    2017-07-01

    The effect of mixing ratio and nutrients addition on the efficiency of a two-stage composting system in removal of total petroleum hydrocarbons (TPH) from storage tank bottom sludge (STBS) was investigated. The system consisted of ten windrow piles as primary composting (PC) followed by four in-vessel reactors as secondary composting (SC). Various initial C/N/P and mixing ratios of STBS to immature compost (IC) were examined in the PC and SC for 12 and 6weeks, respectively. The removal rates of TPH in the two-stage system (93.72-95.24%) were higher than those in the single-stage one. Depending on the experiments, TPH biodegradation fitted to the first- and second-order kinetics with the rate constants of 0.051-0.334d -1 and 0.002-0.165gkg -1 d -1 , respectively. The bacteria identified were Pseudomonas sp., Bacillus sp., Klebsiella sp., Staphylococcus sp., and Proteus sp. The study verified that a two-stage composting system is effective in treating the STBS. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Results of revision anterior shoulder stabilization surgery in adolescent athletes.

    Science.gov (United States)

    Blackman, Andrew J; Krych, Aaron J; Kuzma, Scott A; Chow, Roxanne M; Camp, Christopher; Dahm, Diane L

    2014-11-01

    The purpose of this study was to determine failure rates, functional outcomes, and risk factors for failure after revision anterior shoulder stabilization surgery in high-risk adolescent athletes. Adolescent athletes who underwent primary anterior shoulder stabilization were reviewed. Patients undergoing subsequent revision stabilization surgery were identified and analyzed. Failure rates after revision surgery were assessed by Kaplan-Meier analysis. Failure was defined as recurrent instability requiring reoperation. Functional outcomes included the Marx activity score; American Shoulder and Elbow Surgeons score; and University of California, Los Angeles score. The characteristics of patients who required reoperation for recurrent instability after revision surgery were compared with those of patients who required only a single revision to identify potential risk factors for failure. Of 90 patients who underwent primary anterior stabilization surgery, 15 (17%) had failure and underwent revision surgery (mean age, 16.6 years; age range, 14 to 18 years). The mean follow-up period was 5.5 years (range, 2 to 12 years). Of the 15 revision patients, 5 (33%) had recurrent dislocations and required repeat revision stabilization surgery at a mean of 50 months (range, 22 to 102 months) after initial revision. No risk factors for failure were identified. The Kaplan-Meier reoperation-free estimates were 86% (95% confidence interval, 67% to 100%) at 24 months and 78% (95% confidence interval, 56% to 100%) at 48 months after revision surgery. The mean final Marx activity score was 14.8 (range, 5 to 20); American Shoulder and Elbow Surgeons score, 82.1 (range, 33 to 100); and University of California, Los Angeles score, 30.8 (range, 16 to 35). At 5.5 years' follow-up, adolescent athletes had a high failure rate of revision stabilization surgery and modest functional outcomes. We were unable to convincingly identify specific risk factors for failure of revision surgery. Level IV

  18. Plan-Belief Revision in Jason

    DEFF Research Database (Denmark)

    Jensen, Andreas Schmidt; Villadsen, Jørgen

    2015-01-01

    When information is shared between agents of unknown reliability, it is possible that their belief bases become inconsistent. In such cases, the belief base must be revised to restore consistency, so that the agent is able to reason. In some cases the inconsistent information may be due to use of...... of incorrect plans. We extend work by Alechina et al. to revise belief bases in which plans can be dynamically added and removed. We present an implementation of the algorithm in the AgentSpeak implementation Jason....

  19. Revised Huang-Yang multipolar pseudopotential

    International Nuclear Information System (INIS)

    Derevianko, Andrei

    2005-01-01

    A number of authors have recently pointed out inconsistencies of results obtained with the Huang-Yang multipolar pseudopotential for low-energy scattering [K. Huang and K. C. Yang, Phys. Rev. 105, 767 (1957); later revised by Huang, Statistical Mechanics (Wiley, New York, 1963)]. The conceptual validity of their original derivation has been questioned. Here I show that these inconsistencies are rather due to an algebraic mistake made by Huang and Yang. With the corrected error, I present the revised version of the multipolar pseudopotential

  20. Coupling failure between stem and femoral component in a constrained revision total knee arthroplasty.

    LENUS (Irish Health Repository)

    Butt, Ahsan Javed

    2013-02-01

    Knee revision using constrained implants is associated with greater stresses on the implant and interface surfaces. The present report describes a case of failure of the screw coupling between the stem and the femoral component. The cause of the failure is surmised with outline of the treatment in this case with extensive femoral bone loss. Revision implant stability was augmented with the use of a cemented femoral stem, screw fixation and the metaphyseal sleeve of an S-ROM modular hip system (DePuy international Ltd).

  1. Comorbidity, age, race and stage at diagnosis in colorectal cancer: a retrospective, parallel analysis of two health systems

    Directory of Open Access Journals (Sweden)

    Rowe Krista L

    2008-11-01

    earlier stage of CRC diagnosis. Multiple factors, perhaps including increased interactions with the healthcare system due to comorbidity, might contribute to this finding. Such increased interactions are seen among patients within a healthcare system like the VA system in the US versus sporadic interactions which may be seen with FFS healthcare.

  2. Design of nonimaging concentrators as second stages in tandem with image-forming first-stage concentrators

    Science.gov (United States)

    Winston, R.; Welford, W. T.

    1980-02-01

    The paper discusses the paraboloidal mirror as a tracking solar concentrator, fitting a nonimaging second stage to the paraboloidal mirror, other image-forming systems as first stages, and tracking systems in two-dimensional geometry. Because of inherent aberrations, the paraboloidal mirror cannot achieve the thermodynamic limit. It is shown how paraboloidal mirrors of short focal ratio and similar systems can have their flux concentration enhanced to near the thermodynamic limit by the addition of nonimaging compound elliptical concentrators.

  3. Design of nonimaging concentrators as second stages in tandem with image-forming first-stage concentrators

    Science.gov (United States)

    Winston, R.; Welford, W. T.

    1980-01-01

    The paper discusses the paraboloidal mirror as a tracking solar concentrator, fitting a nonimaging second stage to the paraboloidal mirror, other image-forming systems as first stages, and tracking systems in two-dimensional geometry. Because of inherent aberrations, the paraboloidal mirror cannot achieve the thermodynamic limit. It is shown how paraboloidal mirrors of short focal ratio and similar systems can have their flux concentration enhanced to near the thermodynamic limit by the addition of nonimaging compound elliptical concentrators.

  4. America's Next Great Ship: Space Launch System Core Stage Transitioning from Design to Manufacturing

    Science.gov (United States)

    Birkenstock, Benjamin; Kauer, Roy

    2014-01-01

    The Space Launch System (SLS) Program is essential to achieving the Nation's and NASA's goal of human exploration and scientific investigation of the solar system. As a multi-element program with emphasis on safety, affordability, and sustainability, SLS is becoming America's next great ship of exploration. The SLS Core Stage includes avionics, main propulsion system, pressure vessels, thrust vector control, and structures. Boeing manufactures and assembles the SLS core stage at the Michoud Assembly Facility (MAF) in New Orleans, LA, a historical production center for Saturn V and Space Shuttle programs. As the transition from design to manufacturing progresses, the importance of a well-executed manufacturing, assembly, and operation (MA&O) plan is crucial to meeting performance objectives. Boeing employs classic techniques such as critical path analysis and facility requirements definition as well as innovative approaches such as Constraint Based Scheduling (CBS) and Cirtical Chain Project Management (CCPM) theory to provide a comprehensive suite of project management tools to manage the health of the baseline plan on both a macro (overall project) and micro level (factory areas). These tools coordinate data from multiple business systems and provide a robust network to support Material & Capacity Requirements Planning (MRP/CRP) and priorities. Coupled with these tools and a highly skilled workforce, Boeing is orchestrating the parallel buildup of five major sub assemblies throughout the factory. Boeing and NASA are transforming MAF to host state of the art processes, equipment and tooling, the most prominent of which is the Vertical Assembly Center (VAC), the largest weld tool in the world. In concert, a global supply chain is delivering a range of structural elements and component parts necessary to enable an on-time delivery of the integrated Core Stage. SLS is on plan to launch humanity into the next phase of space exploration.

  5. Multifunctional Solar Systems Based On Two-Stage Regeneration Absorbent Solution

    Directory of Open Access Journals (Sweden)

    Doroshenko A.V.

    2015-04-01

    Full Text Available The concepts of multifunctional dehumidification solar systems, heat supply, cooling, and air conditioning based on the open absorption cycle with direct absorbent regeneration developed. The solar systems based on preliminary drainage of current of air and subsequent evaporated cooling. The solar system using evaporative coolers both types (direct and indirect. The principle of two-stage regeneration of absorbent used in the solar systems, it used as the basis of liquid and gas-liquid solar collectors. The main principle solutions are designed for the new generation of gas-liquid solar collectors. Analysis of the heat losses in the gas-liquid solar collectors, due to the mechanism of convection and radiation is made. Optimal cost of gas and liquid, as well as the basic dimensions and configuration of the working channel of the solar collector identified. Heat and mass transfer devices, belonging to the evaporative cooling system based on the interaction between the film and the gas stream and the liquid therein. Multichannel structure of the polymeric materials used to create the tip. Evaporative coolers of water and air both types (direct and indirect are used in the cooling of the solar systems. Preliminary analysis of the possibilities of multifunctional solar absorption systems made reference to problems of cooling media and air conditioning on the basis of experimental data the authors. Designed solar systems feature low power consumption and environmental friendliness.

  6. Decommissioning plan - decommissioning project for KRR 1 and 2 (revised)

    Energy Technology Data Exchange (ETDEWEB)

    Jung, K. J.; Paik, S. T.; Chung, U. S.; Jung, K. H.; Park, S. K.; Lee, D. G.; Kim, H. R.; Kim, J. K.; Yang, S. H.; Lee, B. J

    2000-10-01

    This report is the revised Decommissioning Plan for the license of TRIGA research reactor decommissioning project according to Atomic Energy Act No. 31 and No. 36. The decommissioning plan includes the TRIGA reactor facilities, project management, decommissioning method, decontamination and dismantling activity, treatment, packaging, transportation and disposal of radioactive wastes. the report also explained the radiation protection plan and radiation safety management during the decommissioning period, and expressed the quality assurance system during the period and the site restoration after decommissioning. The first decommissioning plan was made by Hyundai Engineering Co, who is the design service company, was submitted to the Ministry of Science and Technology, and then was reviewed by the Korea Institute of Nuclear Safety. The first decommissioning plan was revised including answers for the questions arising from review process.

  7. Decommissioning plan - decommissioning project for KRR 1 and 2 (revised)

    International Nuclear Information System (INIS)

    Jung, K. J.; Paik, S. T.; Chung, U. S.; Jung, K. H.; Park, S. K.; Lee, D. G.; Kim, H. R.; Kim, J. K.; Yang, S. H.; Lee, B. J.

    2000-10-01

    This report is the revised Decommissioning Plan for the license of TRIGA research reactor decommissioning project according to Atomic Energy Act No. 31 and No. 36. The decommissioning plan includes the TRIGA reactor facilities, project management, decommissioning method, decontamination and dismantling activity, treatment, packaging, transportation and disposal of radioactive wastes. the report also explained the radiation protection plan and radiation safety management during the decommissioning period, and expressed the quality assurance system during the period and the site restoration after decommissioning. The first decommissioning plan was made by Hyundai Engineering Co, who is the design service company, was submitted to the Ministry of Science and Technology, and then was reviewed by the Korea Institute of Nuclear Safety. The first decommissioning plan was revised including answers for the questions arising from review process

  8. A predator-prey system with stage-structure for predator and nonlocal delay

    DEFF Research Database (Denmark)

    Lin, Z.G.; Pedersen, Michael; Zhang, Lai

    2010-01-01

    This paper deals with the behavior of solutions to the reaction-diffusion system under homogeneous Neumann boundary condition, which describes a prey-predator model with nonlocal delay. Sufficient conditions for the global stability of each equilibrium are derived by the Lyapunov functional...... and the results show that the introduction of stage-structure into predator positively affects the coexistence of prey and predator. Numerical simulations are performed to illustrate the results....

  9. Setting safety stocks in multi-stage inventory systems under rolling horizon mathematical programming models

    NARCIS (Netherlands)

    Boulaksil, Y.; Fransoo, J.C.; van Halm, E.N.G.

    2009-01-01

    This paper considers the problem of determining safety stocks in multi-item multi-stage inventory systems that face demand uncertainties. Safety stocks are necessary to make the supply chain, which is driven by forecasts of customer orders, responsive to (demand) uncertainties and to achieve

  10. Trends in Revision Elbow Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers.

    Science.gov (United States)

    Wilson, Alexander T; Pidgeon, Tyler S; Morrell, Nathan T; DaSilva, Manuel F

    2015-11-01

    To determine the frequency of revision elbow ulnar collateral ligament (UCL) reconstruction in professional baseball pitchers. Data were collected on 271 professional baseball pitchers who underwent primary UCL reconstruction. Each player was evaluated retrospectively for occurrence of revision UCL reconstructive surgery to treat failed primary reconstruction. Data on players who underwent revision UCL reconstruction were compiled to determine total surgical revision incidence and revision rate by year. The incidence of early revision was analyzed for trends. Average career length after primary UCL reconstruction was calculated and compared with that of players who underwent revision surgery. Logistic regression analysis was performed to assess risk factors for revision including handedness, pitching role, and age at the time of primary reconstruction. Between 1974 and 2014, the annual incidence of primary UCL reconstructions among professional pitchers increased, while the proportion of cases being revised per year decreased. Of the 271 pitchers included in the study, 40 (15%) required at least 1 revision procedure during their playing career. Three cases required a second UCL revision reconstruction. The average time from primary surgery to revision was 5.2 ± 3.2 years (range, 1-13 years). The average length of career following primary reconstruction for all players was 4.9 ± 4.3 years (range, 0-22 years). The average length of career following revision UCL reconstruction was 2.5 ± 2.4 years (range, 0-8 years). No risk factors for needing revision UCL reconstruction were identified. The incidence of primary UCL reconstructions among professional pitchers is increasing; however, the rate of primary reconstructions requiring revision is decreasing. Explanations for the decreased revision rate may include improved surgical technique and improved rehabilitation protocols. Therapeutic IV. Copyright © 2015 American Society for Surgery of the Hand. Published by

  11. Identification and Fibrosis Staging of Hepatitis C Patients Using the Electronic Medical Record System.

    Science.gov (United States)

    Anand, Vijay; Hyun, Christian; Khan, Qasim M; Hall, Curtis; Hessefort, Norbert; Sonnenberg, Amnon; Fimmel, Claus J

    2016-09-01

    The aim of this study was to noninvasively assess the severity of chronic hepatitis C virus (HCV) in large patient populations. It would be helpful if fibrosis scores could be calculated solely on the basis of data contained in the patients' electronic medical records (EMR). We performed a pilot study to identify all HCV-infected patients in a large health care system, and predict their fibrosis stage on the basis of demographic and laboratory data using common data from their EMR. HCV-infected patients were identified using the EMR. The liver biopsies of 191 HCV patients were graded using the Ishak and Metavir scoring systems. Demographic and laboratory data were extracted from the EMR and used to calculate the aminotransferase to platelet ratio index, Fib-4, Fibrosis Index, Forns, Göteborg University Cirrhosis Index, Lok Index, and Vira-HepC. In total, 869 HCV-infected patients were identified from a population of over 1 million. In the subgroup of patients with liver biopsies, all 7 algorithms were significantly correlated with the fibrosis stage. The degree of correlation was moderate, with correlation coefficients ranging from 0.22 to 0.60. For the detection of advanced fibrosis (Metavir 3 or 4), the areas under the receiver operating characteristic curve ranged from 0.71 to 0.84, with no significant differences between the individual scores. Sensitivities, specificities, and positive and negative predictive values were within the previously reported range. All scores tended to perform better for higher fibrosis stages. Our study demonstrates that HCV-infected patients can be identified and their fibrosis staged using commonly available EMR-based algorithms.

  12. Lengthening Temporalis Myoplasty for Single-Stage Smile Reconstruction in Children with Facial Paralysis.

    Science.gov (United States)

    Panossian, Andre

    2016-04-01

    Free muscle transfer for dynamic smile reanimation in facial paralysis is not always predictable with regard to cosmesis. Hospital stays range from 5 to 7 days. Prolonged operative times, longer hospital stays, and excessive cheek bulk are associated with free flap options. Lengthening temporalis myoplasty offers single-stage smile reanimation with theoretical advantages over free tissue transfer. From 2012 to 2014, 18 lengthening temporalis myoplasties were performed in 14 children for smile reconstruction. A retrospective chart review was completed for demographics, operative times, length of hospital stay, and perioperative complications. Fourteen consecutive patients with complete facial paralysis were included. Four patients underwent single-stage bilateral reconstruction, and 10 underwent unilateral procedures. Diagnoses included Möbius syndrome (n = 5), posterior cranial fossa tumors (n = 4), posttraumatic (n = 2), hemifacial microsomia (n = 1), and idiopathic (n = 2). Average patient age was 10.1 years. Average operative time was 410 minutes (499 minutes for bilateral lengthening temporalis myoplasty and 373 for unilateral lengthening temporalis myoplasty). Average length of stay was 3.3 days (4.75 days for bilateral lengthening temporalis myoplasty and 2.8 for unilateral lengthening temporalis myoplasty). Nine patients required minor revisions. Lengthening temporalis myoplasty is a safe alternative to free tissue transfer for dynamic smile reconstruction in children with facial paralysis. Limited donor-site morbidity, shorter operative times, and shorter hospital stays are some benefits over free flap options. However, revisions are required frequently secondary to tendon avulsions and adhesions. Therapeutic, IV.

  13. Illumination uniformity issue explored via two-stage solar concentrator system based on Fresnel lens and compound flat concentrator

    International Nuclear Information System (INIS)

    Yeh, Naichia

    2016-01-01

    This paper illustrates details about the solar radiation distribution on the target of a two-stage solar concentrator that combines the Fresnel lens (FL) and the compound flat concentrator (CFC). The paper starts with a review of some FL development milestones such as the two-stage systems and the comparisons of flat vs. curved lenses in addition to the most noteworthy FL-based solar energy application, concentration photovoltaic (CPV). Through the review of the FL based CPV and two-stage concentrators, this study leads to the development of an algorithm to explore the spectrum distribution insight on the receiver of a two-stage (FL plus CFC) solar concentration system. It established the potential for using a correctly positioned 2nd stage reflector of right dimension to selectively redirect the desired spectrum on the target area so as to enhance the concentration flux intensity and uniformity at the same time. The study also helped to chart out the approximate locations of certain spectrum segments on the FL's target area, which is useful for exploring the spectrum control mechanism via the Fresnel lenses. - Highlights: • Map out the approximate locations of spectrum segments on FL's focal area. • Use the 2nd stage reflector to selectively reflect the desired spectrum on target. • Explore the spectrum distribution insight on FL solar concentrators' target area.

  14. Sequenced Peer Revision: Creating Competence and Community

    Science.gov (United States)

    Bowman, Ingrid K.; Robertson, John

    2013-01-01

    Mastering techniques of self- and peer revision is a valuable tool for all writers, especially US-educated Generation 1.5 students, whose near fluency enables them to dialogue successfully about their writing. Using action research, 2 academic writing instructors systematically trained students to more responsibly and effectively revise their…

  15. Quantum interaction. Revised selected papers

    International Nuclear Information System (INIS)

    Song, Dawei; Zhang, Peng; Wang, Lei; Arafat, Sachi

    2011-01-01

    This book constitutes the thoroughly refereed post-conference proceedings of the 5th International Symposium on Quantum Interaction, QI 2011, held in Aberdeen, UK, in June 2011. The 26 revised full papers and 6 revised poster papers, presented together with 1 tutorial and 1 invited talk were carefully reviewed and selected from numerous submissions during two rounds of reviewing and improvement. The papers show the cross-disciplinary nature of quantum interaction covering topics such as computation, cognition, mechanics, social interaction, semantic space and information representation and retrieval. (orig.)

  16. Fast-track revision knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B

    2011-01-01

    Abstract Background and purpose Fast-track surgery has reduced the length of hospital stay (LOS), morbidity, and convalescence in primary hip and knee arthroplasty (TKA). We assessed whether patients undergoing revision TKA for non-septic indications might also benefit from fast-track surgery....... Methods 29 patients were operated with 30 revision arthroplasties. Median age was 67 (34-84) years. All patients followed a standardized fast-track set-up designed for primary TKA. We determined the outcome regarding LOS, morbidity, mortality, and satisfaction. Results Median LOS was 2 (1-4) days...

  17. Quantum interaction. Revised selected papers

    Energy Technology Data Exchange (ETDEWEB)

    Song, Dawei; Zhang, Peng; Wang, Lei [Aberdeen Univ. (United Kingdom). School of Computing; Melucci, Massimo [Padua Univ., Padova (Italy). Dept. of Information Engineering; Frommholz, Ingo [Bedfordshire Univ. (United Kingdom); Arafat, Sachi (eds.) [Glasgow Univ. (United Kingdom). School of Computing Science

    2011-07-01

    This book constitutes the thoroughly refereed post-conference proceedings of the 5th International Symposium on Quantum Interaction, QI 2011, held in Aberdeen, UK, in June 2011. The 26 revised full papers and 6 revised poster papers, presented together with 1 tutorial and 1 invited talk were carefully reviewed and selected from numerous submissions during two rounds of reviewing and improvement. The papers show the cross-disciplinary nature of quantum interaction covering topics such as computation, cognition, mechanics, social interaction, semantic space and information representation and retrieval. (orig.)

  18. Medical writing, revising and editing

    DEFF Research Database (Denmark)

    Pilegaard, Morten

    2006-01-01

    The globalization of science makes medical writing, editing and revision a rapidly growing field of linguistic study and practice. Medical science texts are written according to uniform, general guidelines and medical genres have become highly conventionalized in terms of structure and linguistic...... form. Medical editing often takes the form of peer review and mainly addresses issues of contents and overall validity. Medical revision incorporates the checking of the macrostructure and the microstructure of the text, its language and style and its suitability for the target reader or client...

  19. Optimal design of distributed energy resource systems based on two-stage stochastic programming

    International Nuclear Information System (INIS)

    Yang, Yun; Zhang, Shijie; Xiao, Yunhan

    2017-01-01

    Highlights: • A two-stage stochastic programming model is built to design DER systems under uncertainties. • Uncertain energy demands have a significant effect on the optimal design. • Uncertain energy prices and renewable energy intensity have little effect on the optimal design. • The economy is overestimated if the system is designed without considering the uncertainties. • The uncertainty in energy prices has the significant and greatest effect on the economy. - Abstract: Multiple uncertainties exist in the optimal design of distributed energy resource (DER) systems. The expected energy, economic, and environmental benefits may not be achieved and a deficit in energy supply may occur if the uncertainties are not handled properly. This study focuses on the optimal design of DER systems with consideration of the uncertainties. A two-stage stochastic programming model is built in consideration of the discreteness of equipment capacities, equipment partial load operation and output bounds as well as of the influence of ambient temperature on gas turbine performance. The stochastic model is then transformed into its deterministic equivalent and solved. For an illustrative example, the model is applied to a hospital in Lianyungang, China. Comparative studies are performed to evaluate the effect of the uncertainties in load demands, energy prices, and renewable energy intensity separately and simultaneously on the system’s economy and optimal design. Results show that the uncertainties in load demands have a significant effect on the optimal system design, whereas the uncertainties in energy prices and renewable energy intensity have almost no effect. Results regarding economy show that it is obviously overestimated if the system is designed without considering the uncertainties.

  20. Analysis of difficulties in mathematics problem solving based on revised Bloom’s Taxonomy viewed from high self-efficacy

    Science.gov (United States)

    Prismana, R. D. E.; Kusmayadi, T. A.; Pramudya, I.

    2018-04-01

    The ability of solving problem is a part of the mathematic curriculum that is very important. Problem solving prefers the process and strategy that is done by students in solving a problem rather than the result. This learning concept in accordance with the stages on the revised bloom’s taxonomy. The revised Bloom’s Taxonomy has two dimensions, namely the dimension of cognitive process and the dimension of knowledge. Dimension of knowledge has four categories, but this study only restricted on two knowledge, conceptual knowledge and procedural knowledge. Dimensions of cognitive processes are categorized into six kinds, namely remembering, understanding, applying, analyzing, evaluating, and creating. Implementation of learning more emphasis on the role of students. Students must have their own belief in completing tasks called self-efficacy. This research is a qualitative research. This research aims to know the site of the students’ difficulty based on revised Bloom’s Taxonomy viewed from high self-efficacy. The results of the study stated the students with high self efficacy have difficulties site. They are evaluating conceptual knowledge, evaluating procedural knowledge, creating conceptual knowledge, and creating procedural knowledge. It could be the consideration of teachers in the teaching, so as to reduce the difficulties of learning in students.